Allied Health Professionals (pharmacists, laboratory and other technicians, optometrists, neurophysiologists etc.) are often the unheard and unseen background support system of our mission hospitals. I thank the Christian Medical Association of India for inviting me to speak to them at their 2020 Annual Conference for Allied Health Professionals. I have spoken from our experience at the Makunda Christian Leprosy and General Hospital over 27 years – a testament to God’s blessings and the hard work of numerous co-workers (1). I hope that this video is an encouragement to allied health professionals (and students) in Christian mission hospitals all over the world. May God bless them and make them a blessing to many. I apologize for short segments of the recording that are inaudible (it was recorded over the internet).
Medical Missionary Work – Introduction, Attitudes and Promise
31 Jan
Christian mission hospitals should be God’s institutions of healing in a world of suffering. They have the potential to ‘close the gap’ in access to healthcare and provide high quality accessible services in the most remote and needy parts of the world to those who need them the most – the poor and marginalized.
In 1993, my wife Ann and me moved to a remote part of Assam in northeast India. We were led by verses in the Bible (Jeremiah 29:11-13 for me and Isaiah 6:8 for Ann) to what God wanted us to do with our lives. Over the following 27 years, God took us by our hands and provided us with all the encouragement, strength and wisdom required to transform a closed-down hospital to a thriving institution bringing healing and transformation to many surrounding communities. (1) We were not alone, God brought many committed staff to join us over the years – without them this transformation would not have been possible.
I was privileged to be invited to speak on the theme “Medical Missions” at the (virtual) South Asian regional conference of the International Christian Medical and Dental Association in November 2020. I am not an expert on medical missions but spoke from our experience in walking with God and witnessing a great transformation take place in our hospital as well as from observations on medical missions over many years.
The first session is here – I have given a short testimony, an introduction to medical missions and suggest several important attitudes to cultivate to be fruitful in God’s service:
A Journey of Faith
30 SepMy 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:
- https://www.leadtalks.org/
- https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/
- https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/
- https://the-sparrowsnest.net/2018/05/12/early-days-at-makunda/
- https://www.researchgate.net/publication/342551561_The_Makunda_Model_An_observational_study_of_high_quality_accessible_healthcare_in_low-resource_settings
- https://www.researchgate.net/publication/322476512_’Closing_the_Gap’_-_Using_Global_Health_Doctors
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.
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.
All Things Bright and Beautiful
29 AprIn 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:
- https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/
- https://www.flickr.com/photos/ivijayanand/
- https://www.inaturalist.org/people/8853
- https://creativecommons.org/
- http://orientalbirdimages.org/photographers.php?action=birder&Birder_ID=1033
- https://www.hbw.com/ibc/u/3865
- https://avibase.bsc-eoc.org/flickr_stats.jsp?action=splist&member=50307457@N08
- https://www.xeno-canto.org/contributor/XNOSZCRTKL
- https://indiabiodiversity.org/observation/list?sort=created_on&offset=0&max=10&view=list&user=4409&lang=en&userGroupList=
- https://www.researchgate.net/publication/281798537_Mating_of_the_Greater_Coucal
- https://www.researchgate.net/publication/281374943_Sighting_of_Purple-throated-_or_Van_Hasselt’s_Sunbird_Leptocoma_sperata_brasiliana_in_Karimganj_District_Assam_with_notes_on_its_status_in_India
- https://www.researchgate.net/publication/313108517_Report_of_Platythomisus_octomaculatus_C_L_Koch_1845_and_Platythomisus_sudeepi_Biswas_1977_from_India_Araneae_Thomisidae
- https://www.researchgate.net/publication/320831948_Illustrated_redescription_of_two_large_coreid_bugs_from_Assam_including_Schroederia_feana_Distant_1902_as_the_first_record_for_India_Hemiptera_Heteroptera_Coreidae_Coreinae_Mictini
- http://diversityindianews.blogspot.com/2017/02/rare-spider-spotted-in-remote-hospital.html
- https://www.researchgate.net/publication/315660193_Forest_ghost_moth_fauna_of_northeastern_India_Lepidoptera_Hepialidae_Endoclita_Palpifer_and_Hepialiscus
- http://canvas.pantone.com/gallery/32036105/Makunda-Nature-Club
- https://indiabiodiversity.org/group/makunda_nature_club/show
- https://www.greenhubindia.net/fellowship
- https://www.researchgate.net/publication/330320761_Sighting_of_the_Golden-crested_Myna_Ampeliceps_coronatus_in_Karimganj_District_Assam_with_notes_on_its_distribution
- https://www.researchgate.net/publication/332866269_Tawny-breasted_Wren-Babbler_Spelaeornis_longicaudatus_in_the_Jaintia_Hills_and_an_update_on_its_status_in_Meghalaya
- https://www.researchgate.net/publication/332866279_Asian_Stubtail_Urosphena_squameiceps_in_the_Karimganj_District_of_Assam_and_its_status_in_the_Indian_Subcontinent
- https://www.researchgate.net/publication/338137338_Siberian_Blue_Robin_Larvivora_cyane_from_the_Barak_Valley_of_Assam_with_a_status_update_for_India
- https://www.atree.org/
- https://en.wikipedia.org/wiki/Anwaruddin_Choudhury
- https://www.researchgate.net/publication/334729284_Golden_Jackal_-_Canis_aureus_Linnaeus_1758_-_Occurrrence_in_North_East_India
- https://www.researchgate.net/publication/334729418_Otters_-_Occurrence_in_North_East_India
- https://en.wikipedia.org/wiki/All_Things_Bright_and_Beautiful
Please watch this 7 minute video:
A Christian Hospital in the time of Covid19
5 AprThis post is based on a message I gave today (through videoconferencing) to the staff of our hospital, Makunda Christian Leprosy and General Hospital (1) – the numbers in brackets refer to links given in the references at the end of this post:
Today is Palm Sunday, the beginning of the Christian “Passion Week”. Normally, today, Christians all over the world would have walked streets outside their churches with palm fronds, enacting Jesus’s entrance into Jerusalem, leading on to the train of events that led to His death and resurrection. Palm Sunday 2020, however, is different. Churches all over the world are closed. Most villages, towns and cities are under various restrictions – from social distancing to lockdowns. People are on their phones – talking, chatting and posting on social media, the discussions are all about one thing – the Covid19 pandemic. Till today, over 1.2 million people are infected and over 65,000 have died (2).
Instead of a Palm Sunday message, today’s talk will be about our response to a crisis situation. The Jewish world is about to start their Passover festival – this year it will also be celebrated across the world in similar conditions as Passion Week – from the 8th to the 16th of this month.
We read the story of the Passover in Exodus 12:12-18 (3). The nation of Israel was in bondage to the Egyptians. The ruler of the Egyptians, the Pharaoh, would not let them free – they were his source of cheap labor. The early chapters of Exodus talk about this situation, the story of Moses and God using him to deliver the Israelites from the clutches of the Egyptians through 10 plagues. The last plague was the death of every firstborn in the land. The Israelites were pre-warned of the impending plague and were told to anoint their doorposts with blood from a sacrificial lamb. When the Angel of Death swept through the land killing the firstborn, he “passed over” the homes where there was blood on the doorposts. We too, like the Israelites, should put our faith on the shed blood of the Lamb. The world today is gripped by a powerful pestilence, killing large numbers of people from even the wealthiest and most powerful of nations – all their power and wisdom is unable to stop it. We too have no power over this pestilence, but like the Israelites, we can put our faith on our God, who made heaven and earth. He sends His angels to watch over His people and like the Israelites in the days of Moses, we too can be at peace and without fear.
Let us look at a Biblical model for our hospital as we approach this crisis situation. For our meditation today, I have taken the first 6 chapters of the book of Nehemiah.
Nehemiah starts his story from the city of Susa, where he hears about the sad predicament of the people of Judah and the city of Jerusalem. It is like our situation today, as we hear about the worsening crisis across the world. He knows that this situation is due to the disobedience of God’s people (Nehemiah 1:8) (4) but at that point in time, the problem was to restore the integrity of the city and its walls. He approached the king and is given supplies and assistance to complete this task. He is given authority, in fact, he is made the governor. He (Nehemiah 2:12-16) (5) inspects the city and its walls and takes stock of the situation. We too should understand and take stock of the situation. Through electronic mass media, we are uptodate on what is happening around the world. We know that this pandemic originated in China and then rapidly spread across the world through traveling infected people. It is now spreading from person to person. Each infected person is expected to spread the disease to two others, if given the opportunity to interact with uninfected people. If nothing is done, millions will be infected and many will die. Scientists are constantly studying this disease as it evolves and we are learning how to manage the situation and minimize morbidity and mortality.
Having understood what he was up against, Nehemiah made elaborate plans. He appointed key leaders to take responsibilities for rebuilding different parts of the walls of Jerusalem. When faced with ridicule by his enemies, he responded by ignoring them, showing single-minded determination to complete the task given to him and by prayer. When there was a threat of physical violence (Nehemiah 4:15-16) (6) he arranged for workers to continue working – with construction materials in one hand and a weapon in the other. We too have the responsibility of treating our patients while protecting ourselves and others from getting infected. At our hospital, the local government has designated us as a non-Covid emergency hospital. People need a safe place to go for their deliveries, strokes and heart attacks, bowel perforations and obstructed hernias. In the future, we may be called upon to work with Covid patients too – if government facilities are overwhelmed. Our hospital has created a task force that has readied the hospital to tackle this situation. Separate teams have been formed, personal protective equipment (PPE) is being made with what we have, different areas have been designated for different patients and protocols are in place – we too are preparing to fight on two fronts.
In the 5th chapter of the book of Nehemiah (7), we see him hearing about the plight of the poor and needy. Although his task was to repair the walls, that could not be his only priority. His target population was suffering and they were the focus of the exercise, not the stone walls and wooden gates. Therefore, he steps in and asks people to forgive the debts of the poor and give loans without interest. In this moment of crisis, let us also consider the people we have been called to serve. Many of them were already poor and marginalized, this situation will make them destitute – they have just become financially vulnerable and in danger of losing their vital assets. If we force the poor to pay their bills – for bringing their loved ones to our hospitals and their children to our schools, we would inflict greater pain than the virus. Let us think about how we can be a blessing to the underprivileged communities that we have been called upon to serve. We may ask, aren’t we running out of money too? We don’t have enough to pay our bills and salaries. We must remember that God is no man’s debtor. The Bible tells us that when we treat the poor, He will pay their bills and reward us (Proverbs 19:17) (8)
Later in the 5th chapter, we see Nehemiah counting the costs of the work entrusted to him. He finds that resources are short and the task is great. He decides to set a personal example by not claiming what is his due as a governor. When crisis situations arise, we (and our families and friends) should consider a period of austerity and sacrifice for the people we are called to serve. Makunda went through periods of severe crisis in the past. Each time, bills accumulated, due amounts were demanded by various people – salaries were deferred and many staff donated from what they had to keep the work going. Projects had been started which could not be closed – staff contributed to enable them to continue, today they are institutions on their own, the 1200 student Makunda Christian Higher Secondary School, the School of Nursing and the branch hospital at Ambassa in Tripura – to enable these to become reality, staff were willing to wait for 14 years for running water and electricity to be supplied to their homes. Some staff did not take their eligible leave so that the hospital did not have to spend on paying for replacements. Today, we too have an opportunity to help our institution continue to serve its target people by giving of our time, talents and treasure. We are lending to God and will be repaid with things that money cannot buy – peace and contentment in this world and riches in heaven.
We read in Chapter 6 (9) that Nehemiah firmly denied lies from his enemies and finally completed the task in 52 days. Only then did he start working on solving the root causes of the problem – the disobedience of God’s people. We too need to work hard and diligently to get through this crisis now, when we have got over it we can study the entire experience and put in place protocols and practices to help us do better the next time we face another crisis.
We now come to the last part of today’s message. We hear about fear in people facing this crisis, but we have nothing to fear. Romans 14:8 (10) says that whether we live or die, we are the Lord’s. For us, Christians, life does not end with our physical death but continues on forever. We are God’s ambassadors from the kingdom of Heaven, temporarily posted to this world. We will all die one day but we are at peace. We have handed over our lives into the hands of our loving Commanding Officer – we are dispensable and He can choose the manner and timing of our deaths. Our only concern is that during the time given to us in this world, we live lives that find approval in His sight by trust and obedience and complete the tasks given to us.
Let me close with a few verses from that much loved chapter in the Bible, Psalm 23 (11). In verse 4 we read, “Even though I walk through the valley of the shadow of death, I fear no evil, for thy rod and thy staff, they comfort me”. I remember suffering an acute myocardial infarction (12), rolling about in pain on the 12th of October 2008 – I felt as if someone was trying to pull the life out of me but I was holding on because God was telling me that He had some more work for me to do before I go to be with Him. In verse 6, we read, “ Surely goodness and mercy will follow me all the days of my life and I will live in the house of the Lord forever” – may we submit our lives to Him as we face this crisis and be worthy of this promise, for this world and the one to come.
References:
- http://www.makunda.in/
- https://infographics.channelnewsasia.com/covid-19/map.html
- https://www.biblegateway.com/passage/?search=Exodus+12&version=NIV
- https://www.biblegateway.com/passage/?search=Nehemiah+1&version=NIV
- https://www.biblegateway.com/passage/?search=Nehemiah+2&version=NIV
- https://www.biblegateway.com/passage/?search=Nehemiah+4&version=NIV
- https://www.biblegateway.com/passage/?search=Nehemiah+5&version=NIV
- https://www.biblegateway.com/passage/?search=Proverbs+19%3A17&version=NIV
- https://www.biblegateway.com/passage/?search=Nehemiah+6&version=NIV
- https://www.biblegateway.com/passage/?search=Romans+14%3A8&version=NIV
- https://www.biblegateway.com/passage/?search=Psalm+23&version=NIV
- https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/
A Wrestle with Leprosy
30 JanWhen we were medical students (in the early 1980s), leprosy patients were ubiquitous, found at every street corner, train station and bus stand with open sores and deformities, spending their lives begging from passersby. As we passed through college, we learnt that leprosy (or Hansen’s Disease as it was also known) was caused by Mycobacterium leprae, an acid-fast bacillus similar to the one that causes tuberculosis. The disease affects the skin and nerves and causes skin lesions, loss of eyebrows and lashes, corneal damage, blindness and a host of deformities – most of them secondary to loss of sensation and resulting injury to the insensitive parts of the body (1). The disease is completely curable without any deformities if diagnosed at an early stage. However, the majority of patients at that time never came on time – they did not tell anyone about their lesions, hid their deformities and when it was finally diagnosed, kept the diagnosis secret. This was because of the horrible stigma and fear attached to the disease. No one wanted to be seen with a leper, leave alone have one in the family. This was because this ancient disease (with many references in the Bible) did not have a cure until modern chemotherapy arrived and untreated patients developed grotesque deformities and non-healing wounds. Leprosy patients were herded into colonies, in effect open jails, where they were admitted by their friends and relatives, to spend a lifetime and die unknown. The theory behind the colonies at that time was sound – leprosy could only be transmitted by prolonged close contact and since it was incurable at that time, the best way to limit its spread was to quarantine all known patients and segregate them (2).
In 1993, my wife Ann and me joined the Makunda Christian Leprosy and General Hospital (3,4). This hospital had just become a member of the Emmanuel Hospital Association (EHA) (5). In 1935, Dr. Crozier, a Christian medical missionary from the Baptist Mid-Missions in USA had started the Alipur Mission Hospital near Silchar (later named the Burrows Memorial Christian Hospital). Soon many patients started to come for treatment and among them were leprosy patients. Unable to admit them (for fear of infecting others and the all-pervasive stigma), the missionaries searched for a large piece of land to start a colony. In 1950, such a piece of land was found, 1000 acres of land in the other end of the Cachar District (now Karimganj District) was being sold by the widow of a man who had purchased the land hoping to convert it into a tea-estate. The land was purchased (at present the hospital has only 350 acres of land, the remaining having been taken over by the government), and a team of mission staff started to develop the land, build homes for the staff and wards for the patients, aluminium Quonset huts (6) for the sick ones and large Assam type barracks for the others and develop a large farm to feed the rapidly growing colony. The result was a completely self-sufficient leprosy colony housing about 300 patients. Almost everything was grown on the campus – rice, fish, poultry, oil (from mustard seeds), cotton and silk for clothing, timber and bamboo for housing, sugar (from sugarcane), dal and vegetables. Only salt was purchased from outside. Leprosy patients were brought from everywhere – including all the northeast Indian states and surrounding countries. An American surgeon, Dr. Gene Burrows, joined the hospital and started general medical work (in addition to leprosy work). He started treatment of the leprosy patients, initially with chaulmoogra oil and later with dapsone. He did reconstructive surgery on those who had correctable deformities. Patients whose families were willing to keep them at home received treatment in mobile camps. Unfortunately, in the early 1980s, Dr. Burrows and all the expatriate staff were asked to leave India, never to return. The hospital remained closed till we joined, a decade later.
Our early days at Makunda were tough (7), there were no general patients, they came in small numbers in the initial weeks and months. All our time was spent examining the 60 leprosy patients, the remnants of the original colony, many of them staying since the time the colony had been started. They were being treated with all sorts of regimes by a few old staff, some with the old chaulmoogra oil, some with dapsone alone and some with dapsone and rifampicin. We examined each patient and started the modern Multi Drug Treatment (MDT), a 2 -year course of rifampicin, clofazimine and dapsone on those who needed it. Some patients with deformities were sent to the leprosy hospitals in Calcutta (8) and Tinsukia for reconstructive surgery and prosthetics. Ann spent hours cleaning and dressing wounds, applying plaster casts till chronic wounds healed. I did a number of amputations on limbs which could not be repaired. Those who completed the full course of treatment were given “Released from Treatment” certificates and discharged, certified free of disease and allowed to go out into the world. Some patients, especially the older ones, refused to go (as they feared that they would be thrown out by their family) and they were allowed to stay on. We encouraged the young, able-bodied patients to leave and rebuild a life for themselves and slowly most of them left. We helped some to marry, get good jobs, delivered their children and buried them when they died. We had the privilege of being foster-parents to this large family of reluctant prisoners.
Life in the colony for the inmates was routine, like an informal sort of prison. Many of the patients had resigned themselves to their fate and lived happy lives, doing daily chores in the farm and hospital, organizing meetings for singing and prayer, games and recreation. They were provided free food and pocket money and all their needs were met. They did not have any ambitions, except to live out their lives in peace. A few were angry, rebelling against the unjustified imprisonment for no fault of theirs. Most of them were grateful to us and the other staff for providing them everything they needed. Leprosy was a great leveller, we had inmates who were highly trained government officers and skilled workers as well as unemployed ordinary people, they had all become lepers, united by being infected by the same bacteria. It was interesting to note the attitude of their families. If we wrote to them that their relative was not doing well, no one came to see them or take them home for a break. However, when one of the patients died, one (sometimes a number) of quarrelling relatives would invariably turn up to see what he/she had and collect it (usually a tin box with some cash and personal belongings) – they did not care for the body which we buried on campus! They were exploited by relatives, some politicians, unions and others to try to get land and possessions using their ‘status’ as leprosy patients – these people were not interested in them as individuals and were trying to get land not for the patient but for themselves after the patient died!
In 1997, Ann and me left for our postgraduate studies, me to do my MCh in Paediatric Surgery and Ann to do her MD in Anesthesia at the Christian Medical College at Vellore (9). After completing my MCh, I joined as a Lecturer in General Surgery Unit-III under Dr. Booshanam Moses for a year. One day, I noticed an area of insensitive skin on the dorsum of my right foot and we went with a sense of foreboding to see Dr. Leishiwon Kumrah, our close friend and working in the dermatology department. She did a skin biopsy and the result was borderline tuberculoid leprosy. We knew that leprosy was contagious but never thought that one of us would get it. Ann spent more time with the leprosy patients than me but apparently developing the disease is dependent more on the body’s immunity (T-cell function) than on contact. Later, when we did Lepromin Tests at the big leprosy hospital in Karigiri, Ann was strongly positive while I had no reaction, showing that my T-cell function was poor and hers excellent. Now that we had a diagnosis and no deformities, I thought that I just had to take my course of MDT and I would be fine, not realizing that the worst was yet to come!
I was initially started on a new regime, swapping Ofloxacin for Clofazamine (10), to avoid the dark bronze pigmentation that occurs with Clofazamine. Within a few days of starting treatment, I became hyperactive, keeping Ann awake all night talking nonsense. We soon realized that I had developed psychosis due to Ofloxacin and I was put on the standard 2-year MDT of Dapsone, Rifampicin and Clofazamine. I had difficulty taking the medication but put up with it, counting the days till I would be free. A short time after starting the drugs, I developed swelling and pain of the right lower limb and tender thickened nerves. I was having a Lepra Type I (or reversal) reaction – and was started on steroids. I soon developed severe side-effects of the steroids, tremors, hypocalcemia, hypokalemia, acne and a sort of depression. Although life and limb-saving, steroids are horrible drugs. Some people tolerate them well but others (like me) don’t. They should be used very carefully. After my experience, my blood boils if I see anyone prescribing steroids inappropriately. We were soon back in Makunda. My mother (my father had just passed away) was already upset with me for going off to a mission hospital (to waste my life) and after learning that I had developed leprosy there and was returning to that God-forsaken place, she was quite sure that I must be mad.
When we got back to Makunda, life became very difficult. My close friend, Dr. Samuel Siddharth Swamidoss MD had very graciously volunteered for a posting to Makunda to relieve us to go to Vellore for 3 years – I don’t think anyone else would have wanted to go to Makunda at that time. Unfortunately, he was overwhelmed with problems and struggled to keep the hospital going – he was a physician and had to manage obstetrics and surgery with only one other doctor, besides a lot of administrative and legal issues all by himself. We took over a really sick hospital, with me still on MDT and steroids for my reaction. There was no money, enormous dues payable to a lot of people and no help from anyone. We wrote to many people, to our Association and to possible donors but there were only promises of prayer and demands to settle some of their bills! A number of serious internal problems came to a head at that time resulting in violence on the campus (me being beaten up), Section 144 of CrPC imposed, local people (sadly some former employees, leprosy patients and church members included) occupying the land and demanding that we leave. We (Ann, me and the junior doctors and some others) ploughed the land every morning with a power-tiller and got back control of the land. The trouble-makers then filed a number of false criminal cases against us (hoping that we would leave and allow them to take over the land). We spent the next two years attending court every month till we were acquitted. They also filed a number of labor court cases which kept me occupied. We had made a 30-year strategic plan and this was the middle decade when we were hoping to start major projects to impact local and regional communities. In the midst of all this confusion, we therefore started work on a new English medium school, a school of nursing and a branch hospital in the state of Tripura. It was an audacious move, simply trusting God to provide in the midst of so much uncertainty and most people thought that it was an unsustainable gamble. Through all this, my leprosy reaction subsided and finally my 2-year course of MDT was over. I still have the shiny patch of atrophied skin on my foot to show that I had leprosy and several nerves are still thickened but I am well again.
Looking back at the experience, I know that I got leprosy so that God’s name may be glorified. I never ask why He allowed me to go through all the problems – they are insignificant in the light of eternity, one of those temporary trivial inconveniences that every Christian is called upon to bear. God permitted it to happen to me and that is enough, I don’t have to ask why. To understand a disease from the patient’s perspective, there is no better way than to have the disease yourself. There were times when I wondered whether I would be able to operate again (paediatric surgery demands meticulous attention to fine detail) and when I would be free of drugs, disease and complications but I never doubted the presence of God beside me. Ann was a wonderful person to be with me through all these trials and I constantly thank God for giving her to me – what a precious, wonderful gift.
When leprosy became a major problem, the British government, enacted the Lepers Act, 1898 (11) which provided for the arrest of any person who had leprosy and their incarceration in leper asylums. Along with it came numerous other laws that discriminated against leprosy patients – if you had leprosy, you could be divorced, kept out of jobs and public services etc. Over a hundred years later, even after leprosy became curable and the colonies ceased to exist, some of these laws are still in force, although the main Lepers Act was repealed in 1983. We were told that leprosy was eliminated (brought below the elimination threshold of an arbitrary prevalence rate of 1: 10,000), people started to become complacent and we are now told that the disease is slowly making a comeback (12), with many new patients presenting with disability for the first time as well as presenting in childhood. Aided by a slow natural course and a natural resilience, it is a tough disease to defeat and we could be in serious trouble indeed if adequate timely action is not taken. Leprosy caregivers getting the disease is not new. In the years when the disease was incurable, there was the famous story of Father Damien of Molokai (13), living and caring for leprosy patients, who soon developed the disease and became one among them.
Today (30th January, the death anniversary of Mahatma Gandhi) is Anti Leprosy Day in India (the rest of the world commemorates World Leprosy Day on the last Sunday of January). I am grateful that I lived in a time when the disease was overcome, when it was just an inconvenience and not a life sentence. We must be ever grateful to many scientists and pioneers like Dr. Paul Brand (14) who toiled to find a cure and rehabilitation for those suffering from this scourge and to organizations like The Leprosy Mission (15), AIFO (16), Gremaltes (17), American Leprosy Mission (18), the Missionaries of Charity (19), the government and many others who provided care and cure for the disease – for some years our leprosy work was partially supported by AIFO and The Leprosy Mission.
But for the grace of God and the timely discovery of a cure, I would have been a leper in a prison too. I had a myocardial infarction some years later (20) and now live with an ejection fraction of 30% – I could have easily died that day in 2008. God has taken me through many trials but kept me alive and able to work hard and remain productive. Many of us wrestle with our demons. For some they are sickness, like leprosy, HIV, mental illness and cancer; for others there are issues with parents, spouses and children, each one has his/her own ‘thorns in the flesh’ (21) but we can all find peace and reassurance in that beautiful verse in the Bible, Psalm 37:24, “Though he fall, he shall not be utterly cast down, for the Lord upholdeth him with his hand” (22). I know that God in His grace has given me many second chances and value every moment I am privileged to live and hope that everything that I think, say and do finds His approval and that when my days in this world are over, I would be welcomed back as a good and faithful servant who accomplished the task given to him.
References:
- https://emedicine.medscape.com/article/220455-overview
- https://en.wikipedia.org/wiki/Leprosy
- http://www.makunda.in
- https://the-sparrowsnest.net/2016/02/19/short-video-of-our-work-made-by-emmanuel-hospital-association/
- https://eha-health.org
- https://en.wikipedia.org/wiki/Quonset_hut
- https://the-sparrowsnest.net/2018/05/12/early-days-at-makunda/
- https://www.leprosymission.in/what-we-do/institutions-and-projects/hospitals/tlm-kolkata-hospital/
- https://the-sparrowsnest.net/2017/09/13/obeying-a-call-to-medical-missions-a-testimony/
- https://en.wikipedia.org/wiki/Clofazimine
- https://www.legalcrystal.com/act/133845/lepers-act-1898-complete-act
- https://timesofindia.indiatimes.com/india/leprosy/articleshow/67689369.cms
- https://en.wikipedia.org/wiki/Father_Damien
- https://en.wikipedia.org/wiki/Paul_Brand
- https://www.leprosymission.in
- https://aifoindia.org
- http://www.gremaltes.in
- https://www.leprosy.org
- https://en.wikipedia.org/wiki/Missionaries_of_Charity
- https://the-sparrowsnest.net/2011/11/01/an-encounter-with-a-myocardial-infarction/
- https://en.wikipedia.org/wiki/Thorn_in_the_flesh
- https://www.biblegateway.com/passage/?search=Psalm+37&version=KJV
The Sparrow's Nest 