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Contents CMAI's Healing Ministry Theme 2010: 'Sharing the Pain' CHRISTIAN MEDICAL JOURNAL OF INDIA PROMOTING THE MINISTRY OF HEALTH, HEALING AND WHOLENESS

Letters to the Editor

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Editorial

35

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Health Advocate: Pain — Is It Necessary, Is It Bad?

Biblical Reflections on Sharing the Pain

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From Our Archives

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Overview: Journeying Through Pain - A Mixed Experience

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Dialogue: Is DNB the Answer...?

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Overview in Hindi

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Feature: Sharing The Pain — A Way of Life in the Healing Ministry

Overview in Tamil

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Opportunity

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Feature: Healing Society Contributes to 18 Healing Individuals

Reports of Sections' National Conferences

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In Brief: Quality of Life and Death

20

Book Review

48

Feature: Life Beyond Pain

22

49

Feature: Mission is to Share the Pain of People — A Letter from CMAI Orissa

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Towards a Fair and Sustainable Health Care System for India International Perspective

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Feature: Shalom...Healing...Peace

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Feature: Seven Spiritual Spices

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Feature: Sharing the Pain of the Poor and the Excluded

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Issue Sponsor: St Stephen's Hospital

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Humour

62

Obituary

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Institutional Series: CSI Hospital, Trichy 32 VOL: 25 NUMBERS 1 - 4

JANUARY - DECEMBER 2010

OFFICE BEARERS: President: Dr M C Mathew, Consultant Developmental Neurologist and Professor of Developmental Paediatrics, Pondicherry Institute of Medical Sciences, Pondicherry; Vice President: Captain John P Macwan, Retd Major, Salvation Army; Treasurer: Mr Augustine Aiyadurai, Adminis trator, Scheffelin Institute of Health-Research & Leprosy Centre (SIH-R & LC), Karigiri; Editor: Dr Sudhir Joseph, Director, St Stephen's Hospital, Tis Hazari, Delhi; General Secretary: Dr Vijay Aruldas, CMAI, New Delhi Communications Advisory Committee: Dr Sudhir Joseph, Dr M C Mathew, Dr Vijay Aruldas, Ms Leah Macaden, Mr Milind Gude, Dr John C Oommen, Dr Shobhana Bhattacharji, Rev Stanley Thomas, Rev Mrs Shirley Lal, Dr John Thomas, Ms Jancy Johnson, Mr Stephen Victor, Mr A P Berry, Rev Job Jayaraj, Mr Justin Jebakumar, Dr Joe Varghese, Ms Jaya Philips Editorial Working Group: Dr Sudhir Joseph, Dr Vijay Aruldas, Dr John Thomas, Ms Jancy Johnson, Mr Stephen Victor, Mr A P Berry, Rev Job Jayaraj, Mr Justin Jebakumar, Dr Joe Varghese, Ms Jaya Philips Editorial Coordinator: Ms Jaya Philips Design and Production: Ms Susamma Mathew

Cover Design: Dr Nittin Parkhe

Subscriptions: Ms Shalini Dayal Publisher and Business Manager: Dr Vijay Aruldas Editorial Office: Christian Medical Association of India, Plot No 2, A-3 Local Shopping Centre, Janakpuri, New Delhi - 110 058 Phones: 2559 9991/2/3, 2552 1502; Fax: 2559 8150; E-mail: cmai@cmai.org, cmaidel@vsnl.com Website: www.cmai.org Bangalore Office: HVS Court, Third Floor, 21 Cunningham Road, Bangalore - 560 052 Phones: 080-2220 5464, 2220 5837, 2220 5826 Fax: 080-2220 5826, E-mail: cmaiblr@vsnl.com, cmaiblr@cmai.org Printed at New Life Printers Pvt Ltd, Mukherjee Nagar, Delhi Articles and statements in this publication do not necessarily reflect the policies and views of CMAI. For private circulation only.

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CMJI VOLUME 25 NUMBERS 1- 4


LETTERS TO THE EDITOR

Use of T er ms that Stigmatise Ter erms Dear Sir, I read with great interest the Jacob Chandy Oration (1) by Rev Dr K C Abraham: a thought-provoking address in which he asserts, “healing is integral to the Messianic mission of Christ”. I do agree, in particular, with his point that “Jesus was responding to the social dimension of illness”. Jesus on several occasions extended His healing power to individuals affected by leprosy (or “Hansen’s disease”, as some prefer to call it nowadays). These people presumably received not only a “medical cure” (recovery from M. leprae infection and from any physical disability arising from the disease) but also a social restoration. Jesus was, I believe, concerned to see them return to full acceptance by – and participation in – their local communities. Since he looked at their hearts and saw God’s image in them, I am sure He would never have used, nor would countenance

use of, derogatory language in relation to people affected by leprosy. Likewise, we who follow Him and aspire to be like Him, should not use stigmatising words to refer to people suffering misfortunes such as those affected by leprosy… or those suffering from epilepsy… or those born with Down’s Syndrome… or those who have congenital hypothyroidism… or those handicapped by cerebral palsy… They are people (our brothers and sisters) who are sick or disabled – they are not “lepers”… nor epileptics… nor mongols… nor cretins…nor spastics. In his oration, as printed in CMJI, Dr Abraham says “lepers were ostracised” and “for Jesus to touch a leper meant He was taking a radical step”. I request CMJI Editorial Board to include in future in its editorial policy a prohibition of the use of terms such as “leper” (or any of its local language equivalents, such as “maharogi”), since they perpetuate an unjustified and

Guidelines for Contributors Special Articles CMAI welcomes original articles on any topic relevant to CMAI membership - no plagiarism please.  Articles must be not more than 1500 words.  All articles must preferably be submitted in soft copy format. The soft copy can be sent by e-mail; alternatively it can be sent by post on a CD. Authors may please mention the source of all references: for e.g. in case of journals: Binswanger, Hans and Shaidur Khandker (1995), ‘The Impact of Formal Finance on the Rural Economy in India’, Journal of Development Studies, 32(2), December. pp 23462 and in case of Books; Rutherford, Stuart (1997): ‘Informal Financial Services in Dhaka’s Slums’ in Jeoffrey Wood and Ifftah Sharif(eds), Who Needs Credit? Poverty and Finance in Bangladesh, Dhaka University Press, Dhaka.

 Papers submitted to the CMAI should not have been simultaneously submitted to any other newspaper, journal or website for publication.  Every effort is taken to process received papers at the earliest and will be included in an issue where they are relevant.  Articles accepted for publication can take up to six to eight months from the date of acceptance to appear in the CMJI. However, every effort is made to ensure early publication.  The decision of the Editor is final and binding. Letters  Readers of CMJI are encouraged to send comments and suggestions (300-400 words) on published articles to the ‘Letter’ column. All letters should have the writer’s full name and postal address.

unkind stigmatisation of leprosy-affected individuals, which is not consistent with Christ’s teaching. Yours sincerely, C Ruth Butlin, MRCGP, MB BCh. (former staff of The Leprosy Mission International) (1) Healing Ministry In Today’s Context – Some Biblical and Theological Perspectives. Rev Dr K C Abraham, CMJI, vol 24, no.3-4, p 27.

Response to PPoint oint R aised Raised Dear Sir, Thank you for forwarding Dr Ruth Butlin’s feedback to my presentation. I appreciate the point she has made. Yes, we should consciously avoid all terminologies that smack of prejudice and stigma. Yours sincerely, Rev Dr K C Abraham

General Guidelines  Writers are requested to provide full details for correspondence: postal and email address and daytime phone numbers.  Authors are requested to send the article in Microsoft Word formats. Authors are encouraged to use UK English spellings.  Contributors are requested to send articles that are complete in every respect, including references, as this facilitates quicker processing.  All submissions will be acknowledged immediately on receipt with a reference number. Please quote this number when making enquiries. Address for Communication Communication: Head – Communications Dept. CMAI, A-3 L S C, Janakpuri, New Delhi –58 Tel.: 011-25599991/2/3 E-mail:communication@cmai.org

Disclaimer: Views expressed in the articles are personal and do not represent the views of management or membership of CMAI.

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EDITORIAL

A New Beginning

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ecently, sitting in the office during lunch time, engaged in discussions with a colleague, I offered to share my lunch with him. He readily agreed. I then reached for the lunch sent down by our Dietary Department and, on removing the foil, we discovered the repast consisted of plain instant noodles with tomato sauce. On seeing his disappointment I asked him the reason. He then explained he had thought the Dietary would send ‘something special’ for the Director and instant noodles certainly did not fit the bill. This little incident, which caused both of us some amusement, however, made me ponder on the act of sharing. When we are asked to share something with someone else we always look forward to sharing something good. Whether it is good food or just a fun moment, we are eager to partake of the same. However, when asked to share an ‘unpleasant’ situation, we tend to draw back and try our best to get out of it (my friend did eat the noodles!). Sharing the pain of others is never easy. When we visit someone who is sick or dying we make all the right noises, say the correct words of sympathy and come away thanking God we are not in the same situation. We then immerse ourselves into our busy lives to try to blot out the image of the less ‘fortunate acquaintance. We may realise the mental or physical pain they are feeling but we do not share their suffering. In other words, we sympathise but do not empathise.

Even as medical professionals we are trained to ‘keep a distance’ from our patients. We are taught to be dispassionate as, otherwise, our decision making may be coloured and we may not offer the best medical treatment for the disease. We are also told it is better to stay aloof or else we may burn ourselves out. As a medical student I was often offered such advice by teachers and peers. HOW WRONG THEY ALL WERE!

How can we not care fully about the patients in our care? How can we not bother about what happens to them. As a young intern in Surgery, I remember weeping uncontrollably when we lost a young man, an IIT Madras student who was the same age as I. I wept that we could not save him, that I had lost a friend. At that time I tried to hide my tears but his mother sensed my grief and responded by hugging me. It is still a precious memory after all these years. It is only when we share the pain of others that we walk the extra mile, put in a special effort to help them. The Gospels describe the deep friendship between Jesus and Lazarus. When He was informed that Lazarus had died, Jesus wept. This, for a long time, was a mystery to me. Why did Jesus weep when He knew that all was not lost, that He would raise Lazarus from the dead? After all, this was one of the greatest miracles He performed, an act that glorified Him even more. It took me a long time to realise that Jesus wept as He shared

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the pain of the family. He wept because their grief was more than His spirit could bear. As health professionals, grief and pain are our daily companions. We see it on a regular basis. As professionals, we may make ourselves immured to it. As Christians, let us pray that we always feel the pain. That way we will never lose the humaneness of healing. This issue sees the birth of a new initiative to increase the reach of our journal. I have often observed that people are most comfortable reading in their own language. This is specially so for persons who have not used English as a medium for training. With this issue, we are offering the Hindi and Tamil translations of the Overview article. We hope our readers will find this initiative useful. Please do write and give us your comments for improvement.

Dr Sudhir Joseph Editor - CMAI


BIBLICAL REFLECTION

Sharing the Pain – A Biblical Reflection 

Rev John Lunn

The author, a minister and a palliative care consultant, explores what purpose pain serves in our lives

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Rev John Lunn

We are invited to share our pain with Jesus/God. We are reminded that we are not alone in our pain. Jesus has offered to share our burden, to share our pain

e don’t need to look very far to find pain. Pain is all around us – physical, emotional, social, spiritual, and economic pain. Sometimes pain is simple and easily recognised, but often it is more complicated, having many parts and layers. It may be secret, it may be hidden. “Sharing the Pain” is at the heart of our Christian faith: “And if children, then heirs, heirs of God and joint heirs with Christ — if, in fact, we suffer with him so that we may also be glorified with him.” (Romans 8:17; NRSV) Jesus himself reminds us that, “just as you did it to one of the least of these who are members of my family, you did it to me.” (Matthew 25:40) This is the starting point. We are called to share the pain of those in need. This is the command of Jesus. Over the years, I have frequently worked with people dying of cancer. It is the physical pain that is often the most obvious, but their pain is often much more than that. For the person and their families there is the pain of loss, both emotional and spiritual. There is the pain of social isolation. In some villages, it is still believed that cancer is contagious – that you can “catch it.” Often friends stay away because they don’t know what to say or what to do. But Galatians 6:2 says nothing about correct words or actions – it simply says, “Bear one another’s burdens.” Families spend savings or sell land or valuables

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to pay for expensive treatments. For many others, that isn’t an option because of poverty. Pain has a purpose. This idea is beautifully illustrated in the book The Gift of Pain by Dr Paul Brand and Philip Yancey. Dr Brand uses the leprosy patients that he worked with as examples. He talks about how the lack of feeling pain leads to so many problems. Pain serves a purpose – letting the body or even the community know that something is wrong. Mother Teresa said – “Like all gifts, it depends on how we receive it. And that is why we need a pure heart to see the hand of God, to feel the hand of God, to recognise the gift of God in our suffering. He allows us to share in his suffering and to make up for the sins of the world.” 1 For someone in the midst of grief, there is good news and there is bad news. The bad news is that grief never ends. Then what is the good news? Grief never ends. The depth of grief is related to the meaning of the relationship. The person that we have lost to death is remembered in our grief. With the support of our faith and community, the intensity of the pain lessens. That grief becomes sweet and happy memories. That grief is a way for that person to live on in our lives. Sharing the pain has a purpose. 2 Corinthians 1:7 reminds us, “Our hope for you is unshaken; for we know that as you share in our sufferings, so also you share in


Biblical Reflection

our consolation.” We were created to be people in community. Sharing the pain is part of being in community. Jesus says to us, “Come to me, all you that are weary and are carrying heavy burdens, and I will give you rest. Take my yoke upon you, and learn from me; for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.” (Matthew 11:28-30) We are invited to share our pain with Jesus/God. We are reminded that we are not alone in our pain. Jesus has offered to share our burden, to share our pain. In Hebrews 4:15, we are reminded that he has fully experienced our human life and our emotions. “For we do not have a high priest who is unable to sympathise with our weaknesses, but we have one who in every respect has been tested* as we are, yet without sin.” “Bear one another’s burdens.” (Galatians 6:2) This is also a charge to the Christian community. We are invited to share our pain with and within the community. As a community, we are called to support one another. We will all experience pain of some sort. We can grow from that experience. We can become a greater help and support to others who experience pain. It is important that we know

Too often, we as Christians reject and turn away the very people that Jesus has called us to serve, to love, to heal. We find “good” and even righteous-sounding reasons for that rejection

and feel that we are not alone. Sharing the pain requires an atmosphere – an environment. That environment was modeled over and over again by Jesus. It was an environment where there was no condemnation – quite the opposite. We see this in John 8, as Jesus encounters a woman about to be stoned. She has been found guilty of adultery and the crowd is about to punish her. Jesus turns the tables on the crowd. He says, “Let anyone among you who is without sin be the first to throw a stone at her.” (vs 7) With this, he questions the crowd about their own sin. The crowd backs off and leaves. Jesus said, “Neither do I condemn you. Go your way, and from now on do not sin again.” (vs 11)

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Too often, we as Christians reject and turn away the very people that Jesus has called us to serve, to love, to heal. We find “good” and even righteous-sounding reasons for that rejection. In Matthew 9:1213, Jesus says, “Those who are well have no need of a physician, but those who are sick. Go and learn what this means, ‘I desire mercy, not sacrifice.’ For I have come to call not the righteous but sinners.” Do we need to be reminded that God is the Judge and we are God’s servants? We celebrate John 3:16 and its message of God’s love and salvation, but sometimes we forget John 3:17 – “Indeed, God did not send the Son into the world to condemn the world, but in order that the world might be saved through him.” Jesus creates a welcoming space for sinners, for tax collectors, for outcasts, for women and children, for you and me, for all who suffer, to share the pain.

Rev John Lunn is a Visiting Palliative Care Consultant, Christian Medical College, Vellore

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Suffering.net. Date of Access - 10 March 2010 http://www.suffering.net/servmo-t.htm


OVERVIEW

Journeying Through Pain — A Mixed Experience 

Dr M C Mathew

The author analyses the various challenges posed in our journey with pain which is of utmost use in our spiritual and psychological journey here on earth

I Dr M C Mathew

There is an existential dimension to pain – physical pain regulated by the physiology of the sensory nervous system; emotional pain processed through the past experiences of vulnerability or resilience and psychic pain interpreted through the perception of facts or fiction

have been through the demanding and distressing experience of watching staff abstain from work during this week in a hospital, in order to impress upon the management the need for a better pay package. While listening to some of them, I felt that they suffer from a double disadvantage. One, on account of the escalating cost of living, they have a compromised quality of family life. The other being a mindset of anger and reaction, which earns them no sympathy. A true instance of when painful experience makes the personal struggle all the more intense! I was only just recovering from the shock over the loss of all my data in the computer while in the process of transferring it for storage into an external hard drive. I lost most of my photographs, research data, articles, presentations and chapters of three books under preparation. Even this article, which was ready to be sent to the Editor, was lost. As I rewrite this from memory and with new insights, I am all the more aware of our intimate engagement with pain as an ongoing reality.

WHAT IS PAIN

There is a spectrum of reasons leading to the origin of pain. A mother suffers pain inherently associated with childbirth for the sake of fulfilling her vocation for family life. A teenager, who slips into the habit

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of substance abuse inflicts pain on and denies better prospects for the future to themselves. Although there are warning signs all along the road not to ‘over speed’, a biker ignores this and has a road accident, which to me is imposed pain. A senior citizen goes through the travails of terminal illness, consuming that person, which is an existential reality attached to our earthly lives. The helplessness attached to this experience compounds the situation. There is unreasonable pain on account of the indifference of people around us. The farmers being forced to give up their agricultural land to create Special Economic Zones without adequate compensation or rehabilitation is an example of this. There is vicarious pain, which a person may invoke on themselves for the well-being of others. Jesus taking upon Himself the pain of humanity for leading us to God, and St Paul feeling the pain in his spirit that ‘Christ may be formed in you’ are revealing examples of this vicarious pain. It is a calling into which some of us may be led, as a passage into ‘fullness of life’ can follow only through the enlargement of pain, which is what pain can bring when it is creatively endured. The fact of pain being a ‘gift’ was brought to our attention by the sayings and writings of Dr Paul and Margaret Brand. In an interview given to me three


Overview

years prior to his home call, they narrated to me their encounters with pain. Their painful experiences affected them emotionally, socially and spiritually. There was deprivation, loneliness and struggle. But according to them, they were initial formative experiences to complete a transforming process about which they had least awareness when they journeyed through those experiences. In hindsight, they realised that there was no substitute to what they encountered to become what they had become. For Anna and me, the loss of our daughter after a short illness at the age of three months was a devastating experience. Thirty years later, although we still live with some pain over that loss, we realise that it was the seminal event in our lives, one that led us to be involved in the care of children and families with special needs. An experience led us into a vocation and this awakening into a reality, to which we were blind earlier on.

Painful experiences can make most people dwell far too much on the external, physical and peripheral issues of life. What they feel or perceive becomes the whole truth and the rest of reality fades away from their consciousness or stays hidden in their interior as a myth ability or resilience and psychic pain interpreted through the perception of facts or fiction. For coping with pain in these dimensions, appropriate medication, therapy and support are required. These measures may help in alleviating or containing pain. However, the attitude to pain needs attention. There are two possibilities. One can suffer pain as a victim or challenge

THE CHALLENGES IN HANDLING PAIN

There are three challenges before us as we encounter pain in our lives or observe the dilemma that others go through while suffering pain in their lives. The first is to help a person to feel his or her pain redemptively redemptively. There is an existential dimension to pain – physical pain regulated by the physiology of the sensory nervous system; emotional pain processed through the past experiences of vulner-

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pain creatively. Anna and I have a known a friend for thirty years. She discontinued her teaching job at the age of 35 due to a Parkinsonian disorder. Over the years, her physical movements, capacity to use her hands dexterously or continue activities she used to enjoy, such as climbing mountains or walking etc., became increasingly difficult and daunting. She lived a reduced life emotionally and socially for weeks sometimes. The medicines, therapy and counselling she received helped her only marginally. Once, during a boat ride, she noticed a swan floating on the agitated water, least affected by the turbulence of the moving motor boat. That suddenly became a symbol to her. She knew there was still a lot more for her to explore and she also knew she had to find a better inner ambience. She returned to her faith journey; she started to cook simple meals replacing her habit of eating pre-cooked food bought from the supermarket; she started to reconnect with her friends over the phone; she restarted her walks along the lake side; she got an embroidery machine to pursue her favourite hobby; and she attained proficiency in internet use and became a regular e-mailer to friends with pictures she took during her walks. A year later when we visited her again, she looked well, communicated cheerfully and was full of zest for life. We had a few days of celebrating our friendship in a variety of


Overview

Pain is potentially limiting in its role by nature. Most people live with these limitations, either by accepting them or resisting them. In both instances, pain alters well-being. The limitations gradually become the norm in most instances ways, which brought much refreshment to us. She still had much stiffness in her muscles, needed more time to get ready in the morning and had to be cautious while walking lest she fell down due to loss of balance. But none of these difficulties appeared to be the centre of her attention or conversation. On the day of our departure, she mentioned to us that the change process began through a gradual realisation that a few feet beneath the tall and turbulent waves of the sea it was calm and still. This awareness led her to find her resting place in God, who was resident in her soul. God had not changed although the physiology of her body had changed. There was a growing intimacy with God. She had begun to feel her pain redemptively. There was respite even from physical pain. The second challenge is to facilitate an inward jour ney journey ney.. Painful experiences can make most people dwell far too much on the external, physical and peripheral issues of life. What they feel or perceive becomes the whole truth and the rest of reality fades away from their consciousness

or stays hidden in their interior as a myth. While the painful encounter was just one event or sometimes a series of events, there is a larger narrative of life that remains to be explored. The inward journey needs assistance from a senior friend or a counsellor, who through inviting a person to reflect on the major life events or themes in their life, can initiate a pre-occupied person into a liberating journey of discovery of the rich heritage, gains and growth in their life in the past. A teenager suffering from severe arthritis visited me once. He was an athlete, swimmer, tennis player and all-rounder. This illness had offset his pursuit and made him feel helpless. The earlier treatment had given him only marginal relief. During the next three months, I was regularly in touch with him, and we were able to find the cause for his arthritis and start him on treatment and a recovery plan. The recovery plan started with helping him to describe the ‘peaks and valleys’ in life – the high and low points. He used narration and pictures to begin this process. During our weekly meetings in the initial three weeks, he focused on expressing his sadness and anxiety. During the subsequent weekly meetings, there was a progressive appreciation of the goodness and joyful experiences of life. Even the colours he used to paint his childhood experiences changed from greyish tones to bright colours. I noticed that he referred much less to his pain and was full of news of events at school or the sports field. One day he brought a painting he had drawn for me. It was the illustration of the instance of Jesus welcoming children to Him, when parents brought them to Him 8

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for His blessing. It was elegant and artistically rich. He volunteered to tell me the inspiration behind this drawing. As he began to make the inward journey into his life, he was surprised to find that Jesus whom he had trusted was still present in his life, sharing in all his experiences and leading him through all of them. His pain became a shared pain. As I look at this painting now, hanging on the wall in my room, I am taken back to this event twenty years ago, where a boy embraced himself during his inward journey and discovered a larger reality – Jesus, the architect of his life, giving him a new meaning and call through his current life experiences. He is an accomplished professional now with a humane spirit and participates in a spectrum of sports activities. The third challenge is to help people to see beyond their limitations limitations. Pain is potentially limiting in its role by nature. Most people live with these limitations, either by accepting them or resisting them. In both instances, pain alters well-being. The limitations gradually become the norm in most instances. Every reminder of a different prospect, of ‘had the situation been different’ evokes emotions of hurt, disappointment, anger, reaction, etc. There is recycling of self-pity and helplessness, which adds to the baggage of already-existing trauma. This is a self-harming process and one that compounds the complex situation. There is a need to help people to see opportunities beyond limitations.


Overview

WHAT IS BEYOND PAIN

Haruki Murakami is a well-known Japanese author whose books are translated into 42 languages. In 1982, he sold his jazz bar to devote himself to writing. Murakami began running to keep fit. A year later he had completed a solo course from Athens to Marathon and since then has run dozens of such races and triathlons, along with publishing about a dozen critically acclaimed books. In his book, What I Talk About When I Talk About Running, a memoir published in 2008, in the chapter At Least He Never Walked he narrates a graphic detail of his

preparation for triathlon, of swimming for 0.93 miles, a bike ride of 24.8 miles and a final run of 6.2 miles. After participating in six triathlons, he could not participate in any one for four years because he could not recover from a sense of rejection when he was disqualified from one for taking extra time for swimming. He refers to it as, “… painful and there were times when, emotionally I just wanted to chuck it all”. But on the advice of his wife, he received help from a coach, who suggested that he had a habit of hyperventilating at the beginning of swimming, which would make his body stiff and slow him down. With an year-long retraining, he was able to get back to swimming and qualify for the triathlon. Referring to this pain on successfully completing the triathlon, Murakami wrote, “But pain seems to be the pre-condition for this type

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of sport. If pain weren’t involved, who in the world would ever go to the trouble of taking part in sports... It is precisely because of pain, precisely because we want to overcome that pain, that we can get the feeling, through this process, of really being alive – or at least a partial sense of it”. There is this arrival at being “alive” in a mysterious way while journeying through pain so that one is suddenly carried into the plane of beyondness, both for now and future. This beyondness has an existential dimension also. A boy was struggling to take out his hand with a fistful of marbles through the narrow mouth of a jar. He had to let go of them and pick up one marble at a time to take out his hand from the jar. It is not struggle that is always the means for experiencing fullness, but surrender. The Resurrection validated the larger purpose of journey through Gethsemane. What is beyond pain is more real than the present pain itself. What is common to all of us is that we encounter pain regularly in our lives. It is a journey, with a potential to transform us. When we begin to feel the healing of our pain, we can become missionaries to bring the ‘balm of Gilead’ to those festering in their wounds.

Dr M C Mathew is a Consultant Developmental Neurologist and is currently a Professor, Pondicherry Institute of Medical Sciences


FEATURE

Healing Society Contributes to Healing Individuals 

Rev Dr Sunil M Caleb

The author, a professor of Christian ethics and an assistant presbyter, examines what Heal-To-Be-Healed means and compares the conditions present in our society with those of the past

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Rev Dr Sunil M Caleb

It is very often the case that when a society is healthy, in that it looks after the needs of each person and does not tolerate injustice and discrimination, we find that the health of individuals is good too

aul, in his first letter to the Corinthians, chapter 12, speaks of Christians as being part of one body, whose head is Christ. He further goes on to say that because we are all of one body, when one part of the body suffers then the other parts suffer with it and when one part of the body rejoices then others rejoice with it. Thus, it is clear that our pain is healed quicker when that pain is felt to some extent by those who love us and have concern for us. It is very often the case that when we go out of our way to do good for others, we find that good comes back to us. As Jesus said, “Forgive and you will be forgiven; give and it will be given to you.” (Luke 6: 37-38) Further, Jesus clearly stated that the person who would seek to save his or her own life would lose it, but the one who loses his or her life for the sake of being obedient to the demands of the gospel, would find it. (Matthew 16:25) As the famous lines of St Francis of Assisi say, “For it is in pardoning that we are pardoned, in giving that we receive, and in dying that we are born to eternal life.” In the same way it has been found that if we seek to heal, then we too will be set on the way to being healed. The nature of God that has been revealed to us in the Bible as a whole and especially in our Lord Jesus Christ is that of a life-giving God. Right from the account

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of Creation through the exodus of the Hebrew people from Egypt and their sojourn in the wilderness we see that Yahweh is a God who seeks the promotion and expansion of life for all. Jesus carried on this tradition and brought it to a higher level. As Jesus said in John 10:10b, “I came that they may have life, life in all its fullness.” In his reflection upon his ministry that he gave before the congregation at Nazareth, Jesus states that his mission is to “Give the good news to the poor, proclaim release to the captives, recovery of sight to the blind and freedom to those who are oppressed.” (Luke 4:18) When we look at the life of Jesus, it is clear that he was always working to bring wholeness and life to people who were in some position of despair, or were in pain, or in bondage of some kind. Sometimes the giving of life involved only physical healing; sometimes it was the restoration of people into fellowship with the wider community. In the same way, we too are called upon to see how we can promote life in every area. Since a human being is a multi-dimensional entity – with a physical body, mind and a spiritual side – health and healing are not only about physical healing but also about the healing of the mind and of the spirit. Health is something that has to be holistic, that is, it involves a healthy body, mind and spirit. Further, as it is often seen that the condition of the mind affects


Feature

As the famous lines of St Francis of Assisi say, “For it is in pardoning that we are pardoned, in giving that we receive, and in dying that we are born to eternal life.” In the same way it has been found that if we seek to heal, then we too will be set on the way to being healed

the health and physical condition of the body, holistic health is about each part of the body, mind and spirit being healthy and well. The healing of society is also very crucial for the healing of individuals. Society is healthy when there is no discrimination – on the basis of gender, ethnic background, caste, sexual orientation and disability – and when all are treated equally. Further, a healthy society is one where the basic needs of each individual are met – no matter what their background – and where there is a strong emphasis on equality. And it is very often the case that when a society is healthy, in that it looks after the needs of each person and does not tolerate injustice and discrimination, we find that the health of individuals is good too. A recently published book, The Spirit Level: Why more equal societies almost always do better (London: Allen Lane: 2009) summarises a vast amount of research that

shows that the more equal the society, the more healthy the individuals in the society both physically and mentally. Hence, if we as individuals, churches and civil society groups work towards the establishment of a more equal and just society then we are working towards the spread of health in every area. From the way in which God dealt with the people in the Old Testament we can tell that the plan of God is to create community. This can be seen from the way in which the people of Israel were called upon to fight against inequality and hierarchy, which divided people. Even the king was under the judgment of God as any ordinary citizen. (e.g. Ahab could not force Naboth to sell him land, something his nonIsraelite wife Jezebel found strange; I Kings 21). When we look at the various laws found in the books of Leviticus and Deuteronomy we find that there is a continuous attempt to minimise inequalities that could disrupt the formation of greater community, for it is clear that when there are inequalities there will be divisions among people and community feeling cannot be developed. Thus, we have the land restitution laws in Leviticus 25 where all land is to be returned to its original owners every 50 years. In Deuteronomy 15, we find laws that call for the remission of debts every seventh year and the release of all Hebrew slaves after six years. It must be remembered that the main causes of physical ill-health are socio-economic and environmental. The presence of injustice in the economic sphere is a major reason for the various kinds of illhealth that we see. E.g. children who work long hours in match, fire-works, and carpet factories end up with diseases like respiratory and other infections because of the work that they do. Malnutrition in India is rampant with 43% of Indian children under 5 being malnourished. When you add to that the young age at which women are married off in some states, it is little wonder there is so much ill-health. Envi-

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The main causes of physical ill-health are socio-economic and environmental. The presence of injustice in the economic sphere is a major reason for the various kinds of ill-health that we see

ronmental pollution and degradation too are factors that lead to ill-health. Thus, one of the most important ways to promote healing is to eliminate injustice and to enable people to buy sufficient amounts of food of the right nutritional value. Improvement in the environment too is crucial for better health. As individuals, sharing the pain of others will help us to overcome our pain. However, it is more important that we work towards building a fairer society where there is no discrimination and where the basic needs of all for food, shelter, education, satisfying work and medical facilities etc. are met. When we do this work, we make sure that society is providing the context for holistic health for all.

Rev Dr Sunil M Caleb is the Principal and Teaches Christian Theology and Ethics at Bishop’s College, Kolkata


IN BRIEF...

Quality of Life and Death 

Dr Stanley C Macaden

The author, a palliative care expert, says dignity in death is important as a sad death affects the grieving process of the ones left behind

T Dr Stanley C Macaden

Dignity in death can be provided by good palliative care, which aims to restore the shattered comfort and dignity of people affected by a terminal illness by alleviating their suffering. When such people are supported by holistic palliative care they invariably want to live

he night was long, but strangely bereft of anxiety and hopelessness. My sisters and I sat around my mother’s bed. After her second stroke we had watched a steady and progressive deterioration in her condition and now she was slipping away. There was a difference, however: Amma was at home with us, her pain was controlled and she was kept as comfortable as possible by following instructions of the palliative care team. Above all, she was at peace with herself and her Maker. We had also shared a few beautiful moments and heartfelt sentiments with her. The dawn ushered in the first few rays of the sun through the window. We held her hand as she breathed her last… A FAMILY’S EXPERIENCE

Death is an inevitable reality for all. The only certain event after birth is death. We do our best to make birth a safe and good event. However, there is much to be desired in the way we die. According to medical ethics, doctors have a dual responsibility: to preserve life and to relieve suffering. As a person approaches the end of life, relief of suffering is the more important of the two, especially as it becomes increasingly impossible to preserve life. The four cardinal principles of medical ethics are: patient autonomy (or respect for the patient as a person), beneficence (doing good), non-malificence (minimising harm) and justice (including the fair use of available resources). These must be ap20

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plied against the background of respect for life, on the one hand, and acceptance of the ultimate inevitability of death, on the other. Doctors should certainly strive to preserve life but, when such attempts turn biologically futile, it is equally important for them to provide comfort during the dying process. Overlooking this balance can result in untold suffering for both the person who is dying and for that person’s family. As Dame Cicely Saunders, pioneer of the modern hospice and palliative care movement, said, “How people die remains in the memory of those who live on.” A bad death complicates the grieving of those left behind. Palliative care emphasises quality of life, which includes quality of death. The debate on euthanasia intensifies now and then and the collective wisdom over the ages has rightly kept this at bay. With only a handful of countries allowing euthanasia, it is illegal everywhere else. Dignity in death can be provided by good palliative care, which aims to restore the shattered comfort and dignity of people affected by a terminal illness by alleviating their suffering. When such people are supported by holistic palliative care they invariably want to live. The principles of a good death – as outlined by Debate of the Age Health and Care Study Group published in the British Medical Journal in January 2000 – includes the following:


In Brief...

Slipping away peacefully, with dignity and surrounded by loved ones

 To know when death is coming and to understand what can be expected  To be able to retain control of what happens  To be afforded dignity and privacy  To have control over pain relief and mitigation of other symptoms  To have choice and control over where death occurs (at home or elsewhere)  To have access to information and expertise of whatever kind is necessary  To have access to spiritual or emotional support, as required  To have access to hospice care in any location – not only in hospital  To have control over who is present and who shares the end  To be able to issue advance directives which ensure last wishes are respected  To have time to say goodbye

These principles must, of course, be applied in the context of regional and cultural backgrounds. We must all do our bit to make death good. As individuals facing death we can express our wish that we do not want our life to be prolonged by inappropriate interventions – and even leave clear instructions to this effect. As health professionals we should, through joint multi-professional consultation, respond to the complex decision that death is imminent and change focus to provide comfort in dying. This is possible by applying existing, evidence-based guidelines, such as the Liverpool Care Pathway for the dying. As a community and a society we must accept the inevitability of death and let nature take its course. A peaceful and dignified death surrounded by loved ones can be a

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reality if we all work towards this. In the words of Rabindranath Tagore, “Death is not extinguishing the light. It is putting out the lamp because dawn has come.” We can all find meaning in death when it is good. Source: Deccan Herald, ‘Living’ Supplement, 3 April 2010

Dr Stanley C Macaden is a Palliative Care Consultant and Coordinator Palliative Care Programme, CMAI


Feature

I was left with fouryear-old Abel and one-and-a-halfyear old Learncy. Life came to a standstill and it seemed that I was surrounded by darkness. The future was empty and my mind and heart were numbed

roles in a new world was possible only because of the strength that God gave. In a sudden blow, my husband suffered a massive heart attack and went to be with the Lord in October 1997. I was left with fouryear-old Abel and one-and-a- half-year old Learncy. Life came to a standstill and it seemed that I was surrounded by darkness. The future was empty and my mind and heart were numbed. As I groped in the darkness I experienced God’s indescribable peace in my spirit and the assurance of His abiding presence. Gradually the trauma of the loss decreased. I sought His strength and grace daily. My children were too small to grasp the depth of this loss. Their innocence, trust and joy of life taught me many lessons in life and living. I looked around and came to know many who had suffered loss and pain, and were in difficult circumstances. Through God’s grace I reached out to them and through prayer and sharing of experiences shared His message of hope. I became convinced that my life experiences were being used to shape myself and others. There were times of insecurity. My rela-

tives and friends in the South called on me to return to my native place. A comfortable home, the assurance of a job and security of family and friends beckoned. As I sought the Lord, He comforted with the promise “…the reproach of your widowhood you will remember no more. For your husband is your Maker whose name is the Lord of hosts.” (Isaiah 54:4&5) I took the bold decision not to return. My children grew and progressed in their studies. Many students I had counselled and prayed for are now established professionals in different parts of the world. I have the privilege of an ever widening circle of friends who have supported me in different ways. Over the years, a few friends have become part of my family and we

My father breathed his last in my arms. The pain of another loss was deeply wounding

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share intimate and caring relationships. My father had always been a source of inspiration and strength. Six years after my husband’s death, he breathed his last in my arms. Though I was thankful to God for giving me the privilege of caring for him in his last days, the pain of another loss was deeply wounding. God’s promise of being “a father to the fatherless” (Psalm 68:5) sustained me during these times. And so the journey of the past 30 years continues… Is there life after loss? Undoubtedly yes. In times of insecurity, Christ became my security. In times of emptiness His Spirit filled me. In Him, there is surely a hereafter and the blessed assurance of a future. The life of Jesus Christ was one in which He suffered much but through it He also demonstrated that suffering is but temporary and can be overcome through God’s grace. Faith, hope and trust have sustained me and will see me through my journey’s end. Mrs Evelyn P Kannan is Assistant Secretary of Trained Nurses Association of India


FEATURE

Mission is to Share the Pain of People A Letter from CMAI Orissa In Orissa, mission hospitals were at the centre of attacks against Christians but were spared in the violence perhaps for a purpose. It is up to us to redefine that purpose

It appeared that Christian hospitals had somehow been left out of the hateviolence. Was it because even the mobs knew the hospitals are needed by all? Was it because the hospitals have served selflessly for years without trying to push our religion on others? Was it sheer divine providence? We do not know. We the Christian hospitals were special. We called it the Esther Paradox

Dear fellow pilgrim, ay I invite you to trace with us the journey of the last few years; a journey of pain and joy; of brokenness and healing. Let me explain the context in three parts.

M

1. BROKENNESS AND VULNERABILITY: ORISSA, AUGUSTSEPTEMBER 2008

On 24 and 25 August 2008, we, the Christian community of Orissa found ourselves suddenly engulfed in a tsunami of hatred and violence. The hatred had been cultivated over years. Pre-existing caste faultlines and economic tensions were cleverly channelised to create a communal time bomb. The killing of Swami Laxmananda Saraswati in Tumudibandh on 23 August ignited the tinderbox. Kondhamal District – the central highlands of Orissa – was converted into a hunting ground…. A pogrom against anything Christian – people, houses, institutions, vehicles…. A whole community was reduced to penniless refugees in their own place, hiding in forests as their homes and churches were reduced to rubble and ashes. And as if by design, the hatred and violence spread across Orissa, with rioting mobs smashing and burning the domestic and religious infrastructure of the Christian community. 24

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We watched aghast as people we had known for years turned against us. Vulnerability was relative and the Dalit Christian women were again the most vulnerable and broken. The Christian community was left broken and shattered – physically broken, mentally shattered, socially ostracised and economically crippled. Many of us discovered God anew at this time, for it is only in times of pain and brokenness that we can see clearly – when the clouds and dust of false security and personal ambition is brushed aside by stark suffering. God emerged as our only refuge. And in numerous places, Christians came together across denominational lines that divide us in times of plenty. (I must confess that in the years since, we have frittered away the spirituality and faith given to us at such great cost; drowned in the floods of relief money, the circus of persecution rhetoric and the hypocrisy of cynical Church leaders. There is a deep need for us as a community and a Church to examine ourselves in all humility and honesty, to repent for our behavior before and after the riots and to seek God’s leading and renewal.) 2. THE ESTHER PARADOX: OCTOBER 2008

As the violence abated and sanity returned,


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we looked around to count our wounds and assess the damage. And an interesting inference emerged. It appeared that Christian hospitals had somehow – by accident or by design – been left out of the hate-violence. Was it because even the mobs knew the hospitals are needed by all? Was it because the hospitals have served selflessly for years without trying to push our religion on others? Was it sheer divine providence? We do not know. But whatever it was, there seemed to be a pattern. We the Christian hospitals were special. We called it the Esther Paradox. In the Old Testament, a beautiful Jewish girl in a foreign land is chosen to be a Queen. She was safe and secure in the palace even as a pogrom was being planned against the entire Jewish community living in that country. Esther’s uncle Mordecai comes to Esther and asks her to intervene. She hesitates. His reply to her sears her soul: “Do not think that because you are in the king’s house you alone of all the Jews will escape. For if you remain silent at this time, relief and deliverance for the Jews will arise from another place, but you and your father’s family will perish. And who knows but that you have come to royal position for such a time as this?” (Esther 4 : 13-14; NIV) And the rest is history. We, the Christian hospitals of Orissa, found ourselves face to face with the Esther Paradox. Who knows but that we had come to a secure position for such a time as this? We needed to ask God again about what He was calling us to Be and to Do about of what His vision and mission was for us. 3. RE-THINKING MISSION: CMAI REGIONAL CONFERENCE, SEPTEMBER 2009

We had two in-depth sessions that lasted about ten hours altogether. We had inputs from theologian friends in different places. But at the end of the day, it was a question of searching in our hearts, of listening to God and His voice

Eighty members of the CMAI in Orissa met at Christian Hospital, Bissamcuttack from 18 to 20 September 2009. This was not

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like the usual Regional Conferences we had had. We were meeting not in power, but in brokenness; meeting at the feet of God to search together to find what mission means; for what really is the mission of a mission hospital. This was not an academic / theological debate such as so often occurs in such gatherings. This was for us, a question of survival – a search for the reason for our existence. We had two indepth sessions that lasted about ten hours altogether – of study and search. We had inputs from theologian friends in different places – sent in by phone and email. Review of a book, Transforming Missions by David Bosch, provided substance to the discussion. But at the end of the day, it was a question of searching in our hearts, of listening to God and His voice. We would like to share with you the lessons God taught us. We are privileged to have been part of the suffering Church. Can we share our insights with you before they disappear in the complacency and comfort of security? The Lessons Learnt: A. Mission is God’s – “Missio Dei”: The question is not what is my mission or your mission. Mission is God’s. God is at work in the world – loving, healing, transforming, redeeming.... Our calling is to listen to His tune and to dance to His music; to discern what He is doing and to join Him. Our mission is to be God’s People, and to do His will. (Too many mission groups are jumping up and down, creating missions at the drop


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of a hat – including the irrational desire to start new mission hospitals in pre-fabricated or transplant mode. Stop. Be Still. And know that He is God. Listen. And then when He calls, get up and dance to His tune.) B. The pattern for mission is from the original missionary – Jesus Christ himself. This is Incarnational Mission Mission. As St Paul says in Philippians 2:5-8, “”Christ Jesus: Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death — even death on a cross!” (NIV) And Paul prefaces this poetry with the words, “Your attitude should be the same as that of Christ Jesus”. This then is the pattern or model for mission: Incarnational. Becoming part of the place we are called to serve, whether it be our hometown or a distant land. Not in power and pomp, but in humility and vulnerability. Not by force, but by love. Sharing the pain of people. Being transformed and transforming. (We have made many mistakes in mission. We are in need of repentance, healing and renewal. The Lord we serve rides on a donkey. We the Church and mission agencies ride on an elephant. India sees though our game and rejects us, because we do not live out what we preach.) C. The healing ministry and Christian involvement in health care is one aspect of mission. It is God’s healing ministry. God is at work in the world – healing people, situations, relationships.... We are invited to listen, to recognise, and to participate with God. For God is a Healing God. Healing in Christian understanding is holistic; not just cure or repair. It includes the physical, the mental, the social, the economic, the political and the spiritual. God is there – active in all these. He invites us to come and join Him. The endpoint of healing is restoration to the purpose for which God created us; healing of

body, mind, soul and relationships; or Shalom. Jesus’ method is compassion. The word ‘compassion’ means, ‘to suffer with’. Or to share the pain. This is the Christian approach to health care. The healing ministry of God is working in many ways, all the time, with and without us. Wherever there is pain and suffering, whether physical, mental, social, economic, political, or spiritual, God is there – suffering alongside, crying alongside, sharing the pain, healing, transforming, recreating…. He invites those who recognise

We have made many mistakes in mission. The Lord we serve rides on a donkey. We the Church and mission agencies ride on an elephant

and love Him to join in. We become the Church – where 2 or 3 are gathered together, with Him. The outcome is Shalom or holistic healing. The Healing Ministry of God is multidimensional: Not restricted to medicine, but surely including it; not involving only health professionals, but surely including them; not only in Christian mission hospitals, but surely and especially including them. (So many of our mission hospitals and Christian health professionals are winding down for want of a vision and a reason for existence. Managerial techniques are offered as a substitute for an aim. It does not work. Self-perpetuation or organic growth 26

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or financial security cannot be the mission of a mission hospital. We will come down in due course under the weight of our own contradictions. Our leaders rarely have the theology needed for this question. And our theologians and pastors are too entrapped in the politics of the Church and mission organisations to give us the insight we need. Our only option is to return to the base – the foot of the Cross). So what then is our calling as Individuals and Institutions in the healing ministry?  Our mission is to BE and to DO  To BE God’s people and to DO His will  To share the pain of people in humility and brokenness  To let go and become part of, not as Manufacturers of Health but as Sharers of Pain  To be the Difference And transformation will come… in us… in our patients… in the health and happiness of our people. So whether we are nurses or doctors, allied health professionals or administrators, chaplains or lay people, we are called to sensitivity and identification; to become part of the communities we serve, to share the pain from inside. The Christian approach to health care is therefore different; our whole perspective is different. Don’t hide behind the fig-leaf of professionalism or objectivity. Take sides. Cross over to the other side of the table, so that the patient and we are both facing the illness or the bereavement together. This is true whether we are in paediatrics or in surgery, in haematology or in rehabilitation; in medicine or in nursing; in clinical care or in research; in community health or in tertiary care. God is on the other side. He invites us to join Him. To be the broken bread and poured out wine. God Bless.

The participants of the CMAI Regional Conference September 2009


FEATURE

Shalom… Healing… Peace 

Usha Jesudasan

What does Shalom mean? The author, who has known suffering from a very young age, says Shalom refers to the grace which we are given and which we can give to another

S Usha Jesudasan

Days and weeks after the funeral, she was still crying, and everyone avoided her. All the words of condolence had been spoken and now no one knew what to do

halom… healing… peace… harmony… such beautiful words! We long for them in our lives. But it seem that fate (or destiny or just plain life) often deals us pain and suffering and the ugly words that accompany them – fear… uncertainties… death. Pain has been an unwelcome guest in my life ever since I can remember. I had polio as a child, and had the first of the reconstructive surgeries on my leg when I was six years old. This was long before effective painkillers were on the market. I remember the pain searing through my leg and crying softly to myself. My younger brothers Ramesh and Sunil, and my cousins Suna and Chandru, were constantly at my side. They would sit beside me and stroke my good leg to make the pain go away. Young as they were, they gave up the usual outdoor games to be with me and share my pain. I learnt early that one cannot take away another’s pain – one can only share it and make the pain less. When the pain is less, there is healing, and with healing comes Shalom – that beautiful peace that takes away pain. So with pain being a kind of tagalong friend, we journeyed together through life. Now and again it would abandon me and gave me freedom to live without pain. Such times were good for my soul as they were times of peace and prosperity. In my first year of university in the UK, I made friends with a girl

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who lost her mother within three days of our meeting each other. As Melinda cried and sat alone in her room, a few of us went to visit her the day she came back from the funeral. But days and weeks after, she was still crying, and everyone avoided her. All the words of condolence had been spoken and now no one knew what to do. So staying away from her seemed the best idea until she was ‘over’ her mother’s death. At such times, I would remember my cousins who stayed by my side and so sat in her room, stroked her hair, copied notes that she had missed, brought meals for her and made endless cups of tea. A lot of the time, I felt like a piece of furniture in the room. Weeks later, one day she smiled and said, “Let’s go shopping.” There at the end of many painful months was Shalom – waiting for us like a patient parent. Often it is those who have been through intense pain themselves who can understand another’s pain. They, the wounded healers – “I know what you are going


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through, I’ve been there too and have come to share pain” – are the bearers of Shalom for those in pain. They bring the kind of peace and hope which one can have strong faith in – for looking at them we know that we too will one day come out of our pain. At a meeting in Geneva, I had had some difficult news from home and was reduced to tears. I sat in the canteen crying into my coffee cup. I was aware that several people I knew were also in the same room. But no one came near me. A young Rwandan, young enough to be my son, drew a chair to my table and asked if I wanted another cup of coffee. He quietly went and bought one and came and sat beside me and over the coffee I spilled out my pain, little by little. He listened, lent me his handkerchief, and at the end gave a big hug and a lift back to my hotel. He told me something which I have never forgotten. “You have cried, I have cried with you and He has heard both our cries. Our tears will not be wasted.” A Shalom bearer. Shalom at a time of pain can mean many things. I was at a camp in Sirgahzi, Tamilnadu, where some of those affected by the tsunami were housed. There I met nine-year-old Murugeshwari. On the morning of 26 December 2004, she was on her way to buy tomatoes for

her sister. Her mother was outside, cleaning fish. Suddenly, Murugeshwari heard a strange sound. She turned and saw the sea rushing towards her. The people around her saw this too and urged her to run. Her first thought was to run and warn her sister and mother, but before that thought could turn into any kind of action, she saw the sea swallow them both. Terrified, she ran and ran and ran. Today Murugeshwari is at a tsunami camp. Her bright eyes fill with tears as she tells me her story. She wipes them away with the hem of her skirt. Some children playing nearby see her wiping her eyes and come running over. They quickly surround her and two of them put their arms around her. “We are her friends, whenever she cries, we try and make her happy,” they said. “How do you make her happy?” I asked them. “Some of us go and sleep with her at night, so that she does not miss her mother and sister too much,” said one. Another said, “We always hold her tight when we sleep.” “I thought a present would make her happy. I asked my mother for some money to buy her a present. I bought her these,” said another girl pointing to a row of brilliant, green, glass bangles around

I learnt early that one cannot take away another’s pain – one can only share it and make the pain less. When the pain is less, there is healing, and with healing comes Shalom

Murugeshwari’s wrists. Yet another little girl said, “I gave her this,” pointing to a beautiful, black, red and gold bead necklace Murugeshwari was wearing. “Where did you buy it?” I asked her. “I didn’t buy it,” she said. “The sea swallowed my mother and my sisters also, so I don’t have anyone to ask money from. It was mine; it was around my neck when the tsunami came. I gave it to her to make her happy,” she said. Shalom is often a state of grace. A grace which we are given and which we can give to another. Pain is not something we plan for, or want in our lives. It usually hits us when we least expect it and leaves us numb with shock. Some of those in pain cry out; others retreat into a shell of silence. Almost all long for someone to share it with. Someone who will just sit and listen to them. Someone who will understand. Someone who will just be there for them. Usha Jesudasan is a writer who writes on issues of healing and peace

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FEATURE

Sharing the Pain of the Poor and the Excluded 

Dr Sara Bhattacharji

While considering people who live on the edges of her society, the author ponders on ways to change systems that maintain poverty

W

Dr Sara Bhattacharji

We can choose voluntary poverty like Mother Teresa, but this is not a practical option for many of us. We can hold our possessions lightly, as a trust that has been committed to us for the use of not just ourselves but of others too. We can choose to live in simpler and more cooperative ways

hat do we mean by sharing the pain of people who are poor or excluded within society? For me, rich, comfortable and a stranger to hunger, it feels audacious as well as arrogant to speak in this way of “sharing the pain.” Yet, as a physician who works with very poor people, I have experienced some of the difficulties and joys of this work and have been touched as well as changed by the encounters. Sheila Cassidy, in her book Sharing The Darkness, speaks of the doctor-patient encounter. At first, the doctor is sitting at the desk, with coat, steth, and a nurse in attendance. Meanwhile, the patient is across the table, ready for the examination, clothes removed and vulnerable. The doctor listens with sympathy. As the relationship develops, the “space” between them lessens. Gradually, doctor and patient are side by side, the barriers of techni29

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calities removed, making a closer interaction possible. We could speak of this as mutual empathy. At the next stage, the barriers professionalism poses to human closeness shrink still further. The doctor too becomes “naked” along with the patient. Both are open and vulnerable. This is perhaps when real sharing can occur. I wonder if this is possible except for very exceptional persons…. Most of us do keep a professional distance of some sort, to protect ourselves. For some of us, it is possible that such an encounter might happen once or twice in a lifetime, but this is not the routine of our lives. If this is what it


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means to “share the pain”, am I saying that true sharing is not possible on a regular basis? Maybe. Let me tell you a story. Hajeera, who is 30 years old, comes from one of the slums

Walking alongside those who are poor or marginalised has taught me humility and hope, as well as challenged me to live differently

of Vellore. She presented to our unit with the complaints of feeling tired and listless. We found she had diabetes and started treatment. She was irregular in taking the treatment and her blood sugars were not controlled. So we decided to make a home visit. Hajeera lives in one of the crowded, poorer areas of Vellore. Hers is a minority community and many of them are poor, lack education and do not have access to good jobs. Hajeera’s parents, though, had tried to give her an education. As a girl from a minority community, she faced many difficulties: conservative family members at home, poor teaching at school and teasing from the local neighbourhood boys as she grew older. So, after she finished class eight she dropped out of school. Around this time she met a young man from the neighbourhood and they became fast

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friends, even though they came from different backgrounds. They got married. This made her family cut her off, though she was accepted by her husband’s family. A son was born, and soon after this, her husband took to alcohol, spending most of his earnings on drink. For him, finding that his wife had diabetes was like the straw that broke the camel’s back. He became violent and abusive because she needed money for the treatment. The experience of encountering Hajeera in this way has changed our relationship with her. From a ‘non compliant’ patient in an Out Patient Clinic, she has become for us a person, with all the problems and struggles that being alive means for her. How do we share in her pain and what do we learn? Does this ‘encounter’ change us? We continue to ‘walk’ with Hajeera, help in whatever way we can, but we can never really share in her life. We do however, carry her in our hearts, and we do whatever we can to ease her burdens as well as sharing in the small joys that come her way. Often when we despair, Hajeera teaches us hope. Another story. Baby Sundari was referred to our unit for care. She had a near fatal illness and her mother could not afford care in the big medical centre. The mother, Bujhi, was a dazed looking teenager of 18 years who did not seem to know what was going on. So I asked to see an older relative. A neatly dressed, thin, dignified lady came to see me with the baby in her arms. I told her that this child had a fatal illness and would not live very long. Holding the baby in her lap, she told me her story. The family belongs to a snake-catching tribe. The animal rights movement however has made life very difficult and they now live by catching rats. Often they go hungry. This baby is her son’s child. Bujhi is her brother’s daughter. Soon after their marriage, Bujhi fell ill and her husband had spent a lot of money on her treatment. One day during a quarrel, he lost his temper and slapped her. She promptly left


Feature

to go to her father’s home and he disappeared. They have not seen him since. Meanwhile Bujhi discovered she was pregnant. When the baby was born, they were told that she would not survive. So Bujhi’s father came to his sister. "The baby is your problem," he said. She had brought Bujhi and the baby to the big hospital in the hope that this one link with her lost son could be saved. Tears running down her cheeks, she looked at the sleeping baby. With deep sadness, she said, "What does it matter if you are or you are not?" Then lifting her face and looking at me she asked, "Does God not know that we are poor people?" I was silent. Platitudes about a God who chose the cross and identifies with our pain seemed irrelevant at this time. I held her hand and we cried together. Was this sharing her pain? The team continued to walk with this family for the next few days teaching them how to care for the baby and then they went home. We have not seen them again. We hear many such stories in our daily work, and many of our readers would have similar experiences. What do these do for us? I can only speak for myself. As I have walked with my brothers and sister who are poor, excluded from the mainstream of society, or live on the edges, I have come to understand that inequity and injustice exist in many forms and that I am very much part of the systems that prop this up. These experiences have taught me that it is not

Lifting her face and looking at me she asked, "Does God not know that we are poor people?" I was silent

enough to try to live more simply, but that I must work in whatever way I can to change systems that create or maintain poverty. The problem of being poor is one that continues to trouble me a lot. Why was Jesus poor and why are the poor the blessed ones? The Gospels exhort us to give up riches, to choose to be poor. What is the meaning of this? Is poverty a virtue? The poverty I see is degrading; something no human being should suffer. Yet I have also seen that compared to those who have a lot of material possessions, the poor are free-er and more ready to share what they have. They are more co-operative, understand the need of others better and are more ready to help if needed. They are satisfied with little and live with hope. What about us? We can choose voluntary poverty like Mother Teresa, but this is not a practical option for many of us. We can hold our possessions lightly, as a trust that has been committed to us for the use of not just ourselves but of others too. We can choose to live in simpler and more cooperative ways. Walking alongside those who are poor or marginalised has taught me humility and hope, as well as challenged 31

CMJI VOLUME 25 NUMBERS 1- 4

me to live differently, though I acknowledge that in some ways the gap between us always remains. Let me finish with a quote from our own bard from Bengal who expresses some of my thoughts so beautifully in this poem. "Here is your footstool and there rest your feet where live the poorest, the lowliest and lost. When I try to bow to you, my obeisance cannot reach down to the depth where your feet rest among the poorest, the lowliest and lost. Pride can never approach where You walk in the clothes of the humble among the poorest, the lowliest and lost. My heart can never find its way to where You keep company with the companionless among the poorest, the lowliest and lost." Rabindranath Tagore

Dr Sara Bhattacharji is Incharge of the Low Cost Effective Care Unit of CMC, Vellore


INSTITUTIONAL SERIES

C SI Hospital – To Serve and Not to be Served 1910 – 2010 

Dr D Samson Daniel

In our institutional coverage series, we look at CSI Mission General Hospital, Trichy, which completed a 100 years in 2010. Its Medical Superintendent outlines his hospital’s quest to stay true to the teachings of the Greatest Healer

Dr D Samson Daniel

The hospital is part of the legacy the Methodist missionaries left behind when the Church of South India was formed. The hospital has been making steady progress over the years

he Church of South India Mission General Hospital, Trichy, is a multispeciality hospital with modern facilities, infrastructure, dedicated management and staff.

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It is the command of Jesus to set the poor, sick and oppressed, free. The Church, through the running of schools, hospitals and other institutions, is obeying this command.

VISION AND MISSION

HISTORY

We strive to make our hospital a centre of healing and witness by working for the welfare of people in need – especially the poor, under-privileged and the marginalised – in rural areas. We are also dedicated to providing excellent, high-quality medical care with compassion and the love of Christ at affordable costs to all who need it. Thirdly, we work towards providing committed and devoted role models to young doctors and other health care workers thus working out their desire to serve the poor. From the days of its birth till today, Christianity has never forgotten the poor.

Methodist missionaries started our hospital in 1909 as a women’s dispensary. It closed after 15 days, only to be restarted in January 1910. The Lord God has faithfully led us over the last 100 years. The present hospital is part of the legacy the Methodist missionaries left behind when the Church of South India was formed in 1947. The hospital has made steady progress over the years. The late Dr (Mrs) S Stephen, who was Medical Superintendent for nearly 24 years (1953-1976), improved the building and other facilities. She established Women and Child Care. The next team, led by Dr K Jeremiah (1977-2003) and Dr Mrs Jeremiah (1977-2004), trans-

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Institutional Series

formed the hospital. A 40-bed hospital for women and children was transformed into a general hospital for all. Since then, medical, surgical, paediatric and maternity cases – all are treated, both as outpatients and as inpatients. Dr Kingsly Jebakumar (19841987) and Dr Suresh Chelliah (1992-1997) established noteworthy paediatric services and Dr J V Peter (1994-1997) upgraded the Medical Unit and founded a good Intensive Care Unit. Dr Samson Daniel (1985-till date) established a high quality Ortho and Traumatology Centre and now a DNB accredited postgraduate training centre. We are recognised by the National Board of Examinations, New Delhi, for the postgraduate training of doctors in Orthopaedics, Obstetrics/Gynaecology and Family Medicine. Those trained here write the national level examinations towards the award of “Diplomate of National Board” (DNB) in various specialities mentioned.

buildings for Casualty, Infectious Diseases wards, underground parking for twowheelers, Reception and office buildings etc. were constructed at a cost of around Rs One crore – our own savings. The Lord, in whom we trusted, has been gracious and we have never been in want. The present Medical Superintendent, Dr Samson Daniel, took over the adminis-

STEWARDSHIP OF OUR RESOURCES

The aim of the hospital is to give quality medical care at affordable prices to the under-privileged, rural population in and around Trichy. Good buildings and equipments were needed for this purpose. Many thanks to two former bishops – Bishop Solomon Duraisamy and Bishop Paulraj – and the German agency, EZE, which helped in two phases in 1979 and 1989. Like the parable of the talents, we were able to multiply the help rendered by EZE. And all the growth the hospital has seen – like the School of Nursing, residential quarters for staff, nurses hostel, expansion of ICU wards, physiotherapy buildings, blood bank, Orthopaedics, Outpatient Department, dental OP, multipurpose hall etc. – was made possible by our own earnings. In 2002,

Like the parable of the talents, we were able to multiply the help rendered by others. All the further growth the hospital has seen was made possible by our own earnings

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tration on 14 May 2003. He also runs the busy Orthopaedic and Trauma Services of the hospital. The hospital has 150 beds. The Outpatient registration runs from 8:00 am - 12.30 pm and 3:30 pm - 5:30 pm. Doctors usually start seeing patients around 9:00 am in the OPD. Different specialties like General Medicine, General Surgery, Orthopaedics, Cardiology, Paediatrics, Obstetrics and Gynaecology function in the Outpatient Department. In the Casualty Department, emergency cases are seen 24 hours a day. Medico-legal and accident cases are also seen here after the initial accident register entry is done at a nearby government or designated hospital. In addition, visiting consultants are available on call for Emergency and Inpatients in the following super-specialities: Urology, Nephrology, Neurology, Neuro-surgery, Cardio-thoracic Surgery and Vascular Surgery. Part-time consultants conduct outpatient clinics in our premises on specific days of the week. There are six operation theatres with central gas supply, central suctioning, full air-conditioning, modern lights and tables, under water cutting diathermy and C-arm image intensifier. A well-equipped, spacious, Physiotherapy and Occupational Therapy unit is functioning. The Physio Department treats musculo-skeletal, neurological and cardio-respiratory problems through physical methods and modalities like exercises, and with equipments like interferential therapy, ultrasound therapy, traction and moist heat therapy. Ours is a government-approved centre for family planning surgery. We received an award for best performance in Tamilnadu


Institutional Series

in 1998-1999. The hospital was adjudged Best Hospital for Service and was given an award by Vishwaseva Telemedia, Tamilan Television and Lions Club of Chennai for the year 2009. We also have a licensed governmentapproved blood bank. We encourage volunteers to donate blood. Every donor is screened for HIV, VDRL, Hepatitis, MPMF etc. We have diagnostic services like ECG, X-Ray, treadmill, ultrasound scan and echo scan. We also have well-equipped laboratories for clinical pathology, biochemistry and microbiology. We have now started a full-fledged Cardiology Department with a full-time Cardiologist (Dr B S Vimalraj, MD, DM) trained at Christian Medical College, Vellore. A state of the art, flat panel, cardiac catheterisation equipment (imported from Germany) has been installed to perform high quality interventional cardiology procedures like angiogram, angioplasty etc. With this equipment, “pin-hole” procedures can be done in select cases so as to avoid major open surgeries of the heart and blood vessels. We give treatment to poor patients under the Chief Minister’s Insurance Scheme for Life Saving Treatments. We are

We received an award for best performance in Tamilnadu in 1998-1999. The hospital was adjudged Best Hospital for Service and was given an award by Vishwaseva Telemedia, Tamilan Television and Lions Club of Chennai for the year 2009

also recognised by the Tamilnadu state government for treatment of state government employees and pensioners vide GO Ms No. 547 dt 14.11.2007, and GO Ms No. 50 dt 19.02.2008. We have an open policy towards HIV+ patients who come for various treatments including surgeries. They are all treated compassionately – without fear or bias – and at no extra cost. The outreach programme is based at satellite centres at Kailasapuram, Kamaraj Nagar and Thuvakudi at the periphery of the town. The School of Nursing is an integral part of the Church of South India Mission General Hospital, Woriur, Trichy. It was started in March 1993 as a teaching arm of the hospital to prepare general nurses who would function as members of the health team. We provide our students with knowledge and equip them with professional expertise to enable them to meet the changing demands of society. It generates pride in their profession, besides keeping them abreast of current knowledge and professional trends – necessary to have a successful career. The course runs for 3½ years in General Nursing and Midwifery. It is recognised by the Tamilnadu government and Indian Nursing Council, and follows the syllabus laid down by them. Fourteen batches of graduates have passed out from this institution and are working in prestigious hospitals not only in India but also abroad. We, as a team of dedicated doctors, nurses, and allied health personnel, are committed to this service. We hope the devotion and dedication of the hospital personnel, which arises from a deep commitment to witness to Christ, will make His love known to people who come for medical help.

Dr D Samson Daniel is Medical Superintendent of the CSI Mission General Hospital,Trichy

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HEALTH ADVOCATE

Pain – Is It Necessary, Is It Bad? 

Dr N Devadasan

Our regular writer of this column returns in this issue to draw up some instances of pain that might not really be necessary

A

Dr N Devadasan

He cannot look his parents in the eye. He sees their embarrassment as they explain to friends and relatives, “Our son is doing BCom”. As an afterthought, they add, “He plans to take up chartered accountancy”

s a child, I viewed everything in black and white. Honesty was good, lies were bad. Kindness was good, cruelty was bad. Pleasure was good, pain was bad. As I grew up I came across a book by Dr Paul Brand. There he describes how patients with leprosy get ulcers because of anaesthesia on their feet and hands. He discusses how pain is an important sensation and is required by our body to alert us against various injuries. I suddenly discovered that pain has its uses; that it is not necessarily an evil thing. However, while pain can be good, many times we inflict pain on ourselves and others unnecessarily. I share some vignettes of such instances to make my point. What happens when we put our child to school? We expect the child to study hard, learn a lot, but more importantly, COME FIRST. We put pressure, the means ranging from homework, tuitions, late nights to snide remarks at not coming in the top ten. What do we produce? A child who considers himself a failure – all because he is not able to measure up to his parents’ expectations. Imagine the pain that he experiences every day when he looks at himself in the mirror. Is this pain necessary? Is it good? Then comes college education. God help him if he has not got into a professional college. He cannot look his parents in the eye. He sees their embarrassment 35

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The best is learning how to learn so that our knowledge continues to grow with us, not stop the moment we leave our colleges. The best is when we can smile and laugh at life, instead of taking it too seriously as they explain to friends and relatives, “Our son is doing BCom”. As an afterthought, they add, “He plans to take up chartered accountancy”. Can we imagine the pain that this ‘young man’ experiences? He has let the people closest to him – his parents – down. How can he face the world? Is this pain necessary? Is it good? Imagine the professional who graduates, does postgraduation and then looks for a job. He is advised by all – aim for the


Source: Mr Ram K Robert

Health Advocate

one that pays the highest salary. If he is a software engineer – Infosys is not good enough, move to an MNC, they pay more. If he is a cardiac surgeon – CMC is not good enough, move to Apollo, they pay more. If he is a teacher – Kendriya Vidyalaya is not good enough, move to one of those international schools, they pay more. In his quest for more, he forgets his own likes and dislikes. He subdues his requirements, his passion and his commitment, all in the race for MORE. Can you imagine the pain of a sportsman who loves a jog, but cannot indulge in it anymore because of his 16hour work schedule? Is this pain necessary? Is it good? The young worker progresses through marriage, children, their education and their careers. During every phase the story is the same – trying to get the best out the world for ourselves, without realising that the best need not be the costliest, the

best need not be the latest, and the best need not be what our neighbours have. The best is in playing games with our friends, scraping our knees but forming everlasting bonds. The best is learning how to learn so that our knowledge continues to grow with us, not stop the moment we leave our colleges. The best is when we have the time to admire a spot of beauty and not worry about deadlines and schedules. The best is when we can smile and laugh at life, instead of taking it too seriously. There is enough pain in this world; can we save ourselves from the unnecessary ones?

Dr N Devadasan Institute of Public Health Bangalore

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Errata The collages on the cover and centre spread of the Biennial issue of CMJI (Issue No. 24.3 & 4) were designed by Dr Nittin R Parkhe, Head, Dept. of Radiology, St Stephen's Hospital, Delhi. We regret that his name was omitted from the credits in the aforementioned issue.


FROM OUR ARCHIVES

THE JOURNAL OF THE CHRISTIAN MEDICAL AS TION OF INDIA ASSS OCIA OCIATION

50 Y ears Ago Years

75 Y ears Ago Years

Some Economic Problems in Medical Progress

O

ur hospital and medical work programme must be flexible. We must adapt ourselves and our institutions to new situations rapidly and efficiently. This is a state of our minds and an emotion of our hearts, as much as a matter of bricks and mortar. We say that our buildings, and wards are overcrowded, and our equipment is non-existent, but should we not ask whether we are maintaining what we have in proper efficiency? Our hospitals and dispensaries may be of poor design, but are these existing facilities being fully utilised? In the United States in 1958 1 the general hospitals had an average bed occupancy of only 74 per cent, that is, there were 1,59,000 beds unutilised during the entire year. But more important that the empty beds themselves is the waste of operating funds because it costs about 50 per cent as much to maintain an empty bed as one that is occupied. Maintaining these empty beds costs the USA $700 million, which is Rs 350 crores. Everybody talks about poor hospital planning and location, but, like the weather, nobody does anything about it! In India are we worse or better off in any way? Our hospitals are occupied, often to 110 per cent of capacity! But what may this mean, really, except that existing facilities are tied up because treatment is delayed or ineffective? As soon as we provide more speedy and adequate facilities and more expensive modern treatment, what is likely to happen? At the Clara Swain Hospital, for instance, we have 260 beds, but the average census amounted to 200 patients, giving us an average bed occupancy of only 77 per cent — just the same as for the larger hospitals in the USA. Yet a good friend of the hospital, a lawyer, insisted only last week that it is 'almost never possible to get a private room in the Clara Swain Hospital without having to wait!' Charles V Parrili, Superintendent, Clara Swain Hospital, Bareilly, U P The Journal of the Christian Medical Association of India Volume XXXV Number 4 July 1960

Surgical T uberculosos Tuberculosos

H

ibbs and Smith of New York have some interesting things to say about joint tuberculosis. They begin by saying 'There is perhaps no other class of surgical cases in which the diagnosis is so often faulty and in which the treatment is so archaic and ineffectual as in that of joint tuberculosis.' That is criticised as unjust as far as Great Britain is concerned, but I am not sure that it is not true in this part of the world, except of course in the practice of present company. They maintain that 'in order to make certain that a tuberculous joint is healed and will not recur, absolute elimination of motion is essential and this can be obtained only by arthrodesis or fusion of the joint'. And this in spite of the many hard things that have been said and written regarding the excision of tuberculous joints, so that during the last decade radical operation had been largely abandoned. The chief elements in this decision are the possibility of recurrence and an objection to the prolonged recumbency necessitated by conservative treatment. In German literature dietetic treatment has figured quite conspicuously, the chief one apparently being a dry diet treatment. This diet alternates with an ordinary diet in fortnightly periods. During the dry period a cup of milk in the morning, and a cup of tea in the evening is the only liquid allowed and striking improvement, sinuses healing and abscesses disappearing, are reported. A later German writer, however, considers the diet detrimental to sufferers from surgical tuberculosis. Injection treatment of sinuses and abscesses is still being tried, some of the latest solutions being iodoformosol, chloroform, iodine, and ioduretted iodine, with good results in closed cavities and as before, disappointing results in fistulous conditions. P W Brigstocke The Journal of the Christian Medical Association of India Volume X, Number 2, March 1935

1

Let the Public Control Utilisation through Planning,' 1959. 1.34. December 1 Hospitals

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â—?

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DIALOGUE

Is DNB the Answer… 

Dr Mathew Santhosh Thomas

The ‘Dialogue’ is a feature that presents the different views of our membership on issues vital to the CMAI network. The purpose is for members to express different points of view on an issue, and thus enable a ‘dialogue’ that will provide us food for thought which in turn will guide our actions. We encourage readers to write in with your thoughts and views, which we can carry in the next issue. Please send your comments to communication@cmai.org

The author poses a question about whether DNB accreditation is the best way forward for smaller mission hospitals

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Dr Mathew Santhosh Thomas

The question for us is – while we need to build the next generation of mission leaders through accredited programmes, is DNB in small institutions the answer? Or do we need to look at newer paradigms of accredited trainings?

he Diplomate of National Board or DNB, in the last few years, has opened up avenues for many mission hospitals to be accredited as training centres. Large urban institutions and a few large rural hospitals took this opportunity, and were able to integrate training into the care they provide without many challenges. However, in the last five years, following the example of these large institutions, many smaller mission hospitals have ventured into this thus-far “unchartered territory” with much enthusiasm. Some of these institutions have taken up one field, most commonly DNB family medicine, and some other multiple fields, like rural surgery and specialties. The objective of venturing into this arena was to attain commendable goals. These included, building up a new generation of mission hospital leaders, contributing to the health care manpower of the country and value transfer by providing opportunities for training in the context of rural and Christian health care. Although some of these institutions have 38

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done remarkably well, the road gone past has been rough and the bit ahead does not seem smooth. Many challenges, some that were anticipated and some that were not, have made the process slow and cumbersome and left some wondering – was all this effort worth it? The challenges started at the selection stage itself. Though the expectation was


Dialogue

that we would be able to build the next generation of mission leaders, there were very few applicants for these programmes. In some places, a majority of the applicants were non-Christians who had come with a clear desire to gain another degree and move on. Especially in specialty areas, very few Christian candidates had cleared the “CET” and / or had done Diploma courses before applying for DNB. Many saw DNB from a “TINA” (There Is No Alternative) Perspective and this affected the morale and enthusiasm. The applicants for family medicine were generally fewer than the available seats, and the numbers have further lessened over the last couple of years due to the very low pass percentage nationally. In family medicine, many of the initial candidates who cleared the exam and moved on could not find a “niche” or “role” in the current mission hospital set-up. They moved on to taking up other postgraduate courses as an addition, and this further affected the number of applicants. The curriculum and exam pattern itself was a challenge. For family medicine, the candidate had to go through the four primary specialties and learn X number of cases to be managed in the context of “family practice”. Very few institutions had “family practitioners” teaching and this resulted in specialists teaching family medicine at a level to which they would be comfortable. This would vary depending on the specialist’s

levels of knowledge and learning, when the criterion should have been a family practice model. The public health or primary health topics taught would focus on the “primary health care and community health” but the examination questions would be related to government public health programmes about which many consultants had inadequate knowledge. Family practice, as seen by the DNB, expects the trained family practitioner to run a “PHC” whereas mission hospitals would focus on skill building for the many medical emergencies and common diseases seen in these hospitals and primary health care.

The objective of venturing into this arena was to attain commendable goals. These included, building up a new generation of mission hospital leaders, contributing to the health care manpower of the country and value transfer by providing opportunities for training in the context of rural and Christian health care

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Yet another challenge was the “unanticipated structure change” what came about due to the transition from an institution that provided care to one that had to give formal training in the context of care. Many of the smaller institutions that had multitasking medical teams had to move into “departmentalised” structures, where specialists and residents would do only their department’s work. This has led to the need for more numbers of consultants being needed for institutions, and the setting aside of designated teaching time for these consultants. Though departmentalisation has benefits in large institutions, for smaller institutions, It meant increasing overheads, fragmentation of care and a structure that cannot be sustained due to paucity of professionals willing to join missions. Large numbers of residents in small hospitals, where multiple DNBs were running, created some unforeseen challenges. The financial sustainability of running a small institution with 15 to 20 residents and adequate consultants is always a challenging task. Large numbers of residents who had no exposure to a mission set up or the culture of medical practice in a rural and mission set up created “conflicts of culture”. Some locations went though a culture change due to the “imbalance” created by large numbers of “residents” with a different practice culture joining the programmes. The possibility of the DNB admission being centralised will further affect the way we run these programmes. The question for us is – while we need to build the next generation of mission leaders through accredited programmes, is DNB in small institutions the answer? Or do we need to look at newer paradigms of accredited trainings? Dr Mathew Santhosh Thomas is the Director of EHA


FEATURE

Sharing The Pain - A Way of Life in the Healing Ministry 

Dr John C Oommen

In this article, which was written for the Healing Ministry Week 2010, Dr John Oommen talks about the “Jesus Option” as a paradigm to adopt in our attempts to share the pain of others THE CONTEXT OF OUR HEALING MINISTRY: INDIA AND THE WORLD TODAY

S Dr John C Oommen

Jesus offered his open arms to all in trouble and hurt. In story after story, he is moved with compassion at the pain of people. It consumes him, and he heals with that compassion

o much anger, hatred and violence is sweeping the country. Terrorism erupts frequently, punctuating national life with bomb blasts and fear. Naxalism grows quietly but surely, polarising society in almost half the country. Goondaism and police atrocities hog headlines. So much of this violence and terror is fuelled by a feeling of hurt and bitterness; a perception of justice denied and loss of faith in the system; a cultivation of self-righteous indignation and hatred; a painting of oneself as the victim and not the perpetrator. And violence begets violence in a vicious spiral. We see this endemic violence at different levels:  at a mass level – wars between nations  at the community / society level – caste-based and communal violence  the individual and household level – domestic violence against wives, maids, children; or even in schools against students Perhaps there is a different way. An alternative paradigm, like Gandhiji offered us decades ago – a Jesus Option. Jesus – the man who refused to hit 40

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back, but turned the other cheek…. The God who allowed his mortal creations to humiliate and kill him.... Jesus, who did not consider it a right to cling to his position in heaven, but came down to our level, became one of us, took the pain of being human upon himself. It killed him, but by his stripes, we are healed. And through his resurrection, we learn that evil and hatred and power do not have the last word. The Jesus methodology works. The course of history changed. And we continue to be transformed by that event 2,000 years later. SHARING THE PAIN – A METHODOLOGY FOR MISSION AND HEALING

a. I first recognised this approach in the work with spinal cord injury patients in the Rehabilitation Institute at CMC, Vellore. For many of the patients there, we could not offer a cure but we could be friends. We could share their pain and together we could be healed and rehabilitated. This is so true in palliative care too, as we seek to ease the way for the terminally ill, hold their hands, and share their pain. This is true too in work with HIV, in oncology and haematology. It is the foundational principle in Christian nursing and in Christian counselling. In Christian health care, we are called to share the


Feature

pain of our patients… to get alongside and see the situation together and to walk the journey to healing. b. I learnt this again in the practice of community health. There are so many issues in the community. You cannot play Dr Fixit. You really cannot change the world. You are not meant to. This came home to me most starkly in the death of one of my health workers during delivery, many years ago. It left me feeling vulnerable and helpless. And as I sat there crying, the understanding came. This is my calling – to share the pain. The Christian approach to community health is to live with people – to cry and laugh and dream with the people; to get involved and become part of the community; to share their pains and their joys and to be transformed together. Today, thanks in part to the things we did out of that incident, maternal deaths are far rarer in our area. Infant mortality is less than half of what it was then. c. In our search for mission models, this is the Incarnational Model, for Jesus is the original missionary. God calls us to vicari-

THE BIBLICAL BASIS

You cannot play Dr Fixit. This came home to me most starkly in the death of one of my health workers during delivery, many years ago. As I sat there crying, the understanding came. This is my calling – to share the pain

ous suffering; to share the pain; to see from within; and to allow God to transform the situation, the context and us.

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We should ask where all this comes from. We should not come to our conclusions and then search for Biblical pegs to hang them on. Let us try to see if this pattern and logic is from God Himself. The Suffering Servant Servant: The Prophet Isaiah paints an eloquent picture of the Suffering Servant (Isaiah 53). The servant of God who demonstrates the power of powerlessness; who “took up our infirmities and carried our sorrows”. “And by His stripes, we are healed”. God’s special servant who comes in brokenness and not in power; who fulfills God’s purpose by sharing our pain. Jesus’ life and death reflected the picture of the Suffering Servant. It was also a model for us, God’s people, and for the Church. Jesus’ life and teachings best exemplifies the concept. This was his Way. Jesus offered his open arms to all in trouble and hurt. Come unto me all ye that labour and are heavy laden, he said, and I will give you rest. In the grief of Mary and Martha on the death of their brother Lazarus, Jesus comes to them. He weeps with them. In story after story, he is moved with compassion at the pain of people. It consumes him, and he heals with that compassion. Compassion means “to suffer with”; and that was his way of life and mission. In Philippians 2:5-8, Paul describes it in these words: “Christ Jesus: Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death — even death on a cross!” (NIV) And Paul prefaces this poetry with the words, “Your attitude should be the same as that of Christ Jesus”. Paul’s teaching to the early Church was to care and share – to mourn with those who mourn, he says in Romans 12:15. This has always been the way advocated to the Church.


Feature

We have to ask ourselves if our training and professionalism discourages us from sharing the pain of our patients SOME POINTS FOR REFLECTION

As an individual Christian involved in the ministry of healing I am called to be as Christ in my neighbourhood and service; to share the joys and pains of people around me. Through this comes healing. Points: 1. We have to ask ourselves if our training and professionalism discourages us from

sharing the pain of our patients. 2. We need to ponder upon the trends of commercialisation and medico-legal complications and ask ourselves whether they hinder us in this process. We should not be seeing patients as income-sources or as potential litigants. 3. Perhaps we are constantly building walls and barriers around our hearts and minds to pre-empt and prevent all possible hurt and pain; to decrease our vulnerability…. All this makes us less sensitive to the pain of others. As an Institution Institution: e.g. a mission hospital Points: 1. Maybe we cannot truly be a mission hospital if we are not rooted in the local community. 2. We should not opt to be technical, nonfeeling pain-blitzers, rather than sharers of pain. 3. Our hospitals and educational institutions must actively seek to share the pain 42

SHARING THE PAIN

of our staff, our students, our patients and the community. We need to ponder how we can recognise, feel and share their pain. 4. This need not be a one-way process. We should be willing to lower our guard and allow others to share our pain too. Perhaps there is a virtue in brokenness and vulnerability. As a Church Points: 1. Our Church should not be a Christiansonly club or a caste organisation. It should be the body of Christ, broken for the world. A club for non-members; a circle turned inside out… 2. We should move our focus as a local Church from being inward-looking (where the key issues are elections to posts, maintenance of Church property, choice of seats, membership etc.) to being an outward-looking worshipping community, focused on the needs of the people around us. Their pain should become our pain, our agenda, our motivation. All this should not get effectively blocked out by our Sunday suits and mindsets. 3. We should know whether our Church has ever taken a stand with the poor, the dispossessed, the marginalised. The key question to ask is, “Where would Jesus be on a Sunday morning?”

Dr John C Oommen is the Head of the Community Health Dept. at Christian Hospital Bissamcuttack, Rayagada District Orissa


OPPORTUNITY

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CMJI VOLUME 25 NUMBERS 1- 4


SECTIONS' NATIONAL CONFERENCES

NATIONAL CONFERENCE OF ALLIED HEALTH PROFESSIONALS, KANYAKUMARI

A

llied health professionals from different parts of the country assembled at Kanyakumari for the conference held from 24 to 26 September 2010. People from distant areas started coming from the 23rd. Then other delegates started coming as individuals and in groups. There was good representation from different places. At the inauguration function, Mrs Indira Alexander, retired Principal of Women’s Christian College, Nagercoil, Mr Suresh Carleton, Chairperson of the Section, Dr Vijay Aruldas, General Secretary, CMAI, and Mr Paul David Patrick Brown, Regional Section Secretary of Tamilnadu, AHP, were on the dais. After the opening prayer and welcome, Dr Vijay Aruldas, inaugurated the conference. In his inaugural address, he highlighted the growth and new initiatives of the AHP section. Mrs Indira Alexander delivered the Keynote Address on the theme, Sharing the Pain Pain, which was well accepted as it was full of her experiences in sharing the pain. Mrs Alexander is a respected personality in Kanyakumari district who has served as English Professor and Principal at the Women’s Christian College, and has been a mentor to many young girls. The Male Voices, the choir from Meignanapuram, conducted by Prof Kutty Jaskar, sang an anthem of praise and several songs immediately after the inauguration. In the evening, we also had some cultural events. There was a group dance by Neyyoor School of Nursing, CSI Hospital Neyyoor, which depicted the culture of South India. The girl students from the Christian College of Physiotherapy performed a ‘mime’, which brought out the life of Jesus Christ. It was a novel idea and took a lot of skills. There were also songs to entertain the delegates. This was followed by a fellowship dinner, which gave time for reunion and personal interaction. In the Inaugural session, the Alan Cranmer Award was given to Mr Satyanand Dani, Lab Technician, Evangelical Hospital, Khariar, Orissa. The second day started with devotion led by Mr Eben Jeyaraj, Medical Record Officer from JIPMER, Pondicherry, on a biblical understanding of leadership development. We thank him for his voluntary efforts. Later there were scientific sessions in different disciplines, as listed below: 1. Ms V B Reshma - Pelvic floor exercise for urinary inconti-

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nence 2. Ms Sheeja Rani - Exercise in diabetic neuropathy 3. Mr I R Asher - Hospital related laws 4. Mr Devakirubakaran - Hospital procedures & coding in Medical Records 5. Mr Rengit Singh - Artifacts in Computer Radiography 6. Mr Abbasali- Evaluation of Head Injury in CT/MRI 7. Mr Thanga Darwin - Multi Detected CT (multisliced) in Angiogram Mr Puran Shain presented a poster on postural changes in children. The Bishop of CSI, Kanyakumari Diocese, (Deputy Moderator), Rt Rev Devakadasham who graced us with his presence, took a special devotion and warmly felicitated the delegates. The 2nd day’s cultural programme was led by the participants. In this, sisters from Kerala sang songs and the physiotherapy college boys performed a ‘mime’ about ragging, seniors forcing juniors to use drugs, its effects etc. This gave a good message to the youth and was at the same time entertaining. The great show was a tableau of the beheaded John the Baptist in the set up of the king’s palace. This had everyone spellbound and horrified. The third day being Sunday, we all gathered within the venue for worship led by CSI Church. Some portions and the sermon were translated from Tamil into English for the benefit of other delegates from different places. There was a good Valedictory function. Dr Benjamin from CMC, Ludhiana, and Mrs Helen, Vice Principal, School of Nursing, were the chief guests. They distributed the participation certificates and mementoes to all the delegates. The conference came to an end after lunch. We are thankful to Dr Jeyasekaran Medical Trust for sending volunteers and the staff for helping us with the logistics. We also thank Dr Jeyasekaran Medical Trust and The Cross Institute of Paramedical Science for making financial contributions. We praise God for His enduring love and for our successful conference.

SHARING THE PAIN


Sections' National Conferences

NATIONAL CONFERENCE OF THE ADMINISTRATORS SECTION, SHIMLA

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he YMCA, Ridge, Shimla, bore a festive look when around 40 people congregated there from 7 to 9 October 2010 for the XII National Conference of the Administrators Section. Since no vehicle is allowed anywhere near the heritage site, the delegates braved the steep climb to reach the venue. However, the effort was worth it as the YMCA offered idyllic settings amidst perfect weather conditions for a wonderful conference. Of course, it was not only relaxation and merriment. Every morning the delegates met for a time of praise and worship followed by a devotional talk. The delegates sat down to widen their knowledge base. There was a strong lineup of distinguished speakers. The topics of the technical presentations along with details of the presenters are listed below. 1. The role of governance in mission hospitals – Dr Ashok Chacko, Regional Director, EHA 2. Recent judgments which have impacted health care delivery – Mr Samuel Abraham, Legal Officer, CMC, Vellore

3. Quality in health care Mr Justin Jebakumar, CMAI 4. Innovations in materials’ management for hospitals – Mr Sivakumaran, Vice President, Apollo Hospitals 5. Modern IT applications for hospitals – Mr Vennimalai, CEO, Aavanor Systems Pvt Ltd. The General Body of the Administrators Section also met to discuss and take stock of the situation. Under the chairmanship of Mr Samuel Abraham, the members resolved to locate new members for the Administrators Section of CMAI. The conference ended with a meaningful Holy Communion service led by Rev Paul of CNI.

NATIONAL CONFERENCE OF DOCTORS SECTION, KOTTAYAM

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he Doctors Section National Conference was held from 18 to 20 November 2010. It provided a great time of fellowship for doctors from across the country. There were quite a few new faces this time. There was a total registration of 64 participants. The Kerala Regional Committee, including Rev M T Tharian (CMAI Regional Secretary, Kerala), Dr Mathew Tharian (Regional Sectional Secretary, Kerala), Dr Sojan Ipe, Dr Marina Rajan, Dr J C Vijayan and Mr Paul Raj and Mrs Elsy John from Bangalore CMAI offered much help. The conference started on a high spiritual note. Morning devotions were led by Rev Dr Jagat Santra – Faculty and Dean of PostGraduate Studies, Union Biblical Seminary, Pune. Dr George Samuel who was a nuclear scientist, from ‘Navjeevodayam’ spoke on the theme sharing his own life testimonies of having seen the chronic disability and deaths of two sons and his wife. He spoke about the assurance of their eternal life in heaven because of their faith in Christ Jesus which assures resurrection from the dead. All were touched and encouraged by his witness in the face of such suffering. Dr Vijay Aruldas, General Secretary, CMAI, gave an overview of CMAI, as to what has been happening over the years, what is new and future plans, with inputs from participants whose institutions had benefitted from CMAI programmes. A panel led by Dr Sudhir Joseph (Director, St Stephen’s Hospital, Delhi), Dr Christopher Roy (Director, CSI Rainy Hospital, Chennai), Dr Alexander Thomas (Director, Bangalore Baptist Hospital, Bangalore) and Dr James Thomas (Vice Chancellor, 45

Padmashree Dr D Y Patil University) presented Urban Mission Hospitals and their significance in today’s world, problems faced and on continuing to be a Christian witness. The Inaugural function was initiated by Bishop Thomas Samuel of Madhya Kerala Diocese. Dr Nitin Joseph, Chairperson, Doctors Section, welcomed all the participants and the special guests. Mr Thomas Jacob (Editorial Director, Malayala Manorama) gave felicitations and Dr Vijay Aruldas briefed on CMAI. Dr Suranjan Bhattacharji (Director, CMC, Vellore) delivered the Keynote Address and Dr John Thomas gave the vote of thanks. At the fellowship dinner following this, everyone relished delicious Kerala food. Scientific paper presentations chaired by Dr Mathew Tharian and Dr Sirish Pargaonkar:  Role of mission hospitals today – Dr Christopher Roy  Performance related remunerations scheme – Dr Alexander Thomas  Experience with PMTCT programme in peripheral mission hospital in terms of infant HIV outcome – Dr Paul Mathew  Management of chronic radiation proctitis – Dr S R Bannerjee, Pondicherry Institute of Medical Sciences  Bronchogenic cyst – Dr Umesh Suna Palliative care session chaired by Dr James Thomas and Dr Satyajit Jiwanmall:  Dr Anil Paleri – Model of palliative care at the Institute of Palliative Care, Calicut  Dr Naveen Salians – Multi disciplinary approach & spiritual aspect of the palliative care from a Christian perspective

CMJI VOLUME 25 NUMBERS 1- 4


Sections' National Conferences

 Dr Ravi Livingston – The Bangalore Baptist model of palliative care 3. Mr Tony – How to use the media to spread awareness of palliative care 4. Dr J Jacob – National and international training opportunities for palliative care. The boat ride through the beautiful backwaters of Kumarakom, Kerala, was a great delight. During the evening cultural evening, we had participation from different delegates and their families including children – there was presentation of instrumental music, songs and dance, which went on till late evening after dinner. On the last day, the Holy Communion service was conducted by Rev M T Tharian at the gorgeous and historical Cathedral close to the CSI Retreat Centre. Rt Rev K G Daniel, Bishop, CSI East Kerala Diocese, gave the message encouraging the doctors. This was followed by the Business Session chaired by Dr Nitin Joseph. Various matters were discussed, including increasing the number of student members, workshops on geriatric medicine, focusing on and reaching out to states like Rajasthan, Bihar, Jharkhand and UP in the future.

Dr Thomas Sen Bhanu presented two proposals to offer accreditation of CME programme with CME credits, and to facilitate research in mission hospitals. Dr Shri Hari Babu presented about his work in Jharkhand and the proposed mission hospital there. Dr Anuradha Sunil (Consultant Dental Surgeon and Professor in Oral Pathology) and Dr Abhay Vijay Sarathy (Paediatrician) gave the response on the conference at the Valedictory Function. This was followed by the vote of thanks by the Doctors Section Secretary, Dr John Thomas.

NATIONAL CONFERENCE OF THE NURSES LEAGUE, TIRUVALLA

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th

he 66 National Conference of the Nurses League was held at the Believers Church Seminary, Tiruvalla, Kerala, from 25 to 27 November 2010 and 350 delegates from 12 different states participated. The conference started on 25 November with the worship service led by the students of the College of Nursing, Tiruvalla Medical Mission. The morning devotion was led by Mr P L Johnson in which he covered topics like true education and false education, Jesus, the greatest teacher, and also our calling to be a blessing for others. The inauguration programme began by invoking God’s presence through an opening prayer by Mr Thomas Mathew and a hymn by TMM Nursing students. The august gathering was warmly welcomed by Mrs Jancy Johnson, Secretary, Nurses League. The Chief Guest, Most Rev Dr K P Yohannan, Metropolitan of the Believers Church, led the dignitaries in lighting the Kuthuvillaku. This was followed by the Chairperson’s Address by Mrs Shirley David, who introduced the activities of the Nurses League of CMAI. The address by the Chief Guest touched our hearts as he encouraged nurses to reflect God’s love in their day-to-day work. Dr M C Mathew, the President of CMAI, gave Nurses League members three seminal foundations for the future of the Section – to articulate that nursing is a vocation, promoting the art of nursing and for nursing service to practice holistic healing. Mrs Mariamma George, Principal, School of Nursing, proposed the vote of thanks. After the Inauguration programme, Mr Thomas Mathew delivered the Keynote Address on the theme Sharing the Pain Pain. He

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emphasised the need for a vision for every nurse, the need to be aware of the specific call of a Christian nurse and also the need for genuine commitment. After that there was delicious fellowship lunch. The afternoon session started with an address by Dr Vijay Aruldas, General Secretary, CMAI, who briefly introduced the activities of CMAI. This was followed by the scientific session on the topic Quality Indicators in Nursing Practice by Mrs Leena Raj, Principal, School of Nursing, Baptist Hospital, Bangalore. This session was chaired by Mrs Selva Titus Chacko, Deputy Dean, College of Nursing, CMC, Vellore. Thereafter, Mrs Mercy John divided the participants into different groups for the home group activities. This was followed by the Business Session in which the members expressed their suggestions for future activities of the Nurses League. Simultaneously, there was a special session for the students taken by Mr P L Johnson during which he emphasised the need for genuine Christian values in one’s life as well as one’s profession. In the evening, there was a Bible quiz conducted by Mrs Jenny along with Mrs Shirley David. The students participated with great enthusiasm. On the 26th, after the worship and morning devotion, there was a talk on the topic Evidence Based Practice in Nursing Practice by Mr Samuel Fernandes, College of Nursing, Wanless Hospital, Miraj. This was chaired by Mrs Mercy John, Principal, School of Nursing, Bissumcuttack, Orissa. This was followed by a talk by Rev A C Oommen, in which he stressed on identifying the need of the divine calling in the field of nursing. Further, he projected the Christian nurse as the hub of the healing machinery and most

SHARING THE PAIN


Sections' National Conferences

importantly as a channel of God’s grace flowing through him / her to the needy world. Then all of us went for a boat ride in the backwaters of Alapuzha which was truly exhilarating. The night was enlivened by the vibrant cultural programme put up by the students. On the 27th, after the devotion, the home groups enjoyed a time of fellowship and prayer followed by the participants performing a brief mime (dumb charades). After that was the Valedictory function inaugurated by Miss Kuruvilla

and chaired by Mrs Shirley David. Two representatives each from the students and the staff expressed their feelings about the conference. The NL Secretary thanked each and every one. The conference emcee was Mrs Selva Titus Chacko. The conference ended with the Holy Communion service, which was led by Rev A C Oommen.

NATIONAL CONFERENCE OF THE CHAPLAINS SECTION, VELLORE

The 8th National Conference of the Chaplains Section was held on 27 and 28 October 2010 at Sneha Deepam, Vellore. The conference began with morning devotion led by Rev Dr Malhia Joshua, Head, Chaplains Department, CMC Vellore. Then Rt Rev Dr George Isaac, Bishop Emeritus, CSI, inaugurated the conference with the Keynote Address. After tea, Rev John Lunn, Chaplain, CMC’s Palliative Care Unit, presented a paper on The Ministry of Presence with the Dying. This was followed by discussions among the participants. After lunch, the delegates visited two traditional places of worship – Ponnai Annaicut and Zion Hills. At Ponnai Annaicut, the participants held a group discussion on Sharing the Pain with reference to the life of Job. The Ponnai Annaicut Celebration Committee hosted special tea. At Zion Hills, Sandhya, i.e. evening worship, was conducted by Rev Karunakara Venson, former Vice President, Diocese of Vellore. This was followed by the talent evening organised by the delegates and dinner hosted by the Zion Hills Celebration Committee. The next day, Rt Rev Dr George Isaac led the morning devotion. This was followed by the Holy Communion service. The Section then had its annual general meeting - 48 members were present. It started with a prayer by Rev Chithranjan Polson. The minutes of the previous annual general meeting of the Section held in Aurangabad on 23-10-2009 were presented and approved. Some of the issues discussed were: Members Data Data: It was emphasised that there be a data bank of the members of CMAI’s Chaplains Section living abroad and in India. He said that there are 701 members on the rolls as of now. Youth Chaplain Chaplain: The Chairperson requested the members to recommend suitable youth candidates to be appointed as youth chaplain. Byelaws Revision Revision: The revised byelaws of the Section as approved by the Executive Committee held on 26 October 2010 at Sneha Deepam was presented by the Section Secretary and was approved with a few corrections and modifications.

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Annual 3-week course course: 26 students participated in the 3-week course on Pastoral Care And Counselling For The Sick And Suffering held at Karigiri Hospital, Vellore, from 1 to 25 October 2010. This was the first time that we had international participation for the training, with one participant from Nepal and another from Sri Lanka. SIHR-LTC Karigiri was thanked for hosting the workshop. Repor eportt of activities activities: Rev Job Jayaraj, the Section Secretary, presented a detailed report of the activities held during the reporting period and it was well accepted. Future Plans that were discussed included included: — Organising more fellowship meetings in consultation with the respective regional sectional secretaries — Requesting member health care institutions to organise seminars / retreats in their regions — Inviting MTh students of nearby theological seminaries for conferences and retreats of the Chaplains Section — The Chairman emphasised the importance of the Healing Ministry Sunday, and requested all pastors to observe it in their churches The conference closed with the Valedictory function at which the dignitaries were Rt Rev Dr George Isaac, Mr Augustine Aiyadurai (Treasurer, CMAI), Rev Emmanuel Gnana Zion (Chairperson, Chaplains Section), Rev Dr Malhia Joshua and Dr Vijay Aruldas. Valedictory addresses were given by Rt Rev Dr George Isaac and Rev Rajavelu, Honorary Secretary, CSI Vellore Diocese, where the healing mission of the Church and her servants called to care for suffering humanity was emphasised. The participants of the 24th annual 3-week course on Pastoral Care and Counselling for the Sick and Suffering received their certificates and membership card, and were also honoured with a shawl. The meeting closed with prayer by Rev Dr Malhia Joshua and benediction by Rev Rajavelu.

CMJI VOLUME 25 NUMBERS 1- 4


BOOK REVIEW

BOOK REVIEW * Reviewed by Frank M Roby, CEO, Concero Global and USA liaison, Board for St Stephen’s Hospital, Delhi

"Out of Solitude" Henri Nouwen

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enri Nouwen, the prolific author who wrote Out of Solitude, understood the difference between people who seek comfort and desired authority, and Jesus, who endured suffering and accepted responsibility. The book has three meditations on Christian living that awaken his readers to the value of solitude, the importance of caring before curing and the joy of expectation. As Nouwen weaves together these meditations on the Christian life, it is clear he shares a belief attributed to Dr Paul Brand by his biographer, Philip Yancey, in Ten Fingers of God. “(Brand understood that) pleasure and pain are not opposites, but rather mutually dependent parts of the richest experiences of life” says Yancey. According to Nouwen, it was in solitude that Jesus understood his complete reliance on God the Father. And, according to Nouwen, we avoid solitude so that we are able to control how we are perceived by others. Yet in solitude, we are able to move past our managed reputations and come to God with the humble realisation that all our gifts are from God. The ability to cure is one of the most sought after abilities of humanity. But Nouwen makes it clear that mankind has ample examples of cures being rejected when they are not accompanied by caring. He asks whether Jesus would have fed the 5,000 if not for the caring willingness of those who chose to share what they had. To cure without caring is to avoid participating in the pain of others and through that separation to miss the opportunity to be present in the way that Jesus responded to those who suffered. Finally, Nouwen connects expectation to our spiritual life. Without expectation, we fall into boredom and bitter-

ness. With expectation, we develop the patience to wait for the Lord and seek the promise in the adversity we face. It is in expectation that we experience the joy God intended for us. In solitude, we see ourselves as God sees us. In caring, we see the connection of all God’s creation. In expectation, we see the joy of God’s promise. As an American learning his way through India, Nouwen’s lessons help me become a better student of the rich history and bright future of the remarkable country of India.

* We are happy to review books written by CMAI members or recommended by CMAI members. In order for a book to be reviewed, a copy should be sent to the Head, Communication Department, CMAI, who will arrange for a review. The book will be retained for CMAI’s library. CMJI reserves the right to review the book and publish the review. The reviewer’s views are personal and do not represent any official CMAI endorsement unless specifically mentioned.

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FEATURE

Towards a Fair and Sustainable Health Care System for India 

Dr Rajkumar Ramasamy

Primary health care could be what fills the gap between health care for the rich and poor in this country. It is a system that is much cheaper, easy to establish and maintain, and based on community values. In this special article, Dr Rajkumar Ramasamy elaborates the virtues of the system, based on what he has observed as a primary health care practitioner

A

Dr Rajkumar Ramasamy

In India, private and government primary care doctors are not trained to practice primary health care. In countries with a sustainable health care system, 50% of postgraduate medical training is in primary health care compared to India’s 0.5%!

health care system that reaches the weakest sections of the community is a Christian priority; primary health care was the subject of passionate arguments 20 years ago as a means of achieving that. Like some good intentions that demand sacrifice, it appears that we got tired just talking about this before we really tried to implement it! Primary health care (PHC) or family medicine is in utter confusion, being equated with a hospitalbased generalist or, at the other extreme, with community medicine and a means of generating monetary grants. India has a chaotic health care delivery system where generalists and specialists compete wildly to make profits. The weakest people suffer — for them sudden health care expenditure is the most common cause of irreversible debts. Merely spending more money on health care cannot improve India's health — reorganising the health care delivery system is key. We need to go back to primary health care with a clearer mind to know what it is. These true case histories (names changed) illustrate how it could work. They are based on patients seen at the K C Patty Primary Health Centre, a joint program of the Palani Hills Health Development Trust and the Christian Fellowship Hospital, 49

CMJI VOLUME 25 NUMBERS 1- 4

Oddanchatram. KCPPHC caters to the primary health needs of 17,000 mainly Adivasi people in remote villages of the Lower Palani Hills of Tamilnadu. Chandran Chandran: Is a poor 27-year-old man; often develops palpitations, difficulty breathing and chest tightness during challenging situations. He consulted a cardiologist, who arranged several tests that quickly cost Rs 10,000 — paid for with borrowed money. When his symptoms continued, Chandran finally visited a trained family physician who diagnosed generalised anxiety disorder. Chandran was seen by a team of staff in the health centre who explained how anxiety could mimic cardiac symptoms. Chandran is now well. Even if these symptoms recur, he knows how to deal with them himself. Treatment cost only Rs 80 pm. Mild to moderate mental health problems are very common in India and often mimic physical illness, leading to unnecessary expenditure on futile specialised investigations. These illnesses can be managed by trained family physicians with minimal expenditure. Only those with major mental illnesses need referral to a psychiatrist. Unfortunately in India, private and government primary care doctors are not trained to practice primary health care. In countries with a sustainable health care system, 50% of postgraduate


Feature

medical training is in primary health care compared to India's 0.5%! Internationally, PHC training is a recognised specialised field of medicine with a well-developed modern syllabus, which India woefully lacks. Selvi: When Mani, aged 14 Mani and Selvi months, developed fever and cough, his parents as usual took him to a local doctor with no PHC training. As usual, Mani received an injection and expensive tonics costing Rs 160. His condition deteriorated, and he required treatment for severe pneumonia in a large hospital costing Rs 10,000 paid for through loans. Selvi,15-months old, also had fever. Her mother, Rubini, took her to a health centre staffed by doctors and health workers trained in primary health care. Previously, whenever Selvi had similar fevers, she only received paracetamol and advice on how to feed a child suffering from viral illnesses. Health workers explained why viral illnesses do not need antibiotics or injections and Rubini understood that. However, on this occasion, the doctor explained that Selvi was breathing a little fast. The PHC staff knew modern clinical guidelines — a small child with fever and fast breathing should be treated as having pneumonia when the most rational antibiotic is penicillin. Selvi started this treatment and returned for review, as requested, the next day. Rubini found the nearby PHC, with familiar staff, not scary like hospitals. Selvi improved and the treatment costing only Rs 100 was completed. Selvi's life was never at risk. The PHC team approach not only removes fear but improves communication gaps between urban doctors and poorer rural people. These gaps can lead to misunderstandings and wrong diagnoses; health workers bridge them and provide explanations for treatments given, which are then likely to be accepted and completed. Health workers can also be health educators who visit schools and villages to provide health education in radical ways, motivating and encouraging people to understand when to see health professionals and how to prevent disease.

"My health center!" Patient and health worker trained from local community

Parameswaran and Karthik Karthik: When farmer aged 46, had a sudden stroke and Parameswaran had a serious accident in a was rushed to a big hospital. He recovered rural area it took two hours to reach the but was found to have hypertension. He hospital. He was in prolonged shock from was sent home on several medications, blood loss, which caused irreparable brain which after 6 weeks, he could not afford to damage despite excellent hospital treatcontinue. Twelve months later, he had a ment. When Karthik had similar severe infurther stroke and since then has been pajuries, he recovered fully because he was ralysed. Ravi, aged 43, had a similar stroke first taken to the local PHC, where bleedand was brought to the primary health cening was controlled and fluids replaced, betre. His family were informed of the diagfore transportation to hospital. In emernosis, costs and benefits of hospital admisgencies, PHCs in rural areas can provide sions in simple language. He made good the crucial stabilisation that allows later specialised care to result in a good outcome. For example, urgent emergency treatment called thrombolysis after heart attacks can be given in PHCs with trained family physicians before referral to a specialised hospital. Ravi: A critically ill patient in a PHC, stabilised before Murugan and Ravi Murugan, a small referral 50

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recovery in hospital. Ravi also had hypertension that caused his stroke. Health workers explained how hypertension is silent and therefore he should not stop treatment even if feeling well. The PHC has a 'chronic disease register' and recall system that ensures people like Ravi receive monitoring so that treatment is continued. When Ravi did not return after six months of regular treatment, the recall system ensured a health worker visited Ravi's home. Ravi said the nine medicines prescribed in the hospital cost an unaffordable Rs 15/day. The PHC team concluded that 90% of protection from further strokes was provided by just four medicines that cost only Rs 2 per day. Ravi remains well on this affordable treatment four years after his stroke. Ravi's stroke was also due to his smoking. The health worker held a meeting with all the young men in the village who smoked and Ravi told them his story. Home visits and recall systems can encourage preventive care and ongoing care of those with chronic illnesses. Without PHCs, crucial preventive and continuing care become nobody's responsibility, leading to money spent on hospital admissions being wasted. A young smoker stopping smoking will save his family an average Rs 5 lakh

through prevention of illness and lost working days. Targeted home visits also ensure that weaker members of the community are not neglected and that those who do not come to the health centre also matter! Jayanthy and Mariammal are both twoyear-olds from families that are similar in their poverty. However, when both developed viral influenza, Jayanthy developed severe respiratory complication but Mariammal did not. This difference occurred because Jayanthy had moderate anaemia like many Indian children. Mariammal's village was visited by the local PHC health worker monthly. The children and women there were regularly given iron and worm tablets. Prevention of anaemia does not need expensive tonics, but needs cheap iron medications that stop simple illnesses becoming serious. PHC is where preventive and curative care can be integrated. These histories show that PHC, practiced by a trained team, leads to sustainable care for everyone — rich or poor. However, for PHC to be effective we need to:  First improve the quality of it in India; then,

The PHC team approach not only removes fear but improves communication gaps between urban doctors and poorer rural people. These gaps can lead to misunderstandings and wrong diagnoses; health workers bridge them and provide explanations for treatments given, which are then likely to be accepted and completed  Change the health delivery system so that PHC plays the pivotal role, recognising also that PHC cannot bethe responsibility of government alone but must include a regulated private sector. Only government legislation to reform health care can make these steps a reality. A. STEPS TO IMPROVE THE QUALITY OF PHC IN INDIA:

A team home visit to a hypertensive patient 51

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CMJI VOLUME 25 NUMBERS 1- 4

1. Legislate that all those newly entering primary care must undergo a 3-year postgraduate training program in PHC, just like hospital specialists have to, and those doing so are recognised as specialists in PHC. 2. Develop a modern PHC syllabus suited to India. The existing syllabi in family medicine are obsolete and designed by hospital specialists and community physicians, not


Feature

family physicians. 3. Despite inadequate numbers of trained PHC doctors in India who are able to train others, appropriate training can still be ensured if the final examination in family medicine tests skills that are appropriate to primary health care. Internationally, it was not just the selection of training centres that improved the quality of PHC, but the quality of the final examination that doctors had to pass. Examinations based on those of the Royal Australian and UK colleges of general practitioners provide examples of exams that ensure candidates must learn skills relevant to family medicine. In India, exams must also test how PHC practitioners can select sustainable health care from the best of modern medicine. 4. Family medicine training must include two years in smaller general hospitals (not super-specialised hospitals) and one year in primary health practice with regular reorientation classes in PHC throughout the course. The number of family medicine postgraduate training seats in India should equal the total of all other specialities. 5. All those practising primary health care must do compulsory continuing medical education (CME) if they are to be re-registered three-yearly. It will be easy to set up online CME programs for general practitioners by adapting excellent, already available, online interactive CME programs developed internationally by colleges of general practitioners. Therefore, lack of trainers in family medicine in India need not be a hindrance to enforcing CME required to improve the quality of PHC. 6. These developments for medical graduates must be paralleled by training of nurses as primary care nurse practitioners and development of a modern locally adaptable syllabus for health workers in PHCs. B. REGULATING THE HEALTH CARE SYSTEM TO BE PHC-BASED

Once the quality of primary health care is

secured, the chaotic, unjust health care system can be reorganised. 1. Every Indian is registered with a trained primary care team who will be the sole primary health care providers for that person. Referral to hospital specialists should be encouraged through this PHC team except in emergencies. This policy will ensure that basic investigations are completed at primary care level and appropriate referrals are made to the correct specialist, saving time and expenses. For example, specialists seeing patients referred through recognised family physicians can be given a government rebate. Specialists

Home visits and recall systems can encourage preventive care and ongoing care of those with chronic illnesses. Without PHCs, crucial preventive and continuing care become nobody’s responsibility, leading to money spent on hospital admissions being wasted

should also be encouraged to discharge patients to family physicians with a management plan to the PHC without providing simple ongoing care in hospitals. Overall government health expenditure will markedly reduce because of reduced hospital workloads. 2. Provide government incentives to PHC practitioners who implement preventive 52

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care activities in assigned target populations. For example, grants can be given if infant immunisation rates are high. Antenatal mothers are given a minimum of care, blood pressure checks and smoking interventions are given opportunistically etc. This system may need monitoring through the creation of family medicine boards in each area but it will markedly reduce the nation's overall health costs by preventing illness. 3. Develop an accreditation system in primary health care for centres with a team of health workers, nurses and doctors practicing quality integrated preventive, emergency and ongoing primary care with registration and recall systems and the required equipment in place. Same standards should apply for government and private centers. Patient visits to these centers should then attract a government subsidy. Powerful medical practitioners will resist these changes because the current chaotic system benefits doctors' income. Elected governments must realise that health care costs will simply become unsustainable for the government as much as for the poor if no changes are made to the current system.

Dr Rajkumar Ramasamy is a Primary Health Care physician at KC Patty Primary Health Centre


INTERNATIONAL PERSPECTIVE

Sharing the Pain The former General Secretary of CMAI, Dr Daleep Mukarji Mukarji, who is currently Chair of the Overseas Development Institute, London, writes from his experience of working in the health sector in India and abroad that Christian organisations like CMAI can play a lead role in equitable health care

D Dr Daleep Mukarji

The most vulnerable sections of society – dalits, tribals, women and children – suffer the most. They experience daily pain and rejection in the high levels of discrimination, injustice, neglect and marginalisation that is their reality

oes the pain and suffering of others really matter? This pain is probably most easily felt if it is that of our friends and family members. What then do we do when the pain is further away, when it hurts and affects people we do not know and when we become aware of the suffering, injustice and disease of so many who are poor and excluded. What will help us to share this kind of pain? Do we become insensitive to the problem of pain of others? It is a challenge for Christians and the Church to deal with this pain too. If we are to love our neighbours we must consider what we may be able to do for the millions who suffer every day from disease, poverty, discrimination and lack of basic services. This love for the neighbour must lead to practical action that does make a difference. CMAI is a fellowship whose objective is the "prevention and relief of human suffering". CMAI claims to work towards "building a just and healthy society" and "to bring relief from pain and the joy of health among India's poorest and most deprived sections of society, people who the rest of the world forgot". This is very laudable and yet what does it expect from those associated with CMAI? Churches, members, institutions and friends of CMAI need to be inspired, empowered and equipped to take action to do something about the suffering and disease in India and elsewhere. About 45% of India's population lives below the poverty line of less than $1 per 53

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day. Over 40% of the children are underweight and this is the highest level for any country in the world. Levels of poverty, inequality, illness, disease and preventable mortality are shocking for a country that wants to be seen as a new superpower and one that has got so many rich people too. Each year, well over 1 million women and children die from poverty-related diseases and lack of health care. Sadly, the most vulnerable sections of society — dalits, tribals, women and children — suffer the most. They experience daily pain and rejection in the high levels of discrimination, injustice, neglect and marginalisation that is their reality. It does hurt when people see their children die from lack of food and health care, when parents have inadequate income to take care of their needs and when very few listen or understand their pain. Yet the problem is not only in India. Today about 1.3 billion people live below the poverty line in the world, mainly in South Asia and sub-Saharan Africa. Over I billion do not have access to clean and safe water and many go to bed hungry every night. There are wars, famines, floods and earthquakes that make these problems worse. It seems the poor suffer the most always. Poverty, suffering and pain must be more than just statistics. We collect, record, dispute and often ignore them too. We are dealing with real people behind all these numbers — people with faces, feelings,


International Perspective

names, stories, families and all children of God made in God's image. Sadly too many are dehumanised and denied their basic human rights. We should ask our selves how we feel when we hear these facts. We need to identity with the problem, have a sense of solidarity or empathy that will move us to action. Feeling this pain may ignite in us a spark of anger or frustration and a passion to do something. Hopefully it will not make us indifferent. As a young medical doctor from Vellore I went to rural Andhra to do my service with the Church. I saw first-hand the problems of our rural communities and understood you could not improve health through health services alone. People needed income, jobs, water, food and so much more but what shook me was the way women, dalits and poorer people were treated. This experience changed me and my life. I then went on to study public health, community development and other related subjects that I hope enabled me to be of some value to rural communities and people excluded. I realised that health had to be a means and a measure of development. Thanks to God I have been able to spend most of my professional life working on issues of social justice, community health and poverty eradication in India, Geneva and London. Very soon I realised that we could not just deal with the symptoms of poverty but had also to deal with root causes. This meant dealing with the structures, systems and policies that kept people and countries in poverty. CMAI can take a lead in dealing with poverty and injustice. But then we need to accept that this will lead to politics… not party politics but politics about influencing and having an impact on the policies and practices of the Government, the multinationals, the rich and the powerful and those who, in India and elsewhere, are part of the problem. It will not be easy, as we will rub people the wrong way. We need to be part of a movement for social change and help organise, mobilise and empower people to fight for their rights and their

I realised that we could not just deal with the symptoms of poverty but had also to deal with root causes. This meant dealing with the structures, systems and policies that kept people and countries in poverty future. CMAI has a policy team and advocacy agenda that works for the basic right to health of all people. It wants to "influence perspectives, policies and practices of Government and civil society on issues of health and social justice." CMAI also wants to influence the debate on health and development in India claiming that this is more than a job… a calling… and that the obstacles are many, but that it would like to go on building on its achievements. It even says that it is prepared to initiate a political and legal process to demand basic health care as a fundamental right of every citizen guaranteed under the Indian constitution. I applaud this approach and wish the Association every success. This action has huge potential to have impact on the health of the nation. The ministry of healing cannot be just about the survival and services of our hospitals. These are important but must be seen as a means to an end… the health and well-being of the nation. Our essential purpose must be working for a more just, healthy, inclusive and fair society in the perspective of the kingdom of God. And we cannot think of India alone as we are part of the wider community of nations where both India and Indians can play 54

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a key role in building a better and safer world. We are one world — a world that God loves — but we are destroying it in a variety of ways. It is a broken, sick and unhealthy world today. We are all in it together, but "if one member suffers, all suffer together with it." (1 Cor 12:26) Christian relief, development and advocacy agencies need to work with each other and with people of other faiths or no faiths to help prevent suffering and pain, working in alliances, partnerships and collaborating with governments and international bodies where necessary. Where is God in all this pain and suffering? We seem to think God does not care and allows the poor and weak to suffer so much. Whether it is the suffering of the individual, the family, the community or the nation, God is there. God already shares in this pain. His son Jesus came into the world to experience our sorrow and pain and suffered himself. God understands and is a resource we can rely on to give us hope and strength to cope and persevere in our efforts to make change possible. It is part of God's mission to reconcile this world to Himself. We are to help promote the kingdom. Jesus gave his disciples "power and authority over all… and he sent them out to proclaim the kingdom of God and to heal." (Luke 9: 1&2) Our vision must be a new heaven and a new earth where all people will live healthy and with justice. This is the essence of the ministry of healing and reconciliation. It will expect we feel the pain of others and it will inspire us to be agents of healing for a better world.

Dr Daleep Mukarji is Chair of the Overseas Development Institute and Y Care International (development agency of British YMCAs)


Feature

(1 Cor 1:18) and you will be saved (Matt 24:13). So it relates to the past, the present and the future. We were saved the day we called upon the name of the Lord. But we are also being saved day by day as we follow Christ and submit to him. And he who endures to the end will be saved. LIVING HOPE

The second spice we see is in verse 3 and it is a “LIVING HOPE.” We are seasoned with a REAL LIVING ACTIVE hope. We do not have a DEAD hope or a BLIND hope. We do not have a BLIND FAITH as some people assert. No! We have a MOST REASONABLE FAITH based on Scripture, Science, History, Archaeology, Philosophy, Logic and more. Biblical Christianity makes GOOD SENSE. When someone dies who knows Christ, we do not have to weep or fear for them. Because we have a “LIVING HOPE” we know that they are not dead but ALIVE with HIM, JESUS, who gives us HOPE. The non-believers are HOPELESS and without a RELIABLE HOPE. My own father has admonished me,“ I don’t want there to be great sadness at my funeral. In fact, I want you to rejoice because it is my HOME GOING!” I told him, “Yes, I agree. But please don’t go soon!” Only a person with a “LIVING HOPE” can confidently speak like this. INCORRUPTIBLE INHERITANCE

The third spice we see is in verse 4 and it is an “INCORRUPTIBLE INHERITANCE.” When someone dies, they search for their “will” to see who gets the inheritance. Sometimes there are big surprises in the will. Sometimes certain relatives who expected to get something are cut out of the will. And sometimes the inheritance is more or less as expected. But do you know that as a child of God, you are written in the “will” of your Heavenly Father. You are assured of a GREAT INHERITANCE kept in heaven for you. It is “incorruptible.” The riches of this life eventually pass away. Houses collapse over time. Cars rust out. Jewelry gets tarnished.

My father has admonished me, “I don’t want there to be great sadness at my funeral. In fact, I want you to rejoice because it is my HOME GOING!” Only a person with a “LIVING HOPE” can confidently speak like this

Money runs out. They are not eternal. But your heavenly inheritance can never spoil or fade. Jesus said, “I go to prepare a place for you. In my Father’s house are many mansions.” And Paul talks about receiving heavenly rewards for those who are faithful and for those who build with “gold, silver and precious stones.” Don’t build with “wood, hay and stubble.” You may be saved but only by fire and your share of the inheritance will be less. POWER SHIELD

The fourth spice we see is in verse 5 and it is a “POWER SHIELD.” Peter talks about our faith shielding us with God’s POWER. And Paul also talks about the SHIELD OF FAITH (Eph 6:16). We have to face spiritual battle in this life. There is no option. We are born for battle against the Devil. Paul says “FIGHT the GOOD FIGHT of the FAITH (1 Tim 6:12). But God provides us with everything we need to fight and to win. We need to understand this. We need to take up the armor of God daily and stand 56

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against the enemy. We cannot face the enemy in our own strength, talents and abilities. Sometimes we try to do that and it fails. We try to solve our own problems in our own ways. But face the enemy BY FAITH IN CHRIST’S STRENGTH. We must stand on the WORD and on the PERSON OF CHRIST. We must BELIEVE and PUT OUR FULL FAITH IN HIM. We also need to be filled with the power of God who is the Holy Spirit. It is not enough to talk about the Holy Spirit doctrinally. We need to cry out to God to fill us. We need to empty ourselves and yield to the Spirit. The Holy Spirit is the MANIFEST PRESENCE OF GOD ON THE EARTH. And he wants to FILL YOU and to FLOW THROUGH YOU! TEMPORARY SUFFERING

The fifth spice we see is in verse 6 and it is “TEMPORARY SUFFERING.” This is one of the bitter spices I mentioned earlier. Nobody wants to suffer! We all want HEALTH, WEALTH and HAPPINESS! But that is not what Christ sought after! Christ SACRIFICED his GOOD HEALTH to be BEATEN and KILLED on a CROSS. Christ had NO MATERIAL WEALTH and used all the OFFERINGS for the MINISTRY. He had no where to lay his head. Christ FORSOOK the PURSUIT OF HAPPINESS in his efforts to save the world and to mentor his hardheaded and hard-hearted disciples. And IT WAS NOT IN VAIN! He may dump the spice of suffering into our lives to build his character in us. We often pray to be TAKEN OUT of the problem. But he may want to take us THROUGH the problem. The Israelites had to GO THROUGH THE RED SEA! The three Hebrew children had to GO THROUGH THE FIERY FURNACE! Jesus had to BEAR THE SHAME AND SUFFERING OF THE CROSS! God is able to TAKE YOU OUT but he is also ABLE to TAKE YOU THROUGH if that is his PURPOSE. Verse 7 talks about the goal and purpose of suffering, that it “may result in praise, glory and honor when Jesus Christ


Feature

praise, glory and honor when Jesus Christ is revealed.” My wife has been sick for several years now. In fact, she is mostly bed ridden with undiagnosed and untreated neurological problems and chorea. Every day is a great struggle for her and also for our children and me. We have done EVERYTHING we know to do medically and spiritually. But things have only gotten worse. Our main focus has been on her getting healed and getting well by any means and that has been my prayer focus. But in recent weeks, God has been speaking to me through this passage and I have added a new dimension to my prayers. I still pray and hope for her healing. But I also regularly pray something like this, “Lord, please be REVEALED in ME, MY WIFE, OUR FAMILY and MINISTRY through this suffering. And let it result in PRAISE, GLORY AND HONOR to Jesus, coming from my own lips and from others also.”

as everything is going fine, you never really know that person. Through my own crisis of my wife’s sickness, a lot of what has been revealed in my own life is NOT CHRIST, but some JUNK from deep inside me that I did not even know was there! My innermost being is being exposed by fire and I don’t like some of what I see. There are CRACKS! But my prayer is that Christ will purge and cleanse me and build his character in me and remove the cracks. And this verse also says that OUR FAITH IS OF GREATER WORTH THAN GOLD. And these days gold is reaching record prices around the world. People are flocking to buy gold as a hedge against inflation and the weakening dollar. But Peter says that our fired and tested faith is even more valuable. I was reflecting on this truth and realised the greatest thing I could give to my children is NOT GOLD OR SILVER, but a GENUINE, FIRED FAITH IN CHRIST. That is my desire! The verse also mentions that gold perishes even though refined by fire. And I did some research to find out how you could destroy gold. It is not very easy to do. But it can be done by putting the gold into a nuclear reactor. Sometimes our faith is tested to such an extent that it is like being put into a nuclear reactor. But your faith can survive it! There are people who

FIRED FAITH

The sixth spice we see is in verse 7 and it is “FIRED FAITH.” The Romans used to put their clay pots and jars in an oven to fire them. Any flaws inside the pots would be exposed when put to the fiery test of the oven and cracks would appear. Those would be rejected. But the ones that survived the fire would be stamped with a stamp marked “GENUINE” and those would be sold and used. We will not know the QUALITY OF OUR FAITH until it is FIRED. The best way to know who a man really is, is to watch him in a crisis. Then you can find out his strengths and weaknesses. But as long

We need to take up the armor of God daily and stand against the enemy. Face the enemy by faith in Christ’s strength

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have faced terrible, terrible things and still have their faith intact. May that be true of you and I also. Corrie ten Boom was such a person placed in a Nazi concentration camp under Hitler. Every day people were being murdered in Hitler’s gas chambers. She lost most of her family members. But her faith remained intact and she led many to Christ before they were killed. GLORIOUS JOY

The seventh spice we see is in verse 8 and it is “GLORIOUS JOY.” Here is one of the SWEET spices. He is ready to pour HIS JOY UNSPEAKABLE AND FULL OF GLORY into your life! It is NOT HAPPINESS because happiness is based on circumstances. But it is JOY and joy is not based on circumstance but JOY IS BASED ON A PERSON and that person is JESUS! He will NEVER LEAVE YOU NOR FORSAKE YOU! The JOY OF THE LORD is your STRENGTH! He will ANOINT you with the OIL OF JOY for MOURNING! So, we have seen the seven spiritual spices in this passage. You may be going through a really tough trial right now. You may be tasting the bitter and sour spices in your life. I want to encourage you not to despair. I am in the same place. Sometimes, you might even think of ending your own life under the weight of your sufferings. But I want to give you the same word the Lord is giving me for my trial. And that is “HANG ON!” Don’t let go of the rope. Hang on! Hang on! Hang on! As Robert Schuller says, “Tough times don’t last but tough people do.” And remember that Paul says, “For our light and momentary troubles are achieving for us an ETERNAL GLORY that far outweighs them all (2 Cor 4:17).” RUN THE RACE SO AS TO WIN THE PRIZE! IT WILL BE WORTH IT ALL! Rev Scott Zior www.WeeklyWorship.org


ISSUE SPONSOR

St Stephen's Hospital Completes 125 Years St Stephen's Hospital, Delhi, celebrated 125 years of its existence in 2010. Here is a brief history of this illustrious hospital

With most superspecialities and diagnostic facilities available at the lowest rates among hospitals in the non-government sector, and with a vibrant community outreach programme, the hospital is serving the poor and needy sections and the lower-middle class and middle-class population of North Delhi

Priscilla Winter

INTRODUCTION

S

t Stephen's Hospital, Delhi, is a 595bed superspeciality tertiary-care hospital located in North Delhi. Opened on 31 October 1885 by Lady Dufferin, it was Delhi's first hospital for women and children.

HISTORY

Back in the mid-nineteenth century, Dilliwallas in need of medical advice and treatment had to rely on hakims, vaids, untrained dais and foreign doctors, most of whom were male. And the community did not welcome the idea of male doctors examining women folk. In 1864, a 22-year-old Englishwoman, wife of a missionary, perceived the needs of the poor and purdah women living along the banks of the Yamuna River, and decided to work towards alleviating their mis58

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ery. Her name was Priscilla Winter. She expressed her compassion through the almost unperceivable act of distributing simple home remedies from her box of medicines — she was not trained in any medical discipline. The confidence and trust generated in the community by this singular service called for a more organised medical service. Mrs Priscilla Winter called in the help of others in 1867 through what was known as the "White Ladies' Association", which led to the establishment of a small dispensary in a rented house in Chandni Chowk in 1874. After Mrs Priscilla Winter's death in 1881, ironically in childbirth, the Society for the Propagation of the Gospel — where her husband worked — and the Cambridge


Issue Sponsor

Mission to Delhi built a small 50-bed hospital for women and children in Chandni Chowk to continue the work started by her. It was named St Stephen's Hospital, and was opened on 31 October 1885 with the motto "In Love Serve One Another" from Galatians 5:13. The hospital steadily grew under the leadership of dedicated pioneers such as Dr Jennie Muller and Sr Alice Wilkinson, among others. In 1891, a new three-storey block overlooking Chandni Chowk was added to accommodate more inpatients.

Germany, and Interkirkelijke Co-ordinate Committee Ontweikklings Ophyjkten (ICCO), Netherlands. In 1996, a new Mother and Child Block — now renamed Dr Lucy Oommen Mother and Child Block — constructed through a generous grant from the ODA (Overseas Development Agency) of the British government, was commissioned. This modern, well-equipped building replaced the old maternity hospital built in 1908. This new block made possible several additional facilities. Today, St Stephen's is a 595bed multi-superspeciality hospital treating patients from all walks of life. The hospital continues to keep its commitment to society to provide quality care at an affordable cost. With most superspecialities and diagnostic facilities available indoor, and, on average, Quasquicentennial Celebrations in January 2010 the lowest rates among hospitals in In 1908, the hospital moved to its the non-government sector, and with a vipresent site in Tis Hazari. Starting with 100 beds, it expanded into a 180-bed hospital by the mid-twentieth century. In 1969, the St Stephen's Hospital Society was registered under the Societies Registration Act of 1860, under a Certificate of Registration dated 24 March 1969. In 1970, on the formation of the Church of North India, St Stephen's Hospital continued to be a constituent part of the Church of North India. In 1976, the hospital was upgraded to a 450-bed general hospital. The main hospital complex was built through generous grants from overseas agencies such as Evengelische Zentralstelle for Entwicklungeschilfe B.V. (EZE), West 59

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brant community outreach programme, the hospital is serving the poor and needy sections and the lower-middle class and middle-class population of North Delhi. With its recent expansion into Gurgaon, the hospital aims to reach out to those who are limited by distance but still wish to avail of its dedicated service. TRAINING

Since its inception, St Stephen's Hospital has been committed to training. Informal training of nurses was started by Mrs Winter and her associates in the 1860s, even before the hospital came into existence. Formal nursing training was started in the 1870s. Today, the hospital runs the 4-year BSc (Hons) Nursing course affiliated to SGGIP University, the 3½-year General Nursing and Midwifery Diploma under the aegis of the Delhi Nursing Council, four degree courses in allied health disciplines in association with CMAI-IGNOU, seven diploma courses in allied health disciplines, five of which are CMAI courses and 1 an IMA course, and the DNB programme of the National Board of Examinations in 16 medical disciplines including some superspecialities. FACILITIES AVAILABLE

Since becoming a general hospital in 1976, facilities were constantly added to make holistic health care available under one roof. Today, the hospital has many superspecialities and most of the modern facilities, which include the following: Anaesthesiology, Cardiology (with Invasive Lab), Cardiothoracic Surgery, Dental Surgery, Dermatology, Endocrinology, Otorhinolaryngology (ENT), Gastroenterology, General Medicine, General Surgery, Neonatology, Nephrology and Dialysis Unit, Neurology, Neuro-


Issue Sponsor

Since becoming a general hospital in 1976, facilities were constantly added to make holistic health care available under one roof. Today, the hospital has many superspecialities and most of the modern facilities

Units (Medical, Surgical, Paediatric, Coronary and Neurosurgical) and a wellequipped Nursery. CHARITABLE SERVICES

The hospital runs a free OPD every Wednesday and Friday afternoon to cater to the needy sections of society. The hospital also has a model Community Health Development project in two areas in and around the city of Delhi. Among other projects, the hospital looks after the health and community development of an urban slum with a population of 80,000. This includes women's upliftment and child-to-child education—two highly successful programmes. The Ophthalmology Department of the hospital is actively involved in conducting screening camps in and around Delhi. Shortlisted patients are operated free of charge. The department has also launched tele-Ophthalmology services. The hospital has a free polio programme for poor patients and provides prosthetic and orthotic aids at subsidised rates or free of charge to the needy. Babies brought from the nearby Missionaries of Charity Home are given free treatment. Besides the free care provided, as listed above, the hospital provides a subsidy on almost 70% of its beds, which are in the General category.

surgery, Obstetrics & Gynaecology, Ophthalmology, Organ Transplant, Orthopaedic Surgery, Paediatric Surgery, Paediatrics and Neonatology, Plastic Surgery, Psychiatry, Pulmonary Medicine, Rehabilitation Medicine, Reproductive Medicine (with an IVF Lab), Respiratory Medicine (with a Sleep Lab), Rheumatology and Urology (with Urodynamic Lab). The supportive services include the following: Artificial BIOMEDICAL AND Limb Centre, Blood Bank, CaHAZARDOUS WASTE sualty, Central Sterile Supply MANAGEMENT Department, Dietary, LaboraThe hospital has a well-detory (including Clinical Patholployed waste management ogy, Haematology, Microbiolprogramme that is managed ogy, Serology, Biochemistry, Cyunder the guidance of a tology and Histopathology), Hospital Infection Control Laundry, Medical Records, OcCommittee. It is a model cupational Therapy, Pharmacy hospital for the WHO in this (with a formulary), PhysioMost Rev Purely regard. Lyngdoh therapy, Occupational Therapy An Effluent Treatment and Radiodiagnosis (including Plant treats liquid effluent before disX-Ray, Ultrasound, CT Scan and MRI). charge into the municipal drains. The hosThe hospital also has a suite of 12 Oppital is a mercury-free organisation, using eration Theatres, several Intensive Care

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A grand function was held at Siri Fort Auditorium on 12 November 2010, which was graced by the Chief Minister of Delhi, Smt Sheila Dikshit, and the Health Minister, Prof Kiran Walia. The event also featured the first public performance of the hospital anthem

only digital thermometers and BP apparatus. ISO CERTIFICATION

St Stephen's Hospital was the first hospital in India to be certified for ISO 9001:2000 (Quality Management System, now ISO 9001:2008), ISO 14001:1996 (Environment Management System, now ISO 14001:2004) and OHSAS 18001:1999 (Occupational Health and Safety Management System, now BS OHSAS 2007). QUASQUICENTENNIAL CELEBRATIONS

The 125 years' celebrations of the hospital began on 1 January 2010 with a Thanksgiving and Rededication Service. The Moderator of CNI, Most Rev Purely Lyngdoh, was the Chief Guest. He spoke of the mis-


Issue Sponsor

Smt Sheila Dikshit, and Prof Kiran Walia

General Secretary, CNI, and two former Bishops of Delhi, Rt Rev Pritam Santram and Rt Rev Karam Masih. Monthly public lectures were conducted by the Community Health Department and several of our doctors were featured on television channels to spread awareness about health issues. A grand function was held at Siri Fort Auditorium on 12 November 2010, which was graced by the Chief Minister of Delhi, Smt Sheila Dikshit, and the Health Minister, Prof Kiran Walia. The Chief Minister released a commemorative brochure on the occasion. Most staff of the hospital and several friends enjoyed the programme that featured group songs, skits and professionally choreographed dances, all fea-

sion of Stephen, the first Christian martyr, the mission of the Church, and how both these stem from the love of God. He said that we have a mission to serve the poor and needy, and this is an occasion to rededicate ourselves to this. The Moderator released a wall clock and a wall calendar on this occasion. The wall calendar features photographs of flowers that bloomed in 2008-09 in the hospital gardens. Rt Rev Franco Mulakkal of the Catholic Church and Very Rev Scariah from the Orthodox Church were also present on this occasion, besides Rev Dr Enos Das Pradhan,

turing our own people. The event also featured the first public performance of the hospital anthem. CONCLUSION

The flame of Christian service that was started by a young lady moved by compassion in the late 19th century burns on. Started as a mother and child hospital, it has evolved into a superspeciality tertiary care hospital. Let us hope and pray that it stays alight for centuries to come, meeting the needs of the people even as they change from time to time.

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HUMOUR

You know you’re in a small town... - when you don’t use turn signals because everybody knows where you’re going. - if you speak to each dog you pass, by name ... and he wags his tail at you. - if you dial the wrong number, and talk for 15 minutes anyway. - when the biggest business in town sells farm machinery. - if you write a check on the wrong bank and it covers you anyway. - if you missed church on Sunday and the preacher sends you a get-well card! ******************************************************************************* A guy walks into a restaurant and orders soup. It takes a while before the soup arrives, and when it arrives — it is too hot. While waiting for the soup, the guy starts feeling he has to go to the bathroom. “Now, while I’m in the bathroom, somebody might just come and eat the soup” thinks the guy. “What can I do?” Then he has this flash of insight, and he pulls out a piece of paper and a pen and writes: “I spat into the soup!” After putting the sign right next to the soup, our clever guy runs joyfully to the bathroom. When he returns, he sees an addition in pencil underneath what he wrote: “Me too.”

Your other sister, Mary, had a baby this morning. I haven’t heard if it’s a boy or a girl, so I can’t tell you if you are an aunt or an uncle. Your little brother came home from school the other day crying. All the boys at school have new suits. We can’t afford to buy him one, so we will buy him a new hat and let him stand at the window. Uncle Dick was drowned last week in a vat of whiskey at Dublin Works. Four of his workmates dove in to save him, but he fought them off bravely. We cremated the body, and it took three days to put out the fire. Kate is now working at a factory in Birmingham. She’s been there for six weeks. I am sending her some clean underwear as she says she’s been in the same shift since she got there. Your father didn’t have too much to drink at Christmas. I put a bottle of castor oil in his pint of scotch, and it kept him going to New Year. I went to the doctor Thursday, and your father went with me. The doctor put a small glass tube in my mouth and said to keep it shut for ten minutes. Your father offered to buy it from him. It rained only twice last week — first four days, and then three. On Monday it was so windy that one of our chickens laid the same egg four times.

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We had a letter from the undertaker. He said if the last installment on your grandmother wasn’t paid — up she comes.

Dear Son,

Your loving mother

Just a line to let you know I’m still alive. I’m writing the letter slowly because I know you can’t read fast. You won’t know the house when you come home, because we have moved. It was a lot of trouble moving. The hardest part was the bed. The man wouldn’t let us take it in the taxi. It wouldn’t have been so bad if your father hadn’t been in it at the time.

P.S. I was going to send you 10 dollars, but I already sealed the envelope.

About your father, he has a wonderful new job with 500 people working under him: he cuts the grass at the cemetery. Our new neighbor started raising pigs — we got wind of it this morning. I got my appendix out and a dishwasher put in. There was a washing machine in the new house, but it isn’t working too well. Last week I put two shirts in it, pulled the chain, and I haven’t seen the shirts since.

****************************************************************************** This guy in a car is pulled over by a cop for driving through a stop sign. The cop asks the man why he didn’t stop and the man responded, “I slowed down; slowing down and stopping are just about the same thing, aren’t they?” The officer proceeds to pick up the man by the collar and beat the man in the face mercilessly with his nightstick. While he is doing this, the officer says, “Now, do you want me to SLOW DOWN, or do you want me to STOP?”

Your sister got herself engaged to that fellow she’s been going out with. He gave her a beautiful ring, it has three stones missing.

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Courtesy : The World Wide Web


OBITUARY

Dr S M Chowdhury passes away

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r Swehla Mong (S M) Chowdhury, former Medical Superintendent of the Christian Hospital Chandraghona (CHC) and Christian Leprosy Centre (CLC) Chandraghona, Bangladesh, went to be with the Lord on 31 October 2010. He had been undergoing treatment at Christian Medical College Hospital, Vellore, after a month of illness at his home in Chandraghona. At the time of his death, he was official Advisor to CHC. He graduated from Dhaka Medical College Hospital in 1960, and joined the Christian Hospital, Chandraghona, as Medical Officer. In 1965, he became the first national Medical Superintendent of CHC, a position he held until 2002. A committed Christian, he believed in helping the disadvantaged – regardless of race, colour, creed or ethnicity. He held many religious positions locally in Chandraghona and in the Hill Tracts, including being an authorised Pastor, Marriage Registrar, President of the Chandraghona Baptist Church Sangha, and Pastoral Superintendent. He led the hospitals during times of transition from missionary leadership, through wars, civil commotions and natural disasters, including the cyclone of 1970 and the 1971 War of Liberation. He saved thousands of lives during these two periods in particular. He was the first President of the Bangladesh Baptist Church Sangha, President of the National Council of Churches in Bangladesh (NCCB), President of the Bangladesh Baptist Church Sangha (BBCS), Chairman of the Christian Medical Association of Bangladesh (CMAB) and Chairman of the Chris-

tian Commission for Development in Bangladesh (CCDB). He played a key role in promoting ecumenical solidarity in South Asia and was Executive Director of the Asian Friendship Society of Bangladesh (SEVA-AFS Bangladesh) as well as being a Founder Member and President of the South Asian Council of Churches (SACC) and member of the Presidium and several other international church organisations. He was a great friend and supporter of CMAI, ensuring that a delegation from the Christian Medical Association of Bangladesh participated and presented a memento at every CMAI Biennial Conference. He was warmly encouraging, appreciating the work that we did and advising us on practical issues of strengthening ecumenism. In spite of his busy schedule, he personally attended several CMAI Biennial Conferences, the last one being the 2007 Shillong Biennial. He also invited CMAI to every CMAB Conference, where he personally made sure that the CMAI delegate was comfortable and well looked after. He sought to strengthen genuine fellowship and partnership between our Associations and our countries. In his passing away, Bangladesh, the SAARC region and the world have lost a leader who practiced ecumenism in trying circumstances effortlessly and with commitment. We at CMAI will miss his wisdom, insights and encouragement. He was buried in Chandraghona on 4 November 2010, at a service attended by thousands from all walks of life. He is survived by his wife Proshun, sons – Drs Stephen and Victor – his daughter, Dr Angela and family, as well as by his grandchildren.

Dr Benjamin Pulimood

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r Benjamin Pulimood, former Director and Principal of CMC, Vellore, went to be with the Lord on 5 February 2011 in Vellore. He was 75. Dr Pulimood studied at Trivandrum Medical College (1957) and joined CMC, Vellore. While working there, he went to England to get the MRCP (1962) and FRCP (1973). At CMC he was Professor from 1969 to 1995, Principal from 1981 to 1987 and Director from 1987 to 1994. After the completion of a term as Director, he returned as a Professor, viewing with satisfaction the leadership of CMC being taken up by his juniors. As Principal and then Director, he influenced many students with his calm demeanour, his warm love for everyone, and his willingness to discuss issues. As Professor, he mentored many to take up new areas of sub-specialisation, and worked

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tirelessly for the betterment of the institution. He was deeply committed to mission hospitals and the Church, encouraging graduates to serve in needy areas, and supporting leaders of mission hospitals through personal encouragement and through various institutional arrangements such as advocating for faculty positions that would primarily link to mission hospitals. Dr Pulimood was President of the Indian Society of Gastroenterology and also served as Chairman, Karigiri Hospital Governing Council. He represented the Marthoma Church in the World Council of Churches at Nairobi. The funeral service was held at the Salem Marthoma Church cemetery in Kochi on 10 February 2011. Dr Pulimood is survived by his wife, a daughter and two sons.

CMJI VOLUME 25 NUMBERS 1- 4


Obituary

Dr H S Martin passes away

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r H S Martin, former Medical Superintendent of Dhamtari Christian Hospital went to be with the Lord on 3 January 2011. He was the first Indian Medical Superintendent of DCH. Born in 1930, he was the son of Mr Joseph Martin, who was “House Father” at the orphan home in Dhamtari. In 1953, the younger Dr Martin took his degree in medicine from Government Medical College, Nagpur. At this time, Dhamtari Christian Hospital was a 60-bed hospital and Dr Yoder was the Medical Superintendent. The latter inspired Dr Martin to render his services to DCH. Unlike many new doctors of the time, Dr Martin turned his back on foreign jobs and private practice and joined this mission hospital. He went to England for further studies in 1957. After completing his FRCS (in 1966) and also learning pathology work in London, he returned to India in 1967. Thereupon, he took charge as Medical Superintendent of Dhamtari Christian Hospital – the first Indian to do so. It was a 100-bed hospital then. His vision for DCH was that it should grow every day. He collected

grants for adding several new buildings to the hospital before retiring in 1993 at which time the bed strength of the hospital had grown to 360. Dr Martin was actively involved in church and social activities along with his wife, Komolini Martin, who started the Mennonite English Medium School in Dhamtari. He was Treasurer of CMAI for two Biennium i.e. 1988-1990 and 19901992. He was also Council Member of CMC & H, Vellore, representing the Mennonite Council of Mission Boards in 1968-1970 and 1972-1976, and the Mennonite Medical Board of the Mennonite Church in India from 1975 to 1992. His son, Dr Pradeep Kumar Martin, and daughter, Dr Teresa Henry, are both alumni of CMC Vellore, belonging to the MBBS batches of 1974 and 1984 respectively. His other two daughters are Ruba Bernard in Jabalpur and Shashi Perera who is a Medical Physicist in Des Moines, Iowa.

Sponsoring CMJI This issue of CMJI has been sponsored by St Stephen's Hospital, Delhi. We are looking for sponsors – mission hospitals or Christian organisations – who would be willing to sponsor part of/entire cost of an issue of CMJI. The sponsor who bears the entire cost will get a two-page write-up in that issue and free one-page ads in every issue of that year. If interested write to us at cmai@cmai.org for more details.

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SHARING THE PAIN



'Sharing the pain' CMJI January - December 2010