Contents THEME : WHY ARE WE IN EDUCATION? CHRISTIAN MEDICAL JOURNAL OF INDIA PROMOTING THE MINISTRY OF HEALTH, HEALING AND WHOLENESS
University Education Through CMAI
The Christian Minority in India and
Education - A Right or a Responsibility? Professionally Competent, Socially
Relevant and Spiritually Alive Education and Why am I in it?
Choosing to serve the Poor and Marginalised
Has Education made a Difference in My Life?
CMAI’s role is Empowering Students
Tips for Teachers
VOL: 23 NUMBER 2,
From the Editor's Desk Editorial Biblical Reflections Book Review From our Archives Opportunities
2 3 4 31 32 33
Overview Moving with Times and Needs
Health Advocate Education for whom?
Dialogue A Commentary on the Purpose of the Current CMAI Constitution Review
APRIL - JUNE 2008
OFFICE BEARERS: President: Dr Joyce Ponnaiya, Consultant Pathologist, Schieffelin Institute of Health Research - & Leprosy Centre (SIH-R & LC), Karigiri, Tamilnadu; Vice President: Rev Robin P Lepcha, Chaplain, CMC, Vellore, Tamil Nadu; Treasurer: Mr CK Tewari, Director, Nur Manzil Psychiatric Centre, Lucknow; Editor: Dr Leila Caleb Varkey, Public Health Consultant, Noida, UP; General Secretary: Dr Vijay Aruldas, CMAI, New Delhi Communications Advisory Committee: Dr Leila Caleb Varkey, Dr Joyce Ponnaiya, Dr Vijay Aruldas, Dr JC Vijayan, Ms Shirley David, Dr CAK Yesudian, Ms Amelia Andrews, Dr John C Oommen, Rev Farida Nath, Mr AP Berry, Mr Justin Jebakumar, Rev Job Jayaraj, Ms Jancy Johnson, Mr John Churchill, Dr Sunita Abraham Editorial Working Group: Dr Leila Caleb Varkey, Dr Vijay Aruldas, Ms. Jancy Johnson, Mr AP Berry, Mr Justin Jebakumar, Rev Job Jayaraj, Mr John Churchill, Dr Sunita Abraham Managing Editor: Mr John Churchill Editorial Coordinator: Ms Suba Priya Rabindran Design and Production: Ms Susamma Mathew Cover Design: Mr Vineet Samuel 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: email@example.com, firstname.lastname@example.org 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: email@example.com, firstname.lastname@example.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.
FROM THE EDITOR'S DESK
We invite your views and opinions to make the CMJI interactive and vibrant. As you go through this and each issue of CMJI, we would like to know what comes to your mind. Is it provoking your thoughts? Would you like to see the issue from a different perspective? Maybe you or your institution has approached the issue differently. Share it with us all. This may help someone else in the network and would definitely guide us in the Editorial team. E-mail your responses at: email@example.com Articles of humour, cartoons etc. are welcome.
Disclaimer: Views expressed in the articles are personal and do not represent the views of management or membership of CMAI.
Guidelines for Contributors Special Articles CMAI welcomes original articles on any topic relevant to CMAI membership- No plagarism y Articles must be not more than 1500 words. y 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 eg. 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 234-62; 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. y Papers submitted to the CMAI should not have been simultaneously submitted to any other newspaper, journal or website for publication. y Every effort is taken to process received papers at the earliest and will be included in an issue where they are relevant. y 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. y The decision of the Editorial Working Group of CMAI is final and binding. y Letters y 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. General Guidelines y Writers are requested to provide full details for correspondence: postal and e-mail address and daytime phone numbers. y Authors are requested to send the article in Microsoft Word formats. Authors are encouraged to use UK English spellings. y Contributors are requested to send articles that are complete in every respect, including references, as this facilitates quicker processing. y All submissions will be acknowledged immediately on receipt with a reference number. Please quote this number when making enquiries. Address for Communication Communication: John Churchill, Head – Communication Dept. CMAI, A-3 Local Shopping Centre, Janakpuri, New Delhi – 110058 Tel.: 011-25599991/2/3; E-mail:firstname.lastname@example.org
Why are we in Education?
his issue of CMJI on “Why are we in Education?” was a very difficult issue to bring out as there were many perspectives for the theme. There are no clear-cut answers to this question. This issue of the CMJI is, therefore, a medley with the songs sung by many different voices. It provokes us to think about education from two perspectives. Why we, as individuals, make a career in education, and why CMAI, the association, works in the field of education? This issue of CMJI deals with both these perspectives. This is because the very personal Christian values we have are what form the basis of why we share in CMAI’s vision of our ministry through education. For some of us when we think of education and CMAI, it at once brings to mind the professional training courses CMAI runs such as those in nursing, laboratory technology, X-ray technology etc. As we all know, most of the leadership in design and evaluation of these courses, training programmes and workshops is done by CMAI members in their voluntary capacity. Dr Thomas Sen Bhanu’s overview provides details of how most of these activities are structured and administered. The voluntary effort, and the basic Christian tenets upon which this willingness to participate is based, is what sets CMAI’s work in education apart from that of other public and private institutions. This has been so beautifully described in the ‘Reflection’ by Dr Vinod Shah and the article by Dr V I Mathan. This tenet is rarely, if ever, articulated so openly. However, as you read articles written by Dr Sheena Singh, Ms Grace
Matilda, Mrs Mercy John, and Dr Premkumar you will find in them testimonies of the commitment of individual members involved in education. One of the biggest challenges CMAI member institutions and their leadership face is in ensuring that courses designed and administered are of good quality and relevant to the changing needs of institutions and individuals. Our health advocate, Dr Devadasan in this issue, challenges us to dwell upon whom we are training in his article called “Education for whom?” The latest initiative of CMAI in setting up the CMAI-IGNOU Chair in IGNOU’s School of Health Sciences is reported here by Dr Vijay Aruldas and Mr Berry. This is an initiative to ensure that education and accreditation by CMAI are also recognised nationally and by this Open University. We see this as the mainstream of our work in education and increasing our educational contribution to our nation. Every moment of a trainee’s time is used up. How do we make room for the transmission of values and beliefs during this tightly scheduled training? The tips for teachers section provides examples of how teachers like Ms Subhashini Singh use Biblical examples to inculcate Christian values during the course of the training itself. Another pressing but uncomfortable issue is how to maintain a positive balance sheet while trying to provide quality education to the most deserving candidates within an ever increasing market based health economy? Mrs Triza Jiwan was asked for her views on these issues. 3
For many institutions the trainee’s apprenticeship provides the bulk of human resources to run the institution. The fees and charges they pay help keep them afloat. When does profit begin to enter the picture? If fees becomes prohibitive, and admission criteria are purely based on ability to pay, should CMAI as the accrediting body look the other way? This was seen as such an uncomfortable area that we were not able to find anyone who wanted to write openly about this!! In an effort to add more views from membership, we are adding a feature called ‘Dialogue’ that presents different views of our membership on vital CMAI issues. You are welcome to write on any topic. The current one is on the Constitution Review. The Constitution of CMAI is being reviewed by a special Constitution Review Committee. One of the critical debates taking place is whether its name, objectives and rules reflect the CMAI we are and want to be. Rev. Ninan Chacko has shared his thoughts on this with us. You are welcome to write your comments to the President of the CMAI who is chairing the Constitution Review Committee. E-mail: email@example.com Finally, please let us know if you consider this issue of CMJI educative – even if you are not a CMAI member. We look forward to feedback from all our readers.
Dr Leila C Varkey Editor - CMAI
Why Educate? Dr Vinod Shah
King Solomon said “The fear of the Lord is the beginning of wisdom and knowledge of the Holy One is understanding”
For who makes you different from anyone else? What do you have that you did not receive? And if you did receive it, why do you boast as though you did not?“ St Paul in I Corinthians. Secular education is either one or two dimensional but Christian education needs to have three dimensions.
All artificial distinctions between the various disciplines have to go. We have to think in an interdisciplinary fashion. Again Christian knowledge is not ornamental; that is, one does not acquire knowledge as a means of notching up one’s status in society. Knowledge is acquired to “love” others. If
Dr Vinod Shah
These dimensions are HEAD HEAD
Jesus established a close relationship with His disciples to be able to teach. If we are to train effectively, we have to have some relationship with our students
Experts often refer to these three as Knowledge Knowledge
Anyone can master a lot of facts and announce them to an audience. However Christian knowledge is “whole”. All things need to fit together. This is because truth is a “unity”. There cannot be a distinction between faith and reason, science and theology, theory and practice. They complement each other. 4
knowledge is not used in this way it can “puff” up people. This is what Paul says. We see many people who acquire degrees to lift up their sagging self-esteem. Knowledge has to be translated into the language of “love”. Thirdly, true knowledge leads to “behaviour” change. Knowledge that is merely factual and leads to no change in behaviour is like a man who builds his house on sand. How can one accomplish these things? There are two secrets that we can use to be able to transfer knowledge: y Relationality and
y Role-modelling. If a teacher does not have a relationship with a student, knowledge transfer cannot take place. In fact, if the relationship is strained, there can be an aversion of the subject. Jesus established a close relationship with His disciples to be able to teach. If we are to train effectively, we have to have some relationship with our students. Do our courses have a scope for such a relationship? It is one thing to ask a student to study and be a scholar, but without role-modelling scholarship this cannot be achieved. True scholarship, means a pursuit of truth at any cost; we let go of our opinions, our egos and our pet theories and become utterly objective. If we role-model such an attitude to knowledge, the students will become scholars. ATTITUDE (HEART):
This is an area where we are espe-
obligated to God. It precludes arrogance which is so common among the “learned”. It should lead on to “stewardship” of knowledge. The intellectual property rights, so to speak, belong to God and we have to use it for His kingdom. Any other form of use is a form of stealing. If we use our medical knowledge for merely selfish purposes, without serving our neighbours, then it is a violation of God’s intellectual property rights; a negation of stewardship. This is an attitude that needs to go along with the education. A third important attitudinal reformation needs to happen in the way we view other people. Each person has intrinsic value; they are not valuable because they have a position or because they are gifted but simply because they are persons who are made in the image of God. This radically new understanding of personhood will ensure that the weak, marginalised and the ‘invisible’ people will find succour at the hands of our trainees. SKILLS (HANDS):
cially required to influence and a very important reason why we train. The key verse is I Corinthians 4:7 “F or who makes you different from “For anyone else? What do you have that you did not receive? And if you did receive it, why do you boast as though you did not?” Both the capacity to learn and the knowledge itself are a gift; if it is so it has several implications: It compels an attitude of humility; the more we learn, the more we are
Education in skills is often called “coaching”. Coaching is often a very slow, tedious process requiring great patience and perseverance. A coach has to see beyond the performance to potential and inculcate enthusiasm when utter despair exists. This is the Christian calling and is not easy. Secular people often want gifted, skilled and clever people to train because they want their job to be done easily without sweat. Christians will have to train those who are willing to serve and make sacrifices but who may not always be the most gifted or very highly skilled. Therefore, our calling 5
is to be even more patient and encouraging, so as to bring out the best in our trainees. Finally, what is the relationship between education and Christian values? Or why should Christians be involved in education? Or is there any unique Christian calling in education? These are good questions and need to be answered.
Firstly, I believe that any instruction in truth approximates one to God. We already said that truth is a unity, and, any truth is an invitation to see the Glory and Beauty of God. Therefore any education in any truth is a small act of evangelism. Secondly, education is an act of empowerment because truth brings freedom from the bondage of falsehood or sin. To control and manipulate people is evil but to empower is to set people free.
Dr Vinod Shah Head, Department of Distance Education Christian Medical College and Hospital, Vellore Tamilnadu
University Education Through CMAI Dr Vijay Aruldas & Mr A P Berry
CMAI is privileged to establish the CMAI Chair of Health Sciences at the prestigious Indira Gandhi National Open University (IGNOU). This provides new and exciting opportunities for CMAI to influence healthcare in India
O Dr Vijay Aruldas
19th July 2008 became a landmark day for CMAI, when we signed the agreement with the prestigious Indira Gandhi National Open University (IGNOU) to establish the CMAI Chair of Health Sciences at IGNOU
ver the years with advances in all fields of medicine, the complexity of education in the health sciences has also grown. CMAI, which is involved in the areas of nursing, allied health, postgraduate medicine and other areas, has kept up with these changes. In the field of Allied Health Education, CMAI’s education initiatives have been acknowledged as being among the best available. Because of this many employers, in India and abroad, prefer CMAI trained allied health professionals for their quality, commitment and work culture. Nevertheless, we have been facing challenges on two fronts: more and more States have been setting up Paramedical Councils and an increasing number of employers were asking for a “degree” as a minimum qualification.
recognition is more a matter of political will rather than proving that the CMAI’s diploma programmes are of adequate standard. In some states like Karnataka, CMAI centres have been offering both the CMAI diploma and the state diploma simultaneously in order to comply with the state requirements while ensuring quality education and good job opportunities to their students.
Getting recognition from each emerging State Council means that each State has to be approached separately. We do not have the advantage of a national body to get pan-India recognition (as we had for Nursing when the Indian Nursing Council was set up), and we have found that securing
Mr A P Berry
CMAI courses have provided affordable education and good job opportunities for those who did not have the option of a degree education, and the teachers have always taken pride in the great benefit that students from disadvantaged backgrounds have received through this education. How-
THE CMAI-IGNOU PARTNERSHIP
The CMAI partnership with IGNOU provides a way forward for most of these concerns. After evaluating various options, IGNOU emerged as the
preferred choice for a number of reasons. y The IGNOU is a Central University under the Government of India. It has been set up by an Act of Parliament, is legally authorized to affiliate study centres in all parts of the Country, and its qualifications are nationally accepted. y IGNOU is an Open University, which means that students can leave and re-join a course at defined points provided they meet set criteria. This makes lateral entry possible because it is an integral part of IGNOU’s phi-
administration a number of key concerns were clarified and the following terms accepted. y CMAI will continue to offer its Diploma courses. Centres can offer both simultaneously, and students studying at such a centre can register for both courses at the same time y Centres that offer the IGNOU programme will continue to offer the CMAI Diplomas to the students in parallel with the IGNOU degree. This will ensure that the CMAI students will benefit from the intensive inputs that the CMAI training provides, as also from the degree level education and credibility the IGNOU will bring. y Students who have already completed CMAI courses earlier will be offered lateral entry into the IGNOU degree programmes. FOR THE CMAI CENTRES
y Centres can offer both the CMAI and the IGNOU courses, provided they are admitting the same students in both the CMAI Diploma and the IGNOU degree. This will ensure that the CMAI students will benefit from the intensive inputs that the CMAI training provides, as also from the degree level education and credibility the IGNOU will bring. y·To offer the IGNOU degree, centres will have to provide the required facility, staffing, patent load and other characteristics. This will be intimated by IGNOU when centre registration is opened y As a special privilege for CMAI centres that offer IGNOU programmes concurrently with the CMAI Diploma, CMAI will be permitted to admit eligible students and then register them with IGNOU. y CMAI Centres that chose not to offer the CMAI courses simultaneously CMAI
ever, with degree education becoming more easily available, an increasing number of employers are asking for degree qualifications, and many CMAI students too were aspiring for degrees once they had worked for a few years. There was a need to offer upgradation options. To offer degrees, each of our centres would have to seek affiliation to a local university, undergoing not only the inspections and procedures stipulated but also the many uncertainties associated with this process. They would also have had to stop offering the CMAI courses. However, the CMAI training centres and the Training Committees were confident that the quality of education the CMAI courses provided was on par with degree courses, and said that they would prefer to continue offering the excellent CMAI courses if possible. They were also concerned that students would lose the stamp of quality that had helped them to be preferred in job recruitments. The ideal solution, therefore, would be one by which each centre could continue to offer quality CMAI courses while also providing affordable degree-level allied health training that would be acceptable nationwide. It was also important that those who had completed the diploma earlier could access an upgradation to degree with due weightage to their earlier qualification (i.e. lateral entry into a degree level programme).
losophy of education. y IGNOU hosts the Distance Education Council, which is responsible for setting standards for distance education in the country. Thus, the Chair’s courses will be consistent with the national and international guidelines. y IGNOU’s education strategy is Open Learning, which is not restricted to education by Correspondence. Courses that need full-time studentship can also be offered, and it has been agreed that the CMAI Allied Health programmes will be fulltime ones. y IGNOU degree courses are among the most affordable of the degree programmes presently being offered. During deliberations with IGNOU 7
will follow IGNOU’s usual admission process: students will apply directly to IGNOU and will be allotted by IGNOU to the study centres. y CMAI’s quality contributions in education will continue to be available. THE CHAIR: STRUCTURING THE PARTNERSHIP
One of the questions we faced was about the kind of partnership we should have with the IGNOU. Each of the several available models were discussed in detail with the Convenors of the Training Committees, the CMAI Board and General Body. Af ter much discussion, we have instituted a Chair at IGNOU, the CMAI Chair for Health Sciences. The Chair is not a Professorial position as in many Universities. It is an autonomous body within IGNOU that enjoys autonomy in course development and implementation and in administration, within the overall guidelines of the University and with the concurrence of the appropriate “School” within the IGNOU (in this case, the School of Health Sciences). The Chair has a Joint Advisory Committee that makes decisions on the courses to be offered, and has five members each from IGNOU and CMAI. This means that CMAI can develop programmes of its choice (which should be technically vetted by the IGNOU School of Health Sciences and accepted by the IGNOU Academic Board), and offer them at centres across the country. The autonomy this Chair provides is ideal to quickly offer CMAI’s Allied Health programmes at the degree level, as also any other programmes that we believe are relevant. Under the Memorandum of Understanding, the CMAI-IGNOU Chair will offer short and long term training courses in several areas of health sci-
ences including allied health, medicine and others. We will work together to produce and distribute self instructional course materials besides imparting training through the available satellite communication channels for teleconferencing, and other modes. The University will award degrees to the students who will complete the courses. So it was with great joy that 19th July 2008 became a landmark day for CMAI, when we signed the agreement with the prestigious Indira Gandhi National Open University (IGNOU) to establish the CMAI Chair of Health Sciences at IGNOU. The agreement was signed by Prof Rajasekharan Pillai, Vice Chancellor, IGNOU and Dr Vijay Aruldas, General Secretary, CMAI in the presence of Dr Joyce Ponnaiya, President CMAI. Also present were IGNOU Pro-Vice Chancellor Dr. Latha Pillai, IGNOU Registrar Dr. Laxman, Director IGNOU School of Health Sciences Prof S B Arora, CMAI Vice President Rev Robin Phipon, CMAI Chairperson of Allied Health Professionals Section Mr Suresh Carleton, Secretary AHP Section of CMAI Mr A P Berry, members of the General Body of CMAI and other IGNOU and CMAI staff. SIGNIFICANCE
This CMAI Chair has tremendous significance for several reasons. a) It brings together the expertise in healthcare education of CMAI network and IGNOU’s extensive reach with internationally acknowledged excellence in Open Learning, in order to make quality healthcare education available to the nation and to 8
the world. IGNOU is the world’s largest open learning university, and apart from its extensive presence in India, also has 45 study centres in 32 countries. CMAI healthcare education is known for its quality and the competence and commitment of its trainers and students. b) The fee structure at IGNOU is reasonable, less than that of the private colleges and universities that offer degree education. Moreover, since the material that is given as part of the course is comprehensive and in modular and distance learning format, students can complete the programme well with limited access to expensive reference material. The programmes of the Chair will be open to all eligible centres. In this way, CMAI education will reach a much wider audience. c) The Allied Health Programmes of the Chair are only the first of the many programmes that the Chair can and will offer. The Chair will also consider courses that have been so far directly offered by CMAI member institutions, and interested member institutions are requested to contact Mr Berry. By using CMAI’s Chair, they will have the advantage of a quick decision on acceptability of the course, and the various benefits that have been described earlier. Contd...on page 12
Moving with Times and Needs Dr Thomas Sen Bhanu
Ever since the CMAI came into existence, it has done a yeoman service to the country in the form of its healing ministry as well as a Centre of Excellence to the member institutions by offering multi-speciality programmes which were commended even by WHO
T Dr Thomas Sen Bhanu
he early missionaries in India started a fellowship known as Medical Missionaries Association in 1905 that later in 1926, assumed the name Christian Medical Association of India. CMAI is a Charitable Society, a well known NGO in India acting as the official health agency of the National Council of Churches in India (NCCI).
CMAI's Mission & Vision
The multi-speciality programme of CAMS is perhaps the only innovative training of its kind in the world conducted by an NGO outside the ambit of universities or governmental control
The Mission Mission: In response to the love and command of Christ, CMAI’s mission is to serve the churches in India in its ministry of healing and to build a just and healthy society. The Vision Vision: “That they ...may have life... and life in its fullness.” The Mandate Mandate: “Then He sent them out to preach the kingdom of God and to heal the sick (Luke 9:1-2 Objective Objective: Promotion of knowledge in health sciences and training in health professionals and others involved in the ministry of healing.
Where as before India's independence there were more than six
hundred health institutions managed by the churches, more than half had to be closed down due to non availability of committed staff to run the institutions; the foreign missionaries having left the country creating a vacuum in the Ministry of Healing. The lack of committed staff is still a problem for some. To counter this one of the aims of CMAI therefore has always been the training and teaching of health care personnel. The CMAI helps Mission hospitals to fill the vacuum and to restructure, reopen and rehabilitate the closed down or unhealthy institutions (hospitals), health centres and community programmes. With a history of more than a century, CMAI is constantly set to find solution to challenges. Its main concern in education was training and teaching personnel involved in the healing ministry. The pioneers of medical mission realised from very early days the importance of human resource development to sustain their humanitarian endeavours. They knew indigenous talents, if trained and employed, were economical, dependable, efficient and committed. The informal teaching and training programme they started were mainly in nursing, laboratory work and midwifery. Pioneering stations included Neyyoor, Miraj, Madanapally, Bareilly, Ludhiana, Mungeli and Vellore.
ROLE OF NURSING BOARDS
As much as doctors, nursing is one profession that will remain in existence as long as humankind needs medical care. They are men and women in uniform, calm, tender and compassionate. Besides professional finesse they need to be prepared for demanding hard work with discipline, patience, compassion, punctuality and commitment. And elderly doctor once commented “I wondered whether our Indian nurses will ever compare with the overseas sisters of our times. But your nurses are exemplary indeed.” It was an open compliment to the care and dedication of our nursing training programmes that CMAI designed and offered. The beginnings of formal training in nursing in India were started very early at Christian missionary hospitals even before the Government initiative. When the Indian Nursing Coun-
cil was formed, due recognition was given to the Nursing Boards of CMAI (BNESIB and MIBE). The CMAI member hospitals and Medical Colleges run formal nursing training from the Auxiliary to Doctoral level of nursing and its specialities.
continues to meet the expected standards of the employers. But with the increasing pressures to standardise practices across the country, establishments started demanding government recognised certificate. Students who were trained under CMAI cur-
Indian Nursing Council (INC) recognises MIBE & BNESIB as Educational Boards equivalent to State Nursing Councils. State Nursing Council were established to regulate the Nursing Education of each individual State. They can work only under the Regulations of INC. INC has the right to de-recognise the nursing schools/colleges recognised by the State Council if they don’t abide with INC Regulations. INC Rules are often considered too stringent which prevents some mission schools/colleges from functioning. However, they are instituted in order to maintain the quality of nursing education and have set up a minimum requirement of staffing, physical facilities, number of students, requirement of clinical area. As CMAI stands for quality in education we too follow these rules without which we cannot maintain the quality in education. Recently INC has relaxed the standards regarding the intake of the students, qualification of candidates etc. This is an opportunity for us to increase our role in provision of human resources that are in acute shortage. Please contact me to know details. Ms Jancy Johnson Secretary, Nurses League of CMAI
Due publicity on availability of courses and centres of training should be made in advance to reach the rural churches to enable many more applicants to apply
ROLE OF COMMITTEE ON ALLIED HEALTH PROFESSIONALS
The other early important formal training programmes to be initiated were in Clinical Laboratory and in Radiation Technology. The former was started in Madanapally in 1927 and the later in 1952 at Vellore. Neither the Government nor any NGO had ventured earlier to launch the programme although there was a pressing need for such trained personnel. Inspite of several agencies having now taken up the training, the CMAI trained candidates have a national and international reputation and demand. Their approach to patients, their commitment and skill has remained and
riculum and certificates now needed a government recognised certificate. As the demands for newer courses and better trained personnel continues so does CMAI's response to it. There is always novelty in the introduction of courses of studies by CMAI. There are more than 22 different short and long term courses of study conducted by the CMAI within an extensive spectrum including podiatric technology and addiction therapy. They are need-based and are available where no institutions either Government or Universities are providing such education. The successful candidates still find employment readily in the many NGO and Governmental Centres in India and
abroad. The admission mainly from backward areas and communities ensures social upliftment in the community. THE ESTABLISHMENT OF CHRISTIAN ACADEMY OF MEDICAL SCIENCES (CAMS) AND ITS ROLE
For physicians, CMAI offers specialisation in palliative medicine and general practice. Besides these, there are workshops and Continuing Medical Education (CME) programmes and certified postgraduate condensed courses for doctors in Anaesthesia, Endoscopy and Laparoscopic surgery. At the beginning in the 1980’s and 1990’s CMAI members began to be faced with the closure of mission hospitals. It was mainly due to non-availability of consultant level doctors for long term service, and also because of a lack of funds to provide a large enough team of consultants in the hospitals to ward-off competition from corporate hospitals. CMAI explored ways to help hospitals find sustainable means of continuation. During this process, and after serious study and consultation, it was decided in 1989 to start a multi-speciality general practice training for doctors. Such postgraduate training in general practice was not available elsewhere in India at that time. The experience gained by CMAI in many years of conducting several courses in the past was used in design and development of the three year residential postgraduate programme. Thus was born the Christian Academy of Medical Sciences in 1989 and from 1990 students were admitted for training. Selected Mission Hospitals and training hospitals like Christian Medical Colleges at Vellore and Ludhiana and Miraj Medical Centre were chosen as Centres of training with their faculty. The candidates are awarded FCAMS and MD (GP) of Tribhuvan
COURSES OFFERED BY CMAI FOR DOCTORS
1. CAMS offers a multidisciplinary three year postgraduate residency programme in family practice affiliated to the MD family medicine programme of the Tribhuvan University of Nepal. Vellore, Miraj, Ludhiana and eleven medium size rural mission hospitals of repute serve as teaching centres and field training centres respectively. Short term courses offered by CAMS include Anaesthesia, Laparoscopic surgery, Gastroscopy in different institutions. 2. Fellowship in P alliative MediPalliative cine is offered in collaboration with IPM – Calicut. Doctors are required to attend a total of four weeks as contact session. 3. As part of the Quality Diabetes Care Initiative (a collaboration between SIHR & LC, Karigiri, CMC, Vellore & CMAI) doctors, nurses and others from 100 centres have been trained 4. Training on Management of Paediatric Emergencies & Neonatal Resuscitation, OBG Emergencies and Counseling in Health & Family Welfare Services are also conducted. Dr Susan Passah Secretary, Doctors Section, CMAI
University on completion of the course. The sponsoring bodies have agreed to accept this courses equivalent to regular postgraduate degrees in terms of appointment, salary, status and promotion. The feedback from the candidates as well as the employers is heartening and hospitals where they are posted are showing much progress which is a testimonial 11
to the success of the course. Being trained in multi-specialities, mainly Medicine, Surgery, Paediatrics and Gynaecology, they are capable of handling many of the diseases and conditions needing secondary level of management bringing down referrals of many cases. The efficiency of the mission hospitals chosen as training centres also improved with better infrastructure, increase in staff strength and mentors themselves updating their knowledge on recent advances in management of cases. Another advantage is the potential of multi-speciality specialists capable of becoming trainers of trainees. Continuity of service of general practice specialists will also be an advantage especially in rural areas. Attending WHO conferences representing CAMS, on medical education in developing countries, I understand that the multi-speciality programme of CAMS is perhaps the only innovative training of its kind in the world conducted by an NGO outside the ambit of universities or governmental control, a proud status indeed for CMAI and for India. PALLIATIVE CARE FELLOWSHIP
The newly started fellowship in palliative medicine is a jump in the speciality care of the terminally ill. There are many mission hospitals and health institutions in our land which with existing or with minimal improvement could organise and develop the speciality. Even for mission hospitals planning to introduce new specialities, the palliative care will be to its advantage both in the development of the institution as well as making available this essential care economically to the unfortunate ones needing it. DIRECTION FOR THE FUTURE
While CMAI has a laudable history in
educational programmes, we need to think, plan and reorganise our educational activities for the future. At present there are central committees and individual boards for standardisation, for syllabus and curriculum, conducting of examinations and maintaining of standards in training centres. Training centres should be obligated to take more students from rural and needy areas who have a commitment to work in mission hospitals. There are many sick mission hospitals in need of reorganisation and some are planning for expansion. Without strictly adhering to the old concept of struggling with their core specialities there should be encouragement for taking on new areas
such as prevention and curative therapy, orthopaedic, pulmonary and electro-physiology technologies. Functions in these hospital can be diversified profitably with their existing infrastructure. A market survey would also be helpful for assessing the specific requirements of the region. Although we have expert committees and advisors, to avoid stagnation wider panel of educationists and medical administrators of national repute and experience should be nominated and mandated to meet at specified intervals to guide our policies and implementation. Due publicity on availability of courses and centres of training should be made in advance to reach the ru-
ral churches to enable many more applicants to apply. While quality of training is maintained it is essential that students imbibe Christian ethos and ethics. Let us look forward and work towards the day the CMAI educational wing is reorganised and changes its status into an Academy, Open University or Institution of Excellence with the freedom to expand activities and gains greater national and international recognition. Dr Thomas Sen Bhanu Coordinator, Christian Academy of Medical Sciences C/o CMC Campus Bagayam Vellore
University Education Through CMAI Contd....from page 8 This chair also marks a further and very significant step forward in strengthening CMAI’s presence in healthcare education. CMAI has made many pioneering contributions to professional education: y In Nursing, formal educational bodies were established in the early 1900s, and we now have two Boards of Nursing - the Mid India Board of Education (MIBE) and the Board of Nursing Education South India Branch (BNESIB) – accrediting over 50 schools of nursing. Only a few are aware that the Nursing Boards, MIBE and BNESIB, are the only non-government bodies in the country permitted to accredit nursing education (ANM, GNM, Post-Diploma Nursing certificates) by the Indian Nursing Council and are on par with the State
Nursing Councils for this. y In the areas of Allied Health and Chaplaincy, CMAI’s Central Education Board (CEB) offers courses in 9 areas (the first being offered since 1927) that are considered the best in the country, and are available at 56 centres including seven medical colleges. The allied health professionals so far trained by CMAI have proved themselves by providing quality services in India and abroad when compared to others, and the professionals state that the quality of education they underwent has been much appreciated and that they have also been accepted by various Universities. y For Medicine and Related areas, CMAI’s Christian Academy of Medical Sciences offers a 3 year Postgraduate Fellowship in Multi-Disciplinary 12
Practice along with MD (General Practice) of Tribhuvan University, Nepal. The CMAI - Institute of Palliative Care (IPC) 1-year Fellowship in Palliative Medicine is also offered. This initiative is the fruit of the contributions that the various training committees, their convenors and the training centres have selflessly made over the years to train young people as committed, quality professionals.
Dr Vijay Aruldas General Secretary CMAI & Mr A.P Berry, Secretary, AHP Section, CMAI
The Christian Minority in India and Education – A Right or a Responsibility? Prof V I Mathan
Christian institutions involved in education and healthcare in the pre-independence days were established to carry forward Christ's call to teach and heal. These institutions are protected under article 30(1) of the Constitution. Are we still faithful to this call?
T Unfortunately this gift is seen by many as a right to protect vested interest and not a responsibility to fulfill the Master's command. History will judge us as to how we have responded to this gift
he central role of the Healing Ministry in Christian life and witness derives directly from the command of our Master “Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons. Freely you have received, freely give” (St. Mathew 10:8. NIV). Healing is not confined to restoration of the well-being of the body by appropriate medicines or surgery, but requires the restoration of the total balance of the individual personality, body, mind and spirit. We are bound to obey our understanding of our faith in the Risen Lord Jesus Christ, by the involvement of each Christian in the healing ministry of the Church, the body of Christ. The role this command plays in the life and witness of the Indian Church is debatable, but a few have been given the privilege to learn the art and science of healing the body. All of us in the CMAI have this special privilege and we are called to special commitment to use our skills for His greater glory and to train others to follow in the footsteps of the Great Healer. We also have the responsibility to challenge and enthuse the Church to respond appropriately to 13
the command to Heal and to work towards the full expression of the Healing Ministry. Christian Missionaries in pre-independence India set up two great traditions, education and health care. The large number of Christian schools and arts and science colleges, were complemented by the wide network of Mission Hospitals, especially in rural and remote areas. As this witness evolved three institutions for formal training of health workers (Schools of Medicine) at Ludhiana, Miraj and Vellore, were started by visionaries who recognised the importance of training Indian Christians to continue the work when independence inevitably became a reality. In fact Dr. Ida Scudder, the founder of Vellore, recognized in 1942, the value and necessity of Indian ownership, management and staffing of the college if it was to continue and grow into the future. All three institutions have significant contributions to Healing, health care and education in the more than 100 years of their existence. MINORITY RIGHTS IN EDUCATION
The Fathers of the Constitution of the
Republic of India have enshrined several Fundamental Rights. Among them what is of particular relevance is Article 30 (1), which gives the right to establish and administer educational institutions of their choice to religious or linguistic minorities. Since 1957, when the Kerala Education Bill was tested in the Supreme Court of India, a large number of judgements have clarified the ambit of this fundamental right. Minorities, both religious and linguistic, have the right to establish educational institutions of their choice, not only for religious or linguistic education but also for general and higher education (including Medicine, Nursing, Dentistry etc). While regulations can be made by appropriate authorities to achieve and maintain high standards of education, the administration, including admission of students and appointment of teachers, is in the hands of the minority that owns and administers the institution. Seats can be reserved for students from the minority community even if their qualifying marks are less than that of other students, but the process of admission has to be open and transparent and merit, even if it is inter se within the candidates from the minority community, cannot be given the go by. Fees charged should not be exploitative, but can yield a reasonable surplus for the further development of the college. If a minority educational institution accepts aid from the Government the permissible restrictions have also been clarified. Unfortunately almost all the Christian schools and colleges accepted aid from public funds and thereby have ceded much of their ability to witness. He who pays the piper calls the tune! The Church should have seen Article 30 (1) as a gift from God to us to continue the magnificent witness by
education and health care, which transformed many lives in pre independence India. This gift should have been accepted as a challenge and the Indian Church take the responsibility to build on what had been achieved. Unfortunately this gift is seen by many as a right to protect vested interest and not a responsibility to fulfill the Master's command. History will judge us as to how we have responded to this gift. EDUCATION, ENTREPRENEURSHIP AND PROFIT MAKING
There was another development in the field of education from the middle of the last century, which has influenced the development of education, especially Higher and Technical education. A group of successful and entrepreneurial business men recognised that the provision of education in fields such as medicine and engineering, could be an extremely profitable venture. The demand for admission was many times that of available seats and the policy of reservation prevented many meritorious students from getting admission. This was the birth of the capitation fee colleges, which collect substantial amounts, generally unaccounted, from aspirants for admission to much wanted courses. This money ensures high returns on the capital invested by the entrepreneurs and allows those who can afford, to purchase seats for their children. This approach has reduced education to a profit making industry and training especially of professionals has become a commodity of variable quality. Although this commoditisation of education has been condemned by the Supreme Court of India, money power ensures that this evil is still flourishing and much of what the Courts have pronounced is unenforced. There has been another debilitat14
ing direct effect of this “for profit” medical educational system. If you invest significant capital to acquire a degree, you are required to earn your investment back with a significant profit in the shortest possible time. This is the basis of the present trend of crass commercialization of health care. Ordering unnecessary investigations and procedures, the high professional fees, the scramble for a few ‘profitable’ specialities and the deteriorating standards of medical ethics and care are direct results of this scramble for profit. In fact corporate healthcare institutions have institutionalized the profit motive by referring to themselves as the Health Care Industry, proudly reporting their profits. This is one of the end results of the commercialisation of health education. The other is the travesty of healthcare givers, in a country where facilities are not accessible to the majority of our population, promoting India as the mecca of medical tourism for “cost effective” treatment for residents of affluent countries. Healthcare truly has become a profit industry and no longer a vocation. THE NEED FOR CHRISTIAN PRESENCE IN EDUCATION, ESPECIALLY MEDICAL EDUCATION
As we are commanded, healing and teaching are an essential part of the ministry of the Church and the responsibility of each individual Christian. In the current globalized market economy, the pursuit of money and power are the twin gods that are worshipped. This culture has recognized that education is no longer a vocation, but a profit making marketable commodity. The Spirit of Christ challenges us to be teachers and healers, so that we become vehicles of His love and redemptive power. Actions speak louder than words. A Hindu postgraduate student from a northern In-
dian State wrote to me a few months after his return to a Government Medical College “My three years at Vellore have opened my eyes to the true meaning of your motto ‘Not to be ministered unto but to minister’. I find the working ethos here difficult and distasteful, but I hope to bring here the kind of care I learnt at Vellore”. When I visited him nearly 20 years later, I found an excellent department of Gastroenterology where compassionate care is provided. He had built up a small group of doctors in Government service who were like-minded and who had made a difference. In our great country we are a small minority and we are called to act as leaven. What better witness than to be a teacher and a healer and influence the life and witness of our students and show the power of healing to transform lives. This ability to be a teacher and to witness is not confined to Medical Colleges. Recently a student of mine who works in a Christian Hospital in an area where Naxals are widely prevalent, told me “The people there need medical care and I have to be the example for my Junior doctors and the other staff. Because of the compassion and care we provide without questioning, we know that the Naxals would never hurt us”. Each of our Christian Hospitals are training Institutions, many with schools of Nursing and Allied Health Sciences training programs. Each of them are potential areas where witnessing through teaching and healing can challenge and change our Nation. It is critically important to recognise and acknowledge that the majority of current and past workers in Christian Hospitals and health programs are not trained in the two Christian Colleges, but in the State Government Medical Colleges. I wonder whether capitation fee colleges have
provided any workers for Christian hospitals. The CMAI and two Christian Medical Colleges have a responsibility for the nurture and development of the Christian heath care professionals training in such institutions. If we do not place the challenges and rewards for a life time in His service before these young minds we will be failing in our duty. CURRENT REALITY
Till the end of the last century there were only two Christian Medical Colleges in India, each witnessing by teaching and healing in the spirit of Christ. Each of these colleges had their own distinctive character and ethos. By the early 1990’s several capitation fee Medical Colleges were functional primarily in Karnataka and Maharashtra started by business groups or politicians. Professional education as a potential profit-making commodity got much publicity from 1993 with the verdict in the Unnikrishnan case by the Supreme Court of India. Based on that judgment several state Governments tried to get greater control over Private Medical Colleges and all this was challenged in court over the next 15 years. It became clear to many that if you were a religious or linguistic minority you had a better chance to resist Governmental control and run a profitable Industry, marketing education. In the last decade at least six more Medical Colleges have appeared which claim protection under Article 30 (1) as Christian minority educational Institutions. It is a reality that establishing a medical college is capital intensive. Achieving the standards set by the Medical Council of India for infrastructure, hospitals and the staff requires an investment of several hundred crores. Ludhiana and Vellore have been built over more than a century
with much of the capital invested before independence. They also have traditions and reputation, which ensure that qualified teachers are keen to work there. The new Christian Medical Colleges have to depend on money to fulfill all the requirements and of necessity collect this from the students. In other words other than the religious affiliation of their owners they are no different from the other capitation fee colleges. They are part of the Health Care Industry and will contribute their mite to the continuing deterioration of health care standards in our country. Is this a contribution to Christ’s call to teach and to heal? CMAI and the two Christian Medical Colleges at Ludhiana and Vellore have a special responsibility along with the Church to challenge and transform the faculty and the students of these newly formed colleges to our mission to be healers. How do we channelise market forces to fulfill His charge? Workers for the vineyard have to be recruited as the need is high. How we respond to this challenge will determine the future witness of the Indian Church.
Prof V I Mathan Former Director CMC, Vellore
Education for Whom? Dr N Devadasan
In a country like India where there is a great demand for healthcare professionals most students who study healthcare do so to simply make a profit and are not oriented to serve society. Are Christian institutions that train healthcare professionals countering this trend?
Dr N Devadasan
We need to tailor our courses to the needs of our region, our country rather than mindlessly training without any social objective
n most countries, health and education are considered a core of the social sector. Both are seen as “public goods” that need to be definitely financed and possibly provided by the government. For example, in Belgium education is free to all students upto +2. And since their government schools are very good, most parents send their children to these schools. Private education is the exception. Even higher education is subsidised to a considerable extent. In Germany, higher education, including a PhD programme, is free. That is the value they put on education. However, India strives to be different; both education and health care are financed and provided by the private sector, be it for-profit or otherwise. Naturally those students who have paid vast amounts of money for their education are unlikely to have any social obligation and work for the betterment of society. Most are interested in earning large salaries so that they can repay the educational loans they have taken. In this context, the not-for-profit sector has a major role to play to plug the gap between the demand and the supply of professionals. Christian institutions have traditionally been the backbone of this sup16
ply, but today this is much less than before. What are the reasons? FOR WHOM ARE WE TRAINING?
Is it for our country or for the USA? Our country needs ANMs and general nurses, nurse anaesthetists and nurse practitioners (and doctors in many places) . According to the Rural Health Statistics Bulletin, there is a major demand for ANMs. But with many ANM schools closing down, there is a huge shortage. Are we responding to that demand? Or are we upgrading our nursing schools to a BSc course, so that we can charge high fees and get students who make it up in the USA, UK and UAE? Where are the courses for nurse anaesthetists? For a long time the doctor anaesthetists’ have not allowed any other profession to be considered licensed including MBBS doctors. Are we interested? Women die while delivering, just because the government hospitals are not able to provide emergency obstetric care. And this is mainly because there are not enough anaesthetists to go around. Just imagine how effective a nurse anaesthetist would be in such a setting? Today, most high income countries are shift-
ing to the concept of nurse practitioners to provide primary care at the first level. While we are happy to import their technology mindlessly, why do we lag behind when it comes to copying some of their practical and optimal solutions for our country? We need to tailor our courses to the needs of our region, our country rather than mindlessly training without any social objective. WHY DO WE INSIST ON THE TOP EDUCATIONAL STANDARDS FOR ADMISSION INTO OUR NURSING OR MEDICAL SCHOOLS?
By this simple step, we exclude a majority of potential candidates who would otherwise have been happy to become an ANM or a GNM and then serve their country. By insisting on English speakers, we encourage the middle class of our country to get admissions into these schools and then into hospitals abroad. On the other hand, if we insisted on vernacular speakers, there would be many local applicants who would be happy to continue working in the local context. Of course, there is the immediate response – “Oh these local girls are not good enough!” But good enough for whom? For the geriatric Britishers? I also challenge this concept that low
marks in +2 is an indication of intelligence and aptitude. At the Gudalur Adivasi Hospital (GAH), we recruited 10 th failed girls and trained them. In addition to the usual nursing topics, a lot of time was spent on teaching them mathematics, English and communication. Today most of these nurses handle most normal deliveries, assist our surgeon in all the surgeries and of course manage the hospital admirably. Dr Nandakumar was amazed at the way these nurses assist – “better than my specialist trauma nurses at New York” All it took was some extra time and effort. And though most of them had lucrative offers from private hospitals in Kerala, they were happy to work in Gudalur, because that was their home. Can we talk about such models? Recruiting nursing students from the taluk/district where we work? Of course the next argument is about objections from the Nursing Council etc. But then we need to work with them, confront them with the reality of India and challenge them to meet this need. I think that if there are enough representations from like minded organisations, the council will change, will have to change. ADMISSION CRITERIA CAN HARM SOCIAL OBJECTIVES
Most of them are trained in medical colleges and see their professors using high technology to diagnose and treat. And they feel that without this, it is impossible to manage health services. I remember a medical student from CMC – Vellore who visited us at 17
GAH and asked in amazement “How do you manage deliveries without a foetal monitor?” I tried to explain to him that most women in India deliver at home but I could see the disbelief in his eyes. But if students graduate with this thinking, it is not surprising that they don’t continue their careers in mission or government hospitals. So what can be done? Can we make changes in our existing medical and nursing courses to accommodate an extra year of training where the students have to be trained in a mission hospital under the able supervision of a senior who demonstrates how good care can be given without latest technology and 4th generation antibiotics? Dr John C Oommen (the latest recipient of the CMC, Vellore Paul Harrison Award for community services) was inspired by the mission hospital at Bissamcuttack, and stayed on to serve the local adivasis. Can education take place not just in tertiary but also in secondary hospitals? The “secondary hospital teaching programme” of CMC, Vellore and the mission hospital exposure of CMC Ludhiana are steps towards this. Can we have more Bissamcuttacks?
Dr N Devadasan Institute of Public Health 250, 2nd C Main, 2nd C Cross Girinagar, 1st Phase Bangalore
Professionally Competent, Socially Relevant and Spiritually Alive! Dr Sheena Singh
CMC Vellore and CMC Ludhiana have made their mark by providing quality and value based medical education in India and Asia. Admission to these institutions is tough, because of high professional excellence in medical education. They have etched a place of honour in India. It is indeed a rare distinction to be on the teaching staff of these prestigious institutions. A bird's eye-view of how CMC Ludhiana imparts Christian values in their teaching by Dr Sheena Singh
Dr Sheena Singh
There is a need to equip students with multiple skills to make them feel competent to work in a primary health care setting without sophisticated gadgets available in a tertiary care hospital
tudying at CMC Ludhiana is a unique experience because of our rich heritage of service to the community and values that have been handed down from one generation of teachers and students to the next. I will share my perspective on how Christian values and teachings can be brought into professional training and highlight the positives that I have observed in the education being imparted to students at Christian Medical College Ludhiana. The Mission statement of the College is to build Health Professionals who have the attributes stated in the title: ‘Professionally competent, Socially relevant and Spiritually Alive!’ OUR LEGACY
CMC Ludhiana began as a school of Nursing under the supervision of Sister Kay Greenfield in 1889, and Dr Edith Mary Brown, the founder was
instrumental in starting the Licentiate course in Medicine for women in 1894. The college was then known as The North India School of Medicine for Christian Women. This was later upgraded to the MBBS course in 1953 for both women and men students. Today, the College is ranked as the 14th best Medical College in the Country. It has been recognized for excellence in training and education of health professionals. Community based Medicine was always an integral part of the curriculum. Missionary doctors like Dr Carl E. Taylor got the pioneer MBBS batch of Medical Students to experience community medicine hands on, at the Narangwal Community Health Center. The pioneer batch was admitted in 1953 and my parents were in that batch. Under this approach, social and preventive medicine came alive, as students implemented strategies to prevent communicable dis-
tions, but also directly benefited the eases such as typhoid, cholera and community and students. dysentery by actually constructing Dr Rambo, Professor and Head of sanitary toilets for villagers. Through Ophthalmology, is remembered for this task, he also inculcated in the students the values of humility and serhis missionary zeal in preventing vice to others. blindness and spreading the Word of An excerpt from his book titled, God to the community. He paved the ‘Just and Lasting Change’ reads way for Community Ophthalmology. “Go to the people, live among the The Department continues to do expeople, learn from the people, tensive outreach work through eye plan with the people, work with camps and school screening prothe people, start with what the grams which include training of teachpeople know, build on what the ers to detect visual problems in chilpeople have, teach by showing, dren. Students and Interns participate learn by doing not a showcase, but in these programs. It is just about goa pattern, not odds and ends, but ing an extra mile. a system, not piecemeal, but an The list of inspirational teachers integrated approach, not to conform, but to transform, CMC, Ludhiana not relief, but release.” Dr Beryl Howie, Professor and Head of Ob/Gynae from 1959-1981, also ignited a spark in the minds of her students to study community problems and answer questions through research. Dr Ashok C. Antony, one of her students at CMC now working as a Professor of Medicine at the Indiana University School of Medicine (USA), could go on, but I think I have illusexplored the problem of Folate defitrated how the culture of community ciency in girls of childbearing age and service and reaching out to patients discovered that it was associated with has been built into our curriculum since the inception of the college. the development of neural tube deMaking Medical Education more than fects in their babies. the transmission of bookish knowlHe brought this project back to edge is not possible without teachers CMC Ludhiana a few years ago, and who are committed to teaching as involved the Medical students in a well as practicing their specialty. community based intervention. Students developed skits & street plays OUR COMMITMENT to educate rural women on how they Christian Medical Colleges have had could easily prevent this defect by a tradition of selecting students for taking folate supplements. Thus Dr medical training sponsored by variHowie’s initiative to teach her stuous Churches in India. Students thus dents had a snowball effect and has selected, make a service commitnot only added to the body of interment of 2-5 years, to serve at a Chrisnational medical research publica-
tian Mission Hospital before continuing with postgraduate training, even today. Several students from my generation were inspired by the role models they found at these hospitals and chose to make a lifetime commitment to work at these hospitals after post graduation. Several are Administrators of these hospitals today, carrying on the mission and mandate to reach out to the unreachable. To name a few there is Dr Cecil Harrison in Jagadhari Mission Hospital, Dr Sunil Sadiq in Philadelphia Hospital, Ambala, Dr Philip Alexander in Manali Mission Hospital and Dr Anil Henry in Christian Hospital Bissamcuttack. EARLY EXPOSURE TO MISSION HOSPITALS IN REMOTE AREAS
Earlier this year, second year Medical students were sent to various Mission Hospitals to get an exposure to the work going on there and meet the doctors who are serving there. Each group was accompanied by a faculty member. They learnt about local and endemic health problems, and completed small projects, learning about the prevalence of sickle cell anemia, a care center for differently-abled children and interacted with patients being served at these hospitals to assess satisfaction levels. On their return to CMC, they presented their project reports in the institutional Saturday morning Grand Rounds. The presentations were enlightening and revealed how the students had got involved with the community. They were enthusiastic about serving in the community, as they spoke to us about their experiences.
STUDENT SPIRITUAL NURTURE
At CMC we are mindful of spiritual nurturing and inculcating Christian values. CHAPEL SERVICES
Regular ministerial services are there including College and Hospital Chapel services and students participate in the service every morning. FUND RAISING TO HELP POOR PATIENTS AT CMC
They organise fundraising for poor children’s fund through events of choir singing for the faculty and students and have helped slum children. EU GROUPS & RETREATS
We have regular in campus EU meetings which bring us closer as a community. Students have the opportunity to go on retreats organised by the Fellowship Department to nearby areas, a time for fellowship and prayer.
The faculty takes ‘Foster children’ under their wing; 6-7 students from various batches form a group. This gives them a home away from home. COUNSELLING AND PSYCHOLOGICAL SUPPORT GROUP
‘Mitra’ (Friend), a centre for training and counseling services managed by qualified counselors and chaplains, has been an active functional unit of the CMCH under the auspices of the Fellowship Department. The Centre focuses on pastoral care and counseling to the staff, students, patients and their family members. MEDICAL ETHICS
The Medical, Dental and Nursing stu-
dents are taught ethics that manage their lifestyle in the professional fraternity. The ethics classes are coordinated by the Chaplains with different Doctors. Students discuss topics like: the doctor – patient relationship, issues of prenatal sex determination and female foeticide, euthanasia, and become aware of ethical practice in medicine. It is a good opportunity to introduce values into medical training.
Domiciliary services require medical and nursing students to work together as a team fostering a healthy and respectful interdisciplinary work relationship. Our graduates have had the opportunity to be part of disaster management teams reaching out to earthquake affected Gujarat and similar calamities. The Pulse Polio drive is an excellent way for students to learn how their role in the universal immunization program can make a difference. to the people, live among the people, In recent years, there learn from the people, have been a lot of workwith the people, work with the people, shops on Awareness about start with what the people know, the prevention of spread build on what the people have, of AIDS. Patients are treated with compassion teach by showing, at CMC, Ludhiana. The learn by doing not a showcase, AIDS counseling cell edubut a pattern, cates HIV positive patients not odds and ends, before and after testing. but a system, Students learn to adopt a helpful and understanding not piecemeal, attitude towards all patients but an integrated approach especially with sensitivity not to conform, for those with ‘stigmatising but to transform diseases’. ENCOURAGING RESEARCH MENTORSHIP AND ROLE MODELS
A true mentor gives of himself to his disciples. “You give but little when you give of your possessions, it is when you give of yourself that you truly give” (Kahlil Gibran) There was a fascinating documentary film, on Doordarshan (DD) in the eighties about the community outreach work of Dr Hans Urlich Nagar a CMC Ludhiana alumnus, which I had found particularly inspiring at the time. It contained the message that we can make a difference if we try. 20
In recent years, students are encouraged to take up ICMR research projects each year and many projects are community based. The discipline and integrity that are needed to undertake research work are values that our students learn. STRENGTHENING THE COMMITMENT TO SERVE
There is a tradition of bringing the educational experience to a culmination with a dedication service known as the ‘Baccalaureate Service’ and stu-
CARRYING THE MANDATE FORWARD
The values that we have imbibed as students have helped us in every sphere of our lives and we hope to hand down to our students these same values to guide them. Nowadays, Medicine is becoming more commercialised, with high-tech Corporate Hospitals opening up. However, at CMC we teach our students that nothing beats a good bedside clinician who can elicit a good and complete history and physical findings. These skills are in danger of dying out if young doctors rely only on a battery of investigations, many of which are unnecessary and expensive for the patient. We teach our students to be a good basic doctor who is caring for the community and reaching out to many needy people. If we look at the statistics in India, we had a target to achieve ‘Health for all by the year 2000’, it is the year 2008 and we still have a long way to go to provide health for all. There are 283 medical colleges all over the country out of which about 32,000 medical graduates pass out every year. But this number remains inadequate in terms of doctor to patient ratio, which is extremely low, especially so in rural India. There
trends and be a leader in this cause. “Whatsoever you do to the least of my people that you do unto me.” (Matthew 25:40)
In recent years, there have been a lot of workshops on awareness about the prevention of spread of AIDS through NACO the National AIDS Control Organization, and all such patients are treated with compassion at CMC
are 683,582 registered allopathic doctors in the country, only one in 10 doctors works in a rural area. There is a problem in supplying doctors to the most needy. Why? Some of the issues mentioned are lure of better opportunities for specialization in big cities in India and abroad, pursuit of better lifestyle and financial stability, poor infrastructure in the rural areas to engage doctors for long. These are real problems that need to be addressed and improved over time. If we as Christian institutions of excellence in medical education and health care are sending our graduates to serve the community, we are setting an example for the country to emulate. Let us continue to set the 21
Dr Sheena Singh Professor & Head Dept. of Physiology & Vice Principal Student Activities CMC, Ludhiana
Idents place a lit candle in the map of India drawn on the ground in front of the Lady Wellingdon Assembly Hall. This is a great moment of renewal of the commitment to serve, as students realise the responsibility they have towards the people in the far reaches of the country where each one of them has to be like a luminous candle of care and compassion. It indicates that from their Alma Mater, CMC Ludhiana in the North, the care-givers will reach out to many states of India.
G M Eye Hospital Mettupalayam and W M Eye Hospital at Gudalur
urgently requires Ophthalmologists with or without surgical experience. y We offer good salaries, PF, free accommodation, good working environment and personalised training y We follow the high standards set by OEU, Canada and LVPEI, Hyderabad y Both places have got good English medium schools y Low cost of living y We assure professional satisfaction and opportunities for growth. Please apply to: The President Emmanual Blind Relief Society 12, Woodcote Road, Coonoor 643 102, Nilgiris Tel: 0423-2206403 & 0423-2207692 E-mail: firstname.lastname@example.org
Education and Why am I in it? Prof Triza Jiwan
Inculcating professional norms into Nursing Education is challenging when all around are willing to lower standards. The balance of head and heart is important
I Ms Triza Jiwan
When I joined education long back, even today is: to make the difference in a student’s life and by making this difference in the student’s life is to make a change in the life of its family and through the family, a change in the society and thereby, the nation and the humanity at large
opted to be a nurse and became one on developing awe and esteem for the nursing profession – the one in the service of the sick and ailing around the clock without a break! And, this is by no means a mean achievement. During the course of my service as a nurse, I realised that I would do still better if I became an educationist in the field of nursing, as then, I would play a pivotal role in shaping the personality and being of the future nurses by imparting to them the skills and values that are crucial to deliverance of nursing care with a smile and empathy. I had observed that the nurses that were skilled in nursing theory and practice (cognitive strength or I.Q.) and had requisite dexterity (psychomotor skills or conative strength) on one hand, and emotional strength (affective strength or E.Q.) on the other, were those selected few who always excelled. I, further, found that these nurses had the knack of doing their duty with such a degree of expertise that even the most difficult jobs that they performed looked easy. One thing more that I observed about them was that by and large they practiced positive living (thought, spoke and acted positively) and this was most important of all. I felt that as a teacher I would be in a better position to contribute a little to creation 22
of physically fit, mentally agile and spiritually elevated nurses by helping them imbibe all the good values. I concur with Plato that once we have given our community a good start, the process will be cumulative. By maintaining a sound system of education you produce citizens of good character. And citizens of sound character, with the advantage of a good education, produces in turn, students better than themselves; and the better will be able to produce still better students in their turn, as can be seen with animals. Thus began my voyage to the realm of teaching. I began preparations to be in nursing education by acquiring the mandatory academic requirements. Concurrently, I tried to delve deeper into the writings of great persons about teaching. I found that there was recognition of the value of knowledge, though concern about the system of education as well, and the great persons had wonderful understanding of the tricks of the trade that could help me in pursuance of my aim – to bring the above-said good qualities in my students. The word education comes from the Latin e-ducere meaning “to lead out”. While Socrates argues that the education is about drawing out what was already within the student, some others feel that education is a means to create leaders. What ever be the
Even if in my entire life span and career as an educationist I can create one student who imbibes all the values that I value, I shall feel amply rewarded, because one earthen lamp would dispel all the darkness when lit.
initial implication of the word education, one thing is very certain that the ‘Education is the most powerful weapon which you can use to change the world’ as Nelson Mandela once remarked. Jean Jacques Rousseau declares in on Philosophy of Education, “Plants are shaped by cultivation and men by education. We are born weak, we need strength; we are born totally unprovided, we need aid; we are born stupid, we need judgment. Everything we do not have at our birth, and which we need when we are grown, is given us by education.” De Montaigna observed, “I would like to suggest that our minds are swamped by too much study and by too much matter just as plants are swamped by too much water or lamps by too much oil…….” He added, “In truth the care and fees of our parents aim only at furnishing our heads with knowledge: nobody talks about judgment or virtue.” Albert Einstein observed, “Knowledge exists in two forms - lifeless, stored in books, and alive, in the consciousness of men. The second form of existence is after all the essential one; the first, indispensable as it may be, occupies only an inferior position.” I realised that education empowers like scientific discoveries and inventions; but, unlike and beyond them, it also bestows insight and wisdom for proper exercise of the power gained. The education is both teaching and learning and doing all things crucial to it like setting standards; maintaining excellence, transparency and relationship; and, adhering to the norms of the University and those of
other bodies governing the functioning of the institution that are pre-requisite for applying, getting and retaining University affiliation for any educational institution. Besides, a teacher has also to cater to the needs of the economically and otherwise weaker sections of the society and ensure that the benefits available under various schemes put forward by government and NGOs percolate to them. Ensuring admission priority as per reservation policy and scholarships benefits to the eligible are two such duties. He/ she may, also, make value additions through suggestions during deliberations of the University senate meetings for bringing about improvements in deliverance of education and education-inclusion. He may persuade the NGOs and influential segments of the society to sponsor education of the brilliant but economically weaker students and/or to sponsor scholarships. When asked why I am in education, my usual response - as it was when I joined education long back even today is: to make the difference in a student’s life and by making this difference, to make a change in the life of the family and through the family, a change in the society and, thereby, the nation and the humanity at large.
Prof Triza Jiwan Prof & Principal College of Nursing C.M.C., Ludhiana
ties i n u ort Opp
Christian Medical College, Ludhiana invites applications for the following posts: Civil Engineer & Electrical Engineer : B.Sc (Engineering), BE or B Tech. Age upto 60 years Apply to: The Director Christian Medical College Ludhiana 141 008
Christian Academy of Medical Sciences (CAMS) Three-year Residency Training Programme MD(GP)/FCAMS General Practice/Family Medicine Course starting May 2009 Apply for details to: Dr Thomas Sen Bhanu Coordinator, CAMS Christian Medical College Vellore - 632 002, Tamil Nadu Tel: 0416- 2265036
Choosing to Serve the Poor and Marginalised Ms Mercy John
CMAI's entry into education stems from the need to nurture young people to make them value-based and service-oriented healthcare professionals irrespective of their backgrounds so that they in due course choose to serve the poor and marginalised
T Ms Mercy John
What better reason is there for CMAI to be in education! It stems from the need to nurture young people in faith and service; to help them grow in and experience the knowledge and love of Christ, so as to inspire and empower them to live as disciples of Christ
he Christian Medical Association of India has evolved over it’s century-old history in many diverse ways. But the basic core has remained what it was originally started for – A. A source of fellowship and accompaniment for missionaries in health care on the lonely paths they trod, and B. A forum for pioneering, standardizing and rolling out training programmes for the nurturing of value-based health care personnel for the needs of India. So when we ask the question over a hundred years later – Why is CMAI in Education, it is primarily as a reality check; to question and may be reaffirm our vocation. One could list a variety of reasons for our involvement:
The numerous training committees under the CMAI Central Education Board do the same for Allied Health Professionals. We have newer courses for doctors too in General Practice and in Palliative Medicine. ‘Training and Education’ have always been one of the key objectives of the CMAI.
The country is very much short of healthcare personnel especially in the field of Nursing. We are presently seeing the call of the government to grossly upscale training capacity to fulfill the national needs for trained healthcare personnel, under the National Rural Health Mission. The Christian Training Institutions in Health have a century old track record of training value-based pro-
Missionaries in Medicine and Nursing in India, felt the need around 1905, to train and educate local people for the various health care professions. The two Nursing Boards – Board of Nursing Education South India Branch (formed in 1912) and the Mid India Board of Education (established in 1926) continue today with the course-design and training of nurses.
‘Preaching, Teaching and Healing – is the three-fold mandate of the Church. These have been usually interpreted to foster Evangelism, Schools and Hospitals. But Health Care Training offers a strategic opportunity to do all three at one go. Our Christian Teaching Hospitals become Churches, Schools and Hospitals – all in one. NATIONAL NEEDS AND DISTINCTIVE COMPETENCE
times more than necessary), to serve in our institutions. They have entered the field of education to instill a positive influence in young people’s lives and to make a difference for eternity. When the entire faculty works with one vision, miracles happen! Water is turned into sparkling wine!
PIONEERING AND INNOVATING
fessionals. Our success is measured by the number of our graduates who choose to serve the poor and the marginalised, rather than by the biggest campus-recruitment pay-packet or the export rate (as is used to measure many other training institutions in the country). There is a need and we have something extra to offer – the model of Jesus Christ Himself- the ultimate Healer. What better reason is there for CMAI to be in education! It stems from the need to nurture young people in faith and service; to help them grow in, and experience the knowledge and love of Christ, so as to inspire and empower them to live as disciples of Christ. May I also add what I feel have been, and should be, the hallmarks of all the training we give through the CMAI. EXCELLENCE IN QUALITY & STANDARDS
CMAI’s Education Boards have always been sticklers for excellence, setting standards far above the mere statutory requirements. With numerous courses in various institutions, covering diverse areas and for excellence can be of much complexity. EMPOWERMENT
People’s empowerment occurs, espe-
cially of women, from the remote areas in which the institutions are situated. This is best seen today in the under-developed regions of central India, where Nursing Education is one of the best tools available for empowerment of young women. VALUES
Christian values – of love, honesty, respect, justice, faithfulness in and sacredness of work, can only be acquired, not taught. They have to be imbibed by the students from those around them during their training. Do we have these values in adequate concentration for this to happen ? EQUIPPING
CMAI's products are able to cope and provide the needed services because the course content is strong on skills, and not just knowledge. Thus making them skillful in their profession, to step out into the world in Government or non-Governmental settings. COMMITTED TEACHERS
Teachers are the heartbeat or the pulse of an educational institute. Many of the CMAI teachers are deeply dedicated, and have had to sacrifice greater fiscal rewards (some-
CMAI has led the way in starting new courses, or innovating with curriculum changes and educational techniques way ahead of others; and in many cases, the Government/others followed years later. We have always had the depth of expertise and the flexibility to be able to do this. AND FINALLY
It has been my vocation to be a team member of a CMAI training institution in a very remote place, and also an active learner in the MIBE for the last 15 years. I could go on and on. But in conclusion let me say: “Thank you and God bless” – to all those who were and are part of the teaching and learning process – tutors and students ! Also to all those who have gone before us, educating us and thousands of other students who passed through the ‘hands’ of CMAI, to emerge as competent, caring and confident Christian professionals.
Ms Mercy John Principal, School of Nursing, Christian Hospital Bissamcuttack, Orissa & Chairperson, CMAI Nurses’ League
Has Education made a Difference in my Life? Dr Prem Kumar
“The steps of a good man are ordered by the Lord, and He delights in His way” Ps. 37:23
M Dr Prem Kumar
Life is like crossing a river. You are swimming across it, but you could also do it with a boat with which crossing becomes much easier. Jesus is like that boat
y father’s name is Ramaswamy and my mother and I were the only first generation Christians in our family. I did my schooling at Erode, Tamil Nadu and Pre-university at the American College, Madurai with the help of Christian missionaries. Subsequently, I joined the three-year Occupational Therapy programme at CMC-Vellore without even understanding what it was all about! After joining the course I realised that I did not have sufficient money to undergo the programme. I wrote to The Leprosy Mission (TLM) and they funded the actual cost of the study and also living expenses. I signed a service bond and after my training I was posted to their center at Salur, A.P. My job there was chiefly to supervise footwear manufacture and to make insoles for deformed leprosy feet. I enjoyed this work very much, as it was creative and enabled me to use my hand skills. But I also had a keen interest in research. My first research publication was from this center on how to relax spastic hand muscles with a specific splinting. It was published in 1977 in the Rehabilitation in Asia journal. The same year I joined Schieffelin Leprosy Research and Training Centre, (SLRTC) Karigiri, T.N. as an Occupational Therapist. Since it was a research institute, its administration always en26
couraged its staff in undertaking research studies. The then Director, Dr. Ernest Fritschi, suggested a few studies that I could undertake. I reported to him from time-to-time on the progress of the studies that he had assigned me. At one point he told me that though I had research potential I lacked proper qualifications. So I enrolled for a BA programme with the Delhi University. My institution sent me to Delhi to undergo a Post-Graduate Certificate Programme in Health Education as my work involved a lot of patient and mass education. Subsequently I earned a Masters degree and with the American Leprosy Missions’ funding went to United States and United Kingdom to learn the latest hand rehabilitation techniques. Within one and a half years of my return from the USA, I had the privilege of being invited by Dr. Daleep Mukarji, the then General Secretary of CMAI, to join the organisation as the Secretary, Paramedical section. SLRTC gave me long leave to take up this new position at Nagpur. I had enrolled for a PhD programme in Social Sciences at Nagpur University. In 1998 I also received the license of the MGR Medical University, Chennai, to be a supervisor for doctoral studies. What difference did education bring about in my life? I would say that it helped in associating with different experts for research studies both in
my institution and outside. This to me gives great satisfaction in my professional life. My education and working at the SLRTC has also helped in my current involvement in a small multi-centric study of the WHO, which is looking for a new paradigm of medical care for persons with disabilities. Similarly, in 2007-08 I had the opportunity of being a part of a research team of the London School of Economics that was looking into the health and socio-economic outcome of a long running community-based primary health care project in Maharashtra. My education gave, and still continues to give, me an opportunity to systematically evaluate the published work on the effectiveness of communitybased primary healthcare for a project undertaken by the American Public Health Association. Did education help me to live a life that pleases Jesus Christ? The answer is, “I do not know”. I know there are frequent failures in my life while attempting to lead such a perfect life. Nevertheless, like other fellow believ-
ers, I too try to make an earnest attempt to get back on the correct track. If I think further on the above question, I would say that education has no correlation with Christian living. I lived as an unbeliever till at the age of 32 I met a young Physiotherapy intern from Hong Kong at SLRTC. His message about Christ was simple. He said, “Prem, you think you can lead life on your own with your strength; but it is stressful. Life is like crossing a river. You are swimming across it, but you could also do it with a boat with which crossing becomes much easier. Jesus is like that boat”. It made me to think and that night I opened the Bible and read a passage from the Psalms; but decided not to be carried away by clever presentations and to find the truth on my own. Thus I started reading the whole Bible from Genesis without the assistance of any devotional books. There were a lot of questions while reading but after a few months I was fully convinced that Christ is the way. At Vellore I worship in a small Tamil fellowship and our Pastor is not highly
qualified and his messages are very simple and I find it extremely useful for my day-to-day life. I believe it is from God to me and it is not a theological discourse. Education perhaps helped me in discerning a number of Christian periodicals that comes my way. My assessment is that the only objective of more than ninety per cent of such publications is to make money. They make it appear as though Jesus Christ is in their shirt pockets and if people approach Him through them, Christ will give whatever the devotees’ hearts desires may be! Let me conclude by saying that education has made a great impact in my professional life. At the same time it has no effect in my Christian living.
Dr Prem Kumar Department of Occupational Therapy Schieffelin Institute of Health Research and Leprosy Centre Karigiri, Vellore Dist Tamil Nadu
Why am I in Education? Teaching for me was not something which I started only after my education. As a student and in the first few years that followed, it was obvious that students were attracted to persons (whether teachers or not) who were confident, pleasant, genuine, tried to understand their problems, worked with them, and who would not humiliate them before others. They would listen to and follow anything this person said—yet they were shrewd and could not be taken for a ride. I have listed some ‘basics’ which made education my mission:-
y ‘Sorry’ is to be said when needed; egos should take the second place y Students see through your genuineness or mask y Students have emotions just like me, whether it pertains to correction or respect y It is a rare teacher who will allow a student to overtake her/him in life— that is greatness y We can’t ‘know’ for sure—today’s fact is tomorrow’s fallacy. Knowledge keeps expanding, and it is our duty to keep abreast. y One should be a role-model and get into policy making to improve
nursing education in our country – be it curriculum, syllabus, setting standards or even hand-holding. Thank you CONCH (Melvishram) and Fundamentals of Nursing Dept. (CON, CMC, Vellore) and Bissamcuttack for allowing and helping me to learn to teach. Ms Mercy John Principal, School of Nursing, Christian Hospital Bissamcuttack, Orissa & Chairperson, CMAI Nurses’ League
CMAI'S role is Empowering Students Ms T Grace Matilda
CMAI educational training aims to mould the basic character of trainees, condition their minds and develop their intellect so that they become service oriented healthcare professionals. The author looks at the way the CMAI education has progressed since its inception
C Ms T Grace Matilda
The value based educational services provided by CMAI member training institutions are essential to generate professionals in Nursing, AHP, Medicine with a difference
hristian Medical Association (CMAI) earlier known as Medical Missionary Association (MMA) was started by challenging its members to improve their work in health and medical relief. Begun in 1905 it changed to its present name CMAI in 1926. Several men and women passionately believed that their mandate was to preach the Kingdom of God and Heal the Sick. And they felt Mission was to serve the Church in India in its ministry of healing and to build a just and healthy society. The questions we need to ask ourselves are: Is this mandate and mission still relevant today? Should we as CMAI continue this ministry of healing just as our predecessors believed? Should CMAI still be in education? And what is its role in empowering students? To my simple way of thinking God has not changed His purpose for the church or for the humanity. He loves people as His very nature is love. HISTORICAL PERSPECTIVE
Missionaries shared the good news of Jesus Christ and preached the kingdom of God in the beginning. But when they began actually working 28
with people they soon realised that they needed to respond to the immediate needs of human suffering and sickness, and changed their perspective on mission work from just preaching the Gospel to actually serving the communities. As sickness and early death among mothers and children was rampant, simple medical work became essential which then led to the opening of medical centres and dispensaries. Medical missionaries from North America, Pacific and Europe came to India and were involved in providing much needed medical care and relief to the sick. The need for trained nursing care led to the setting up of Training Centres for women and young girls in India. Thus formal training work began at these medical centres. In the MIBE (Mid India Board of Education) records it says that, it began by providing education to nurses and compounders (in the vernacular language). Four boards of nursing education were set up: in South India, Central India and Western India and North India providing nursing education. The first examination in Nursing was conducted by North India Board of Examiners for mission hospitals in 1911. The challenge of providing
Give a man a fish and you feed him for a day Teach a man to fish and you feed him for a lifetime (Chinese proverb)
EDUCATION CHALLENGES MEMBERS
trained nurses for mission hospitals led to the Christian Nurses League of CMAI responding by setting up four boards of nursing education. BIBLICAL PERSPECTIVE WHY CMAI IN EDUCATION?
Education empowers the mind and develops the intellect, moulds character and prepares good citizens. Jesus went about teaching, preaching and healing all manner of sicknesses. In Matthew 25:31-40 Jesus talked about the value of responding to human need. Teaching and training prepares people to be involved in useful work which in turn builds the society. Mission work was an integration of medical and evangelical work. The same may be understood as holistic healthcare – dealing with the physical, mental, social and spiritual. Responding to the Need for Education – a part of the Evangelical purpose “I was hungry, you gave me food I was thirsty, you gave me drink I was in prison and I was sick, you visited me I was a stranger, you took me in I was naked, you clothed me” (Matthew 25:35-36)
“In as much as you have done it to the least of these my brothers/sisters you have done it to me.” (Matthew 25:40) These are the words of Jesus. So responding to the basic needs of people is a Christian service. Thus the value placed for doing such services is tremendous as doing it to the Lord. In James 2:1 says “ as the body without the spirit is dead so faith without work is dead”. So we may understand that the Christian response to human suffering is to show forth the love of Jesus in our works. Poverty and ill health are a curse and on occasions they lead people to act violently as they struggle for survival. Caring for the sick and suffering and preserving their spirit from destruction was a cause which was given a fitting response by the early medical mission. So too, even today, the biblical teachings guide and challenge us in building up those that are in need for survival. It also means that we should be involved in building people up by showing them how they can meet their own basic needs. It is much better to teach people how to catch fish than supplying them fish. 29
Why should the CMAI members be engaged in education and empowering the youth? Medical missionary work and Evangelism work as an integral part of the church and CMAI’s educational work has prepared many for teaching, administration and for clinical work. The value based educational services provided by CMAI member training institutions are essential to generate professionals in nursing AHP, Medical with a difference. Example: Nursing with a difference, diagnostic services with a difference, medicine with a difference. Whereas health and medical education is seen as a booming profit making industry with high-tech medicine and fast diagnostics, the reality is that medical services need to form the common core of a just and righteous society. The current high-tech cost intensive healthcare that is coming up in India is beyond the reach of common man on the street I believe, Members of the CMAI can come together and promote value-based training and affordable healthcare. I believe, training is not for survival of mission hospitals but an essential form of preaching the Gospel. This strong belief comes from experience. During my tenure as Secretary of the Nurses League I visited many training institutions. I have seen students who are ambitious and are also committed to working in mission hospitals. I even attended a Student’s conference in Chennai where students prepared an action plan and suggested ways to revive ailing mission hospitals. I believe the minds of
our students are open to Christian service. As members of CMAI and leaders, we must strive to create more opportunities for them so that they can get involved in the healing ministry of the church. CALL TO THE CHURCH AND ITS INSTITUTION
The church must rise to the challenge in the present context of modernisation. The church should nurture youth so that they would get interested in medical/allied/health and nursing education. This in turn should be followed by nurturing and guidance in institutions so that the future leaders for mission hospitals in India can be prepared. CHALLENGE TO NURSE LEADERS
It is documented that Christian Nurses League pioneered nursing education in India in the early 20th century. The challenge today is to influence curriculum change to ensure that nurses continue to be professionally
Teaching and training prepares people to be involved in useful work which in turn builds the society
competent and that the quality of practical training is good. It should also raise the issue of recognition and permission for adding more needbased courses with the National accreditation authority – the Indian Nursing Council. The health problems at present in society like HIV/ AIDS and Tuberculosis and increased geriatrics population calls for shortterm orientation courses for nurses. Nurses League together with the boards of nursing education should
aim at introducing course or subjects into the curriculum like legal issues in Nursing practice, Christian and professional ethics, and mainstreaming of HIV/AIDS. The role of nurses has changed from an emphasis on institutional care to community care. The need for nurses in trauma, diabetic health nurses and midwifery practice to work in health centres, has been emphasised by numerous private surveys and government reports. With what I have seen and experienced as a senior nurse and as the former secretary, I am convinced that CMAI has a definite role in empowering students. I will be happy to receive your comments. Ms T Grace Matilda Former Secretary, Nurses League Professor and Vice Principal Katrina Moller College of Nursing Arogyavaram Medical Centre Arogyavaram
MIBE Graduate School for Nurses Invites applications from Trained 1. T rained Nurses (GNM) for Post Basic B.Sc. Nursing (2 Years) course at MIBE GRADUATE SCHOOL FOR Y 7, 2009 NURSES, Indore commencing on JUL JULY 2009. The College is recognised by Indian Nursing Council, Mahakoshal Nurses & Midwives Registration Council, Bhopal and Affiliated to Devi Ahilya Vishwavidyalaya, Indore. Eligibility Candidate should: a. Have passed 10+2 examination or its equivalent from a recognised board. b. Be a registered nurse and midwife with any state nursing council (a male candidate should have passed an alternative course prescribed by the INC in lieu of midwifery). c. Have minimum of three years experience after qualifying as General Nursing & Midwifery/alternate course. 2. From GNM Nurses for 10 months DIPLOMA IN NURSING EDUCA TION AND ADMINISTRA TION EDUCATION ADMINISTRATION course commencing on July 7, 2009.
Eligibility: Registered GNM Nurses with 2 years experience are eligible for the course. Sc BSc Application forms and prospectus for Post Basic B Nursing and DNEA course can be obtained from the office of the Principal on payment of Rs. 500/- and Rs.300/ - respectively by cash/Demand Draft in favour of “Graduate School for Nurses (MIBE)” payable at Indore. Hostel accommodation is available. Last date for issuing application forms: (1) P ost Basic B.Sc. N. - May 20, 2009 Post (2) DNEA course - June 20, 2009 (3) Last date for receiving completed form: May 28, 2009 Apply to: The Principal, MIBE Graduate School for Nurses Christian Hospital Campus, Sanyogitaganj Indore, M.P. 452 001; Phone: 0731 2704729,2700527 E-mail: email@example.com
Tips for Teachers Ms Subhashini Singh
A. How do you teach your students about Christian V alues in Values Healthcare Education? Through following ways: y The daily morning evening devotions — led by students and faculty. y Encourage students to attend church service every Sunday. y Conduct retreats and prayer meetings y During class teaching – give examples from the Holy Scriptures. y When students face difficulties and problems — council them. Some one sick at home —pray for them
B. How do Christian V alues Values help students? It helps them to: y Provide quality care to patient y Develop effective rapport with their colleagues, teachers and public. y Develop positive thinking and positive actions y Be courageous in taking initiative in leadership y Be optimistic y Be loving and affectionate. C. Work as a kind hear ted person hearted y Gain from the Teacher’s knowledge in spiritual matters y Are directed by how Jesus Christ our Lord can fulfil His mission through us
y Spread the Gospel message through work, attitude/ behaviours y Realise that every soul is valuable and that self development of spiritual status is beneficial for oneself, others and profession also. y Eliminate corruption from profession. y Their empathetic touch and care bears witness to our faith and makes the people think y Guides them to recognise the needs of people and fulfil them. Ms Subhashini Singh Lecturer, MIBE Graduate School of Nursing, Indore
BOOK REVIEW * by Ms Jancy Johnson, Secretar Secretaryy, Nurses League, CMAI The Mid India Board of Education of Nurses League of CMAI has published two books through BI Publications, Chennai.
2. Notes on Introduction to research
1. Educational Methods and Media for teaching in the practice of Nursing
This book also by Mrs Mercy John elucidates detailed insights into the research process. Though brief, it will definitely guide the students and teachers to go ahead with the research methodology. It explains the steps in very simple language and it will be very helpful for the research beginners. The main attractions of this book are as follows:It gives a very simple explanation on the types of research design. The author explains the data collection methods in such a way that a new researcher will find it very useful. The simple diagrams on how to present data will also be a good tool for the students. In order to present data in a systematic and organised way, statistics is very much necessary. The author has highlighted the way how to use statistics in research.
This book provides valuable insights into the educational aspect of Nursing training. As the new curriculum has introduced the subject Educational Methods and Media for teaching in the practice of Nursing, this book will give the trainers as well as the students a clear idea about the subject. The author Mrs Mercy John has given the advantages & disadvantages of different types of teaching methodology, which will help the readers to choose the appropriate method of teaching. A teacher needs to plan his/her teaching well before the actual teaching takes place. The sample teaching plan and the explanation of how to write a teaching plan will help the student teachers to plan their teaching in a better way. A detailed description on various types of audiovisual aids is an eye opener for the students.
Available at : BI Publications; Price: Rs. 75.00
Available at: BI Publications; Price: Rs. 60.00
* We publish reviews of books written by CMAI members and those sent in by CMAI members recommending a book with a review. The reviewer’s views are personal and do not represent any official CMAI endorsement unless specifically mentioned. The CMJI reserves the right to publish the review.
FROM OUR ARCHIVES
THE JOURNAL OF THE CHRISTIAN MEDICAL AS S OCIA TION OF INDIA ASS OCIATION
50 Y ears Ago Years
75 Y ears Ago Years
The memorable days of a student nurse's life
A Student Organisation
here are thirty-seven nurses in our Training School, too many to feel that they are all one, working together, unless there is something definite done to unite them. Realising this and the need to develop leadership among our nurses, we have recently helped them organise a student government. Each class of nurses meets and appoints two members to the student council every six months. The council elects its president from the senior council members, a vice-president from the junior members, and a secretary from the first year members. These officers act for the Student Nurses' Association also, which comprises the entire student nurses' body. The council meets weekly, and acts upon any business brought to it in writing by any member of the Association. The Association meets monthly, wherein the minutes of the council are read and discussed, and any new business desired acted upon. Each class appoints one member to form a social, library, home, rules and regulations, and religious activity committees. Whenever a matter comes before the council regarding one of these committees, the chairman of that committee is asked to attend the council meeting. The staff nurses are not included in the organisation. They each take a group of nurses to advise, guide, and encourage, as 'big sisters'. We wish that we could say that the Student Nurses' Association is working wonderfully well. It is too young to do much, but we hope that it will develop leaders and create a feeling of unity and cooperation. It is time to instruct the nurses in the principles of conducting business, the proper way of assuming authority without offending, an d of being just without fear of criticism. We have had to fight jealousies, pettiness, and indifference, but we do feel that it is worth while. We should like to hear about other student organisations. Helen Benjamin, Nellore The Journal of the Christian Medical Association of India Vol. IX No.2 March 1934
n the life of any nurse, perhaps trained in a Mission Hospital, there stand out two days as memorable. These are the 'capping' and the 'graduation' days, standing like lamp posts on the road of the life's career ever guiding forward and warning where necessary. They form the beginning and the end of the school career of the nurse and are worth mentioning, as they are universally felt by those who practice them to be a great means of providing the incentive and the inspiration necessary to take up the vocation, so noble and so dignified, but so poorly recognised by the public. This helps to form a target to be achieved by the nurse and as such a motive to sincere work, study and success. The address was simply heart rending. We were referred to as angels of Mercy and not angels; and as angels we were admonished to be loving, docile, cheerful and to bring comfort and happiness to each sick bed. We were warned against being angels, poking and causing pain and irritation. Since these two functions present such a great challenge to the nursing profession and to the paths of service, and since college and high school girls are so often attracted to this high calling, I strongly recommend the observance of these two functions in schools of nursing. It would be an incentive to many a cultured and educated girl if the college and high school girls are invited. This is the channel by which the standard of nursing in the eyes of the public can be raised. Alice Zachariah The Journal of the Christian Medical Association of India Volume XXXIII Number 5 September 1958
TLM Community Hospital Faizabad, UP
Pondicher ondicherrry Institute of ondicher Medical Sciences (PIMS)
Fellowship Mission Hospital Kumbanad
urgently requires y Full time dermatologist 1 y Full time lady doctor (MS or DGO or MBBS with experience 1 y Full time resident doctors w/ without experience 1 y Pharmacist 1 y Accountant 1 y Staff Nurses 4 Attractive salary with children education allowance, health fund, provident fund and other allowances will be offered. Free furnished quarters are available. Committed personnel from any church background are requested to apply with detailed CV to the following address: The Superintendent TLM Hospital Motinagar Masoda, Faizabad - 224 201 Tel: 05278-254025 Mob: 09935083026 E-mail: firstname.lastname@example.org
(Christian Minority Institution) (A Unit of Madras Medical Mission)
This is a 200-bedded Multi-Speciality Hospital trying to serve the total rural community consisting of over 16% Senior citizens and about 25% Below Poverty Line (BPL) group. We need the following additional staff staff:y Paediatrician, MD/DCH y General Surgeon / MS preferably with Laparoscopic surgical experiences y Gynecologist MD preferably with Laparoscopic surgical experiences y Dental Surgeon MDS/BDS (Female) y Casualty Medical Officers , MBBS with experiences 2 y Junior Medical Officers. MBBS 4 y Radiographers 3 Conditions of service negotiable. Apply to: The Administrator Fellowship Mission Hospital Kumbanad, Pathanamthitta Dist. Kerala 689 547 Tel: 0469 2664249, 2664760; Email:email@example.com
Pondicherry Institute of Medical Sciences (a Medical Council of India recognised Medical College) affiliated to Pondicherry University needs healthcare professionals including doctors, nurses and other paramedical staff for the hospital and the college with undergraduate and postgraduate programme and College of Nursing. Those who have worked in mission hospitals and are willing to take up academic responsibility are welcome to apply. Remuneration as per prevailing scales. Those who are eligible, please do apply at the earliest to: The Director-Principal Pondicherry Institute of Medical Sciences Ganapathichettikulam Pondicherry 605 014 E-mail firstname.lastname@example.org
BANG ALORE BAPTIST HOSPIT AL, BELL AR Y ROAD, HEBBAL, BANG ALORE - 560024 BANGALORE HOSPITAL, BELLAR ARY BANGALORE OFFERS 1. Diploma in Clinical Pastoral three years in professional pastoral Medium of instruction: English Counselling (DCPC) ministry or B.Th or B.D. Degree from Qualification y Affiliated to Senate of Serampore any university/college, with a BachBTh or BD both male and female College (University) elor degree in any subject from any candidates should have completed y For pastors and Christian workregular university. Both male and fetwo years in professional pastoral ers interested in pastoral care and male candidates should have comministry. counselling training (postgraduate pleted three years in professional pasFor application and prospectus, level). toral ministry. please send a demand draft for Rs. y Predominantly clinical emphasis, Single accommodation will be pro150/- in favour of Bangalore Baptist using clinical pastoral education, vided in the hostel Hospital, with detail postal address. 2. Diploma in Pastoral Healing (CPE) as the model of learning. Application could be obtained from Ministry (DPHM) Number of seats – 5 the office of the Director (CEO) at Medium of instruction: English Under Christian Medical Association the above mentioned address. Qualification of India. (CMAI) Issue of Application – 15/12/08. B.Th or BD Degree of the senate of Number of seats: 5 Last date of receiving - 4/4/09. Serampore College, or its recoDuration: One-year with clinical exapplication gnised academic equivalent. Male perience based learning for both candidates should have completed posts
A Change we need: commentary on the purpose of the current CMAI Constitution Review Rev Ninan Chacko
An argument for change of the present name and objectives of CMAI. As a fellowship organisation the decision making and leadership should be equally shared among members of the various sections of our national network, argues Rev Ninan Chacko
W Are we afraid of stating the change that we want, and are we only going through the notions of looking at legal barriers and not really looking at ways the law can help bring about the changes we need?
e must be willing to see the need for change. Change is chiefly needed in the name and objectives of our association so that they truly reflect our ethos. Change is urgent and possible! Change is mandatory and fundamental to our vision for a just and healthy society, we ought to change and move forward. I would like to use this forum as a plea to the CMAI membership to consider changing when reviewing our constitution. WHAT ARE THE ISSUES SURROUNDING THE NAME CHANGE?
1. Our name defines our work and purpose The term “medical” no longer defines what our work encompasses. Health does a better job, since it is not just the medical areas that we work in. We are a membership association of nurses, doctors, and other allied health professionals, including health administrators and pastors but we seem to be emotionally and historically imprisoned by the adjective 34
‘medical’ to describe who we are. The whole world has moved on, away from a ‘medical model’ which I see as a strictly hierarchical structure with doctors always in leadership positions, to a more inclusive “health model” -which I see as a comprehensive approach with a wider understanding of enhancing life and living needs. 2. We have already accepted Health and the Health Care Model rather than a Medical Model in our work but are hesitant to change our name. We seem to have become comfortable with hypocrisy when we all accept the WHO definition of health, and participate in the work of the Ministry of “Health” and (note even that is not called medical) Family Welfare, but keep our old name. For example, when invited to gatherings we are represented by our “CMAI” leadership who eloquently speak about national health policy, and are active in working around the National Rural Health Mission but are always represented by the medical profession.
3. We have accepted healing as our Christian Mandate and hold positions of leadership in the Church’s Healing Ministry. I feel that we certainly have a mandate to proclaim the healing ministry of Christ which is a holistic ministry. That is the reason why we are called Christian health care providers. In Part II of our constitution we have moved beyond the medical and have accepted the term Health as a better description of our work. The term “health” is frequently used and has replaced medical. Even within our own membership we have moved from calling some of us “paramedicals” to “allied ‘health’ professionals”. 4. We can change our name, we have changed names earlier, and others of our brethren have too There is no precedent that we cannot change our name. Our own Association changed its name in 1926, from Medical Missionary Association to Christian Medical Association of India. As I understand it, also our Roman Catholic brethren changed their name from Catholic “Hospital” Association to Catholic “Health” Association of India in 1993. Our theological slogan is “Healing Ministry”, and its meaning is printed and published in many of our CMAI publications including the diary. WHY ARE WE SO UNWILLING TO CHANGE?
It takes visionary and vibrant leadership to accept the inevitability and uncertainty of change. But without change there can be no growth. We can surely find the strength within us to face legal problems that need to be handled. We need to view the legal cautions as an opportunity to review CMAI’s constitution and make it more dynamic, relevant, and appropriate for a network working in health care.
It is only when we follow our vision faithfully that we can put the legal obstacles behind us. We must not be afraid to incorporate our vision into the objectives and aims of CMAI just because our lawyers ask us not to do so. Are we afraid of stating the change that we want, and are we only going through the notions of looking at legal barriers and not really looking at ways the law can help bring about the changes we need? Being legally correct but ideologically dead is not the primary aim of a constitutional review process. 1. Our comfort with the status-quo leads us to deny the need for change I feel we are, perhaps, in a denial mode when it comes to moving towards a more dynamic and relevant name, and we refuse to spell out our commitment to health and healing in our objectives. 2. The theological and practical underpinnings for moving towards using words that dignify the more holistic and inclusive work we are doing have already been accepted. Our articles of faith are clearly defined and spelt out in the healing ministry statement of CMAI. Our faith assumptions are printed in bold print, and circulated in all our publications. This ideological position is also reinforced during the Healing Ministry Sunday, year after year. We use the language of healing and health in our Journal, and not the language of medicine. Palliative care, pastoral care, counseling, nursing care, nurture of health professionals, reaching out to those on the margins, our advocacy role-all these, and other programmes of CMAI, speak in one voice about health and healing. But the objectives in our Constitution are not inclusive of this wider concept. Our objectives do not spell our vision, the real nature, and call35
ing of our Association. We are still glued to the words provided during the missionary era and its objectives, which were mainly medical in nature. Why are our faith assumptions deliberately kept outside the premises of our constitution? If our motivation and inspiration is the healing ministry of Christ it is not seen. This conspicuous absence of our fundamental ideological position from our name and constitution is an anomaly we should rectify in our day. Today, we are primarily Christian in our understanding of health, and so we have a responsibility to state our position clearly and honestly and consistently across all our documents. We see that Part I of our constitution, as it stands, lays down a medical model of health as our foundation. The terms “prevention of disease and suffering”, for example, I feel is a gross understatement. It is narrow, insular, and tribal in its composition, nature, and vision with objectives stated. In this form we are tied down to a narrower exclusive medical vision and are not at liberty to move forward with issues of health and healing. The constitution review allows us to address this gap in rhetoric and intention and honestly restate our intentions in name and deed. Therefore, I feel there is an urgent compulsion on us to explicitly re-state and re-formulate our vision and objectives, and our role in the light of our wider understanding of health under the title, objectives of the Association. We should mean what we say, and we should say what we mean. Those who see our name (in India and abroad) will not understand our role and responsibilities as a health agency, which draws its inspiration from Christian healing ministry. By not being willing to change our name we will be left out as a group that calls itself health professionals in our country and in our generation.
STAYING RELEVANT BEING MEANINGFUL
A case for reviewing our constitution is also about our attempt to staying relevant, appropriate and meaningful in how we state our objectives and aims. While arguing for a change of name and objectives, I am also pleading for a greater sensitivity on our part to the realities of health care in India and the world around us. If we describe ourselves as the Health Arm of the NCCI, the Church in India we need to be able to share a name that affirms our identity, our vision, our mission, our role and responsibility as a health agency. It should spell out nothing less, nothing more. The name does not matter, is an argument mooted the powerful in CMAI. By saying so we forget who we are, and we forget our mandate. Rewriting the objectives and changing the name of CMAI is vehemently being resisted on the grounds of practical considerations. The arguments amount to throwing out our commitment to healing ministry, and reducing ourselves to a group of technicians. Technology has, perhaps, usurped our theological position as the Church’s ministry of healing. The argument for opposing the change has wider implications for the membership of CMAI. If we take an honest and critical look at ourselves, we can see that our leadership has always been from the doctors’ section; others have been given only a marginal share in leadership. During the past 10 years of CMAI who has held the leadership positions of the organization? There are only two occasions one when non-doctors were leaders – a nurse became the President Ms Aley Kuruvilla 1984-86 and another when a nurse became the Editor of the Association Dr Leila Caleb Varkey 2007 to date. The CMAI biennial conferences
are the venue where decisions about leadership and change are considered. At these conferences why is it that we assume that key positions of CMAI leadership should always be from the medical profession? Does this not have something to do with our name? Why hasn’t a nurse, an allied health professional, a chaplain or a health administrator ever become the President or General Secretary of the Association? The reason for this is an obvious bias towards doctors. So in many ways our current name CMAI does signify that we are medically driven. We should not then falsely claim that we are a membership and fellowship organization of health care providers where all hold equal worth/value. If CMAI is a fellowship organization then decision making and leadership should be equally shared among members of the various sections of our national network. The current hierarchy or professional categorisation in CMAI leads to a repeated denial of the rightful claims of nurses and people from other sections from leadership positions. These exceptions prove the norm. If our concept is medical, CMAI would then be limited to only the practice of medical care. So today, if, we are willing to make a change for a wholistic and inclusive national network, why are we uncomfortable with the decisions/actions we need to take when we seek to change our name? History shows that emotions run high when there have been attempts at rotating leadership among the five sections of CMAI. The sheer differential in numbers is a contentious issue. Do we, like a democracy, agree to let the majority decide? If so, we would run into more sectional politics since we know that in terms of numbers, nurses lead, followed by allied health professionals, 36
followed closely perhaps by doctors, administrators and chaplains. Part I of our Constitution should be changed to honestly reflect the true nature of our fellowship, our vision, and our commitment to the healing ministry. We should, therefore, consider appropriate, meaningful, and inclusive names, such as : Indian Christian F ellowship in HealthFellowship care, Christian F ellowship of Fellowship Healthcare in India, or F ellowship Fellowship of Christian Health Professionals in India India, and such others; always holding high the vision of health and healing over practical considerations. The decision to change or not is still open. My plea is that we rise above sectional vested interests and participate in this process of debate by sending in our opinions. So far the sections of CMAI have met and the issue has been discussed. Only two Sections in CMAI have passed resolutions against the name changedoctors and administrators. The Nurses section are still debating the issue. The Chaplains section has resolved for changing the name. Change, for which the time has come in CMAI, should be a liberating exercise for us helping to build a more healthy and just society and not just an opportunity to move towards a more medicalised society.
Rev Ninan Chacko (Member Board of Management CMAI, Former Chaplain, CMC, Ludhiana & Presbyter, Church of North India) email@example.com
Readers are requested to send their views on this subject to The President CMAI C/o firstname.lastname@example.org Editor