Monday, September 20, 2010

Mission Hospital Blues!!

With every passing year, the number of surviving mission hospitals grows smaller and smaller. And the number of doctors who would even consider thinking about mission hospital work as a career option also diminishes year by year. So much so, that over the last few years, the big question on the lips of leaders and workers in mission hospitals at every meeting and conference has been - What is the future of the mission hospital system and what is the best 'model' that we need to follow.

Well, I am not going to try to answer a question which many greater minds than mine have still deemed a mystery!! And I am not even going to sound a clarion call (at least, not yet!!) for doctors all over the world to drop everything and rush to the forbidding (and often, dirty!!) corridors of the 100 or so surviving mission hospitals in the country. Actually, this post comes at the end of a long day of trying (and sometimes failing) to empathise with patients and relatives whose ideas and understanding of patient care are often at a totally different end of the spectrum from mine!! And I thought it would be cathartic (and possibly entertaining!!) to enumerate a few of these basic differences that I have with our patients here at Roberts Hospital. Here goes....

OXYGEN ANTIPATHY: I thought I should start with the most mind-boggling of all the local ideas that 'interfere' with our idea of the 'best medical care' every day. There is a widespread superstition in Meghalaya that oxygen is a precursor to death and hence must not be given to a patient, come what may!! I didn't believe it myself at first and was surprised when the sisters would ask the relatives permission to start oxygen when a sick patient came in. And when they would (to my disbelief) refuse, I would spend many precious minutes trying to explain in every-which-way possible (scientific or otherwise, politely or otherwise!!) that oxygen was the most important ingredient of the air that we breathe and so on and so forth. To absolutely no avail. I guess this superstition began when people realised that most patients who were started on oxygen would eventually die, mainly because of the poor resuscitation facilities that were available (more on that later!!). And now, it is firmly rooted in their minds - oxygen kills the patient!! Beat that for a superstition!! I have come up with a solution - though some of you may question the ethics of it!! I just start the oxygen and forbid the staff to tell the patient what it is (though some disobey, as they themselves believe the superstition!!). If the relatives ask what it is, I just say it's a special medicine that is given into the lungs. So far, they have all believed me!!

ALLOPATHY ANTIPATHY: I can hear my brothers and sisters from mission hospitals across the country lending their voice of assent to this observation. It is amazing that after so many decades of allopathic practice in our land, the local 'quack' is still more acceptable than the poor doctors who have struggled with the confusing concepts of medical practice for 6 and a half years (and in many cases, more than that!!). Here in Meghalaya, there is an alternate system of medicine which we call Khasi medicine and there is great faith in its efficacy through all classes of people. Even some of our doctors take Khasi medicines when they are ill!! Now, I certainly agree that there will surely be some logic and science in all alternate medicinal practice. However, when it comes to some diseases like cancer, I feel these systems of medicine are still way behind the rapid strides that allopathy has made with surgery, chemotherapy and radiation. Just 2 days ago, I saw a lady who was admitted in the medicine ward for control of her blood pressure. She had presented to us about 9 months ago with a small growth on her lip. At that time, all it would have taken was a small operation and a clearance of the local lymph nodes to cure her. But she decided to take Khasi medicines. Now, it is a huge fungating growth involving the complete lower jaw, pouring with pus and bleeding regularly. But the saddest thing is that she is still quite sure that the Khasi medicine is working. She says she is feeling better and wants to continue those medicines.... I had tears in my eyes as I left the room.

OPERATION ANTIPATHY: I guess this too, would be a common finding in all mission hospitals. Patients are sometimes just unwilling for operation. I have lost count of the number of patients who have flatly refused even to enter the operation theatre for a dressing, let alone a procedure!! With ailments ranging from life-threatening intestinal perforations to run-of-the-mill abscesses, patients from across the board display a strange revulsion to the very word operation (which seems to translate the same in all languages!!). And now, here's the interesting part. I have actually seen some of these patients completely recover without the operation that we had insisted on performing!! Perforations have sealed, abscesses have ruptured, infected wounds have cleaned up and fractures have set, just with antibiotics and TLC. In fact, this became so common at one point, that I even discussed with our good friend and psychiatrist Dr. Sandy Syiem whether it would be worth studying this phenomenon - that patients who refused surgery often got better anyway!! Thesis topic anyone!!

LAPAROSCOPY ANTIPATHY: Once the patient has been convinced, through our most persuasive entreaties, that an operation is absolutely essential and life would be at risk if they delayed (my cheeks burn sometimes at the various persuasion tactics!!), we run up against the next big hurdle. As we have been blessed with a lot of sophisticated equipment, we have the facilities to carry out minimally invasive laparoscopic and endourological procedures for most of the common problems here. However, our patients are dead against this. Throughout the world, there are papers coming out every day clearly showing the great benefits of laparoscopy over open surgery, but nearly every day, we have a 'discussion' with a patient about it and fail to convince them!! Here, laparoscopic and endo-urological procedures go under the sobriquet, 'drill'!! I have no clue where that came from, but I do know that the early laparoscopic surgeons had a few complications and now patients will refuse the 'drill' outright!! Again, we have had to slowly begin the re-brainwashing and have banned the word 'drill' from hospital parlance. However, while things are certainly better, just last week, we had a patient who preferred to have an open cholecystectomy, a procedure that is now completely outdated in most parts of the world except in places like Meghalaya!!

RESUSCITATION ANTIPATHY: Now, this is a 'superstition' of the hospital staff that I have seen in nearly all the mission hospitals that I have worked in (five and counting). It is a common belief that aggressive resuscitation is a waste of time and effort and hence not worth even beginning. In most of the hospitals, the doctor is informed that the patient is 'gasping' and when he or she arrives, the patient is in the late stages of rigor mortis!! In fact, some doctors take their own sweet time to come and see the 'gasping' patient, so that by the time they arrive, the patient is well and truly dead and they don't have to make the pretense of CPR, intubation and resuscitation. I guess with better medical education and more aggressive doctors, this will change in the next 10 years or so, but till then, it is rather stressful to be at the bedside of a patient who is arresting, with absolutely no resuscitation equipment ready or organised.

THLEN FEVER: In Vellore, we have a large number of patients who come to the community hospital every month for vitamin tablets. They are given the fancy-sounding diagnosis, KKI. This actually stands for the Tamil translation of hand-leg-pain!! Every hospital will have these patients, who come mainly to see the doctor, chat a bit and go home feeling reassured that all's well with the world and their body!! But here, there is a slight difference. A mythical snake-like creature called the Thlen is said to have haunted these parts in the days gone by. It was killed, but then regrew. (For the full story, read this). Now it returns every now and again to haunt the local people. So many patients who feel weak, giddy, gaseous, uneasy and basically have KKI, believe that the Thlen has got them. This makes the cure even more difficult (as if it was not tough enough already!!). Of course, this also gives an opportunity for prayer, but then, most of the people who come in with Thlen fever are actually Christian!! And here's the best part. I have heard at least 2 doctors confirm the existence of the Thlen and corroborate instances of its haunting of people.....

There are many more favourite superstitions of our local people that confound and frustrate our best attempts to provide quality care to them, but I guess I will leave those for another day. Some of these are common to all mission hospitals, while others are totally unique to Roberts. I can imagine some of you won't believe me, but hey - this stuff is just a part of the great excitement of life in a mission hospital!! You have just GOTTA experience it to believe it.... And trust me, it's TOTALLY worth it...

P.S. Just to make it clear, my understanding of a mission hospital is one which is built on the foundations of a relationship with Jesus (individually and corporately), which attributes its existence to His call to preach the gospel and which concentrates its energies on the poor people and the marginalised..... Of course, there are very few hospitals that would fit this description exactly, but you get the general drift...


  1. Hi Arpit and Amy,
    I enjoyed reading your blog. Brings back the lovely memories of shillong.By far,shillongites are the most simple, modest, humble and honest people.
    Keep up the good job.

  2. Thank you for that entertaining post. We empathize with your 'antipathy blues'.In the same vein please write another post about 'grateful hues' as your patients respond to your care and interest in them. It is all the grace of God that enables you to serve happily in a mission hospital and God who heals so tell us some of the high points where you have experienced God's enabling.

  3. Keep working, praying, helping, writing. God is good - and uses very limited folks like us for His Kingdom.

  4. Thanks everyone. And total agreement with you Anamika, about the people of Meghalaya (more so with those from other parts of the state, I would say!!)

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