CMC - Day Ten

The first order of business on Thursday mornings, bible study, is a reflection of (and on) the Christian roots from which this institution draws its purpose. There is a weekly bible study guide published solely for CMC and the weeks bible passages and lessons are read and discussed throughout the week in numerous small conference rooms across this large campus. Today's discussion centered around the notion of the "mission." If you'll allow me a rare opportunity to quote from the bible: "The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field." So said Jesus as quoted in Matthew 9:37,38, and so have missionaries risen up in response.

The small accompanying reading told of small missionary hospital in north India that was started by a missionary from Scotland who felt god's calling on a trip to India (please understand that i spell "god" with a lower case "g" because my belief is that "god" is in the small things, and in everything; that uppercase "G" enforces, in my mind, an unacceptable distance to they who would draw strength from that energy). "What happened to those who come to CMC from these mission hospitals for training?" the reader is asked, rhetorically. "Are they nurtured? Cared for? Mentored? For most of them the intense training is an exhaustive experience. These are people who go back to the mission hospitals to take up leadership positions. What a great opportunity to invest the lives of these young doctors who will be the leaders of tomorrow?"

Of the 60 undergraduate medical students - i.e. those at my level - that are invited to attend CMC annually, 45 are sponsored by mission hospitals across India. It is not a financial committment, but rather a spiritual one and a bond to a hospital and to patients in communities in India that would otherwise have difficulty attracting physicians. So a discussion of the "mission" has both religious and practical merits. Questions for reflection and discussion were numbered as follows:

1. How can we be involved in a "mission?" Is it going to a rural place in north India, or is it where you are convinced that god has called you to be? Is it the place that matters or the purpose?
2. Is our mission just providing medical care? Where is the place for the Great Commission in this "mission?" In what way are Christian mission hospitals different from other charitable hospitals?

The discussion that ensued revealed something about India. Beryl, the intern i've mentioned before, was asked about her two years mission experience prior to coming back to CMC - she had trained her as an undergraduate. Her time in a small hospital in rural Tamil Nadu was not without its hardships, chief among them was the constant discussions about and demands for money that infected the staff at the hospital, physicians included. Others chimed in with similar experiences. What evolved was not a discussion centered on the purpose of mission hospitals and the doctors that minister there but the corruption of missions, that is apparently endemic. Dr. Peter, the consulting physician, spoke about his experience: the hospital where he spent two years yielded immense profits from the care they provided and from the money they took in from Christian charities abroad. The doctors were poorly paid and the money was channeled into the bishop's pockets and those of their family, which formed a "small mafia" of sorts. This is not, apparently, an uncommon problem. But it is demoralizing. The hospitals end up being cash rich and care poor.

Being a physician is unique because our professional obligations are in and of themselves missionary based. The first line of the Geneva Convention, which we recite as early as our first year of medical school, says: "I solemnly pledge to consecrate my life to the service of humanity." Christian doctors in a Christian hospital have, in some sense, a double mission, a professional and a religious obligation. I explained to the doctors around our little conference table that physicians and medicine are not free of corruption in the U.S. We nurse a relationship with the pharmacuetical industry that benefits the least our patients; we have a system of healthcare that benefits the most those with the greatest conflicts of interest and bankrupts those who choose to utilize it. What should be seen as the biggest scandal, that we pay double per capita what other industrialized nations pay and have neither a completely insured public nor the health indicators to show for it, is not known, ignored, or, worse, accepted. And so we have the challenge, in a relatively secular medical world, of engendering in students and physicians a sense of purpose, or "mission," that will lead them to refuse the inequities of the status quo, that will lead them to change the system for the sake of our patients. How, i asked, can medical education in India train its graduates not to accept the corruption that exists in the missionary hospitals (or any hospital for that matter)? From what can a Christian medical education, or medical model, draw to teach the rest of medicine about what a "mission" really is? No one around the table could say. What it is certainly not a mission is worrying about inadequate salaries while a hospital and its administrators get rich and the patients suffer? (Put that way, our healthcare system doesn't seem so different from theirs.)

I read an editorial in the Journal of the Mahatma Gandhi Institute of Medical Sciences about medical education in India and how it must shed the standards of training it inherited from the English. The author, an Indian physician now based in the U.S., laments the current and rigorous system of rote memorization of all facts medical. He argues in favor of medical education that emphasizes more the humanities, one that reinforces our central humanness, and might allow Indian medical graduates to more readily empathize with their patients by understanding better who they are and where they come from. The system, he continues, must reinforce patient care rather than patient illness. His suggestions mirror changes in medical education that we've seen in the U.S. in recent years, something for which we should be grateful. Maybe, too, this focus on humanities offers a solution to this question about how to instill in students awareness of their professional mission. After all, in the face of corruption and inequality, it's much easier to advocate for a human than a disease.

On the clinical front, we stared incredulously this morning at a CT scan of the brain of a beautiful young girl admitted for recurrent episodes of staphylococcal meningitis. It showed that the "polyp" we'd seen peaking out of her right nose was actually part of her brain. This young girl has a very rare intranasal encephalocele. We returned to bedside with our flashlight and sure enough we could see a flattened gyrus and minute blood vessels of that essential organ which should be inside the head, not out. This girl will have to have surgery to put it back and to close up the hole that let it out.

I'm off to the beach again, this time in Pondicherry, a former French colony about an hour south of Mahabalipuram. My mission, this weekend, is to find a flaky and warm croissant. I'll let you know how it goes.

bon weekend.

justin

One more thing...

Though not a Christian, i think these weekly bible discussions to discuss faith are probably invaluable to the physicians here. We could do with such a thing, just like we could use a set morning coffee break. Whether a Christian, a Hindu, a Muslim or an existentialist, discussions about how our individual faiths contribute to the practice of medicine could only make us better physicians. After all, if we cannot discuss these things amongst ourselves, how can we be expected to do so with patients. When it comes to improving their quality of lives, understanding what spiritual reserves they bring to achieving that lifestyle is critical.