Monday, December 13, 2010

Expectations of a Mission Hospital

When I was asked to write about my expectations of a mission hospital today, my mind went back to my own experiences of a mission hospital. When I was a boy, I was admitted in Neyyor mission hospital in 1964. What stands out in my memory is the friendliness of the nurses and the simplicity of the doctors. The room was small, adequate and clean. I was just a child and the male nurses played with me and showed me how to make small toys with rubber caps of bottles and small cardboard boxes. My family could afford the basic cost of treatment but many received concessions according to their needs. People on the whole were very kind.
This experience stayed with me even after I joined CMC, Ludhiana to pursue medical studies. Many of my teachers who were missionaries showed me the meaning of Concern, Compassion and Care through their interactions with patients. So when I came to Manali with my wife Sheila to run the small mission hospital, I had memories, experiences and impressions to draw from. It was a joy to work with a handful of people and bring about a caring community.
It took time, prayer and a lot of inner quests to develop this work.
"What brings the spirit of Christ into our work?"
"What is excellence?"
"What is efficiency?"
"Do we need to sacrifice one for the other?"
"Do poor people need ‘excellent medical care"?
"What is team spirit?"
"How do we say ‘no’ to the rich and the pushy when we do need money?"
These questions kept us focused and open to God and His thoughts.
But as the work grew and more people were employed, it became difficult to know each of them at a deeper level and pass on the ethos, which we had received. We probably failed to communicate that on a personal level when the numbers became overwhelming. The atmosphere began to change and a group of people working together like a family with common goals became an institution with too many rules and regulations. This led to less interpersonal relationships and involvement with each other on a daily basis. We had no time to give to people to build them up as care givers. The joy of sharing was replaced by hurry, worry and complaints. Patients became problems and business took away time to listen, guide and really care. The more we grew the more indifferent and distant we became. Tension and distress replaced pleasant manners and welcoming attitudes. Yes, we continued to work hard, made new projects and statistics showed that we were viable and self-sufficient. Once we became smart and learned the tricks of the trade, people became irritants and priorities began to change. Real prayer that used to be the foundation of life expressing our dependency on God became more of a ‘duty’ with no depth. Slow spiritual depression set in and continued to keep the external appearances of religion. Various events brought us back to God intermittently and we are thankful to these interventions of grace.
We realized that no one person in the mission field can provide all the care. Every one in the team is important. The staff members that are expected to give care to patients need to first get cared for themselves by the management. If they are treated with respect, they will give respect to others.

So what have we learnt?

♦ Working in the spirit of Christ is possible when we keep it small.
♦ If we become an institution then each department can be given its own independent way of running by the leader so that it still remains a small unit. (Plural leadership)
♦ Prayer is foundational. A core group of people interceding with God for direction and seeking wisdom are vital.
♦ Business strategies learnt in the corporate world need to be redefined by Christ’s pattern of servant hood before they are implemented in a mission hospital. Priorities are different.
♦ Plural leadership is important – it helps avoid power struggles and keeps us accountable to each other.
♦ Delegation is an art to be learnt early in the game….to avoid burnout.
♦ Communication with staff takes root outside working hours.
♦ We need to rediscover the significance of the mission hospital in our own context. It’s different in different places even within our own country. Or perhaps even in the same hospital after ten or fifteen years.
♦ Our staff needs to be cared for if we expect them to care for the patients.
♦ Wisdom in choosing our advisors makes a lot of difference in our work.
♦ Poor patients CAN get excellent medical care at a lower cost as long as our aim is not "making money at all costs".
♦ God provides in unknown ways beyond human understanding…..always keep that in mind instead of a ‘plan B’

Role Models of Care:
If a mission hospital is a place of witness, an arm of the Church which is the body of Christ, then it needs to become a place of compassion to all! True compassion is not natural to humans. Yet those who claim to follow Christ have a working model in the life of Jesus. It can be cultivated and communicated. It ought to reflect the outlook of Jesus. Its administrative outlook needs to be transparent and honest. It should be a place of clinical excellence.

Listening, showing empathy, a kind touch, speaking the truth in love are all hallmarks of the mission atmosphere at all levels of work.

 Dependency on God and trust in His promises to take care of the needs of the mission needs to be expressed through corporate prayer. (At least the core group of people needs to be consistent) Any planning needs to keep the mission mandate in mind; in fact in all planning it is important to take God’s purposes into consideration. Seeking wisdom and clarifying motives needs to be a priority. Leaders need to show consistency in their approach to various issues and know the mind of God expressed in Jesus. It is important to question the reason and relevance of various activities that are brought to focus. Mission hospitals can be a place for God-encounters. Can our system provide such a place? We will fail in different areas as human nature and emotions are unpredictable. But this ought to be a challenge in reconsidering our style of functioning and taking steps to correct it rather than be aggressive and defensive. There is a need to be cautious about those who work against the mission ethos and take the necessary steps to correct unhealthy practices. There is always room in the human heart for improvement. Regular coming together as teams and also having input from patients and relatives about their experience of care are needed to improve the way we work. It is important to look into the family time available for young couples before they get burnt out through over work. Physical and mental tiredness of the staff needs to be taken care of before they quit the mission. Nurturing of new staff by the seniors is vital in sustaining the spirit of commitment and care. Attitude and communication skills of nursing and paramedical staff are vital to create the good will among the patients and relatives. They need all the support to carry out this big job.
Small mission hospitals need to have partners for good referral places for their patients as all these hospitals may not have facilities for certain medical problems. So a good understanding between various doctors, clinics and facilities in the neighborhood are essential. Networking with those who are professionals in various fields is helpful.
Mission hospitals need to take an active role in health education, preventive medicine and training programmes. It can also be involved in research that will not contradict Biblical values. Yes, a caring small mission hospital in rural India can make a big difference if it is motivated by a love for God and people. It can become a beacon of light that will elevate the value of life.
The Challenge of finding human resources Mission work needs money. If there is no financial support from outside or from the church then the management needs to raise it from patients. To attract patients the management needs to provide services, which involves doctors, nurses, technicians, equipment and infrastructure. Now a day’s not many people are committed to missions or its ethos. Many come for salaries and other perks like children’s education, housing, security, leave benefits etc. In this changing world how do we get committed people?

Many people may work for less pay if the atmosphere is a happy one and they experience care and understanding. A sense of vocation and belonging is needed for sustaining this commitment. A sense of belonging that is free of power struggles and full of caring for one another.

The management style, the atmosphere of the workplace, interpersonal relationships, and opportunities to develop confidence are all-important in this commitment building process. There ought to be role models of care in every mission set-up. Opportunities to express feelings and raise questions and seek answers without fear are essential for the commitment to take deeper roots. Medical students and young doctors need to be exposed and challenged to consider mission work. Retired Christian doctors ought to consider giving their time to train young doctors in mission field. This can be their retirement project!
Knowledge is power and sharing power is not normal. My unwillingness to share knowledge and skills with my colleagues is a sign of wanting to remain supreme. Many are put off by this attitude in the mission hospitals. It is a way to control juniors. Knowledge puffs up and power corrupts. Genuine love is the antidote to both. A Mission hospital is a place where real love can be practiced and encouraged. It is the place for learning patient care and developing skills to provide such care.
Continuing medical education by various professions (doctors, nurses, paramedical personnel) is important to make this kind of care effective. It is also a sign of ‘caring’ for our employees. Yes, it is possible to have a good management that will provide the atmosphere for all to serve and take care of the sick. Each department needs to have a caring leader who will give the needed direction and create an atmosphere that will reflect the mission ethos. If the local church is a witnessing and loving community then they need to be involved as partners in caring. Time for personal growth, reflection, recreation, informal dialogue and other such spiritual input are mandatory for the mission staff to stay alive. Fellowship, worship and challenges to follow Jesus Christ are the foundations of mission work. Worth and value of each one in the team needs to be cherished. Good communication, openness and trust needs to be cultivated. Hierarchy, bureaucracy and fear need to be replaced by respect, servant-hood and genuine interest in people. Servant-hood in leadership needs to be seen. Perhaps we need to organize more ‘servant-hood’ seminars instead of ‘leadership’ seminars
Delegation is important
As we see in the Old Testament story it is important to heed the advice of Jethro as Moses did. To share the burden of caring by delegating responsibilities to able people who fear God, who are trustworthy and corruption free. This is the secret of good management. Moses himself had to provide the spiritual leadership and act as a consultant for difficult issues. When we delegate responsibilities we trust that person to do the job. True plural leadership is an outcome of true delegation.
This art of delegation needs to start early in our careers before burn out happens. We need to develop trust in our colleagues if we are to be a community giving care to others. People need to exercise their gifts in their work place and feel part of a team. Individuals with seniority and experience need not be just ‘figure heads’ to be used for attracting project funds, they need to be respected as individuals for who they are…….wisdom in delegation is important.

The basic ethos of a mission hospital:

All said and done heartfelt concern and practical care are the core of a mission
Serving one another is an expression of love.
Loving my neighbor is the only expression of loving God.
Everyone who comes to us in the mission setup deserves to be loved and listened to.
The poor need much more tenderness to retain their self-worth in a cruel world.

A need to redefine ‘mission hospitals’ in our context
In today’s India, there is a need to redefine what we mean by a ‘mission hospital’. What is the public’s understanding of a mission hospital? I think it started off as an expression of the church’s concern for the world. Just like the temple was meant to be a place of prayer for all nations but ended up as a den of thieves, the mission hospital’s original purpose got distorted and corrupted over the centuries to something entirely different. For Mission work to be real the core values and motives should remain Biblical. Just because the title deed belongs to some local church does not make a hospital a mission hospital. It will be like the blind leading the blind.

Many mission hospitals are no longer in remote places. Small towns have grown around them. People are no more illiterate and ignorant like before. Many can afford basic treatment. There are other private hospitals that provide better treatment for a price. Even some of the Government hospitals do good jobs. Diagnostic laboratories have sprouted everywhere. People do not have to travel long distances to get medical care except in some really rural places. There is a need for well-equipped urban mission hospitals that can be referral places for smaller mission hospitals. These mission hospitals can adopt a business model that has a basic Christian agenda. The question will be "can such systems be a witness to the gospel?" (As the majority of the staff may not subscribe to the Christian belief system) Temptation to get side tracked will be high and very few people can cope with this challenge.
I think there is a place now for small Polyclinics and nursing homes where a group of caring Christian doctors and nurses can work together as a team to reflect the "mission" ethos. Again with a trustworthy referral system this can work well.

Search our hearts:
Are we any different from those hospitals around us?

What do we claim ‘to have’ as a mission hospital that is different from others? We need to search our own hearts as leaders. Mission ought to be a place of ‘love in action’ for all irrespective of who they are. There is a need to critically analyze the ‘love level’ of the staff and make programs and training to improve this instead of appraisal forms to be filled in by various heads of departments and introducing unnecessary ‘control’ styles. The staff also needs to reflect the management’s level of compassion and feel free to give the needed input. Both management and staff need to listen to each other and be partners in decision-making processes.

Mission hospitals have a role to play in today’s technologically advanced and financially thriving health care system.

In the midst of all the technological advancement and high cost of medical care how do we continue to have empathy towards the ‘have -nots’? Have we generated goodwill from the community around so as to benefit from their contributions towards the support of the poor and disadvantaged? We can have special clinics, may be else where, both preventive and curative where the poor can come without feeling odd and this could be an exciting venture. Various services can be tailored to meet the needs of those who do not have enough. Unnecessary tests and other expenses can be avoided. Consultants can give part of their time ‘free’ every week to enhance the care of the poor. Those who actually need financial subsidy may be a few on any given day and they must not be left out. Other avenues like medical insurance, sponsorship need to be looked into. Someone needs to develop a special interest in looking into the needs of the poor and find solutions that are appropriate.
A Challenge to Exist
Mission has a higher reason to exist but if the ‘Light’ in mission hospitals is dark then that is a great darkness. Nothing can dispel it. If the salt has lost its flavor, then it is useless! Any thing can be bought with money! But if we are a loving and caring community, people will flock to our doors in spite of us not having the ‘latest equipment’ or ‘sophisticated facilities’. This requires people with commitment, goals, a serving heart and above all a trust in the Almighty. We need not be in competition with the world, rather we and our work should be such that the world would stop and take a good look at us and learn something of value from the way mission hospitals function.

The worldly ways of running an organization need to be abandoned and Jesus’ way ought to be embraced. If this is not possible then we need to throw away the whole mission jargon and have the courage to call a spade a spade and not call ourselves by that name.

Drs George and Sheila Varghese

1 comment:

  1. Very relevant today! Thanks for deciding to make it online. I hope you will be adding more articles over time !