Monday, February 27, 2017

Watching birds keeps depression, anxiety, stress at bay, says a study

People living in neighbourhoods with more birds, shrubs and trees are less likely to suffer from depression, anxiety and stress, according to a new study.

The study, involving hundreds of people, found benefits for mental health of being able to see birds, shrubs and trees around the homes, whether people lived in urban or more leafy suburban neighbourhoods.
Read more about this study here

Then, Keep your eyes open. And consider moving to beautiful rural India!

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Sunday, February 26, 2017

The Kingdom of God

(This is the text of one of my last sermons in CMC, Vellore, before I left in Oct 2015)

If there is any one theme that runs through the entire Bible, tying everything together…..from the Old Testament to the New, from the story of Creation in Genesis, to the call of Abraham, and the choice of the people of Israel, to the coming of Jesus, and the teaching of the apostles, to the description of the return of the Triumphant King (described in Revelation)……….this is it: The theme of the Kingdom of God.

Understanding this theme is so critical and crucial, because it needs to shape our worldview, and influence the way we think and live. It helps us to understand the purpose for life, and discover the reason we exist. It helps us find our life work and vocation.

This is so vital for each of us.

Let me try and tell you the story:

The Great King, one day, decided He was going to create a beautiful and fantastic Kingdom. The Bible begins with these words.

In the beginning, God created the heavens and the earth. The earth was without form and void.

Empty and disordered.

Over the next few verses, we see how God went about Filling and Bringing Order to the earth.
He spoke, “Let there be light.” And there was. “Let there be earth and Sky”. “Let there be land and sea, plants and trees.” “Let there be sun and moon and stars.” “Let there be water creatures and birds” “Let there be animals and beasts of all kinds”

And things happened as God spoke. Immediately. Like clockwork.

But then there is a change in the pace of the story. Somewhere on the sixth day, we find a little conversation. We get the first clue that God is a Trinity, a Relational God, as Father, Son and Holy Spirit discuss together about the next amazing thing they were going to create. The peak of their creation.

Then God said, “Let us make man in our image, after our likeness. And let them have dominion over the fish of the sea and over the birds of the heavens and over the livestock and over all the earth and over every creeping thing that creeps on the earth.”
So God created man in his own image,in the image of God he created him; male and female he created them. (Gen 1: 26-27)

We learn that we were created by a relational God, in His image, to be relational beings. We were created to be related to Him, and thereby, to be related to each other. Moreover, we alone, of all creation, were created in His image, to reflect His beauty and likeness, His divine nature to all of creation.

And then a fantastic thing happens. God appoints man and woman as His stewards and representatives….to continue His task of Filling and Bringing Order to the world.

And God blessed them. And God said to them, “Be fruitful and multiply and fill the earth and subdue it, and have dominion over the fish of the sea and over the birds of the heavens and over every living thing that moves on the earth.” (Genesis 1:28)

Fill the earth, and bring order to it on My behalf. Rule wisely over all of creation as My stewards.

Some theologians call this the Cultural Mandate or the Creation Mandate or Commission. God was inviting human beings to create culture, and order in this world.

Let us pause here for a moment. John Eldredge, the American author and speaker, writes of how we tend to move too quickly from Genesis 1 to Genesis 3. From what he called “Original Glory” to our “Original Sin”.

This was our “Original Glory”: the purpose for which we were created. May we think long and deeply and often about our Original Mandate, and the glory and wonder of how it might have been if we had not sinned. This is the first picture of God’s Kingdom. “God’s people in God’s place, under God’s rule and blessing.”

Think for a moment about these two human beings. We often have this romanticized, Westernised mental picture, based on the images we have seen, of two blonde, fair people in the garden. I wonder how likely that was. These two were the peak of the un-corrupted, human race. All the races of the world were going to develop from them. Between the two of them, they contained the entire richness of the human genome. I think it is entirely possible that Adam and Eve were actually quite dissimilar. Perhaps one was black, and other was white. Perhaps one looked Mongoloid. I don’t know. I think, however, that it is quite likely the first marriage was actually inter-racial. I also think the Garden of Eden was not a small one, but a huge one, with every kind of fruit tree, and watered by many large rivers.

Now think of how it might have been if they had not sinned, but instead fulfilled their Mandate to fill and form the earth on God’s behalf, as stewards of the King. There are a lot of things we do not know about the Garden of Eden.

There are some things, however, we could speculate, using common sense, might have happened.

For example, in time, they would have had children. Over centuries, the earth would have filled with thousands of human beings, and though, as the Bible says, man was placed initially somewhere in the east, in time, we would have seen migrations of human beings to every corner of the globe. New races would have developed. Over time, new dialects would have developed, new idioms, and ways of expression, and eventually, new languages. Though we know that man and woman were originally ‘naked and unashamed’, I believe different forms of clothing would have developed in different parts of the world, primarily, perhaps, as a way of protection from the sun and mist and snow.

Because man is created in the image of God, man is both scientific and artistic, Rational and logical, observant and creative. Over centuries, in the Garden of Eden, different forms of art would have developed. Different forms of music, different musical instruments, different styles of poetry and song and literature, different ways of dancing: cultural differences in different parts of the earth with which people both entertained each other, and worshipped God

Because man, made in the image of God, is scientific and logical and rational, different scientific inventions and discoveries would have taken place, as humans discovered more about themselves, their environment, and invented ways to care for themselves and all of creation better.

Different styles of social organization and government would have arisen in Eden, with different models of business and trade. However, in the Kingdom of God, these systems would have been perfectly unselfish and fair, with servant leaders seeking the best for those they were leading.

Business and trade would have been fair and just, with each thoughtfully, carefully and lovingly looking out for the other, and not pre-occupied only with one’s own interests. Men would have lived at peace with each other, sharing all that they had with each other

Best of all, each human being would have been related to God, enjoying a personal unbroken relationship with Him, as He came down every evening to walk and talk with them in the cool of the day.

What a picture of wholeness and health! Shalom. Life in its fullness in the Kingdom of God.

But as we know, Genesis 3 followed. Man sinned. God’s plan was destroyed. And there were tragic consequences. In one cataclysmic event, all of the cosmos came under the curse and everything changed. Man and woman were cursed, as was the serpent. Our relationship with God and each other was destroyed. We stopped displaying godly nature in its fullness. Adam and Eve ran to hide from God, and began blaming each other. In the next chapter Cain kills Abel.

But that was not all. At the same time, the ground was cursed, symbolizing a curse on the ecosystem, and the entire cosmos. Everything changed.

But in the midst of the desolation and despair, God speaks a word of hope. He talks of the coming Redeemer. The Seed of the woman, who would crush the head of the serpent, set things right and make all things new. The Coming King.

The ‘Kingdom of God’ theme runs through the rest of the Old Testament. For example, God’s dealing with the nation of Israel. Jesus later calls the Israelites ‘the sons of the Kingdom’. The nation of Israel was chosen by God to demonstrate, to be a picture of what it would look like when human beings permitted God to rule over them, and chose to follow his laws, and experience His blessing. However, as we know, they chose to opt out of that covenant.

We also have many remarkable passages like the one we just read today from Isaiah 65, in which God expresses the cry of His heart, His longing for human beings to accept Him as King, and become a part of His Kingdom.

Let’s read again parts of the remarkable description of the Kingdom of heaven from Isaiah 65

vs 17 For behold, I create new heavens
and a new earth,
and the former things shall not be remembered
or come into mind.

18 But be glad and rejoice forever
in that which I create;
God describes what His Kingdom will look like

1. A place of Joy and celebration 
for behold, I create Jerusalem to be a joy,
and her people to be a gladness.

2. Relationship with God restored
I will rejoice in Jerusalem
and be glad in my people;

3. No weeping and distress
no more shall be heard in it the sound of weeping
and the cry of distress.

4. Good health and abundant life
No more shall there be in it
an infant who lives but a few days,
or an old man who does not fill out his days,
for the young man shall die a hundred years old,
and the sinner a hundred years old shall be accursed.

5. Economic prosperity and fruitfulness
They shall build houses and inhabit them;
they shall plant vineyards and eat their fruit.
They shall not build and another inhabit;

6. Justice for the oppressed
they shall not plant and another eat;
for like the days of a tree shall the days of my people be,
and my chosen shall long enjoy3 the work of their hands.
They shall not labor in vain
or bear children for calamity,
for they shall be the offspring of the blessed of the LORD,
and their descendants with them.

7. Close friendship with God

Before they call I will answer;
while they are yet speaking I will hear.

8. Creation at peace
The wolf and the lamb shall graze together;
the lion shall eat straw like the ox,
and dust shall be the serpent's food.

9. A place of holiness and peace
They shall not hurt or destroy
in all my holy mountain,”
says the LORD.

And as God expresses His longing to see human beings experience His Kingdom, many times we could think this passage is talking about some future heavenly kingdom. However, let me remind you of the references to infants dying, and young people dying at the age of hundred. Nobody dies in heaven. I believe that God is inviting us to accept His Kingship, and choose to obey His laws, so that we can experience His blessing to some extent even on earth.

And finally, the King arrived, the seed of the woman, the promised Redeemer of Genesis 3. When Jesus burst onto the scene in Galilee, His first message announced that the Kingdom of heaven was near. “Repent, He said, “for the Kingdom of Heaven is at hand.

Jesus called for a change in loyalty and allegiance.

He announced,
“God is ushering in His Kingdom. The King is at work! Come and be a part of this Kingdom. Come and be a part of this fantastic thing that God is doing. Come under His Lordship. Repent of being so preoccupied with your own small agenda and interests. Come, live and work for the King!”

Unfortunately, these days, we have made the gospel all about ourselves and our personal benefit. Repent, we hear, so that your sins can be forgiven, you can enjoy God’s blessings, and go to heaven when you die. And yes, all this is true. These are some of the spectacular personal benefits we enjoy when we become a part of this Kingdom

Ultimately, however, the gospel is not only all about ourselves. Jesus’ gospel is an invitation to come and become part of something awesome and big, the great canvas that God is painting, His Kingdom coming all over the world.

Do you know how many times Jesus spoke about being ‘born again’? 2 times, both in John 3. How many times did He talk about baptism? 2 times, though there are a couple of references more to Jesus’ disciples baptizing others. How many times did He talk about tithing? 2 times.

How many times did He talk about the Kingdom of God? More than 90 times! He talks about the Kingdom of God more than 50 times in the book of Matthew alone. In fact, He considered this so important that He advised us to Seek God’s Kingdom first, above everything else. To make it our top priority.

He taught us to pray, “Thy Kingdom come!” Most of His parables were about the Kingdom of heaven. For example, He said this was so important, like a pearl of great price, or a great treasure in a field, that a man would gladly sell all he had to buy. In a couple of other parables, He showed that this Kingdom would not come by force, overthrowing the corrupt and wicked systems and kingdoms of the world. Instead, like salt and light, and leaven in a lump of dough, like a tiny mustard seed, this Kingdom would bring change and transformation from within.

When Jesus died on the cross, taking our sin and curse for us, He transformed the curse of Genesis 3 into a blessing, inaugurating the Kingdom of heaven on earth.

For example, the curse of our broken relationship with God. Now, we can have a relationship with God again. “Behold, what manner of love the Father has lavished on us, that we can be called children of God.” 1 John 3:1

Now, we can again display divine nature, the uncorrupted image of God “For those whom he foreknew he also predestined to be conformed to the image of his Son, so that He might be the firstborn among many brethren” Rom 8:29

We can again find our role as stewards acting on behalf of the King. “For we are his workmanship, created in Christ Jesus for good works, which God prepared beforehand, that we should walk in them.” Eph 2:10

And that’s not all!

As Isaac Watts, the songwriter of ‘Joy to the World’ says, “He comes to make His blessings flow, far as the curse is found, far as the curse is found.”

Even the cursed ecosystem, the cursed cosmos, comes under His blessing again.

Colossians 1:16 For by him all things were created, in heaven and on earth, visible and invisible, whether thrones or dominions or rulers or authorities—all things were created through him and for him. And he is before all things, and in him all things hold together.

Verse 19 For in him all the fullness of God was pleased to dwell, and through him to reconcile (back) to himself all things, whether on earth or in heaven, making peace by the blood of his cross.

After Jesus rose from the dead, we read of the intensive coaching He took for His disciples, teaching them about the Kingdom of God, (Acts 1:3). And when He was finally ready to leave the earth, having accomplished His Mission, once again, He entrusted this task of filling the earth, and bringing order to it, to His disciples. The so-called “Great Commission” in Matthew 28:18

All authority in heaven and on earth has been given to me. (in other words, the Kingdom has been inaugurated again) Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, teaching them to observe all that I have commanded you. (in other words, Fill the earth, and bring order to the mess by teaching all to live as Kingdom citizens, as stewards of the King, and teaching all nations to follow the laws of the Kingdom) And behold, I am with you always, to the end of the age.”

The whole Bible is about this: The Kingdom of God.

Of course, we do not experience the full reality of this Kingdom yet. We live in the gap between the Already and the Not yet. The King has come and inaugurated His Kingdom. The King is coming again, when we will experience the reality of this Kingdom in its fullness. We look forward to the day our King will return again to rule in person, when all that is wrong in this world will be burned away, when all the effects of the curse are removed, and only the glorious Kingdom remains.

In the meantime, we live as citizens of the Kingdom. Seeking God’s Kingdom first. Praying “Thy Kingdom Come”. Finding the small piece of the jigsaw puzzle that we hold, the small, but crucial role we must play, to see God’s Kingdom come. Like salt and light, like leaven in a lump of dough, we think and live as agents of the Kingdom, effecting transformation all around us.

Of course, we should care passionately that everybody should experience the love and grace of our amazing King, and be eager to share this good news with everyone. However, when Christians do good things only for the sake of evangelism, our motives can be smelled from a mile away.

Christians get involved in good deeds, because our King is a good King and the Kingdom belongs to Him. We are concerned for the poor, because our King is concerned for the poor. We stand up for the oppressed, because we represent a King who is passionate about justice. We care for the sick, because our King wants all of us to experience Shalom. We care about the environment because our King has entrusted us the responsibility of being stewards of all that He has created. We train ourselves to sing, and play musical instruments, and use all that is good about our culture to entertain each other and worship God, because our King is a happy King, who created art and creativity. We do research because our King has the treasures of wisdom and knowledge (Col 2:3) and wants us to discover better ways of running His Kingdom, and caring for each other. We even get involved in politics, and business, because, as Abraham Kuyper, the Dutch theologian and journalist who went on to become PM of the Netherlands, said “There is not one centimeter of human existence to which Christ who is Lord of all does not say, “That’s Mine!

So come. “The Kingdom of heaven is at hand!” Come and be a part of this fantastic thing that God is doing, as He draws people to Himself, transforming lives and communities and nations. His Kingdom is advancing! Consider what role you could play. Move beyond your own small agenda and self-interests. Seek God’s Kingdom first! Come and find your part on this incredible canvas that He is painting.


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Thursday, February 23, 2017

More knocks

My last post seems to have struck a chord with many readers, with almost 2900 views in the last three days!

Two of my friends have also written very similar accounts in the past from their experience. Do go over to their blogs to see what they have written.

1. Patients who taught me from the blog of Jeevan Kuruvilla
2. Quo Vadis, Doctor, Quo Vadis from the blog of Arpit Mathew

Sunday, February 19, 2017

Three Knocks on my door

Those of us familiar with the story of Aunt Ida (Ida Scudder, the founder of Christian Medical College, Vellore, my alma mater) know of how her life was changed by three knocks on her door one night. Confronted with the problem of three young women dying in childbirth because of the lack of trained women doctors, the young and reluctant Ida was convinced of the need to train in medicine, and return to India as a medical missionary with a desire to train Indian women doctors.

(If you are not familiar with this story, you could listen to a recording of Aunt Ida speaking of the Three Knocks here)

A few years ago, I also had my own Three Knocks experience, when the stories of three patients changed the way I practise medicine. At the time, in 2007, I was working in a 120-bed mission hospital in rural Uttarkhand.

Patient A was an elderly gentleman brought in with a perforated duodenal ulcer. He was very sick. His lungs were permanently damaged due to smoking, and he was now in shock because of the peritonitis. After we resuscitated him and operated, he was shifted to the ICU, where he was ventilated for 4 days. After a stormy post-operative period, he recovered well and was ready for discharge.

Before he left the hospital, his relatives came to talk to me in the OPD. After giving them the usual pep talk (about making sure he ate well and stopped smoking, and so on) I asked them whether they had paid the bill. They had. I was pleasantly surprised, because they looked quite poor, and I had been expecting them to ask for some concessions.

How much was the bill, I asked. About ₹ 10, 000, they said. They had paid ₹ 4000 as an advance, and had now paid the remaining amount. Again, I was quite pleased. ₹ 10,000 was quite reasonable for such a major operation and hospitalisation, and especially for somebody who had been ventilated for 4 days. I felt quite proud of my hospital.

More out of a desire to make some light conversation before they left, I asked them how they had managed to pay the bill. They had taken a loan. (Fair enough, I thought to myself, ruefully. Even I might need to take a loan if I require major surgery in the future! It’s good to hear that even the poor are able to get loans when they need…)

So, what type of loan is this, I asked. They replied that they were going to be paying a 10% interest. For every ₹ 1000, they would have to pay ₹ 100. (Sounds quite reasonable, I thought)

Since we were making pleasant conversation, and they had already received some advice from me with good humour, I thought I would give them some more. “Make sure you pay the loan regularly and quickly”, I advised. “After a year, the amount would have increased to ₹ 11,000. And unless you plan well, you will be stuck with a large debt.”

No, they corrected me. The loan would be ₹ 11,000 by the following month. And it would increase by a further 10 percent the following month.

My jaw dropped, as I realised that the family was, in fact, paying 10% per month as compound interest. I quickly did the math. The repayable amount, after 1 year, for the initial loan of ₹ 10,000 would be ₹ 31,386. A whopping 214 percent interest per year!

Horrified, I tried frantically to prove that my calculations were wrong. But no, the family assured me. Those were, in fact, the conditions of the loan.

However were they ever going to repay this, I asked, aghast. The family, now perhaps seeing how upset I was, tried to reassure me. “No problem, sir”, they said. “The money lender has said that we can work for him on his fields. He will not pay us any money, but give us food every day. We can work for him until the loan is repaid. Nothing to worry!”

Slowly, the realisation of what had happened sunk in. My Du perforation surgery had pushed a family into bonded labour. My colleagues and I scrambled to arrange money to give to this family as a gift, so that they could go and settle this loan quickly.

A few days later, the story was repeated. Patient B. Also admitted for Du perforation surgery and ventilated post-operatively. This time, we asked the questions before the bill was paid, but found the family had already taken the loan. Another ₹ 10,000 loan, being repaid at 214 percent interest. Another generous offer from the money lender that the family could work on his land as bonded labourers. But this story had another twist. The money lender had promised them that if they did not report for work anytime, he would send his goondas to tear down the small tin-shack in which they lived. They were going to be living under the perpetual threat of violence. Again, we tried to put together funds to help this family out of their debt.

A few weeks later, I had the third knock on my door. This time, it was the wife of Patient C, a middle-aged gentleman admitted with acute pancreatitis secondary to chronic alcohol abuse. He was now ready for discharge, and the family was asking for a reduction on the discharge bill. The bill was ₹ 1200, and they wanted ₹ 400 to be reduced.

At that time, I had a clear and firm policy on alcoholic pancreatitis. No reduction in bills allowed. My reasoning was simple: If they had enough money to buy alcohol and drink every day, it was safe to assume they had enough money for the hospital bill! I explained this policy to the wife.

A couple of hours later, a nurse came to my OPD. The patient’s wife had been asking the relatives of other patients for a loan of ₹ 400. She was offering that they could have her 6-year-old daughter until she arranged enough money to redeem her back. I felt like crying. My treatment of alcoholic pancreatitis was pushing this family into human trafficking, possibly even sexual trafficking. We promptly wrote-off the Rs 400, and allowed the family to leave.

I was very shaken by these three knocks on my door. As I read more about the problem of emergency out-of-pocket spending for hospital expenses, I came across this disturbing statistic:

39 million Indians every year are pushed below the poverty line directly as a consequence of emergency health-care related expenses.
(See this Lancet article)

Over the years, I have often remembered these three patients who changed my life. They have taught me some valuable lessons:

1. Even the poorest patients sometimes pay their bills without asking for concessions. They do so, however, at horrific personal costs. In our hospitals, we need to look out for these patients, and actively ask the questions about how finances are being arranged, and sometimes write off costs even when patients do not ask for reductions.

2. Even the highly subsidised treatment available at our charitable, not-for-profit hospitals can push poor patients below the poverty line, and even into human trafficking and bonded labour.

3. While health insurance does seem like the obvious answer to this problem (of out-of-pocket emergency healthcare spending, with its devastating effects on poor families), the insurance schemes available at present, (even those offered by the government to BPL families) somehow often seem to benefit the rich and middle class families, who are aware of their rights, and of available options and schemes. The poorest are often left out of the very schemes designed to benefit them.

4. The public health system is India has been designed to provide free and high quality healthcare to India’s poorest citizens. Unfortunately, due to a number of factors, (poor governance, corruption, apathy, and poorly trained staff, to name a few) our public health system is in shambles. I am convinced that it is our duty, as responsible healthcare providers, to do whatever we can to ensure that the public health system in India is strengthened and equipped to fulfil its role.

Finally, a word to my professional colleagues.

The World Health Organisation, in 1948, defined “Health” as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. When 39 million Indians are pushed below the poverty line every year as a result of healthcare expenses, it is well past the time for us to ask ourselves some disturbing questions. Are we truly promoting health? Or is this itself a symptom that the healthcare ‘industry’ is desperately sick, and in need of healing?

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