(This article first appeared in The Toad, the magazine of the Students Association of CMC Vellore, published in June 2021)
Moving from Sick-care to Health-care
Pradeep Ninan
Let me begin with the story of three patients sitting in the OPD in Madhipura
Christian Hospital, a mission hospital in rural Bihar.
In Room 1, we meet 50-year-old Rani (name changed) who has come for a postnatal
check-up. This was her 6th pregnancy.
Pregnancy no 1 had resulted in a normal delivery at home. Girl child.
Now 31 years old.
And so on. All normal deliveries at home. Resulting in three more daughters
who were now 29, 27 and 25 years old respectively. She kept conceiving and
delivering at home.
Until 22 years ago, when she had finally managed to give birth to a male
child. Relieved and overjoyed, she had undergone a tubal ligation.
Sadly, the story did not end there. The son passed away in a road
traffic accident 3 years ago.
And so, this elderly braveheart underwent hormonal treatment and
fertility procedures to try and conceive again. She had finally conceived after
IVF.
We watched as she came for every check-up on time, faithfully taking her
pills and tetanus vaccinations, looking forward to welcome a new son, 31 years
after her firstborn.
Things did not go as planned. Baby no 6, also delivered by a vaginal
delivery, was A GIRL.
Pause here for a moment to think of the life ahead of this beautiful little baby, born as the fifth unwanted girl child in this family.....
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In Room 2, we meet Ramini (name changed), a 42-year-old lady, who has come for an antenatal check-up. Her obstetric score is G10 P9 L8 END1. Feeling the pressure of society to produce a male child, she has been doing her best. Unfortunately, this has resulted in 9 daughters. 8 of them are still alive, aged 16, 14, 12, 10, 8, 6, 4 and 2 years. The last daughter had died soon after birth. (Let us not speculate too hard on what might have caused this death!). Now she is pregnant again, and wants us to do a scan. We explain to her that we would not be willing to reveal the sex of the foetus. The scan shows that she is pregnant with TWINS.
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In Room 3, we meet little Rajkumari (name changed). She does not know how old she is, but looks possibly 14 or 15 years old. She is dressed in a sari, because she is already married. Her presenting complaint is…………Infertility! She has been brought for evaluation by her relatives, because she has not yet been able to conceive.
The
WHO defined Health in 1948 as “A state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity.”
I like this definition, partly because it is so close to the Biblical
idea of ‘Shalom’.
Cornelius Plantinga in his book Not the Way It’s supposed to be: A
Breviary of Sin helps us understand what ‘Shalom’ means:
“The
webbing together of God, humans and all creation in justice, fulfillment, and
delight is what the Hebrew prophets call Shalom. We call it peace, but
it means more than mere peace of mind or a cease fire between enemies. In the
Bible, Shalom means universal flourishing, wholeness and delight- a rich state
of affairs in which natural needs are satisfied, and natural gifts fully employed,
a state of affairs that inspires joyful wonder as its Creator and Savior opens
doors, and welcomes the creatures in whom He delights.
Shalom,
in other words, is the way things ought to be.’
It is clear that the English word ‘Peace’ is an inadequate translation
for the Hebrew word ‘Shalom’. Shalom is not merely ‘peace’, or the absence
of conflict. Shalom is the presence of wholeness and abundant
life, a truly ‘healthy’ existence, ‘a state of complete physical, mental, and
social well-being’
As ‘health-care workers’, we have the opportunity to help people live
‘healthy’ lives. We need to see our role as not merely ‘sick-care’, or the
alleviation of disease and suffering, but ‘health-care’: the creation of a
world with ‘complete physical, mental and social well-being’. Jesus once said,
“Blessed are the Shalom makers, they shall be called sons of God’. (Mt 5:9). This
was a startling invitation, not merely to resolve conflicts between people, but
to be co-creators, with God and each other, of a world full of Shalom, with
‘universal flourishing, wholeness and delight’. This Shalom is possible only as
people come into a right relationship with God, with other human beings around
them, and with the environment or world around them.
Let us zoom out from the three women in our OPD, and try to get a
birds-eye view of the health situation in our country.
It seems apparent that even if these three women receive good treatment
in our OPD, (and even, theoretically, if we were to help little Rajkumari
conceive!!), it would be very difficult to think of them as healthy…..
Can we call their marriages healthy, when they are treated as
baby-making machines, whose primary purpose seems to be to produce a male
child? Do they enjoy a ‘healthy’ relationship with their husbands?
Can we call their families healthy, when girl children are not valued,
killed either in the uterus or soon after birth and discriminated against
throughout life?
Can we call their communities healthy when girls are not sent to school
and women are treated so shabbily? Are communities healthy when Dalits are
consigned to Dalit ‘tolas’ (a part of the village) far away from the non-Dalit
‘tolas’, when Dalits are not allowed to use the same well as the forward castes
and Dalit women are forced to go the fields to defecate at 4am in the morning
to avoid meeting others and to protect themselves from rape (which is considered
routine and normal in many villages)? Are communities healthy when Dalit
children are not allowed to sit in the same classroom as their non-Dalit peers,
and Dalit men are killed for having the temerity to walk on non-Dalit roads?
Can we call society healthy when such gross inequities exist, between
men and women, Dalit and forward caste, educated and uneducated, urban and
rural, rich and poor?
Can we call our nation healthy when a Muslim man can be lynched on a
train, on the ‘suspicion’ that he was carrying beef, and his body thrown from
the train? Is our nation healthy when such deep divisions, biases and hatreds
persist? Is India healthy when India's richest 1 per cent hold more than
four-times the wealth held by the 953 million people who make up for the bottom
70 per cent of the country's population, while the total wealth of Indian
billionaires is more than the full-year budget?(2017 data)
We live in a world that is desperately sick and in need of a Healer…….
It is in this context that we have the privilege to be health care
workers and Shalom-creators.
Of course, we need to start with the individual, the woman patient
sitting in front of us in the OPD, and give her the best and most compassionate
and ethical curative care possible.
But as a community of ‘wounded healers’ (can any of us claim to be
truly experiencing this life of perfect health and Shalom ourselves?!), we need
to strategically think and work together for the health of families,
communities, societies and nations, and create Shalom in the world around us. No
single person or profession can do everything. There are many ‘non-medical’
people who are also a part of this community of ‘wounded healers’, Shalom-creators
together with us. Each of us has a small, unique and vital part to play, and
every contribution is invaluable. Together with ‘curative medicine’, we need to
collectively develop ‘preventive medicine’ that seeks to prevent ‘un-health’ or
‘dis-ease’ from developing. But at the same time, crucially, we also need to
develop ‘promotive medicine’ which is aimed at helping individuals, families,
communities, societies and nations experience true Shalom….health, joy,
wholeness, flourishing, and abundant life.
“Seek
the Shalom of the city where I have placed you…., and pray to the
LORD on its behalf,
For in its Shalom you will find your Shalom.” Jer 29:7
