Fellow labourers

We were visited recently by Dr. Regi Thomas, and Dr. Rajan, ENT surgeons from CMC Vellore. They visited with their families and conducted an ENT camp here in Manali. Two hundred patients were seen in three days and surgeries performed. It was very refreshing to spend time with them.  Earlier we were visited by Dr. Chuck Thompson, Luke Walters and Lonnie, from the United States. Dr. Chuck is a prominent interventional cardiologist there.

We all need encouragement wherever we may work. This can come from patients, from families, from the turn of circumstances. However, the right hand of fellowship is when two like minded people come together and spend some time together. There is something special when hearts motivated by service to our Master come together, and a commonality emerges as shared experiences that need not be elucidated join paths for a brief while. It leaves each person encouraged, and as paths diverge again to continue the journey, each heart leaves a little warmer.

I was very encouraged by the support that is in the hearts of senior people like these towards work in small areas like that we work in. They are at the apex of academia and practice. They have achieved standards of practice that are internationally recognised and are at the cutting edge of advancement. Yet their hearts reach out to the remote regions and workers who are far removed. This is the love of the Lord, reaching out to us.

It is a proud realisation that we have partners like this, and that we can all mutually continue to strive and encourage each other in our respective journeys.

LOOKING BACK, LOOKING FORWARD

The road to Ladakh is a formidable one. Tremendous gorges plunging into ravines,  and immense sandy plains confront the traveller, stretching the mindscape by its vast hostility and daunting solitude.  This photograph taken in the  rear view mirror of my motorbike is self expressive, from the time we took  a medical camp into the Zanskar valley.  I think it holds a powerful life lesson.

All of us have stories from our journeys. Our life lessons have not all been pleasant tales of green pastures and flowing waters. Yet, on our respective roads, we all do get the opportunity to look back, and then continue to look forward.

Why is looking back important? Even the people of Israel, on their Exodus were constantly asked to “Remember”.  We tend to forget. What does our rear view mirror show us?

For all of us, we can remember times and seasons of struggle, yet support and direction through those battles. Of strength, provision, and friends who came alongside us.  The recognition of the hand of God, watching, leading and guiding. When He has led us thus far, we can draw inspiration for the formidable challenges ahead. Our struggles shape and mould us, develop our muscle to be able to navigate the twists and turns of the boulder strewn horizon more gracefully than we did in the past. And we have the opportunity to draw not just on brute strength, but also the wisdom that was gleaned from pinnacles of the past.

One trekker, who has trekked the Rohtang pass in his youth,  walked over it again in his fifties. He said, that this time, he had one thing going for him. He had less strength and stamina, but he had the wisdom  and experience that his earlier summits had left him with.

We are all called out. We have been led so far. We can look backward with grateful thanks. And that strengthens us to look forward to the future with hope.

• ·      Let us look back and count the times we have been led, guided and helped.
• ·      Where we are now is a testimony to where we have come from and what we have come out of.
• ·      Let us recognize these historicial events in our lives with gratefulness.
• ·      Let this knowledge equip us for the road ahead, secure in the knowledge that the God of our yesterdays holds our tomorrows. 

Todays utmost

A wrong temper of mind about another soul will end in the spirit of the devil, no matter how saintly you are. One carnal judgment, and the end of it is hell in you. (http://utmost.org/classic/today/)

This message from "My utmost for His Highest" is very profound.. try and get your mind around it. It has implications that reach down into the dregs of my soul. How easy it is to judge one another carnally. Little do we realise that it festers deep within us and the person most affected then is ourselves.  

Love your enemies is not an injunction wrapped in toffee paper to make us all sweet and holy. It is an injunction that is our only hope to be delivered from the pit of self destruction. It is an injunction for survival and so little do we realise it. It is like a life jacket that can save our soul. 

How can this even emerge onto our horizon of being humanly possible? I can begin to understand and grow the germ of acceptance and love by understanding 2 Timothy 1:7 which says that we have not been given a mind of fear but of power, of love and self control. 

We often approach our contenders from the point of self control. "I will control myself when I speak with them" is a common decision that crashes and burns. Even if it does not, it adds fuel to the fire smouldering within. 

But if I approach it from the perspective that God has everything in His power anyway, then I can begin to relax my grip on the situation, and begin to learn about love, and what Paul is instructing Timothy when he says in Verse 25 of chapter 2 ... "speak gently, perhaps God may bring them to repentance..."

He controls the wind and the waves, so no matter the boat may rock, He still is asleep in the bow. 

Do we have our life jackets on? 

Life preservers are little regarded till the ship begins to sink.

Let us strive to survive. 

Internet fast

No I did not mistype it.. i did not intend to say fast internet. Today fast internet has almost become one of the basic needs of man.
Food.. optional.
Clothing.. minimalistic.
Shelter… variable.
Fast internet.. essential.

While on holiday, we also took a holiday from the internet. It was not by choice, despite my wanting to make it all spiritual and deck it out with higher motives. It was because where we were, we just did not have access to it in the United States of America. It is indeed paradoxical and satirical, that while in Manali we have a wifi campus, but while in the mecca of technological progress, we did not have access to the internet, despite our best efforts to get “online”.

That did give us an internet free holiday, which in retrospect was very useful indeed. It heightened the awareness of how much time I actually spend surfing the wi, and fie on me for doing so. I realise how essential it is to optimise my “favourite” bookmarks, and minimise my “windows” viewing sites that are “not for profit.”

For those of you who were wondering about my wi silence, i value the time you give to us as a website and for reading  my posts, and promise to keep them succint and informative, to also optimise your wi times.

Please continue to “watch this space”.

With my regards and thanks.

Grow where you are put

We spend a large quantum of our thoughts and efforts contemplating places that we would like to be, places we wished we could be in, places that we have been in the past. How much time and effort do we spend on  the place we are in now?

“Lillies grow where they are put.” This statement from Oswald Chambers is profoundly simple.  Lillies have been held up as an example to us about the provision available in all of nature, a lovely reminder that the world does go around, despite us. Our whirlwind lives often zip right by this wayside parable. And in our race to move on, get ahead, go places, the quiet beauty of a flower growing where it is put holds out a meaning that we might just miss.

How can we grow where we are put?  Just as provision exists for the growth of that flower, our current circumstances have been provided for. This truth holds, even if our current circumstances are difficult, dangerous, or excruciatingly painful.  Those circumstances might even be desperately boring or seemingly unfulfilling.  Flower petals bedecked with dew should remind us that provision permeates the gaps.

Every day awakens the potential to grow, to read, to remember, to consciously develop  ourselves. Resources exist all around even in seemingly desperate situations.  The internet is a huge resource, readily available. People all around us possess wisdom and experience untapped and unrecognized.  That which is in our hands can hold out hope for others.

I remind myself of an graphic incident from my posting in Jadaghri mission hospital. The hospital was about to close. One hundred beds lay empty, with the water and electricity bills not paid.  For a whole month of my posting there was no work. One day, a patient was brought with head injury, seizing, despite every intervention to control the convulsions. Advice to transfer the patient to a higher centre in Chandigarh was met with despair and blank looks from the relatives who were not able to afford the cost of transfer.  The patient would need a surgery. There was no anesthetist, no neurosurgical tools to operate.  A search of the hospital yielded one metal screwdriver and a metal hammer in the maintenance department. I asked the nurse to autoclave these and calling in an anesthetist from another town, made holes in the skull to relieve the pressure. The convulsions stopped. Even a hammer and a screwdriver can become crude  implements that save life.  This story is a reminder to me never to give up. Never give in.  Search for what is available locally and use it. Grow. 

Gossip

Providing feedback is an essential part of  complete communication. The person who communicates has a responsibility to be clear, but his message may often be misunderstood because of the various barriers that hinder communication. Leaving an avenue open for the completion of the communication cycle is very important to facilitate correct communication. This is the responsibility of the person who communicates. The responsibility of the listeners is to respond constructively.

Feedback given inappropriately is destructive. At work and also within interpersonal relationships, providing feedback often follows patterns of gossip rather than being constructive.

Gossip tends to follow the “grapevine” at the workplace, a network of interlinking relationships based on relationship clusters that cross hierarchies and boundaries. Novelty and not the truth, is the fodder of gossip. The problem is that it continues to seek further novelty in order to sustain the relationship, which is not based on true affection or regard. Hence gossip circles become progressively malevolent  at the cost of those in the immediate environment. It is a sort of cancer, growing and feeding upon itself.

 

Gossip hides in the garb of concern. When examined, the entertainment value overwhelms true concern for people or issues.  It is a selfish habit, that propagates out of selfishness.

Gossip does not own or bear responsibility. When confronted, it disappears into the forest of unaccountability and takes shelter in the woods of irresponsibility.  It  cannot be found to be stamped out or exterminated, burrowing into caverns of camouflaged cowardice.

Gossip is progressively delightful,  and once tasted,  inspires a deep yearning for more. It is like an addiction, shackling the soul. Society frowns on addictions to alcohol and dens of substance abuse, but little recognizes that dens of gossip permeate our workplace shackling individuals and institutions with its tentacles.

What can be done to break this pervasive habit?

First it has to be recognized for what it is.  Its masquerade needs to be uncovered and its malevolence recognized by all. Individuals have to recognize the seeds gossip within themselves and be motivated to exterminate them.  Some ground rules may help:

1.     Truly and sincerely examine whether you seek the best of the other individual and of the institution.

2.     Respect one another enough to confront in love.  When doing this, try and follow these steps:

a.     Protect privacy by confronting in private and not in public

b.     Own responsibility by using the first person, such as “I heard” or “i understood”

c.      Seek clarity by expressing your doubt and inviting explanation

d.     Listen and give the other person the benefit of the doubt always.  We often come at people with preconceived notions, having already judged them prior to them speaking. This does not allow us to listen or understand the other person.

3.     Quench gossip wherever you encounter it by replacing the lie with the clarified truth, and by refusing to listen about another person when the person is not in the room or has had a chance to speak on his or her own behalf.

Unless an institution decides on a “zero gossip tolerance” it will not weed this malevolence out. Some institutions have even decided to terminate employment if this habit is practiced. It is an indicator of how seriously they protect the environment within. 

EMERGENCY - 24 HOURS

Providing an adequate response to any medical emergency round the clock is a formidable task. It involves having a well trained team, being able to mobilise it, and respond quickly and appropriately every time.

We are in a mountainous area, prone to accidents, landslides and varied presentations of trauma. Vehicles tumbling down steep ravines, floods washing bridges away and buses overturning are annual affairs. Though assaults and gunshot injuries are rare, there are enough people getting involved in fights to provide patient material to our emergency room. Besides trauma, there has been a rising incidence of heart attacks, and strokes among the local populace. Organophosphorus poisoning is commonplace, with comatose people arriving having consumed it with a suicidal intent.

In many mission hospitals, there used to be a system of a call book. There was a book in the emergency room. This book used to be filled by the nurse on call, and handed over to the security guard, who would proceed to tramp through snow in winter or saunter to the doctors house in good weather. Usually the doctors quarters would be located within the campus, at a variable distance from the emergency room.  Such a call system is totally inadequate in its response time to relevantly provide timely help in the narrow window period that is available to save a life. Sometimes the security guard may even decide to refresh himself with a smoke under a tree prior to delivering the call.

Telephones replaced that system, with landlines interconnecting the campus. Today mobile phones have come into vogue and even replaced the earlier system of black pagers hooked to the belt which made doctors feel very important. However, even this system is awkward and expends precious minutes waiting for the doctor to arrive, which can mean lives lost.

When we first arrived in Manali, resuscitation was more of a last rite than a genuine attempt at saving life.  Precious minutes were lost in waiting for the doctor to arrive prior to the initiation of resuscitation. We initiated a hands on course in resuscitation for all the nurses in cpr, which did make a difference. A further obstacle was being able to have the resuscitation equipment handy. Older wards often have narrow stairs which are formidable obstacles to the emergent transport of life saving equipment. We filled a plastic toolbox, the kind that is available in any department store with emergency drugs and equipment and provided them at every station. These can be grabbed on the go and made the initial response of the nursing staff much more effective.

At code sites, having enough hands available is an essential component to resuscitation. Tertiary institutions have a “code blue” protocol, where a code pager buzzes madly summoning a multitalented team to the bedside of the patient in minutes. Other institutions have had a system of overhead announcements or lights flashing indicating the emergency.  We provided a siren in different wards, with different tones indicating the location. The siren can be heard all over the campus, and proved very effective in summoning those within earshot to the location of the emergency.

Over time, with each of these developments, we have been able to revive patients who present to the emergency room pulseless or not breathing adequately for whatever reason.  In fact, when when a pulseless patient was revived, one of the nurses eyes suddenly lit us as she realized that “This actually works!”

Mobilising the operating theatre within minutes is also a formidable task. Having the scrub team and the anesthesia person within a few minutes of beckoning means stationing them within the campus. Because Manali is a small place, we have been able to move massive trauma to the operating table within ten minutes, which is an adequate response by any standard. This too has resulted in precious minutes and lives saved.

Though BLS and ACLS and ATLS today are buzzwords with a large amount of documented data on implementation and protocolisation, this does mean different things to different people at varied locations. Each area will have to modify and tweak the practical outworking of the resuscitative attempts. The bottom line being, it has to be efficient, immediate and effective, all the time, every time.