Events of a week

A week is not just seven days in the calendar or in the chronology of our lives. Each day is full of happenings which shape our lives and form our character. 

The week began with an unknown car bumping into our parked car, in the parking area causing a dent. The next day the water level dropped suddenly in the open well at our cottage, that we could not pump water into the overhead tank.  A carpenter arrived, after a waiting for six months, to assemble the two cupboards, which we brought with us in a dismantled state form Pondicherry. One packet of special screws was missing, which delayed the work. It was after several years, we were not able to join the holy week evening services as the church we go to, is about an hour journey and it was not possible to go leaving my mother alone at night. The whether has turned hot and humid and yesterday's temperature was 42 degree celsius during mid-day. I had a fall today leaving me with some bruises.

At the end of the week, what strikes me is this photograph, which I used once for an earlier blog. It is a bunch of most delicate flowers, which has often drawn my attention whenever I notice them. They are colourful, pretty, open fully in sunlight and last for about ten days or so. They bloom in the winter months when the day time temperature is low and the nights are cooler. They adapt to extreme climates also. These flowers although are delicate, do not suffer much damage in wind or rain as they sway or adapt well to the stress of the wind or rain. A botany teacher told me that its stalk and the stem are strong.

It is this the Easter message reminds us of. There is enabling and overcoming grace from God in all circumstances. Anna and I did feel the stress; but as we come to the end of the week, there is strength, encouragement and hope. 

This wave of encouragement swept through our soul, when a young doctor drove us to the garage to collect the car after repair and later visited us at our cottage. He was most appreciative of the rural setting and nature's bounty around our cottage, with a stream meandering through our property and the house overlooking acres of paddy field and coconut palms and surrounded by wooded properties.   He lifted our spirit as he described what he saw. He enthused us by his fervour for nature and its grace of beauty and serenity. He was certainly sent for our encouragement and comfort. 

We remembered then, St. Paul's words, in I Corinthians, 10:13, '..God will not suffer you to be tempted above you are able, but with it will send the grace to endure it..'

A pilgrims's journey is seasoned with challenges and comfort.

M.C.Mathew(text and photo)             

A Hospital with a difference

The above picture is a road side view of the main entrance to a well known non-government hospital in south India. This hospital has an inspirational story that draws doctors to its fold for training and patients for holistic health care.  

I have been touched during my visits to this hospital, by the natural  blending of the hospital with its surroundings without any imposing appearance  at its entrance. In fact the only sign board on the front elevation is partially covered by the branches of a tree.The business at the petty shops go on with hundreds using them for their regular needs. An institution, with a reputation does not thrive on visibility factor, but on goodwill of people in its neighbourhood.  

The hospital has visits from about 1500 out patients on some days, which is larger than the attendance at the out patient services in some of the private medical colleges I know of. The hospital is sought after for secondary level care in most of the basic specialties. The hospital chose not to develop super specialties although the quality of care in some branches of medicine is almost at a tertiary care level. 

The physical setting of the hospital is created to suit the health needs of people living in rural and sub- urban areas. The facilities are consistent with their expectations. 

We are in  market driven competitive culture in the hospital practice. Many hospitals conform to 'five star' culture and most of it has to do with appearance, aesthetics, convenience and comfort.

I have several examples of hospitals that I have been too, working beyond their capacity, because they have dedicated professionals and a caring culture with a compassionate attitude. Such an atmosphere  conveys thoughtful acts of kindness and consideration. There is a self giving behaviour of the professionals which is explicit. It is not the payment which patients make, that  determines or quantifies the care or treatment, but the willingness of the professional team to be 'all things to all people' .

There is a counter culture in health care, that this hospital and some others are committed to.

 I was appalled to find out recently that the hospital sector is third most lucrative investment destination in two tier and three tier cities in India. Most of what is offered  by way of patient care is commendable and need based. This will hopefully expand even more. But will the caring culture be self-evident?   

What disturbs me is the surrender of many hospitals to 'corporate culture', where as patients are looking for 'compassionate culture'.

I feel that those in health care practice because of a calling (as against commerce) is on the decline. This indeed is a mission for those who feel the pain and the call.  

M.C.Mathew(text and photo)                     

One game and different styles

I have enjoyed watching and playing some games from my school days. Some of my learning experiences have had their origin from such occasions.

As I watched these three men positioning themselves to receive the volley ball in  a warm up session, I discovered the differences they display in the way they stand, bend, stretch their hands and focus on the arriving ball. Each of them is ready to receive the ball but in a different way.

They were coached by the same trainer; they have been playing together for three years. Each of them is a good player. What separates them is their individual style.  

Yesterday, a resident dropped in to chat and what was upon his mind was about the way, the entrance tests for post graduate admissions are conducted. Most of the tests are based on factual information one can remember. He said that he is able to think rationally and make sense of a problem and work out the answer. After all, the clinical contexts in which we work, are occasions to get trained in 'problem solving'. Why is that the entrance tests favour those who perform well in memorising?.

I was disturbed by this question. In real life, we give allowance to individual variations. But in examinations, we still have standard stipulated approach, where most of the questions are memory based and exclude a consideration  for those who have a different style of learning. 

We are sensitive to protest against any form of discrimination. I wonder whether those who are in education planning, consider that our examinations can be discriminatory, favouring those with one style of learning!  

How can a change be possible! One practice I find becoming common in some medical school is  distribution of credits spread over the duration of the whole course, rather than confined to a few exit examinations. This ensures more sustained learning efforts by students, promoting different learning approaches students would benefit from. The skills needed for memorising, doing  a project to study a clinical situation, clinical bed side appraisals, group work to solve a social challenge linked with an illness, family counselling, therapeutic monitoring of compliance and follow up, etc are different settings where learning takes place, each promoting different learning styles, which can be assessed. 

I feel that these different methods promote more skills than just memory based assessments we still resort to in our examination system. 

M.C.Mathew(text and photo)

      

    

Able and abounding

Anna and I got to know three batches of students well during our two years of stay at PIMS, Pondicherry. This picture is the reception area of the Aura, the inter-medical cultural, the students organised in 2012. It was planned and executed well that the we the, faculty were surprised by seeing some students who were indifferent in lecture and clinical sessions, showing extra-ordinary responsibility and abilities.

After the Aura, Anna and I had some final year students visiting us at home for a chat. The discussion drifted towards the way we teach students in the class room and at the bed side. They were most critical of reducing the class room lectures to power point presentations and the clinics to dry monotonous mini lectures. 

They helpfully defined for us some guidelines, to make the teaching-leaning process student friendly. Let me summarise them. 

Greet students and have a round of catching up with them to connect with them and invite them to be present. They admitted that most students, depending on who engages them, would plan a parallel agenda during the lecture, such as learning for the after noon test in another subject, texting a message, access the internet in the mobile, etc. But a friendly beginning often disarms them of their earlier plan.

Try covering the MUST know matters in the first twenty minutes and build around it clinical examples towards the latter part of the lecture, to reinforce and communicate interesting clinical applications. This promotes interest when attention normally declines half way through lecture.

Make time for some interaction- even if it is about politics, cricket, movie, hostel life, let it be. Students are keen to say something to the teachers. So create an opportunity to hear them. The give us a guided tour into their beliefs and attitudes.

The learning in the class room is minimal; but creating an interest in the subject and topic, is of paramount importance. A teacher who invokes this, naturally becomes a role model.   

The bed side clinics are to be fully devoted to demonstrations of clinical signs and introducing skills of communication and clinical observations. They detested the practice of taking clinics on imaginative clinical scenario, because a corresponding patient is not available for clinical demonstration. They squarely blamed this to the apathy of teachers.  

I have a suspicion that many teachers at Medical schools use outdated teaching-learnign practices. While attending a Medical Education seminar recently, I sensed that the even the latest the  Medical Council of India is proposing to 'modernise' the medical education would need further update as each batch of students is ahead of the previous batch in abilities. They are abounding in skills and enthusiasm.

Where are the teachers to match them! 

I wish, I had  known the above when we joined PIMS! 

M.C. Mathew

Grateful remembrance-1

Annie with her family and Premila visited us at Pondicherry when Anna and I were getting ready to relocate in Kerala. They were the two out of the three who moved with us to Vellore from Chennai, when Ashirvad Child Development and Research Centre was incorporated into the Christian Medical College, Vellore to start the Developmental Paediatrics unit. 

Annie was the first Psychologist at Ashirvad and was responsible for formulating a non-formal developmental appraisal by using play based observations to discover the assets and needs of children. She continued that at CMC and laid the foundation to unfold a way of  neuro-developmental screening of children, which was most child friendly and observation based. Annie's counselling skills, sensitive involvement with 'disturbed' children suffering from post-traumatic stress and supporting the needs of the families became the 'standard' practices for us. She had an equally valuable contribution in upholding the ethos of Ashirvad, 'taking sides' and accompanied some children in their developmental journey. Some families telephone even now to recall this faithful contribution to their lives. Annie has made wise choices as a woman, wife and mother. Her decision to step back a little professionally to be available for her school going children, speak a lot about her choice to offer premium value to holistic family life.

Premila managed the office of Ashirvad at Chennai as a friendly, efficient and caring person, whose courtesies towards children and families have been proverbial. She established a personal rapport with many families because of her sensitivity to understand and recognise the needs of children. It was she who guided the professionals at Ashirvad to be 'family centric' in our approach. Her meticulous attention to details of office up keep helped us to have dependable records of children for neuro-developmental follow up. Premila took interest in making the ambience of work easy, comfortable and relational. Her pleasant manners and thoughtful enquiries about the well being of every member of the team, have been the main stay for Ashirvad to pursue its diverse child development activities. Premila continues with even more commitment  at the Developmental Paediatrics Unit at the Christian Medical College, since 1997. In fact Premila keeps enquiring of our well being with a sensitivity which moves us often.

There are some people who become part of our families by virtue of a natural sense of belonging. Annie and Premila are two such friends with whom we have an ongoing growing friendship. They have done a lot in supporting us during our transitions and offering their friendship to Arpit and Anandit when they were growing up. We are glad that they have been with us in our journey of life and our professional expression. 

M.C.Mathew(text and photo)    

Another beginning

Let me introduce two new blog spots you may want to visit or introduce to others. They will engage themes on child development and life skills. 

I do this in response to suggestions from those who have been regular readers of this blog spot. 

I realize that the social media is occupying most of the space to create opinions and attitudes. The younger generation is fond of this. 

I feel moved to join others to raise questions which need attention and response. 

These two new blogs would explore real life situations for dialogue. Therefore the text I hope would generate two way communication.

Thank you for being followers of this blog

M.C.Mathew(text and photo)

http://childdevelopmentashirvad.blogspot.in

http://www.lifeskillsashirvad.blogspot.in

White, brown, golden and black

Anna and I watched  herons arriving in a wet land on our way to work yesterday morning. Only while scanning through the photographs in the evening we realized that,  they had an array of colours of feather, beak and legs. I suppose it would have been difficult to make it out from a distance of about hundred meters.

This is not  a natural wet land, but an uncultivated paddy field, which got water clogged in the rain of the previous evening.

The herons were the commonest avians feeding in the paddy field on grains, crabs, fish, etc. Now most of the paddy fields lie vacant or have been used for cultivation of pine apple, banana, coconut, etc. The farm labourers are too few and the cost of hiring them is prohibitive that it is no more economical to farm the land fro paddy in the state of Kerala. 

So the herons too have got displaced form their normal habitat. The government has started a heronry in  a vast wet land in northern Kerala as the ornithologists have been campaigning to preserve some species of them who are almost extinct. 

I shared this picture with a passionate bird watcher who mentioned to me that there may be at least ten different species of herons one can locate during the winter months in this part of our state of Kerala, the difference in the species being minor variations of colour of beaks, feather, size of neck, shape of the body, etc. 

The occasion of the sighting of the herons gave me an opportunity to share some childhood memories of playing in the water clogged paddy field outside our cottage, catching fish, crabs, etc. On one occasion, I was bitten by a snake which coiled itself around my ankle which froze me in fear. My parents rushed me to a physician who was specialised in ayurvedic treatment for snake bite. To our great relief, he confirmed from observing the bite marks that it was a non-poisnus snake. I needed no treatment. It was the first time Anna was hearing this story of my childhood.

There is much unexplored memories that spouses can share with each other to relive their childhood and connect even more deeply with each other's life. Marriage, in that sense, is an ongoing journey of exploration, confession and celebration in an ambience of intimacy.

MC..Mathew(text and photo) 

        

Looking out for conversation

Anna and I notice this senior citizen almost every day, on our way to work,  standing outside his gate looking intently at the movements of  the traffic and people on the road. Sometimes people stop to say something to him, but his posture or composure remain the same. We know nothing more than this about him.

We often see senior citizens standing outside their home on the road habitually. While talking to a colleague, I realised that many of them feel lonely and do this to stay connected with people to dispel the inner darkness of enforced solitude.

A Psychiatrist friend, who specialised in geriatric psychiatry whom Anna and I met recently during his short visit to India, mentioned to us that 'loneliness is more distressing than Alzheimer's disease in many instances'. He thought that loneliness may even precipitate a nascent memory and emotional decline.

A seven year old boy helped me yesterday to  understand one more aspect of loneliness. He mentioned to me during a consultation that 'mummy and daddy are always occupied with their work. So I have to play alone'. For this boy, playing alone creates loneliness. His pleasure of play is not complete when he plays alone.

This is the resident human instinct in each of us- we are complete only when we can stay connected with others. We can be lonely when we are left alone. 

Bishop Desmund Tutu,  now in in his early eighties, was in Cochin two days back, while on a worldwide ocean cruise with about two hundred people, mostly senior citizens. He mentioned to  a press reporter, 'I do this cruise to bring peace within and among us because we are all lonely people'. 

We create our own loneliness when we create boundaries around ourselves. Our openness invites others into our lives.

In that sense, this senior citizen is inviting people in to his life, by standing outside his home every morning.

M.C.Mathew(text and photo)     

Daffney is four months old

Anna and I often wonder how we have coped with this puppy who runs rather than walks, appears on the spot    from nowhere when there is any movement or sound and reaches out to smell or grab anything that has an odour or appears like a toy. She consumed the key board of Anna's mobile phone, chewed the cords that connect computer to the printer, and jumps to reach out to anything that is hanging from height especially, the clothes.

But she is good fun. She would appear beside our bed by about 5 in the morning. From then on she is a faithful follower of all our moves. She is not welcome to the kitchen and she would test Anna's patience by inching her way into the forbidden territory quietly and slowly. When Anna notices her trespassing,  she would wag her tail and look kindly at her face. When Anna raises her voice she would have gone to hide under the TV table which is her preferred place to show her regret. The only thing is her regret is short lived and she would be back with the same mischief. 

When we are back from the work in the evening, she would lavish us with her lick. She would not let us sit for a minute till we pick up her ball and throw it for her to fetch. For the next forty five minutes or so she would chase this ball as if she is on a hundred meters run with no respite. When we  stop throwing the ball, she would obstruct us going in to the house by jumping on to us and and running around us, requesting us to continue. 

Fortunately food is her weakness. Anna would have got her supper ready in her bowl by then. So it is a good distraction  and she leaves us to our routine for a while.  

Both ofd us feel that she filled a void during this transition and relocation. Thank you Daffney, you revived our childhood memories.

I must confess that Daffney consumes so much of our attention that the aquarium of fish inside and outside the house have been relegated to the background.

We sense life opening up before us once again after six months of  being in Kerala. We foresee fullness of life returning to us.

M.C.Mathew(text and photo)