I have been to the Ranipet campus of the Christian Medical College, Vellore a few times recently for my medical needs. It has an impressive facility, ambience, and amenities to offer patient friendly services.
The Ranipet campus was conceived By Dr George Chandy during his term as the director. Dr Sunil Chandy initiated the planning process and got the construction commenced during his term as the director. Dr J.V.Peter completed the project and opened the facility for public use during his tenure as the director. The current director, Dr Vikram Mathews has embarked on building a Children's hospital in the same campus.
While the Ranipet project was active, the Chittoor campus of the CMC has developed to have a secondary care hospital, a nursing college and is now getting ready to have a larger hospital in preparation for starting a new Medical College. This came into being through the foresight of Dr Suranjan Bhattacharji, when he was the director.
There is a momentum for physical growth at CMC, a phenomenon which captures any one's attention.
The centenary year of CMC, was in 2000, for which the then director Dr V.I.Mathan started the preparation in 1997. The centenary building where the mother and child health services are located was planned by him during his term in the office, and Dr Joyce Ponniah oversaw the completion of the building project when she succeeded as the director. It was special that a woman faculty was the director of CMC in the centenary year. There were many recollections of Dr Ida Scudder, during the centenary year. The founder's day oration in the centenary chapel service by Dr P Zachariah on the 'foundational values of CMC' grounded the community on values that were historical.
I noticed recently sign boards in the Bagayam and the Town campuses about two significant historical events in the life of this institution.
The college is celebrating the hundredth year of the Town campus in 2024 and the 125th anniversary of the Christian Medical College is in 2025.
Having had an association with the governing council of the the college for 25 years and served in the faculty of the institution of 11 years, these two landmarks of the institution created within me some thoughts about the future of this institution. Let me share seven thoughts to contribute towards the ongoing a dialogue about its future!
1. The dispersal into other campuses.
The institution has its presence in Vellore town, Bagayam, Eye hospital, Kadrigaipattai, Ranipet, RUHSA, and Chittor. Each of these campuses has a hospital service and locates residential accommodation for the faculty. Each of the campuses has its own administrative officers who co-ordinate the activities.
The CMC was known to be a residential community where the students and faculty stay in the campus and create an atmosphere of being a large family of like minded people in health care. The undergraduate students were adopted into faculty families, as foster students, which provided an opportunity for the formative process of students. They through this process imbibed the ethos of the institution as articulated in its motto, 'not to be ministered unto but to minister'! The post graduate training went beyond imparting clinical skills; most trainees feel that they were mentored to be wholistic professionals.
A question I hear while in conversation with the faculty and students, is whether this community consciousness and family optic will continue to be so with multiple campuses and growth in the number of students and faculty. How to augment the nurturing and pastoral care? I hear the chaplains making confession of some limitations in being able to be in touch with students and faculty as before!
2. The selection process to study at CMC, Vellore.
The process of selection of students to study at CMC Vellore was through an entrance test and interview process. The post graduate selection process also had a stipulated process. With the NEET process having been imposed upon CMC for undergraduate and post graduate admissions, the choice of welcoming those who are likely to imbibe the ethos and ethics of the CMC has been done away with. With the earlier practice, the institution was able to choose the faculty from those who were trianed at CMC. Now most people who come to study do not have a traction to stay back. It was considered valuable to have faculty with a 'personal vocation' in alignment with the motto of the institution to sensitise the students to the habit of integrated living and compassionate health care practice.
This raises a need to have a process to enable the faculty to feel rooted in the ethos and values of CMC.
I still have hope that CMC would stand a chance to have its admission process restored.
It is a good time to have a research on the effects of change as of now, following the new undergraduate and post-graduate admission process.
3. Beyond the Quaternary care.
According to the present hierarchy of health care structure, the normal growth trajectory is from primary, secondary, tertiary to quaternary care service. The current status of the institution is a healthy integration of these services with a significant presence in primary care and quaternary health care.
What is beyond the quaternary care! I recall a conversation with Professor Carl Taylor about his vision for the International public health training at John Hopkins University. His vision was that all those in clinical training at post graduate level or higher speciality level would need a good grounding in public health. That is how his department could motivate clinical specialists to come for short or long term training, formal or informal to include a public health dimension in their clinical work. I remember some clinicians getting trained in clinical Epidemiology to have a better grounding on prevalence of diseases, or community based activities to control preventable non communicable diseases. I recall a chest specialist after returning from his training, getting involved in a well sustained public health measure to reduce the smoking habit among the youth in the town, the he lived.
Although CMC runs a MPH programme, it is a stand alone training programme.What if CMC moved to have regular public health introductory training to all its post graduate and higher speciality trainees, like the way, research methodology or medical education programme are introduced to them. Those in the higher specialities come across new disease patterns and presentations, which need to be studied epidemiologically to take public health measures.
CMC Vellore has a salutary presence in primary and secondary community health care. I wonder if it can scale up the public health training component to augment concepts in disease avoidance, early detection and community based support of those who need long term care like those who have non communicable diseases. I know of an institution in the North East which initiated a programme of movement through exercises to reduce arthritis in senior citizens, initiated by a Rheumatologist and Orthopaedician.
Such an approach would have a trans-departmental impact!
4. Promoting transition of hospitals!
The Missions department of CMC has been proactive to support mission hospitals to augment the capacity of the professionals and to help in turning them to be referral hospitals with secondary or tertiary care facilities. The departments of CMC at Vellore depends upon some mission hospitals to carry on the treatment initiated at CMC through collaboration. The department at CMC supports the staff hospital at the mission hospital to get trained through on-line contacts and physical visits by consultants from CMC to sustain the quality of care. I know of some hospitals who function as 'satellite services' in specialities of Oncology, Radiotherapy, Rheumatology, Endocrinology, Haematology...to support CMC in offering the continuity of service.
Is it possible to help some hospitals to move to be a high secondary or regular tertiary care centres? I wonder if CMC would choose about five hospitals in central, north and north east India to help them transition into collaborative hospitals with CMCV over a period of five to seven years!
5. Fellows of CMC Vellore.
Following the death of a women resident doctor in a Medical college at Kolkata six weeks ago, lot of disturbing and disgraceful information have come out in the public domain about the several malpractices that go in some reputed medical colleges, making us feel ashamed of the declining state of ethos, ethics and integrity in health care!
I wonder if CMC Vellore can choose about ten currently working consultants from each state of India, to be Fellows of the Christian Medical College of Vellore! The objective is to support practicing doctors in medical colleges to subscribe to high standards of personal integrity and to be advocates among trainees and professionals to uphold good traditions of practice of medicine.
The Christian Medical College has a calling to be a 'voice in the wilderness' where value based practice of Medicine is slipping away in a highly commercialised health care ambience.
If about 200 consultants in practice from all the states are chosen from among those who were trained at CMC or who have had some association with CMC, then they can be orientated to become ambassadors to practice medicine 'in the spirit of Christ' as articulated in the objective of the institution.
The wind is even more stronger now in India, to make practice of medicine to be a profitable activity, because of which the patient gets displaced from being the primary focus.
The logistics of choice of the Fellows, orienting them and supporting their initiatives would need some dialogue.
To create a group of about 200 consultant doctors as Fellows of CMC offers an opportunity to have a leavening presence to foster ethical and patient centred practice of medicine.
6. Mid life support for the faculty
Now as the retirement age in CMC is 65 years for doctors, they spend 25 years of their mid life in CMC. The mid life is a time of several transitions. It is a time when the doctors have reached the best of their years in professional work; family life has multiple transitions related to children, ageing parents, compulsions to think about future location, house, early onset of some illnesses; leadership roles in the department and or in the institution, carrying the mentoring role, sabbatical leave; preparation for retirement and transition planning...!
I feel that the mid life is a season of generativity according to Erickson's view of psycho-behavioural formation. And yet many walk through this period of life without getting time to feel renewed to be creative and productive. It is a stage to prepare oneself to be an 'elder' and be in a giving role to help in the formation of younger professionals.
I wonder whether doctors in CMC Vellore get adequate orientation and support to turn this season in life as critical and a potential season to grow in to the full stature of their ' being!
I wonder whether CMC would plan to offer regular enabling support individually and in groups for doctors to equip them to be personally ready for mid life transition! I hope this aspect gets included in the faculty support service which the human resource team offers.
7. The schooling facilities in the CMC campuses.
The school education we offer through schools in the different campuses needs an in-depth review as the the method of learning currently practiced, although of high quality, does not seem to offer children the pleasure of learning and an experience the joy of discovery! The schools are for the children of the faculty and staff. They spend long hours in the hospital. Some of the parents feel the burden of making children learn. The three groups in any class room would be: average students, the developmentally stressed and the exceptionally able! I wish the teachers are enabled to address the needs of each of these groups. I wish a study could be done to know the strengths and weakness the educational model the CMC related schools follow.
We live when new approach might be needed for the schooling of the 'Alfa' generation! I wish the emphasis would shift from teaching to learning and formation of children!
As one, who has had some association with CMC Vellore, I allowed my self to dream for CMC, when it is about to enter into a transition phase, after 125 years of presence in health care in India!
I have a sense that a concerted effort for the formation of the faculty in alignment with its ethos, recollecting the foundational values, promoting the community spirit which was inherent to CMC, esteeming the students and trainees as our resource, family life support for the faculty and integration of the different campuses emotionally would be critical for CMC. This involves a journey from physical growth to a formative integration of the faculty and students to the vocation of CMC. That might make CMC even more relevant in the health care frontier in India through its leavening presence.
The reflections above arise within me as I relive my memories of my association with CMC Vellore, starting from 1980, but more closely from 1997.
The recent meetings to recall different aspect of the 100 years of history of the town campus brought together the community at CMC to a new level of gratefulness and recollections. The heritage lectures to recollect the history of evolution of different departments is another activity which contributes towards nearness and togetherness among the different sections in the community. The way Nehemiah brought a sense of fellowship among people after completing the building of the wall of Jerusalem created a new consciousness about their history and the journey ahead!
I have had an imagery of the CMC Vellore being a health care movement that transforms professionals during their training period and scatters them in different places in India and overseas to create new pathways in health care. The Alumni association that connects the global diaspora with CMC Vellore is an illustration of this vibrant community of health care professionals
Let me include in conclusion a letter to Pauline, typed, corrected and signed by Dr Ida Scudder on 18th January, 1938, 'writing very briefly the exact story..' of her experience one night, which led to her decision to train as a woman doctor and return to work in rural India. Dr Keith Sanders, the physician who worked at the Raxaul Christian Mission hospital and later was the general secretary of the Christian Medical Fellowship, UK, passed on this letter to me in i987. He treasured this letter and sent it to me for safe keeping.
We now celebrate the 125 th year of that small beginning!
From then on to now, CMC Vellore has been on a journey of 'faith, hope and love'!
Anna and I send this tree of flowers below, from our garden to the current faculty and staff, who make CMC an ocean of goodness by your being and doing!
We want to remember the students, trainees and residents with flowers from our garden, who make the ambience oF CMC altruistic and mindful of others!
The team of administrative officers in the medical college, Nursing colleges, Allied Health Sciences, and hospitals in different campuses give themselves voluntarily and generously, for whom we send the flowers below from our garden.
The alumni of CMC V who have flown away to different parts of India and overseas, who live their calling, make CMC a movement of wholistic health care, in alignment with the motto of their alma mater, for which we greet them. These Barbets came today in our garden to greet you!
The retired faculty and staff whom Anna and I remember fondly, hope would feel delighted, to see CMC living its mission and vocation! Your presence and service during your time at CMC provided the continuity of this heritage! The flowers are for you from our garden. A small spider found its resting place in the open flower! As elders, all of us can be open to others younger professionals in CMC to find encouragement!
"....Three cheers for the Silver and Blue,
India's star in a sky clear and true,
Clouds of suffering we'd banish for ever,
Three cheers for the Silver and Blue!
Not for fame, not for wealth, our endeavour,
Pride of race nor of creed be our boast;
Each for all, all for each, thus for ever
United from coast unto coast.
Strong to serve, strong to save the defenceless
May thy spirit inspire us anew;
Not to gain but to give be our motto,
Three cheers for the Silver and Blue!"
We like the college anthem for many reasons-one being its call for longing and becoming! It is an inspiration for a pilgrim journey in health care!
Anna Mathew and M.C.Mathew (text and photo, the first two photos are of others. Anna iS an alumnus of CMNC V.)
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