The parables of Jesus have a contextual, contemporary and prophetic message. The parables have profound truths obvious and hidden. Jesus used them to communicate truths that need consideration and response. The parables are different from fables which are stories that relate to inanimate objects in nature. The parables have a human centred narration. Most of the parables of Jesus were illustrations to describe the ‘kingdom of God’.
The parable in Mark4:26-29 is one such narration about the Kingdom of God. It is a farmer centred parable, referring to seed, soil, sower, sprouting, and sickle. It is parable on the growth process.
Let me use these as metaphors to reflect on the ‘Stewardship of professional conduct of health care professionals’.
The health care professionals who profess to be followers of Jesus of Nazareth are involved in the expounding the narration of the kingdom of God. These metaphors, when we relate to the context of the health care professionals in the present times, with regard to thier skills, life, attitude, behaviour, and vocation, would hopefully offer us a new horizon to look at.
The health care scenario in the Indian sub-continent has gone through a seismic change in the last three decades. We have multiplied the number of health care professionals whom we train. Is there a deficit in their ethical perspectives and vocational interpretation of the practice of Medicine! Many in the health care leadership think that there is an attitudinal, motivational, behavioural crisis the health care professionals are going through currently.
In the light of this background, I feel inclined to reflect on this parable to help professionals to consider how they are to be messengers of the kingdom of God in health care practice. There are some young professionals, who go to work in cross cultural situations in the rural areas, who encounter demanding situations. It is good for them to prepare themselves personally and professionally during this transition.
Let me reflect on the five metaphors in this parable.
1.Seed (v.26)
A farmer prepares the seed form the grain he gathers from the harvest. My parents had paddy fields where they cultivated paddy on two occasions in a year. I recall how they prepared the seed from the grain by drying them in the sun for three hours each day and leaving them exposed to the cold of the night for about three weeks. This process of preparing the seed for rice cultivation is done strictly to produce the seed that would yield good harvest. A farmer desires to sow the best seed to the soil. That is his mission as a farmer.
For health care professionals, our skills are the seed. The relational skills, listening skills, diagnostic skills, investigation skills, coping skills, communication skills, counselling skills, breaking the news skills, treating skills, operative skills, etc are the means through which a health care professional reaches out to patients and their families.
It is through diligent learning, observing and practicing them, continuing education and personal discipline of self-directed learning, a health care professional equips oneself to acquire the skills necessary to look after the needs of the patients. Our professional skills define our competency and adequacy as professionals. For people to trust the professionals for their health care, they are to be known for their skills and competency.
As the well-prepared seed is farmer’s way of preparing for a good harvest, it is the cluster of skills which the health care professionals acquire through their training and practice, that would ensure good outcome for their patients. Good stewardship in professional conduct involves being committed to fine tune our skills for effective health care practice.
During my short stint at CMC Vellore between 1980 and 1982, I worked under Professor Malathi Jadhav, belonging to the first batch of the post-graduates in Paediatrics trained at Grant Medical college, Mumbai. She was a clinician and child specialist with an array of skills. Till she retired, her passion was to pass on her skills to younger people. Her interest in Dysmorphic syndromes rubbed on to me and the skills I was introduced to diagnose children with unusual morphology was her investment on me.
Preparing others to be skilled is a vocation. Jesus prepared the followers from being ‘fishermen’ to ‘fishers of men’.
2.Sowing (v.26)
The farmer ‘casts seed on the soil and goes to bed at night and get up by day’
A sower gives away his seed after having prepared it to the best of his or her ability. The farmer was given the grain form the previous harvest which he turned it into seed ready for sowing. The farmer chooses the season, weather, moisture of the soil, manure, and the type of sowing before he casts the seed on the soil. The farmer is a master over seed and sowing.
It is similar with health care professionals. They with their diagnostic, investigative, interventional and interpretive skills give their attention to patients. What they have been given, they pass on for the wellness of patients. Most doctors keep the interests of patients before self. It is the care and attention which health care professionals offer which make a difference in the lives of patients.
Drs Raj and Mabel and Arole, when they returned after their public health training in John Hopkins University in the late sixties, went to set up a small hospital at Jamkhed in Ahemmednagar district of Maharashtra. When they realized that the health indices in the rural areas were abysmal, they got women volunteers from the villages to train them in to being Village Health Workers. Some of them were not literate; only few had gone beyond 8th standard at school. However, they were motivated and available to make a difference in healthcare in their villages. After two years of hands on training, they were commissioned to be resident Village Health Workers in their village with the responsibility of taking care of antenatal women, providing immunization to children, conducting uncomplicated child birth at home, providing first aid care for common ailments, taking care of children during diarrhoeal illness by feeding them with Oral Rehydration Solution, etc
When I met him for the first time in 1976, the Aroles were already recognised worldwide as pioneers in primary healthcare. All the health indices had dramatically changed in the villages in and around Jamkhed during a period of five years. The WHO had adopted their model as an effective approach to primary Health care in developing countries. During a conversation with him, I enquired about their motivation to locate themselves in a village and explore a new model of health care. His response was, ‘We had only the village women whom we could find. They were motivated, but not skilled. We decided to equip them and invested our time and attention to augment their skills. They surprised us by their enthusiasm and efforts to use their skills’.
This is the fruit of sowing. When Jesus spoke this parable to His followers, He focussed on sowing in order that the seeds would sprout.
All of life is a mission in giving. It is ‘in giving we receive’. It is ‘more blessed to give than to receive’. Jesus was in the habit of giving. Jesus washing the feet of disciples stand out as the mark of His self-giving.
3 Soil (v.26)
The soil in this parable metaphorically reminds us of people, whom health care professionals encounter in their work situations. We give our attention and provide care for people in need. We have no choice on who would come to us with health care needs. While most people are genuine, there would be some who would turn hostile. I heard a few weeks ago that security men in a rural mission hospital were manhandled by relatives as they were not permitted to go into the hospital as visiting hour was already over in the intensive care unit. The commotion was ugly and health care professionals are equally vulnerable to anger outbursts for unreasonable reason. Another instance of doing everything to save a mother with eclampsia and deliver her baby angered the relatives as the mother took time to respond to treatment. There would be some people like this among those who seek healthcare. Knowing this, we need to be aware that we have no control over the outcome of what we give.
Let me suggest that we can share with people who come to us, only acts of kindness. I have often been refreshed by this prayer of St. Ignatius of Loyola of 15th century:
Teach me to serve you, Lord as you deserve,
To give and not to count the cost,
To fight and not to heed wounds,
To toil and not to seek rest,
To labour and ask not for reward,
Save that of knowing that I do your most Holy will’.
This ‘Prayer of Generosity’ summarises the attitude with which we are called to serve others. Jesus of Nazareth admonished us: ‘But I say to you, love your enemies, pray for those who persecute you in order that you may be sons of your Father who is in heaven for He causes the sun to rise on the evil and the good and sends rain on the righteous and the unrighteous alike’ (Matt 5:44).
I witnessed something of this while working with late Dr A.K.Tharien, of Christian Fellowship Hospital, Oddanchatram in 1976. We were both in the out-patient area, looking after patients, when a hospital employee walked in, shouting at Dr Tharien, for putting him on the night shift. For the next couple of minutes, he verbally abused Dr Tharien. Dr Tharein sat in his chair still, while patients and I felt most embarrassed and disgusted at the unruly behaviour of an employee. After he left, Dr Tharien disappeared for about fifteen minutes. When he returned, I raised this matter with him. He had gone to pray in the chapel during which time he felt that he ought to forgive him for what he did. He had decided to visit him at his home in the evening to enquire about his family and children. This he did and took with him fruits for the family and toys for his children. Next day, Dr Tharien told us that the employee was profusely sorry and sought forgiveness for his anger outburst. It was the first occasion as much as I can recall, I witnessed such an act of self-giving and a spirit of forgiveness with absolution.
It is common these days, when patients and relatives behave with an attitude of entitlement, demands and pressure that we might feel suffocated and fearful by their imposing posture. Even then, the only option that we are left with is to do all that we can even amidst hostility and ‘commit everything to God who judges righteously’. I know of situations, when health care professionals suffered for doing good. Even in such instances, we shall continue in our mission, because they are the ‘soil’ to whom we shall sow goodness in spite of hate and hostility!
4. Sprouting (v.27,28)
‘…And goes to bed at night and gets up by day and the seed sprouts up and grows-how he himself does not know. The soil produces crops by itself; first the blade, then the head, then the mature grain in the head’.
The above two verses point out that the sprouting is something beyond human efforts or plan. It is a feature of the Kingdom of God. God is the initiator and consummator of all that would happen in the kingdom. Human efforts can be spasmodic or episodic and would vary according to circumstances. But God of the kingdom is always at work. The consolation for the followers of Jesus of Nazareth is that God shall work out His purpose in His own way. The stanza of hymn below clearly suggests this:
‘God is working out His purpose as year succeeds to year,
God is working His purpose out, and the time is drawing near,
Nearer and nearer draws the time, the time that shall surely be,
When the earth shall be filled with the glory of god as the waters cover the sea’.
Let us be witnesses of goodness sprouting all around us, in response to the good that the faithful people of God, invests in the lives of people!
I am reminded of an example of Dr Paul Brand in doing good even in the midst of provocation. He looked after a patient who had ulcers in his legs due to leprosy. He was admitted at Christian Medical College, Vellore for two months. His ulcers healed in his anaesthetic feet and went home with micro-cellular foot wear which was to protect his feet from sustaining injury. After he was cured, he made an accusation that Dr Brand tried to convert him to Christian faith. On investigation by the local civil authorities it was found to be false and the colleagues of Dr Brand was infuriated by this false complaint. A year later this man returned with recurrence of ulcer in the feet and Dr Brand’s colleagues were bit weary of him and wondered how to approach him. Dr Brand knowing the hesitation of his colleagues to befriend him inspected his feet and personally dressed his ulcer for a few days, till his colleagues were more comfortable to look after him. I remember asking Dr Brand about this when I had an interview with him and Mrs Brand at Karigiri, during their final visit to India. What Dr Brand told me then still remains with me. ‘It is when people are angry or hostile to us, we ought to be even more kind’.
What causes the goodness to multiply and fill the lives of others with whom we work is through our generosity in attitude, thought and deed.
‘I cut and God heals’, is what a surgeon believes in. As health care professionals, we are not able to condition the behaviour of patients and relatives towards us. We can choose the way we behave towards them even in adverse or provocative situations. That is the only way we can overcome ‘evil by good’ and allow the sprouting of goodness in human hearts.
Last week doctors at Trivandrum Medical College went on protest for two hours on two days as one of their colleagues was suspended for flimsy reasons at a time most doctors were burdened with the care of COVID 19 patients. I wish the authorities had not provoked the doctors this way. After two days, the doctors withdrew the protest and decided to fast and work. The government revoked the suspension of the doctor. Anything that would inconvenience patients and others whom we are committed to look after, cannot suffer even if we are wronged. This is at the heart of ethics of health care practice. The prayer of Jesus of Nazareth from the cross, ‘Father forgive them for they do not know what they do’ is the gold standard for our behaviour.
I struggled a lot with this way of relating, when I was involved in an organization. There were complex matters which strained relationships. After I left the responsibility in the organization, I was able to send letters of conciliation and apology. I felt moved to lead the way by sharing goodness and thoughtfulness. Some who have responded were gracious, affirming and forthcoming. No situation ought to end up as a stalemate, as there is no alternative to sowing goodness. f When Jesus sowed the seed of goodness in the life of Zacheus, what an abundance of response came forth from him through the offer of generosity towards the poor and others whom he defrauded. Any act of goodness has the prospect of sprouting into an abundant of acts of goodness sooner or later.
5. Sickle (v 29)
A farmer harvests what was born out of his sowing. He has to harvest with a sickle what he nurtured, when the grains are mature. The sowing and harvesting are two connected events. The farmer breaks the ground to sow and cuts the stalk of grains at harvest time. There is transitoriness to all good things. The sickle is a symbol of that.
The qualifying statement is ‘when the crop permits, he immediately puts the sickle..’. I have pondered over it a good deal. There is an opportune time for the crop to be received to the barns. It is from the barns the grains get recycled for food and to be seed for the next sowing season. The crop permits to be cut, because the grains have a larger use if they are cut and gathered into the barn. The grains would become food or seed because they were cut at the appropriate time.
This is the cycle of life. There is a time for sowing and harvesting. This is the rhythm of life for humans, ordained by God. Our life is the soil from whom others harvest all that they need. For health care professionals it is significantly symbolic. We learn, acquire skills and proficiency in order to give them away to those who come to us. Our life becomes the harvest for others to gain and grow.
One aspect of professional life that we do not consider sufficiently is the exhaustion or weariness we suffer from, when we allow others to harvest what they need form our lives. Others take away our time, they turn to us to benefit from our professional skills, those who have multiple needs can deplete us of our patience and resilience, etc. Each of our engagement with others is a giving exercise. That is the only way of being in the kingdom of God.
Our giving of ourselves bring us some returns. When a child with meningitis goes home well; a patient becomes aymptomatic after a laproscopic cholecystectomy; a mother and new born baby return home after a tumultuous time of mother’s Eclempsia during pregnancy, etc. Such events bring satisfaction and fulfilment to the professionals. And yet, we cannot attribute all of those to our skills alone. It was when the farmer slept, the seed sprouted. The good professional outcome we witness in our daily work is the outcome of blessing God adds to our efforts.
St Paul has something profound to say: ‘And what do you have that you did not receive? If you did receive it, why do you boast as if you have not received it’(ICror4:7). Let us grow in gratefulness for our skills, understanding, learning opportunities, positions of responsibilities, etc all of which have been given to us by a good God. Therefore, we can hold on to them only loosely and lightly. What we have been give are God’s resources for others.
Dr Frank Garlick demonstrated this attitude, when he left his position as a professor of Surgery at Christian Medical College, Vellore in 1970 in response to a need to help young doctors in mission hospitals to equip them surgically. He felt the need when some students and residents who used to come to his home regularly asked him once, ‘Where are the senior doctors who are willing to go to mission hospitals to help young doctors to develop their skills’? For the next five years Dr Garlick travelled to mission hospitals and spent his time handholding doctors to prepare them for surgical procedures. His was an example of making his life a harvest for young doctors for their enablement.
The health care professionals are stewards of God given resources. The seed symbolises the skills we are blessed with. The role of the sower is to cast seeds on the soil. The soil is a symbol of all those who come to healthcare professionals for their needs. The sprouting is a symbol of God at work in the lives of people whom we reach out to help through providing health care. The sickle is the symbol of harvest times. The harvest symbolises sharing and giving.
God has called us to be labourers in His kingdom. All those who come to us are seekers expecting a turning point in their lives.
I remember reading books of Philip Yancey, Where is God when it hurts; Unhappy secrets of Christian life; Disappointments with God, during my college days. I found his writing parabolical and evasive of any captivating truth. But his books in the later years, co-authored with Dr Paul Brand had a distinct flavour of insight, inspiration and intimacy with God. Those books Fearfully and wonderfully made, In His image, Pain-the gift that nobody wants, are spiritual classics. I knew that something profound had happened in his life during the in between time.
I found a reference to this change in an article he wrote in the book edited by Keith Danby, Stories from around the world (Authentic lifestyle 2003). The significant event in his life which happened in 1975, was meeting with Dr Paul Brand, at National Hansen’s Disease Hospital at Carville. Referring to his first meeting with Dr Brand, Yancy wrote in the above book, ‘I was a young punk in my mid-twenties, with bushy Art Garfunkel style hair; Brand was a dignified silver-haired surgeon characterised by proper British reserve…Something attracted me to Brand at deeper level than I had felt with any other interview subject. For perhaps the first time, I encountered genuine humility’ (page 66). Elaborating further Yancey confessed, ‘My faith grew as I observed with journalist’s critical eye a person enhanced in every way by his relationship with God. I came to know him as an actual living model whom I could watch in action; at Carville with his patients; in the villages in India; as a husband and father; as a speaker at both medical and spiritual conferences…..Deprived of my own father in infancy, I received as an adult from Brand much that I missed. As much as anyone, he has helped set my course in outlook, spirit and ideals. I look at the natural world, and environmental issues, largely through his eyes. From him I also have gained assurance that the Christian life I had heard in theory can actually work out in practice. It is indeed possible to live it in modern society, achieve success without forfeiting humility, serve others sacrificially, and yet emerge with joy and contentment. To this day, whenever I doubt that, I look back on my time with Paul Brand’ (page 69,70).
I had an opportunity to meet Philip Yancey and hear him for three days at the Christian medical College five years ago. During a brief conversation I referred to what he wrote in the above book about himself and showed him a published copy of the script of my interview with Dr Paul Brand at Karigiri during his final visit to India. He was more than delighted and looked keen to talk. His reflection about Dr Brand was, ‘He lived his life following Jesus, and inspired me to live devotedly and passionately. Dr Brand led me to live peacefully’. Dr Brand became a path finder to Philip Yancy in his journey of life.
Many people come to us as we are health care professionals. Some of them would be seekers of meaning and purpose in life. If only they can find us warm and open, some of them might feel awakened to long for God in their lives. We too can be path finders to encourage those who come to us to be pilgrims as envisioned by John Bunyan in his hymn:
‘He who would valiant be
‘Gainst all barrier
Let him in constancy
Follow the master
There is no discouragement
Shall make him once relent
His first avowed intent
To be a pilgrim.
Who so beset him around
With dismal stories
Do themselves confound
His strength the more is
No foes shall stay his might
Though he with giants fight
He will make good his right
To be a pilgrim
Since Lord, thou dost defend
Us with thy spirit
We know we at the end
Shall life inherit
Then fancies flee away
I will fear not what men say
I will labour night and day
To be a pilgrim’.
We are called to be stewards of our professional conduct in order to be path finders for those who come to us seeking health, healing and wholeness.
M.C.Mathew
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