Boundaries or openness !

During my travels in some countries, I noticed that the boundaries between compounds were either absent or only separated by hedge plants or low brick work of low height with many houses having no locked gate at the entrance. In the place where I live, most houses have high enclosures. Even our own compound has one such enclosure! 

A boundary stands for separation or demarkation. There is a personal claim of right to possess enshrined in this concept of having a well defined boundary. This was created for physical reasons of safety and privacy. 

But symbolically, what has this done to human behaviour! We have increasingly and unconsciously become private in our orientation and perspective. 

I watched this bird sitting on a post, used to to connect the barbed wire of separation to define a boundary. The bird was placed above the boundary fence!

Are we beyond our boundaries in our orientation and responses.   The president of the USA speaks of the Americans, the president of China speaks of the Chinese, the Prime Minister of India seems to represent the interests of the religious majority although he makes public statements of inclusiveness...have we not become more private as individuals and as nations!

The avians live freely loosely defining their territorial rights. The sky without its defined boundaries is their dwelling place. 

In fact the barbed wire fencing alone is most visible in the above photograph. What is on either side of the barbed wire fence is blurred. 

The boundaries and the privacy they represent have become so important or central to our thinking that we are in danger of living with a diminished consciousness of us being  a community people or a humanity!

This has perilous consequences. There is a suspicion that Chinese market is slowly taking over large  global companies when the share prices are dropping in order to contest the American supremacy in the global market! It is already true that the Chinese own prime properties in many countries thereby making their presence stronger in global economy. 

The United Nations Organisation in its charter alludes to the 'brotherhood of nations';  the constitution of India speaks of federation of states and union territories; we belong to a 'Panchayat Raj' culture in India, which stands for opportunities for all and democratic traditions.  The 'Kudumba Shree' movement in Kerala brings together women to create self employment and promote community consciousness. Women from all walks of life are members of this movement.

A church near Alwaye invited people with skills in tailoring to come forward to make masks for free distribution among health workers at this time of outbreak of corona virus infection. People from different religious backgrounds have volunteered to do this. 

I struggle with this a lot at my work place. There is a group of parents who find the fees they have to pay too high for them! Although we subside to the extent possible, I feel some who are financially stressed drop out!

How do we make our boundaries porous and make them accessible to each other!

I stay with the picture of this bird perched at the fence and its body occupying the space on either side of the fence! The bird symbolically abolishes the boundary of partition!

Jesus of Nazareth once spoke of 'giving away one tunic if you have two'!

All experiences in life have an obvious meaning and hidden meaning. 

Considering that it is the first time many countries have a 'locked down' of some sort, which might extent to weeks or months, it is good to explore the message we can draw from this for humanity. 

That message would have something for all of us, who practice an acquisitive way of living, consuming and possessing without measuring its effects on others or on our environment. 

M.C.Mathew(text and photo)

The new ball pool!

This is the new ball pool in the department, waiting for the balls to arrive! We shifted the earlier smaller one to the sensory motor room and decided to have larger one in the Early Learning Centre

Every time we add a new facility for children, we realise how much more is needed!

M.C.Mathew (text and photo)

Fellowship times

One high light of spirit of the team in the department, where I work is the attention the team pays to find time to have fellowship times. 

Anna and I feel grateful for the occasions we receive  their thoughtfulness and visit at our home.

In fact Dulcy was happy that she was almost ready to go with some of them who came to visit us recently! 

To make the work place a setting, where each person is happy to come to and feel a sense of belonging is indeed a challenge! Looking back over the last seven years, this has been more or less possible!

M.C.Mathew(text and photo)

A flower has no choice !

A flower remains open. It has a few possibilities once open. It can remain open till its petals whiter adn fall off. It can open and close like the butter cups do and live for a few days. It invites nectar seekers like in the three photographs above. Some flowers are cut to be kept in a vase for room decoration. Some buds do not become flowers as insects would have consumed them in the bud stage.

A flower has no choice of its own.

Do we have a choice of those with whom we travel in a bus or dine at a restaurant, or attend a meeting!

In fact we can only receive friends who associate with us in our work place or a hostel or in public engagements.

The flower offers its nectar and pollens to every visitor alike.  

I have pondered over it in the recent years. Friendships are sometimes for what others can get from us, or we want from others. Both are utilitarian in function. But when friendships transcend this existential dimension and move on to a trustful mutuality, what transpires is a mutual belonging and sharing of life experiences, affirmation of each other's ways and choices in life and a sense of togetherness because of the desire to give and find delight in the prosperity of others. 

The self giving love, agape is the matrix of such relationships.

To grow into that attitude of seeing others are as the objects of our attention and thoughts would mean  coming to terms with all the experiences friendships can bring into one's life. A flower is left with what is done to it.

That is when some slip into a victim role, which is a risky path towards losing the essence of self giving! No one hurts us except ourselves. 

What others do to hurt can be redeemed just as Jospeh of the Old Testament did in his response to his brothers. His brothers sold him to Egyptians. But when a famine struck families, Joseph's brothers came to Egypt seeking food. Joseph was the one whom they had to approach as by then Joseph had ascended to be governor in Egypt. Joseph welcomed his brothers and offered them food and returned the money they paid for the grains. 

Joseph's rootedness in the nature of God was what he demonstrated. We have an all giving God and His giving has no end. 

Humans carry with them the nature of God as we are 'created in the image of God'. 

We are on this journey to become 'all things to all people'! 

The experiences of the recent years brought this message into greater sharpness and I am glad that I am awakened to this new consciousness of living the mission of friendships-self-giving! Just as a child learning to walk would get up and continue the efforts to walk, so we are to do when we slip from being in the practice of self-giving. 

M.C.Mathew(text and photo)

From seven to eight!

On 14th September, 2019, this rose bush had seven flowers. The day marked completing  seven years at MOSC Medical College, Kolenchery for Anna and myself.

It is also the completion of seven years for the Department of Developmental Paediatrics and Child Neurology.

Today the same rose bush has eight flowers!

As I looked at the addition of one more rose flower overnight, I paused to think of the change from seven to the eighth year we are making at the  Developmental Paediatrics and Child Neurology. 

The eighth flower on the first day of the eighth year is hope giving.

Yesterday Susan showed me a graph Shalini made, comparing the number of children we welcomed for consultation, Early Learning Centre, Learning support Centre, etc form 2015 to 2018.There was a dip in the number of children who visited us in 2017, but the trend is turning upward now. 

In health care, an upward trend in statistics of those seeking help is seen as a healthy sign. 

There was a concern in 2017 when we noticed that our numbers were on the decline! Fortunately that did not consume us to desperation. We knew that with long periods with lesser professionals, the number would dip. 

We looked the time that a consultation or learning support session would take. What was evident was that the consultation time which was on average 45 minutes is now reaching one hour. Similarly the learning support sessions have also become longer!

Are we less efficient! 

What became clear to us yesterday was that, we now engage the families in a wider range of issues. Sleep monitoring record, behaviour check list, home environment, diet record, video-recording of child at play, clinical history, etc are the regular sources of information we seek from parents during a visit. During a learning support session, similarly four or five check lists are filled to get data that might give us a direction in diagnostic screening and developmental planning. 

I include about twenty steps in the clinical examination, which give us valuable information to make a clinical diagnosis as a prelude to make a developmental diagnosis. As morphological screening is included in the clinical examination, it often leads to search for a morphological diagnosis. About sixty percent of children have morphological variations, which make this exercise of clinical screening regular for all children. 

As we know and learn more, we also search for clarity. 

A dip in the number of children welcomed might have many valid reasons other than decline in efficiency! 

Now as there is also a preliminary developmental appraisal of language and communication, cognitive functions and family state of wellness, with each new consultation which the new consultation takes almost 90 minutes. The advantage of this is that there is more preciseness to our diagnostic approach.This is bordering to a tertiary care level in clinical assessment of children. As almost  hundred percent children would have an EEG and blood results to interpret and about 75 percent would have the MRI of brain to study, the time taken for all these steps prolong an initial consultation.  

So we begin the eight year with a new awareness that 100 percent of children who visit us are referred from elsewhere and most of them come for a second or third opinion. We make a clinical diagnosis of a morphological syndrome in about 35 percent of children during the first visit, which in  itself is a departure from what happens in  a regular neuro-developmental clinic. 

We have pursued this direction of upscaling the academic level, hoping that this facility can become a  place for training professionals in Developmental Paediatrics. It is a dream and not a reality as of now! We lost an opportunity in not inviting paediatricians to join when they came seeking for training! 

My own perspective in developmental Paediatrics changed in 1990, when I started going to the clinical meetings at the Institute of Neurology, Government Medical College, Chennai. Until then for about seven years, I had a symptom based approach in Developmental Paediatrics. If a child had spasticity, it needs to be treated. If a child needs mobility or learning support offer them.

When I became regular a the clinical meetings at the Institute of Neurology, I got to know Professor Velmurugendran, and few others, who having noticed my interest in child development encouraged me to pursue the neurological basis for all developmental disorders. That is what got me interested in the study the neurological basis of common developmental disorders. They dissuaded me in registering for adult neurology training as I was serious about my commitment to developmental paediatrics. There was no facility for Paediatric Neurology training in India at that time. It was because of this curiosity to get formal training, I joined for a clinical PhD programme in 1993 at the Institute of Neurology. The Paediatric Neurology training programme started at the All India Institute of Medical Sciences around the same time. By then I got entrenched at the Institute of Neurology academically and clinically that I chose to continue at the Institute of Neurology.

At the end of the three years, my perspectives had changed remarkably. The search for neurological basis, morphological basis, developmental basis, behavioural basis and psychological basis in neuro-developmental disorders became my interest. When in 1997, at the convocation of the TN Dr MGR Medical University, when I was conferred the PhD in Developmental Neurology, it was  a turning point in my clinical journey, because I had vouched to set my direction to pursue the practice of Developmental Paediatrics from a neurological perspective from then onwards. This meant that for every neuro-developmental disorder, I was committed to explore to discover the causal pathway as much as possible.

Having had this opportunity to be in the interface of child development and Developmental neurology for the last 19 years, I feel that this journey has given me a broad canvass of understanding that was unknown to me until then. It is this perspective I explore to practice in my work now.

So here we are with an eighth flower in the rose bush, and the ninth, tenth and eleventh in bud form as of today!

Let me suggest that the latter years can be more effective than the former years in the Developmental Paediatrics and Child Neurology departement at MOSC Medical College! 

M.C.Mathew(text and photo)