Children's long walk to Freedom!

I copied this photograph from an article in the print edition of the The Indian Express,  'Stories not told of the pandemic'  written by an eminent Journalist, Tavleen Singh. This appeared on 3rd May 202.  The the online version, entitled 'When all this is over, it is really important that the big bosses of Indian journalism urge season of introspection' appeared on the same day. I copy this giving credit to the author and the photographer Narendra Vaskar.

It is a story of a guest worker family going home on their feet somewhere in India, from where they lived and worked, after the locked down was announced. 

What held my attention is some disturbing visuals of the family. They are walking in the mid-day, guessing from their short shadows cast on the road. The child held by mother is walking barefoot. Only one of the two children carried by the man has foot wear. The mother might be carrying water on the vessel she is holding on her side. The man is carrying a weight of 25 kilograms or more of the two children on his body. The man is unusually tall and would have been a sought after basket ball player, if he was picked up young and trained. But if he is tall due to a condition like Marfan syndrome, then he might have risk factors in his health domain. They have no protection from the hot sun. If the tall man walking behind  this family is another member of the same household, the bag he carries might contain all their essential earthly possessions.  All the children have an appearance of undernutrition. I would think similarly of the man and woman. However, it is a caring family demonstrated by, the man carrying two children and the mother supporting each step of the boy by lending her hand. 

This is the other India, dissimilar to the India where our national leaders and political pandits live! Tavleen Singh, blames the print and visual media for underplaying the displacement story of about 4 crores of people during this locked down period. Even when this story is narrated by the media, it was only to give a marginal attention. The only exception according to Tavleen Singh was Burka Dutt, a television journalist of 21 years standing with the NDTV, who now runs a YouTube news channel, MoJo

I watched Burka Dutta conversing with a migrant family walking with them, on the road from the video uploaded in her site. She was talking to a family who had walked 100 kilometres on foot nd 1200 hundred kilometres more to cover. This family had three children with them. Mother confessed that she was feeding her children with dry chapatti and salt for three days. Burka did not continue talking as the whole family by then broke down. Burka is an unusual commentator with a human touch and passion for human wellness. She covered nine states during two months, travelling on road and getting stories from the migrant workers while they  were travelling in crowded trucks or walking in the heat. 

One interview with a group of children travelling in a crowded truck, caught my attention. Burka asked a pre-teenage girl, 'What  would  you do when you grow up'?. This girl instantly said, 'I want to help poor people'! In their story of loss and abandonment, it is moving to hear a girl talk about reaching out to the poor. 

I am at a loss! This is the second human migration after the partition of India. It is awful to think that children have to suffer this way in the post-independent India! 

The way our leaders have mismanaged the locked down and the misery imposed on the migrant workers would remain as a blot in our national history. It points to the poverty of humanness in our leaders! 

Thank you Tavleen Singh and Burka Dutta for telling this story, which I knew little from a far distance!

M.C.Mathew (text)

Parent-child interaction

I had opportunities to address parents of lower and upper Kindergarten children at the beginning of a new academic year, when Anna and I lived in Chennai from 1983 to 1997. During such occasions, I took time to meet with children and their parents for a conversation. One question I often asked them was, ‘what would make you happy at home’.  One girl, 6 years, told me once in a choking voice, ‘Tell my parents to make time for fun times, talking times, outings and celebrating birthdays’.  It was the first time I realized that a six years old child can actually express her concerns about her family life. In fact, this formed the substance of an introductory talk I used to give to parents, on building communicative relationship with children. 

It is during the recent years, I became even more aware of the wider dimensions of communication process within a family. During the parenting years of two boys who are now adult men, married and with their own children now, we have had to go through some unlearning and learning about the way we communicate to them and between ourselves as a couple. Following their marriages, we have been through more learning experiences in relating to the married children and their spouses. Anna and I have often felt that our children, their spouses and grand children have enlarged our understanding of communication process during the span of the last forty years. It is only when parents and children become partners in this journey of communication for relationship, deepening of relationship can take place.

Let me try if I can summarize some reflections on making parent-child communication process a means for building relationship. The communication process can promote the following:

1. Parent-child identity

2. Conversation times

3. Dialogue times

1. Parent-child Identity 

Anna and I were immensely glad to have been able to spend some days with our grandchildren, recently. What encouraged us was the way, the parents used  their wakeful periods as communication times by singing, playing, reading, talking going on an outing, involving to him. There was reciprocity from the baby with heightened visual and auditory alertness even from the them in cooking and household chores. It was a reminder to us that children are conditioned for interaction and communication. When a baby cries and a parent gives attention to respond to his or her needs, it assures the baby that he or she is in the midst of those who care. All the expressions of care, which parents offer to a baby in the early infancy would condition the baby to grow in trust, acceptance and self-worth. This is essential for a healthy emotional development of an infant.

The communication times provide the milieu for exploring the dimensions of parent-child identity. Jesus of Nazareth separated himself from his parents during a family visit to the temple for listening and dialoguing with the religious leaders on matters of the law and prophets. His mother had to return to search for him, when he was not found to be with the caravan.  He responded to his mother’s enquiry about his decision to stay back in the temple, by stating the intent of his heart, ‘…Did you not know that I had to be in my father’s house’ (Luk.2.49). Although he accompanied his mother to go back home, his parents did not understand the meaning of his statement.

This incident gives us an insight about parent-child identity while building relationship between parents and children. Parents have a natural overseeing role over their children, as Children are physiologically their offsprings. The consciousness of St. Paul about God, ‘who had set him apart’ even from his mother’s womb (Gal.1.15) gives a child an identity beyond his or her physiological identity. In fact, this enhances the value of every newborn baby from being just the fruit of a physiological union of parents, to being divinely called into being. This offers every baby a belonging beyond the home into which a baby is born. Parents are providers to their children while God is their keeper and children are God’s gift to humanity, and not just to one family alone. 

This is most explicitly expressed by Kahlil Green, (1883-1931) in his poem, The Prophet (knopf, 1923).

‘And a woman who held a babe against her bosom said, speak to us of children,

And he said:

Your children are not your children.

They are the sons and daughters of Life’s longing for itself.

They come through you but not from you,

And though they are with you, yet they belong not to you.

You may give them your love but not your thoughts,

For they have their own thoughts.

You may house their bodies but not their souls,

For their Souls dwell in the house of tomorrow, which you cannot visit, and not even in your dreams.

You may strive to be like them but seek not to make them like you.

For life goes not backwards nor tarries with yesterday.

You are the bows from which your children as living arrows are sent forth.

The archer sees the mark upon the path of the infinite, and He bends you with His might that His arrows may go swift and far.

Let your bending in the archer’s hand be for gladness.

For even as He loves the arrow that flies, so He loves the bow that is stable.’ (italics mine)

The parental role is to enable children to fulfill their calling as soon as children are mature enough to choose. The parents do not ‘own ‘children although they beget them. Children are not independent of parents although they are set free to pursue their calling. Parents and children are in an endearing relationship, but not in a binding relationship. This mutually ‘belonging’ relationship creates intimacy and bonding between parents and children.  It also offers freedom to parents and children to view the relationship subject to the sovereign purpose of God the Father, from whom all families on earth come into being. So, parents and children grow up in a self-giving relationship, both actualizing their identity in mutual acceptance and support without being dominating over each other. 

The Abraham-Isaac story (Gen.22.1-19) clarifies the parent-child identity even more. Abraham set out on a journey to sacrifice his son according to God’s command. Abraham and Isaac ‘walked on together’ (v.8) till they reached Moriah, but when they reached the place for the sacrifice, Abraham bound his son and placed him on the altar for the sacrifice (v.9). Our children are ours by birth, but God’s by calling. Parents need to surrender their children to actualize their calling and children in turn ought to regard their parents. 

I remember a conversation with a ten years old boy, who lost his costly fountain pen, which his parents gave him on his birthday. I asked, if he would get scolded by his parents for losing the pen! He replied, ‘the gift may be lost but the giver’s heart has not lost the giving spirit’. I wonder whether parents can carry the giving spirit knowing that, it is to God the giver of the gift, we surrender our children to fulfill their calling. This frees us from clinging on to our children and burdening them with our expectations. The Biblical call is, ‘freely we have received, freely we shall give’. It is this openness that shall make parent-child relationship a life-long adventure of a mutually supportive anchor.

2. Conversation Times

The conversation times at family mealtimes, during an outing or playtime or shopping, etc. is usually spent in sharing information, listening to each other’s views and ideas. They form the most important link between parents and children to grow in emotional bonding. This calls for guarding such times without being preoccupied or distracted. One comment I heard from a seven years old girl, about her parents is that ‘they are around but not present’. She was desperate for more conversation times at home. Children need to learn a lot through conversations-speaking by taking turns, showing respect even while disagreeing, sandwiching criticism between complements, learning from the experiences of others, understanding values and morals, etc. 

A psychologist whom I personally know well for fifteen years, who studies conversation content within families, recently told me that the subject of such times have shifted to films and film stars, new products in the market, holiday resorts, investment an savings, etc. These are adult oriented conversations and not formative for children. So, if children try out smoking, drinking alcohol, dating, pornography, gaming, stealing or cheating, it is likely that they have not had their minds soundly formed through conversation times at home. Anna used to read stories, biographies and general knowledge related information during our mealtimes, picnics and outings and during long car travels until children were in college. They formed a substantial part of our efforts to build in an inner fabric of values and sound thinking in our boys.

I find that listening is a challenge for most of us, as many interests and needs compete for our attention. I found a parent attending to her daughter’s conversation, while she was entertaining her guests at home. This three years old girl, brought a dead butterfly from the garden and said to the mother, ‘where can I bury it’! The mother after hugging her, excused herself from her guests and accompanied her daughter to the courtyard. She buried the butterfly in a place of her daughter’s choice. Later this mother told me that, the conversation was all about growing more flowering plants in the garden so that butterflies would not starve to death. The family had watched a documentary on children of the world the previous evening, which had some scenes of children in refugee camps in Somalia suffering from starvation.  For her, Somalia was ‘non-existent’ emotionally, but the butterfly did matter to her.

This is how young children’s mind works. They are stringing ideas but are looking for coherence and clarification. Often, children cannot wait for another occasion, as they cannot keep a question hanging in their mind. Their questions often need instant responses. It is one of the reasons why they can appear to be nagging. When denied of that attention due to parental preoccupations, a child can grow up with a feeling that, ‘I do not matter to my parents’. 

A cardiologist who leaves home early and returns only at night mentioned to me that he feels distant from his teenage son and daughter and feels distressed about it. He attributes it to the lack of conversation time he had, when he was growing up. Although it did not exist for him, I encouraged him to spend leisure times with his children to break the ice. Three months later, he was ecstatic about the newfound freedom of conversation with his children. Therefore, it is never too late to start the practice of conversation times. In most instances the intimacy between parents and children can be restored, if they can create unhurried times of listening and discerning. 

The words of Jesus, ‘Let children come to me for theirs is the kingdom of God..’ is an invitation to adults to revise their attitude towards children.  As parents it is our responsibility to make children feel that they have access to our time, and attention.

3. Dialogue Times

The dialogue times are structured times, usually about 20 minutes each time on a topic that a child would like to discuss. They can be topics, which get discussed at school in and outside the classroom. It is done when both parents are present and is organized for all the children together or one child at a time on a topic previously agreed upon. The dynamics of this dialogue is that each person gives his or her opinion on the issue on the first round followed by questions, clarifications or disagreement in the second round. The third round is to express what has become clear or not clear, in which case ,one of the parents would sum up the time with a plan to meet again sooner or later to continue the dialogue if necessary. 

The idea is to help children to discuss matters logically, rationally and critically. The purpose of such times is to give an opportunity for children to express themselves and feel valued for his or her opinion. Most children would settle down to make these times valuable for themselves and parents, once they know that their opinions are listened to. The impulsive anger or loud disagreements or interrupting conversations would also settle down over a period of time, when they know that they have their time for conversation. Usually each child takes turn to moderate these dialogue times, which is one way of introducing them to leadership skills. 

It is during such times, self-disclosures would take place directly or indirectly, which is another value addition to these times. In fact, parents would be glad to have had, an access to the thought world of their children during such occasions without making children feel intruded into their privacy. Most parents form opinions about their children from what the hear from their teachers, friends, neighbors, etc. It is more common to pay attention to the complaints,which parents hear from others and make children feel guilty. Sometimes parents do not make an effort to explore the truth with children and stay biased by what they hear from others. The dialogue times can become most useful private conversations with one child. This gives parents an opportunity to draw near to a hurting child and offer comfort, which is what a child would need when he or she is guilty of an act of commission.

As children go through transitional ages of preadolescent and adolescent years, the dialogue times become even more important. Many children by then are under pressure to conform to peer behavior which they normally hide from their parents. It is the fear of reprimand and punishment, which persuade them to hide facts and truth from parents. It is good for parents to accept that the transition years are turbulent periods for children and what they need is companions to accompany them to conduct themselves soberly. Children would be more comfortable if parents can give them some concession and understand the pressures under which they function. Parents would do well if they can affirm their child and strengthen his or her resolve to change.

The story of the boy who gave away his five loaves and fish to Andrew when he went searching for food at the request of Jesus to feed five the thousand people, is an illustration of the way, a child can be made to think and behave. Normally children would like to hold on to what they have. This child was willing because it was Jesus who was asking for food. Andrew’s friendly demeanor made a child do, what he would not have done ordinarily.  This is a lesson for parents.  The parental involvement with children is to lead them to do what is right and desirable, even though it looks difficult initially. A child’s mind consents to kindness and thoughtfulness more than to reason and logic. 

A catholic Father who is involved in rehabilitating children living in the streets, explained his approach to wean away children from substance abuse, stealing and criminal activity. He has daily meetings with them in the evening around a meal. For weeks he would have to listen to a child before he can influence a child to change. The dialogue times, in a group or in private facilitate to build trust between him and children. He is able to help children when they are ready to change. This catholic Father was amazingly patient.

Anna and I recall several dialogue sessions we have had with our boys when they were growing up. One particular question from our older son when he was around five years opened a new chapter in his life. He asked us, ’Can we have a piano at home’! Although it took a while before we could have one at home, he began his piano lessons then and went to on to complete his Royal College of Music examinations during the school years. He uses his musical skills extensively now and is inspirational to others to advance their musical talent.  It was during the late teen years we have had several dialogue sessions with our younger son about his desire to own a motor bike. It took a while before we could come to an agreement on the conditions attached to the use of a bike. He reciprocated well to our trust in him and became cross-country biker. He became an example to others on the good practices for safe biking. 

The aspirations of children get expressed when we create occasions to affirm parent-child identity and promote conversation times and foster dialogue times. When this happens, parents are in touch with the spoken and unspoken needs of their children.

M.C.Mathew (text and photo)

Conduct of one called to lead!

Anna and I along with Arpit and Anandit, spent a week end with Alan and Noel Norish in their home at Tunbridge wells, during our stay in Britain in 1987.  It was wintertime and the roads and walkways were wet and slushy with melting snow. They took us for a walk into the countryside. The sights of tall oak and fern trees, meadows covered with melting snow, farm houses with cattle in protected shelter and stories Alan narrated of his time in the British Army serving in India in the late forties, made that morning most special. However, what etched in our memory was something that Alan did after we returned home. Our shoes were wet and smeared with mud. We kept them in the shoes rack and sat down for lunch, listening to more stories from Noel and Alan.  When we got ready to go for the evening service at their home church, we were in for a surprise. Alan had cleaned our shoes, dried and polished them. It embarrassed us, but for Noel and Alan, it was only an ordinary act of kindness. Later that night, when Alan showed a booklet he wrote on leadership for the Bible and Medical Missionary Fellowship, whose Executive Director he was, I was able to interpret what he did to us in the context of his world view on leadership. For Alan and Noel, living with a sense of consciousness of others and carrying them on their hearts was the mission of leadership. 

Thirty-seven years have passed since then. I still regard the above experience as my introduction to a journey in exploring the realm of spirituality of leadership. The ‘mantra’ of leadership has been researched and expounded extensively since we entered the management driven approach in business about forty years ago. Let me introduce five dimensions while considering the mission when called to lead.

1. Calling

2. Enablement

3. Intuition

4.Discernment

5. Prophetic sense.

1. Calling

I happened to watch one evening, while returning home from work, a seven years old child from the neighbourhood, running towards the sports filed. I asked, ‘Are you up to some mischief?’ He said, while continuing to run, ‘I must go to cheer my brother as his team is playing football with a tough team’. The purpose of this child was to be present at the football field. His mission was to encourage his brother and his team. His motivation was his sense of belonging to his brother and an engagement in his interest.  These are three ingredients of a calling. 

Recently, I spent a few days with a friend, who is embarking on a new service for young people.  In his presentation to some of us who are his friends, he said,’ I cannot but do it. This mission has grown within me over the last three years’! None of us needed any persuasion to be drawn by his passion and belief.  The calling begins with an awareness, which often leads to self-appraisal of the responsibilities involved and a season of preparation followed by a statement of the mission to make it known to others.

Mr. Narayan Murthy, the former founder Chairman of the Infosys, was brought back to lead the organizations Infosys, to revive its fortune and direction. In his acceptance response, he seems to have said, ‘I accept your confidence in me to make a difference. I know only little, more than what I knew five years back, when I stepped down. But together, we can think, work and find our way’. In this response there was confidence, hesitation and direction. This form of integration of mixed feelings, associated with a calling, was also the personal experiences of Abraham, Moses and Samuel.

The Biblical narration of Abram’s call (Gen12.1-3) expresses the purpose, mission and motivation. ‘So Abram went forth as the Lord has spoken to him.’(v.4) It is explicit that God called and Abram responded. In case of Moses, the call came clearly (Exo.3.10) and the response (Exod.4.10-13) was one of hesitation, clarification and authentication. The inclusion of Aaron (vs.14-16) in this mission, to compensate the deficiency Moses had in speaking, is a good illustration of how God prepares a person to do something, which is ordinarily beyond one’s own capacity. The call has a transcending dimension of all human possibilities. This explains the divine logic, when a least expected person, is sometimes placed in a position of responsibility, to the surprise of many. This is illustrated even more vividly in the case of Saul, (I Sam.9.21). Saul was self-conscious of his humble origin, ordinary family heritage and personal limitations. When Samuel while anointing Saul with oil, said, ‘Has not the Lord anointed you ruler over His inheritance’ (I Sam.10.1), it was an announcement of the intent and content of God’s call. 

The story of anointing of David (I Samuel 19. 1-13.) brings out another dimension of this calling. David was chosen from among all his brothers by Prophet Samuel and ‘..the spirit of the Lord came heavily upon David from that day’(v.13). And yet only in 2 Samuel 2.1-7, we see the actualization of this when he formally became the king. The in between time was spent in isolation due to the hostility of Saul. After the death of Saul, David sought after the Lord (v.1) to receive the mandate to be the king. The calling was sure, but its consummation needed endurance, preparation, maturity, and change of heart with compassion and kindness.  

During a recent visit to a leading institution, I came across two fairly well-known people. One kept pursuing his mission relentlessly and patiently since his coming to the institution in spite of set-backs and obstacles with a cheerful and humble spirit. The other lost his direction and got entangled in seeking for position and control, during which process he reduced himself to be controversial and stressful, devoid of joy of service and relationship. This suggests that a calling needs an on-going nurture and diligent attention to live out that calling. 

Our calling is not just an invitation to a vocation or place of work or a responsibility, but a commission to fulfil what St. Paul wrote in Ephesians 1.11. We are ‘predestined according to His purpose, who works all things after the counsel of His will’. Every person who desires to be a disciple of Jesus is under obligation to live fully in tune with this godly calling. Our lives and living are to be a reflection of this calling. 

This applies even more to those in positions of leadership. It is by conforming to our calling, we leave a trail of affirmation of its value and worth. Jesus of Nazareth expressed this in a statement, ‘My meat is to do the will of the father who sent me’ (John 4:34) . Those in leadership positions have an obligation to others, whom they oversee, to be examples in their rootedness in God and authenticate it through their doings. To have a sense of calling of God in one’s life, with an attitude of prayerful enquiry and openness is a mark of spirituality in leadership

2. Enablement. 

Our lives are formed by our inner orientation to God and integration of life events. Most of us do not feel fully ready or equipped when we accept a leadership role. The fear of the unknown can be a challenge. Our own reading of the opportunity and understanding of the dynamics of the web of responsibilities is from a distance, when we enter into a position of leadership. A scholarly Bishop, whom I knew well before he was consecrated, mentioned to me after two years of being in the episcopal responsibility, that he had to learn essentials in conflict resolution, pastoral care and to relate to tense situations during elections to positions of responsibility. His spiritual exercises of meditating on the scripture, times of silence, conversations with his spiritual director and regular retreats became his enabling resources. 

A professional who works in a multinational firm mentioned to me that he would have his lunch privately three times in a week and practice a period of interior silence before he went for the company meetings. He made them to be his resources to enable his personal preparedness to address challenges in his demanding leadership role. Once, it was during a silent time, before a meeting, that he was ‘given’ an idea, which got endorsed by the top leadership, which paved the way for peaceful settlement of a pending dispute with a collaborator.  He too has a mentor, confidant and a counsellor friend with whom he is in regular touch. 

    

All leadership responsibilities need skills of listening, thinking and analysing, and sensing the open door of opportunity. Most of us would need formal and informal preparation for these. There are courses and learning modules, which we can subscribe to, to enable us formally in the leadership formation. The informal preparation, through reading of biographies, thematic articles, or interviewing others in leadership positions, or receiving feedback from colleagues and members of the governing board are valuable enabling resources. 

Late Bishop Jack Dane, Bishop of Sydney of the Church of England, well known for his pastoral care and counselling skills once mentioned to me in a conversation that his training in leadership was largely informal. He surrounded himself with professionals, whom he turned to, in specific situations of needs or crisis. His habit of consulting and not leaning on to his understanding alone became his enabling resource.

The people whom we are called to oversee or work with, would have advanced professional knowledge, and years of work experience. To be a resource leader to such a group would need advanced self- directed adult education. The core content of this adult education is to make the leader a thoughtful, considerate, sensitive and be a motivator. To see others as human resources or as a ‘knowledge capital’ and value them and communicate this effectively to them, would need self-giving optic. This in itself is a learning journey for most of us. 

Jesus of Nazareth was committed to a long personal enabling journey. He began by pursuing scholarship of the Jewish doctrine, scripture and the law. That was what made him to choose to be with the scholars of the law in the temple at Jerusalem, while rest of the family was caught up in the festivity of the occasion. He enabled himself by subjecting to the discipline of his home, family profession of carpentry and the religious rituals of his home and community. He prepared himself for the transition to his life’s calling, by going to the desert to fast and pray for forty days. He surrounded himself with 12 followers with whom he was in an intense dialogue and discourse about the kingdom of God and righteous living. They gave him resonances, insights and information, which were formative for his mission. The adverse comments of the scribes and pharasees, hostility displayed by them when he healed people on the Sabbath or pronounced a woman caught in an act adultery to be set free, etc. were occasions of intimate encounter with the inner darkness of others around him. His final mission to endure the cross vicariously was facilitated through many such formative encounters and experiences.  

Those called to lead, who have got used to enabling themselves by personal discipline and good practices are those, who would transcend their personal needs and reach out to others. Late Dr. Paul Brand, while he was teaching at the Christian Medical College Hospital, Vellore, was in the habit of visiting men students in the hostel. If anyone missed a clinic or class . he would use the occasion  to teach him what the student missed. Late Dr.Benjamin Pulimood continued this practice, which gradually became a weekly Bible study. I know of five doctors who used to attend this Bible study, who now faithfully serve in the mission hospitals in different parts of India. Dr.Pulimood during his one year sabbatical, spent his time being with his former students to encourage and support them. During a conversation with Dr. Pulimmod few weeks before his home call, in response to a question about this, he said, ’those in leadership ought to be mindful of the least and those struggling to find their way’.  Those who enable themselves become enablers of others. 

3. Intuition

Most of us would recall instances, when we sensed an urge to do something, which was not in our plan or consideration. Later, we would have realized how that inner prompting was most valuable or crucial. Such an intuitive sense seems to have saved people from dangers and perils.  

One illustration of this intuitive sense from the life of Jesus is recorded in Mark.6.45-51. ‘And seeing (sensing), them straining at the oars …Jesus came to them walking on the sea’(v.48). Jesus was far away in the mountain, in prayer, and the disciples had gone out in a boat to go to Bethsaida.  Jesus brought calmness to the sea by getting into the boat with them. Jesus could sense what was in the hearts of people. He knew when a question was asked to trap him. He foresaw what Peter would do when a servant lady would seek his identity during the trial of Jesus. Jesus could predict what Judas would do when enticed with money to betray Jesus. 

Such a sense of presence to an inner consciousness and awareness of situations around, is what we refer to as intuition. It is a habit many of us can cultivate by practice. Those in leadership need it all the more. 

Late, Dr. L.B.M. Joseph, a former director of the Christian Medical college, Vellore exercised this intuitive sense during the turbulent time of the strike of the employees. At a crucial point of the strike, when the state government supported the strike, the hospital service was seriously compromised. The associate director was arrested. Dr. Joseph decided to represent the matter to the central government.  He had a flight to catch from Chennai early in the morning to go to Delhi. He had a strong sense that he would be arrested if he went by the regular route. He took a detour to reach Chennai only to know later, that there were three police check posts set up in the night on the main road to arrest him. There were several instances when he and his colleagues relied on their intuitions, during the strike, which changed the course of events in their favour. Talking about this intuitive experience, Dr. Joseph. once told me, ‘This is a God-given spirit of insight and clarity. If we can be in a habit of prayer, we can increase this ability. It is the voice of God from within’.    

For those in leadership, intuition is a grace given to lead wisely, prudently and decisively. The instance of king Saul consenting to the intuition of David, to challenge Goliath (I Sam.17:37) is a vivid illustration of what leaders can foster when they are sensitive to their own intuitions and those of others. 

One of my colleagues in the department, mentioned in our team meeting, three weeks back, ‘what if we asked the administration to allot an independent house to begin an Early Learning Centre for children?’. All of us felt instantly that, it was the right thing to do. I met the chief administrator of the hospital an hour later with the request. He said that, ’You came at the right time. We have one independent house vacant and we were about to make an allotment today’. He allotted the house for our use, which is where the Early Learning Centre is located, which welcomes children and parents for a home based  pre-school preparation. 

There can be turning points, if we are habitually inclined to sense and act on our intuitions. However, the intuitive insights need to be subject to the spirit of discernment.

4. Discernment.

The prayer of Solomon, (I kings.3:6-9) is often quoted as definition of discernment. ‘So give thy servant, an understanding heart to judge they people, to discern between good and evil. For who is able to judge this great people of thine?’. It is a process of making sense of facts and situations to make a truthful and wise choice. It is this discernment process we read Solomon exercised, when two women came in dispute over two children, one dead and the other alive, both owning the motherhood of the living child (IKings.3:16-28). The proposal to divide the child in to two halves, which made the mother of the living child to plead to save the child made Solomon to offer the child to the other woman, who was the genuine mother, is an outstanding example of the spirit of discernment. In this process of discernment, we come across five steps which led to a clarity, Listening (vs.17-22), paraphrasing both arguments (v.23), weighing the merits of the arguments (v 24), proposing an option (v.25) and arriving at the decision (v.26, 27). Often discernment is possible, only as much aa a person is open and willing to revise one’s own perceptions or inclinations. 

There are situations when individual discernment is needed to make a decision. Philip had to make such a choice (Acts.8:25-40), when an angel of the Lord spoke to Philip to go to Gaza, to meet an Ethiopian, who was travelling in  a chariot. The journey was through a desert road and it looked a long and difficult journey. Philip discerned the voice well and he was able to interpret the Scripture to the Ethiopian, leading him to a faith journey.  

There are occasions when collective discernment is necessary. There are well- established Ignatian and Benedictine traditions that instruct us to this process of discernment. The main thrust of these and other traditions is openness, prayer, waiting, sharing and finding a consensus. 

When the current Pope was elected, none of the five probable cardinals was the final choice. Pope Francis became the choice during the voting through the discerning process. One of the probable cardinals made it known publicly that he felt disinclined to be included in the panel of the probables, as the discerning process commenced.  The heart of the discernment is to seek the mind of Christ. It was this St. Paul wished for all of us, when he wrote in Philippians .2:5, ‘Have this attitude in yourselves, which was also in Christ Jesus..’.

We follow democratic or management principles in many decision-making process in our governing board meetings or other decision making fora. It has its worth and value. However, the discerning process has a transcending foundation. It takes us to exercise the prophetic dimension of leadership. It is rooted in faith and hope and not always in logic and circumstance.

When late Dr. A.K.Tharien came to start a medical work at Oddanchataram seventy-five years back, many dissuaded him from doing so, as famine and drought had prevailed in that region for about five years. There were reports of people turning to saw dust as their food. Commenting on this, Dr. Tharien said in a meeting that, he had already spent six months in discernment to come to a decision, while working at the C.S.I Hospital Kancheepuram. The Christian Fellowship Hospital is a living example of a call that was wisely discerned. 

A leader with such a sense of clarity of purpose and confidence in pursuing a mission is often an inspiration to others. This is one way of ushering the kingdom of God.

5. Prophetic sense

In a leadership responsibility there are existential realities, which consume our attention and energy. There can be challenges and difficulties, which shall test our patience. There will be opposition and resistance, when the leadership does not accommodate the personal interests of some, who want to seek benefits for themselves.

Nehemiah encountered such a situation (Nehem.4:1-8), when his mission to rebuild the walls of Jerusalem was fiercely resisted and ‘all of them conspired to fight against Jerusalem and cause a disturbance in it (v.8). But Nehemiah prayed to God and set up guard against them day and night (v.8). He received steadfastness for this journey from the calling he received during his prayer times (Nehem.1:4-11)

The prophetic sense calls for understanding the contemporary context and approaching the challenges from a divine perspective. Many organizations are borrowing the business management model of ‘strategic planning’ for staying afloat with a mission. It may help us to some extent. However, how can logic, analysis, reason alone be the foundations for conveying the purpose of God. God’s ways include mystical and miraculous dimensions.

The O.P. Tyagi bill introduced in the Parliament in 1979, to prevent religious conversion was in the final stage of getting assent from the parliament when late Mr. Morarji Desai was the prime Minister. No protest or appeal from religious leaders seemed to stop the then government from passing this legislation. Mother Teresa conveyed her personal objection to the Prime Minister passing of this bill and encouraged her sisterhood of missionaries of Charity to pray that the government’s efforts would fail. There was a political realignment around the same time and the Prime Minister had to resign and the bill never got passed. 

A prophetic leadership is characterized by a habitual pursuit of God’s will rather than some immediate answers to tide over a situation. I know of institutions who sell their land and assets to cash on the real estate boom in the hope that there will enough money collected to pay the debts and offer more service to those in in need.  But corruption, poor governance and nepotism, which caused the debts, were never addressed that some of the institutions plunged into greater crisis for survival even after receiving large sum of money from real estate. This is an example of using leadership for gain and personal prosperity.   

A prophetic leadership would transcend these disguised personal intentions and reverently pursue ways to honour God through honest, transparent and inspirational examples to build people and prepare a faith community for pilgrimage. It this ‘remnant’ that I believe Jesus referred to as being the ‘salt’ and ‘light’, who have a calling for incarnational presence.    

I experienced this while involved in the governing council of a prestigious institution.  The management chose to suspend undergraduate admission for one year, till it got the full right to admit students by following the admission process as practiced before. Some of us kept exerting pressure on the administration to consent to admit students by following the revised guidelines of the government and continue to engage this issue in the court of Law. But the administration decided other wise and that institution did not have one batch of students for that year. Looking back, I regret that the administration took an option of convenience which denied some students an opportunity to study in that college. The administration had hoped that there would be a public uproar and reaction, which might send a message to the government to consent to the repeated representation of the institution to allow its autonomy in admission to continue. None of that happened. There are times when those of us called to lead might lose an opportunity to live and act prophetically in adverse circumstances because we lean heavily on our understanding. Even in such instances, God would compensate for our loss, if only we can return to make sense of the direction ahead, in an attitude free of biases. The disappointments and detours we face in life, help us to become familiar with an orientation that transcends our logic and reasoning. There is a way beyond what is expedient.

All of us have a leading role in some way or other. This is therefore a responsibility and an opportunity. 

I have explored here the theme, ‘conduct of  one called to lead’ from my personal experiences and Biblical examples. I hope it would arouse interest for a dialogue and recollection!

M.C.Mathew (text and photo)

Briefing about an illness !

I was brought one evening in May, 1982, to the Christian Medical College, Vellore with a fracture in my right leg, which I sustained at Chennai, while riding pillion on a friend’s scooter. I was given first aid at the Madras Medical College and transferred to the emergency unit of CMC Vellore. The Orthopaedic specialist on call arranged for an X-ray and admitted me in the S ward. Late that evening, professor Selvapandian and his team came to examine me. Seeing my hugely swollen knee joint and the shortening of the leg due to the fracture, they decided to give me a posterior slab and apply traction. Dr. Selvapandian turned to me and said, ‘Sorry, M.C. you seem to have a fracture and some blood in the knee joint. We will offer you some pain relief and decide tomorrow about the treatment plan. We hope we can do something to fix it’.

The next morning, with more X-rays taken, Dr. Selvapandian and the team spent a long time discussing my condition, outside my room. There was gloom in their face, which made me feel that they too were anxious. After further clinical examination, Dr. Selvapandin, said, ’M.C. it is a bad fracture which extends into the joint with multiple pieces of the upper end of tibia. We will wait for the swelling to subside and then decide about the next step. We will keep you pain free as much as possible and I hope we can find a way forward’. Five days later, Dr. Selvapandian ordered for more X-rays and consulted each of his colleagues to make up a plan. When he came for the morning rounds, he said, ’you have made some progress, and we are hopeful. We will keep you on traction for the time being. It will hopefully bring the fractured pieces together’. 

As I look back, I am amazed the way, Dr. Selvapandian ‘broke the news’ little by little, mixing facts with hope in a good balance.  It was a bad fracture and residual disability of limited range of movement of the knee joint was almost certain. Every time he came for rounds in the first week, he conveyed optimism and caution. He spoke gently and thoughtfully. He even had a sense of humour. One day, seeing me siting up in the bed and reading the newspaper, Dr. Selvapandian said, ‘I hope you would not decide to stand up’. Everything, Anna and I needed to know medically, he conveyed on different occasions with sympathy, understanding assuring us of the best possible help. Each time he visited me, he would want to hear from me and wait for my questions or comments. During the next two months, till I was ready to go back home, Dr. Selvapandin communicated his keen interest in my full recovery.

I was already a consultant in Paediatrics for four years by then and had no idea of what it means to ‘break the news’. This was a first hand experience of some guidelines about ‘breaking the news’ of a medical condition, outcome of treatment, complications or adverse outcome.   Let me list five guidelines for us to consider while ‘breaking the news’.

1.Content  

2. Setting

3. Attitude

4.Dialogue

5. Difficulties

1.The CONTENT  

In one sense, the phrase, ‘breaking the news’ is a misnomer. I wish, we use phrases such as, ‘briefing about an illness’ or ‘sharing the health status’, etc. The visual media has sensationalised the phrase, ‘breaking the news’ with stories and photos, which to me adds stress, anxiety and humiliation in most instances. The intent of ‘briefing about an illness’ is to bring comfort, clarity and direction to the patient and his or her relatives and reduce the level of fear and anxiety. Let me suggest that the phrase. ‘breaking the news’ has outlived its use and it is necessary for us to have another phrase to express its intent and content. 

The content of what we intend to share with a patient or the family is central and need to be defined. Let me illustrate. 

The content will vary according to the gravity of the illness and the immediate implications. When a patient is brought unconscious following a road traffic accident, there is some uncertainty about the course of illness and the outcome. The family needs to know about the prognosis and the several immediate measures needed to revive the patient. If Leukaemia is diagnosed in a young healthy asymptomatic adult, the family will be in a state of shock and grief, in which case, the facts about the diagnosis and its implications would need to be shared in stages and in portions that the family can comprehend and respond to. In such situations, grief counselling will be part of the initial briefing about an illness. If a person has a chronic illness such as Diabetes, the content will correspond to the extent to which the disease has progressed affecting different organs. If a new born is acutely ill, following the birth, the content of the discussion with the family would involve the immediate and distant implications of the illness. In such a situation, the family has many pressures weighing on them, such as mother’s health, care of other siblings at home, etc. that, briefing about the illness ought to be just enough for the family to be aware of the progress or decline in the health of the baby. 

A senior doctor is the best person to define the content of this briefing, which in consultation with the team needs to be communicated in a manner the team decides to do. It is necessary that briefing about an illness is done by the designated member of the team, preferably a person with experience and full knowledge of the state of health of the pateint. The disclosure would elicit questions from the family, which would need appropriate and contextual responses. It is for this reason, it is better for this to be done by a person, who is involved in the decision making about the treatment plan of the patient. 

There is sometimes a question, how much of details need to be included in the briefing! Some families need lot of details and others are content with just enough information. In some situations, families may have questions or confusion about the benefits of treatment. It is for this reason, at every stage of a new treatment plan, the consent of the family or the patient is needed.

 There are clinical situations such as terminal illness, where the health care team has the responsibility to introduce the family to palliative care. There may be an unfortunate situation when a patient is brain dead, in which case, dialogue with the family would extent to include organ donation. 

Having worked with families, who have children with neuro-developmental needs, for the last thirty-five years, the challenge that I often faced was to define the content of the briefing. When the parents come with their baby of few months of age with definite indications of neurological insult, they would have had previous consultations and investigations. They are often in a state of shock or denial. In such situations, I have found it more useful to listen to them and help them to pursue their thinking by directing them with relevant questions. It is easier if they find answers to their questions on their own. This form of briefing about an illness needs more time, patience and rapport with the family. The families may know the facts, but they would need an affirming setting to internalise them and respond to the challenges emotionally and responsibly.

The content is central while briefing about an illness, but the setting determines its effectiveness.

   

2. The setting

The ambience of any hospital is busyness, hurry, and anxiety. There are events happening all the time, such as a new patient arriving or someone leaving the ward, or someone suddenly becoming sick. Patients and relatives are witnesses to these happenings. The professionals are under pressure for time and have a long list of important things to do. It is in this context, we need to appreciate the need of a setting in which briefing about an illness can take place.

The physical setting of a quiet and airy room is a desirable facility. A room with good seating arrangements, with wall pictures and text can make the room homely. It is necessary to have low decibels of noise in the vicinity and in the room.

It is important to welcome the representatives of the family, two or three with whom confidential matters can be discussed. The privacy and rights of the patient need to be protected, and we want to avoid any lose talk about the patient and his or her illness. One or two professionals need to facilitate the conversation, out of which one person ought to be the senior member of the team. In some instances, especially when a patient is terminally ill or family is in distress, it is important to have a chaplain in the room to continue being in touch with the family and patient. 

It is a good practice to begin by getting to know the members of the family and sensing their state of anxiety. Similarly the professionals need to disclose their identity. So the time of introduction is most valuable. Following this, the current state of the health of the patient needs to be presented in brief. It is good to let the family ask questions rather than give an exhaustive coverage of the treatment details. The details would get drowned in the emotional upheaval that the family may go through, while listening to all that is happening to the patient.  

The setting is often emotionally charged as any information about the patient does arouse concern and anxiety. There has to be pauses in between the conversations to allow the family to take in and feel the issues discussed. Occasionally it may push a member of the family into a state of grief or anguish, which needs to be received with understanding and support. 

It is one occasion, when the professionals need to show availability and openness without indicating rush or hurry. The pauses of silence need to be welcome as they are a means for emotional recovery and an opportunity for the family to come to terms with the reality. 

It is good to have all the mobile phones in silent mode during this period. It is for this reason the briefing time has to be chosen when there is no anticipated interruption. 

Occasionally it may be useful to show pictures of what one may want to explain about the illness. It is also necessary to avoid loading the occasion with too many details.

The closure of this time has to be planned in advance. Let the professionals decide before hand the time allotted for this briefing. Avoid prolonging the time, even if the family seems to seek for more time. It Is good to plan for another occasion to meet, as such times are intense in attention and listening and prolonging it can become demanding on the professionals. It s good to greet each other while closing, and agree to meet with the family again.

3. The Attitude

The briefing time about the illness is one occasion, when families would expect sympathy and understanding. One way of communicating it, is through the modulated tone of the voice, which befits the occasion. We can convey confidence and nearness to the family by synchronising the voice and the body language. 

Families are comfortable if we can use non-technical language while communicating with them. It may be better to use the phrase ‘swelling all over the body’ rather than the phrase ana sarca while describing the clinical condition of a patient with liver or renal for heart failure.  It is good to use short sentences with pauses in between to allow enough time for the family to take in and giving them permission to interrupt with questions if they so desire. 

I remember one occasion, when a senior colleague called the family aside and bluntly told that their nine years old daughter was about to die and disappeared back into the ICU. It was an abrupt communication without a prelude of postlude. Later talking to me about the hospital experience after one month of the child’s demise, the family referred to this incident with much regret and remorse. 

For some reason or other, people assume that doctors and nurses would be kind, courteous and thoughtful. This is expected to be our natural temperament. It is for this reason, families are most uncomfortable when we get angry, shout, or show arrogance. A hospital is also a place of hospitality, which calls for utmost understanding of the needs and aspirations of people, who come for medical attention.

Let me suggest that as health care professionals, we are engaged in knowledge pursuit. This privilege can make some of us self-sufficient and condescending in our attitude. ‘I am the doctor; I know what I am doing; you listen to what I am saying’. This attitude towards patients and families would hurt them. 

Instead, if we have an enquiring and considerate attitude, we would be able to keep in touch with the families and patients during the time of their need. They would turn to us to confide and to find direction in their lives when they are overcome by sorrow or bereavement. A doctor or a nurse is a companion to patients and families and not just a provider of treatment. 

Most patients and families would need life style changes and order in their lives economically, socially and spiritually when they confront a serious illness in the family. The time of briefing about an illness is the staring point to build relationships. 

A few weeks back when I was admitted to a hospital for a major surgery, the senior surgeon introduced us to his team and mentioned about what would happen during and after the surgery. I thought for a moment, that he almost trivialized my medical condition by speaking about it as just another ordinary illness, in an attempt to take away my fear and anxiety about the surgery. Looking back, I realized that his welcome, approach and friendly ambience helped me to look forward to the coming weeks with ease and expectation. 

The professionals sometimes deliberately keep a distance from the patient and family emotionally, so as to safeguard their professional status. This contradicts the very character of health care, when we are supposed to engage in alleviating suffering and offering wellbeing, ‘physically, emotionally, socially and spiritually’.  There is a humane dimension to health care, about which late Dr. K. N. Nambudiripad, professor of neurosurgery and Director of the Christian Medical college, Ludhiana used to refer to as ‘compassion - an adjunct to therapeutics’. I believe that the role of the mission hospitals is to demonstrate this dimension in practice. A consultant working in CMC Vellore mentioned to me the other day, that, the dignity and care offered to those admitted with AIDS is so touching and affirming that ‘I wish we could do the same to all the other patients who come to us’.

We are constantly engaged in communicating good or bad news in health care practice. How we convey that is the question at stake! One family was overtaken with all the anxiety associated with cancer, when the young mother was diagnosed with breast cancer. During the course of stay in the hospital stay, the patient and the family felt comforted by hope and prospects of recovery, because the attitude of the professionals conveyed that abundantly. Each conversation and contact with the family ought to become an up building and path-finding experience for the family. 

4. The Dialogue

Every communication becomes useful if it creates opportunities for dialogue. The briefing about an illness to the family is an important occasion to prepare them to make several decisions. There are treatment options; there is the economics of the treatment; a choice of the hospital for treatment; outcome of the treatment; and for some families, the option may be not to choose any radical treatment, but only palliative care. 

One of the rights of a patient, according to the Geneva Convention is, autonomy and right to choose. Even in an emergency situation, the relatives are bestowed with the right to choose the nature and the extent of treatment, for which a detailed presentation of facts and implications need to be made to the family. It would appear to be easier, if the medical team, ‘who know best’ was the sole decision makers! However, with the Internet offering all kinds of information, most families would have come with some thoughts and choices. It is for this reason, all decision making is arrived at, after dialogue with families. The prescriptive approach we are more comfortable with, in decision-making, is non-conducive to developing rapport with patient and families. 

One family with their twelve-year daughter came for consultation for intractable seizure because of which, she discontinued attending the school for the last six months. They have been to a few well known centres and had brought reports, treatment schedule and multiple prescriptions of medicines. I refrained from looking at them till I heard their story. Their story of 11 years of coping with the frequently occurring seizures in their daughter did take a toll emotionally, financially and socially. While I requested my psychology colleague to have conversation with the girl, I allowed the family to continue with the narration of their story. After one hour, they were still ventilating their disappointments with doctors, hospitals and teachers who according to them had not supported them during their difficult times. The girl narrated her story of loneliness, tiredness with treatment and emotional weariness over the reduced social life she lives at home. For fear of having a convulsion, she cannot accompany her family for shopping.  

What the family needed was for someone to listen and understand their struggles. I offered them another time to discuss about the treatment options.  The parents and the daughter looked comfortable to return for further discussion. I realize from several such experiences, it is necessary for me to create time to listen. I find, when we listen, we get to know many deeper issues, which are linked to the illness, treatment or long-term implications. When we listen, we affirm the family and open the door of dialogue, including searching for options that they had hitherto overlooked. In case of this family, at the end of the third consultation, they seemed ready to look at the option of epilepsy surgery. Although this was already told to them, five years back by different consultants, they ignored it. I heard recently that she is free of convulsions after the surgery.   

I have found it valuable to involve my colleagues in an active way, even to delegate the responsibility of continuing the dialogue. It is when, conversations take place in different settings and with different people, we can capture the whole picture to guide the family forward. 

When a patient is In critical care, or in an emergency situation, or facing complications, the dialogue will often be brief. But while planning for organ transplant, cancer therapy, assisted reproduction, HIV counselling, etc. a detailed dialogue is central and crucial for optimum therapeutic outcome.

5. The difficulties

Most professionals may not have had any format training in briefing the family about an illness. This is a challenging issue in itself. Even now, this has not become part of the formal medical training. Most doctors pick up some precepts and practice from what they see and hear from their seniors colleagues.

We are still not conditioned to respect the autonomy of the patients adequately. This is because, we are not introduced adequately to the foundations of medical ethics, during our undergraduate or postgraduate training period. The professionals seem to exert authority over their patients by virtue of their skills and position.

Engaging the family or the patient for briefing about an illness consumes time, attention and need openness to revise our approach based on the choice a family may make. Some doctors convey disinterest to pursue a treatment protocol different from what they think as the best. This adds stress to the families and causes strained relationships between families and the professional team.  

Most hospitals do not have designated space for briefing the family about an illness or to offer counselling to the family or to prepare them for treatment, discuss options or support them during their bereavement. It has not yet become one station of service in the care pathway we offer to patients.  

We are in a fast changing scene in health care in India. There are commercial interests in health care. The Insurance sector is breaking the service pathways into tangible components, each of which is charged separately. The consumer forum is active to find out if there was neglect or omission in the service provided to a patient. The professionals are attempting more risky surgery or interventions for treating complicated illnesses. All of these and the increasing consciousness the public has about the rights of a patient, should make the professionals consider how they are using ‘briefing about illness’ as an opportunity to build rapport with patients and families. 

It is necessary to conduct training programmes to help the health care professionals in the art of ‘briefing about an illness’. This needs to be introduced to the interns and postgraduate trainees at the beginning of their programme with refresher training programme during their training period. The consultants and senior members of the team would need advanced training to help them to be equipped to face difficult situations. 

A hospital is a place to communicate wellness to patients and families. Let it be so always!

M.C.Mathew (text and photo)