Raxaul Made Into the National Press...Hmm...Is that good?

The December 2009 issue of The Week in India named Baba Christudas as "Man of the Year." He is a Catholic priest that has spent his life working amongst the lepers of Bihar at a little leprosy hospital a few minutes walk from Duncan Hospital. The hospital pictured to the left is called "Little Flower" and is actually an impressive success at drastically changing the disease outcome and powerfully effecting the lives of people with a highly stigmatized disease.

The interesting thing regarding to this post is the introduction to the article. As authors of The Week rode into town they apparently must have jotted down their first impressions: 

"Bihar is like someone curled up and died. I was told before leaving. But a carcass implies an end. Bihar, to unsuspecting eyes is like a curled-up animal, on its las legs, marked with wounds that seem to fester and pulse with a life of their own. The landscape is dry and arid, tracts of land stretching out on both sides with a few spurts of green in between. It is a land in search of some beauty and some manna.

Raxaul announces itself much before it becomes visible. The narrow one-way street is choked with garbage and lines of trucks wait for clearance to cross the border Children defecate next to vendors selling freshly slaughtered chicken and hawkers selling fried food. Though Raxaul defies words, I realize why there are the most leper colonies in Bihar."

Just thought you might love knowing a bit about what the rest of India thinks of where I am staying. 

Laying the smack down

I have to tell you about something I experienced out in the village the other day. I was working with one of the community health teams when we came upon some children who were playing a game. It seemed awesome, there was soft sand and they were playing in the shade, but after watching it got very interesting.


It started out with a circle in the sand with a stick standing upright in the middle. There is a guard for the stick and all of the kids try to rush in from the outer circle to grab the stick without getting tagged by the guard. If you do get tagged, the whole game changes. You toss the stick away and you set in the middle. Now, the kids rush in and smack the mess out of you and then run out of the circle with out getting tagged. These kids are getting nailed and they love it and smile the whole time. Eventually as people get tagged the pile in the middle getting smacked gets bigger and then once there are 1-2 kids left the whole big pile of kids that had been getting whopped in the back/head/legs chase the 1-2 kids that are left and wail on them. Unbelievable. The kids loved it. This game to me shows cultural differences that are subtle but significant. I first thought that the kids risking their safety ran to the middle to tag the kids and set them free. Then I realized "man they are hitting them really hard." I think a Western mindset is focused on ideas of "rescue, valor, and liberation" but somehow these kids were totally used to getting smacked around and they had a lot of fun doing it together. Just some stuff to chew on.

What Makes Jesus Different than Sai Baba?

One of my favorite things to do here is to get outside of the hospital grounds around 5:30 or 6 in the afternoon and walk around the town in as the sun is going down and any semblance of “cool” is setting in. (It has been over 100 F every day here) The other night I went walking and met a boy that speaks English. He told me he was a Hindu, and I asked him what it meant to be a good Hindu. He didn’t really get what I was asking and he said “ I am a good Hindu because my father is Hindu.” “Well, OK” I thought as we walked past a cow. I pointed to the cow and asked “So this cow, you worship it?” “Oh yes” he replied “we pray to it, put flowers around its neck, put a dot on its head.” “Wow” I thought, “I better not tell him about my last trip to Outback or how cool Only Burger is in Durham.”

We kept talking, and I noticed a necklace his brother was wearing that had the image of an old man on it that I had seen a lot around India. He said the man’s name was Sai Baba and “he died for our sins like Jesus.” “Whoa whoa whoa,” I thought,  “This is crazy talk.” Delving more into what he said, what they mean by that is “Sai Baba lived a good life and when he died he left us a good example of how to avoid sin.”

The lovely man pictured above is known as Sai Baba (“saintly father”) of Shirdi, and he was an Indian guru, yogi, and fakir (Sufi Muslim leader) who lived around the turn of the 20^th century. He went to great lengths to meld Hinduism and Islam and practiced both religions faithfully. He lived in a mosque and dressed in the garb of a Muslim fakir, but he taught using traditions from both faiths. One of his well known epigrams is “Sabka Malik Ek Hai “One God governs all.” He taught a general moral code of love, forgiveness, charity, and inner peace while living his own live engrossed in the effort of self-realization. If you consider Jesus to be just another moral teacher it would be easy to see a lot of similarities between Jesus the Christ of Nazareth and Sai Baba of Shirdi.

You see, this is one of the largest barriers to reaching Hindus. For them, they have thousands, some say millions, of gods. Most of these gods have drifted in and out of humanity and been reincarnated in various forms throughout the centuries. So you say, “No Jesus is different than Sai Baba, he’s God.” They say, “Right Sai Baba is god too.” “No, you see, the Bible says Jesus existed from before the earth was made and that he created all things.” “Right, Sai Baba is the ___th reincarnation of so and so.” “No, you see Jesus rose from the dead and he’s alive today.” “Right, Sai Baba reached perfection and he ascended into becoming one with the Ultimate Reality, and some guy in India claims to be the reincarnation of Sai Baba.” You can see where this is going.

While I am India, I am taking the time to read through the Gospels to remind myself more about who Jesus was and is today. What I find so amazing is that, apart from other faiths, our faith is not based entirely on the sayings and quotations of Jesus as much as they are on the person of Jesus. If you read through the Gospels you will find several frustrating passages where Jesus purposely cloaks his intentions and true identify, and it is hard to understand why. Then towards the middle of the Gospels the writers say that Jesus set his face towards Jerusalem and there was no turning back. Jesus was not a guru with something to say. He was a unique representation of God to mankind that had existed before the foundation of the world and had been prophesied for thousands of years. Jesus was the culmination, in his flesh, of the Jewish temple sacrifice system. Jesus’ significance had less to do with what he said than with what he did.  Our faith is a faith in a God who created thousands of years of history that climaxed with him emptying himself and delivering to us the eternal aspect of his self that we see evident in Jesus, like Hebrews says, “He [Jesus] is the radiance of the glory of God and the exact imprint of his nature.” (Ch 1 vv 3)

One of the verses that I have studied lately that always really convicts me is 1 Peter 1:8. Speaking of Jesus, Peter says, “Though you have never seen him, you love him. Though you do not now see him, you believe in him and rejoice with joy that is inexpressible and filled with glory.” If we are honest with ourselves, there are times where it is tough believing in Jesus, for a whole host of reasons depending on your culture. Over the weekend I listened to Ben Stuart, one of my favorite Bible teachers, teach at Texas A&M. He gave a wonderful talk about the impressive validity of the manuscript evidence we have in the New Testament scriptures. He referenced UNC’s own Bart Ehrman which is another subject for another time. Essentially what we find in our New Testament is overwhelmingly convincing evidence that the record we have of Jesus has been passed down historically from the time of the first generation after his death.

I would ask that you pray for the people of Bihar. Despite the impressive efforts of this hospital and community health teams there is still only a rudimentary  church that exists in the region apart from unorganized prayer cells of disconnected believers. From talking with the doctors, they say that much of south India is Christian because it had an animistic heritage that was easier to penetrate. In contrast, northern India has an idol-based worship that creates a firmer control over the human mind thanks to our desire for the physical fixation as well as direct demonic influence present in the temple acts. Pray that strongholds would be broken for this region that is 0.5% Christian.

I would pray that you would ask yourself the same question for yourself- “What makes Jesus different than a guru from a distant time and place?”

So what ARE you doing anyway?

Greetings everybody who happened to find your way to this blog post. Just to let you know, the title of this webpage TOTALLY does not apply to Raxaul. Boy would it have been nice to end up close to the Himalayas. While I am on the border of Nepal, there are definitely no mountains to be seen. Apparently you can maybe see them if it rains and the thick clouds of dust, smoke, and pollution clear out, but that isn’t likely to happen. So what am I doing here, halfway around the world? As most of you know I am here doing my public health practicum experience. What I have found is an excellent hospital that is running effective community health programs in one of the most difficult places in the world to live.

Just a little bit about Bihar and Raxaul, if I haven’t mentioned it yet.  Bihar is the poorest state in India. The weather here is a sweltering 115 degrees at times during May and June (looking forward to that for sure) and then down in the 30s and 40s in the winter. In June and July there are yearly floods that drastically affect the life, culture, and economy of this border state. Raxaul in itself is pretty safe, at least from what I can perceive walking around. In Bihar there are known to be several trouble-making factions, both the nationalists Indians that want a very pure, Hindu state and Maoists or communist revolutionaries inspired by Mao Zedong from nearby China to the north. This makes travel a difficult matter if you deviate from safer forms of transportation like public trains, etc and makes road travel quite tumultuous. 

The other night I had a good talk with Dr. Sunil, the hospital director, and was asking him a lot about his life, what it means to be a leader in a large, medical-missions organizations, and thoughts on being a rural physician.  I asked him, “So what is the best thing that Western physicians can do to serve EHA?” I was surprised by his answer. What he didn’t say was “Please come here and work” or “Give us more money.” Instead he said “The best thing you can do is to come and do research and teaching to help us learn how to do what we do better. We are always very encouraged by doctors that take an interest in what we are doing out here. We appreciate the exchange of ideas and being able to show people what we are doing at Duncan…Sure there have been Western doctors that have sold everything and moved here to work with EHA, most of them have helped to set up educational programs, etc.” I was very shocked by his answer. I think the answer, in my limited perspective, would be different in an African vs Indian setting. EHA, and I think Indians in general, are less apt to desire “aid” than maybe some other systems the West has created.

His comment left me thinking about a comment I had made in my Bible, who knows how long ago. It comes from Acts 15, just after the Jerusalem Council decides to let Gentiles be a part of the Church. It says “So when they were sent off, they went down to Antioch, and having gathered the congregation together they delivered the letter. And when they had read it, they rejoiced because of its encouragement. And Judas and Silas, who were themselves prophets, encouraged and strengthened the brothers with many words.” I wrote in the margins that this should be an example of how we are to go about doing short-term missions. Part of the beauty of the body of Christ is that we get the gift of travelling halfway around the world to find believers who are striving for a common purpose, and through the Holy Spirit we are able to encourage them and be “mutually encouraged” as Paul would say in Romans 16. This adds a good bit of humility to our efforts and gives a healthy perspective to goals and sense of accomplishment in our travels. My mind has been racing with a lot of the implications of my conversations here with respect to long-term ventures, but we can save that for a later date.

Getting to the point, since I have been here I have found myself doing precisely what Dr. Sunil described was most helpful. It is really easy, when you are overseas in a drastically different setting like this, to be overwhelmed from the stark contrast to life in the States. I would have to admit that I have experienced more of that than I was expecting. That overwhelming feeling typically leads students to spend their time separated by the language barrier and standing back observing all the crazy stuff that is fun to write home about without ever doing much of anything. I’ve been very frustrated that I haven’t had much awesome stuff to write home about, as if many of you cared about most of the gross/exotic/sad things that I really get excited about. In my 12 days here in Raxaul, I’ve been on rounds with all the teams to get familiar with the hospital, spent some time in the outpatient clinics, been to the OR twice, and haven’t delivered a single baby yet. What I have been doing is spending a TON of time learning.

My goal here as part of my practicum is to create a formalized research study using focus groups to draw out social and cultural barriers that exist in the community that may be impeding the delivery of obstetrical care and, in part, contributing to the high maternal mortality in this state. Whew, that is a mouth full. While I haven’t delivered a baby yet, I’ve spent a lot of time being familiar with who does in the state of Bihar. I’ve been learning how to organize a research project from background literature reviews, to getting institutional approval, to writing out research plans, and organizing the intricacies. All of this is in an effort to leave them with some bonafide information that can help in shaping future programming in the community health department. Additionally, I spent a fare amount of time this weekend working on pulling charts for an internal chart review that Bethany and I will work on once the maternal mortality project gets underway and she finally gets here. We will be looking at all of the neonatal mortality cases and seeking to help them get funding for a neonatal resuscitation grant from the WHO. On top of that I have been trying to do presentations at every opportunity and be a part of all that is going on here.

All in all, things are shaping up nicely. I am really looking forward to getting into the hospital more, but this is my public health practicum so I have to be dedicated to that first. All of this work has been very paper work heavy on the front end, but I am leaving tomorrow to get out in the village and visit the antenatal clinics. I wish that I could keep you posted on everything, but this is already long enough. Thanks for making it this far. Peace. 

Picture This

A view outside the female and midwife wards where the women wash clothes and get water for the day.

Outside of the hospital the terrain is a mix of partially finished construction, existing structures, dilapidated buildings, random greenery, and trash EVERYWHERE 

The city of Raxaul is a strange mix of over-crowded streets and a busy train station with wide-open grain fields that are at peak harvest time. 

A Twenty-Six Hour Train Ride is Not Time Wasted

In route to Raxaul from Delhi I had the amazing opportunity to relax for a day in this amazingly well accommodated train for 26 hours. I had a top bunk, just like this one, but minus the trash. Of course there is trash, it is India. Heading to the train station is a crazy experience. Simply driving from New Delhi to Old Delhi is an experience too chaotic for words. Once you get to the train station these guys in red shirts come up to your car and offer to carry your bag. You agree to pay them ~$2 and they take off walking really fast. Now keep in mind, everyone has warned you about how dangerous the station is for getting pick-pocketed, and you are REALLY glad for that and the fact that you are carrying ~$800 in cold hard rupees in your pocket. I had my money in a secret pocket in my super cool North Face pants tucked away under the lap belt of my backpack, but you never know. After passing through a sea of people, being uncertain of how you actually got to where you are going, you finally get to a train. I met a really nice Indian guy my age and talked to him for a while. He was an engineer and spoke English, so we talked for a long time waiting for the train. Too bad he was just waiting with his mom until the train started. So the train starts moving, a bunch of people start getting off and I am left in my little block of 8 beds with a fat guy that managed to snore very loudly all night and a young couple with a baby. The baby cried a good bit at inopportune times, but honestly it wasn't that bad. So you get moving about 530 and the first thing you realize is that there is NOTHING fast about this train. Somehow in my mind we were gonna be going like 100 mph and trucking across the Indian countryside. Turns out, this trip is 960 miles and takes 26 hours.

While on the train, one of the things I did was listen to an NT Wright (NTW) talk that I found on iTunes U from Fuller Seminary entitled “Learning the Language of Life: New Creation and Christian Virtue.” Regardless of what you think about NTW, like our beloved JD Greear says “When Wright is right, he’s right.” I feel like this talk was one instance of NT Wright being very right and something that I rarely really sit and ponder. NTW begins with recounting the story of the famed USAirways flight deemed the “Miracle on the Hudson.” In some ways, it was an absolute miracle that 1000 things came together for those two pilots and hundreds of passengers bound for our beloved Charlotte, NC, but calling it a miracle points out something very interesting about our society. This is a part where the simplicity of what NTW says always comes across as brilliant to me. He said that what was the real miracle that happened was the “power of acquired habits.” In some ways, yes it was an incredible thing, but it also was the culmination of 1000s of hours of flying, dedication, and prepared execution that went precisely as planned to create a desired outcome.

NTW penetrated my own heart when he said “Our culture prefers effortless spontaneity with occasional divine intervention, rather than working with God while developing the muscles which will meet those emergencies with a God-given second nature that appears to be spontaneous but is in fact the result of thinking, choosing, and practicing.”  I was blown away by this statement and felt it as a strong indictment even on my own life. How often in our prayers to we feel like we are doing something really good when we pray for God to do his work? Take notice of it next time you pray, or listen to someone else. We water down our responsibility in this whole process by opening up a bible study praying “God just let your words be spoken here” or by praying in the morning “God please make me humble today.”

You see, what actually got those pilots down safely into the Hudson River was restraint, fortitude, coolness under pressure, and concern to do the right thing. That is what ancient philosophers termed the Cardinal Virtues: Courage, Temperance, Prudence, and Justice. I had to think really hard and examine myself to see if I felt that I lived up to this. Before you go thinking that I or NTW is proposing that you read Aristotle and talk like Commedous from Gladiator you are wrong.

These virtues are precisely what we are called to in the gospel, living as people of God’s New Creation. NTW said, “The grace that meets us where we are is not content to leave us where we are.” Faith, hope, and love regenerate and sustain these four cardinal virtues. Simply learning the language of life, of walking as we are truly called, is like learning a new language. In the beginning we have to put real work into learning the grammar and the syntax because we aren’t fluent yet. I think this is a real problem that is plaguing the men of my generation. Even Christian guys would rather pray for some thing to happen and then throw the ball in God’s court. If you pray for God to save your friend you wait for the Spirit to rush rather than to open your mouth. It is much easier to neglect doing the real hard work of being a man worth marrying while you are praying for God to “just bring you Mrs. Right.” We should probably all pick jobs that are safe and nice and easy for us to succeed in rather than doing the real hard work of living a life that requires courage, temperance, prudence, and justice.

For me, driving to a remote part of India, this was incredibly convicting. What I have found here at Duncan is a group of doctors committed to excellence despite working in desperate conditions. That excellence is because people deserve it, no matter their color, race, or creed. For me, this is easily applicable to medicine, but the truth is, every aspect of our life and culture is crying out for men and women who work diligently to develop the second nature, empowered by the Spirit, but brought about by when time and time again our old nature is wrestled to the ground and our redeemed nature is able to become evident. There is a saying in medical school: “Proper preparation prevents piss-poor performance.” I hope that you can be encouraged to press into the Lord, not out of effortless spontaneity but by taking hold of life, and learning to speak the language of new life.

Getting into Raxaul

So I have been in India for a little over a week now. I arrived to Raxaul late on Monday night, the 3^rd, and got started the morning of the 5^th trying to get acclimated to where I am and what I will be doing. It is interesting how in some ways being here feels like being on the other side of the world, and in others it feels like just another medical school rotation.

I thought I would take a little time to let everyone know a little bit more about EHA and what I’ve been experiencing so far. During the colonial years, there were a number of missionary hospitals set up all around India. Duncan was established in 1930 as one of those hospitals. It is both a huge blessing, and kind of sad, that some things have not changed from a structural standpoint since 1930. In 1947 India gained her independence thanks to the nonviolent revolution led by Gandhi and a number of others. It was strange that I watched the movie Gandhi on the airplane and was left with the sense of this all inclusive, idealist culture that Gandhi sought to create. There is one point in the movie where Gandhi says, “I am a good Muslim, a Hindu, and a Christian.” Despite the horrid theological ramifications of that statement, you are left with the idea that India would have been able to nonviolently overthrow their oppressors and not become oppressors themselves. Disappointingly, as depicted in the movie, with independence came internal violence and impending civil war separated along religious lines. With this and during the time following, missionary visas were no long being given in India and the 2000 missionary hospitals in this vast country dwindled to 500 by 1980. This had a huge impact on the health care system of India. At the time of the revolution, 1 out of every 3 hospital beds was found in a mission hospital. For good reasons, and for bad ones, the Indian government felt they could do it better on their own.

In the late 1960s a group of Indian and international health care leaders met to envision what could become of the former mission hospitals previously established by the US, UK, and Australia. It was in 1970 that the Emmanuel Hospital Association (EHA) officially began. It has grown to be a network of 20 hospitals and 30 community health and HIV/AIDS projects providing care to at least 1.5 million people a year. In order to operate from a sustainable and empowering model, they generate 80% of their operating costs internally and do charge those who can afford it while also providing a good amount of charity care. The additional 20% comes from international sources to help found community health and development programs, replace worn out equipment, and conduct research in order to improve health care delivery.

Stay tuned for more information and stories coming soon.