Aurangabad

I had finished checking out - some of my money was now safely in the cash-till of the friendly-cut-price-supermarket - I had a bag of groceries and was clutching the bill.  The security-man gave me his smile - and I returned it.  I have seen this clean-cut mustachioed man a number of times. 

I asked him how his family was.

He told me that they were back in the village.  In Bihar.

Where in Bihar?

In Aurangabad.

That name took me back.  Back 12 years to when Sheba and I were working at the Nav Jivan Hospital in Satbarwa. 

I told him we used to work at the Mission hospital in Satbarwa - near Daltonganj.
His already smiley eyes light up a few more lumieres.

When were you there?  We used to go there!

And indeed they did.  We used to get patients from far and wide.  Especially for tuberculosis.  Sheba had been able to start an amazing TB control programme - and our successors Dr. Arpit Mathew and Dr. Jeevan Kuruvilla have taken the TB programme so much further. Today the hospital serves as the District TB Control unit for the whole of Latehar District - one of the few in the whole country where a govt. programme is coordinated by a charitable organisation.

Dr. Jeevan Kuruvilla continues the amazing story of Nav Jivan.  His blog (http://jeevankuruvilla.blogspot.in )gives an on-going guts-and-glory look to the challenges and joys of serving among the many, many challenges there.

Nav Jivan will always remain very special to us.  I carried my new bride through the door there.  We served together with an amazing team who our hearts still yearn for.  Our daughter Asha took her first breath of air and announced her presence with the sweetest cry I have ever heard in the main operating theatre at Nav Jivan.

All these memories come to my mind after hearing the word 'Aurangabad' from the mouth of my smiling security-guard friend.

Our lives are knit together with hundreds of threads of meaning and purpose.

Speaking up

We were in a small Bible study that we have each Tuesday night at Shanti - our JSK staff member's home.

Rupa (name changed as usual) said that she wanted to say something at the end.  She did.  She told the small group that her CD4 count had gone up.  She is very grateful to Jesus for answered prayers.  She has not had to start medicine - and with her CD4 counts up - it looks like it will be quite a while before she needs to begin.  Great news!

Rupa and her husband have been trying to have a child.  So far after 5 years of marriage they are still childless.  Rupa and all of us are praying for her.  But there in the small evening meeting she opened up about her HIV condition as if it was the most normal thing in the world.

We are grateful for any opportunity people with HIV have to speak out.  There were people in the room with HIV - and those without.  But we were united in prayer. 

Hats off to Rupa.  We are proud of our sisters and brothers who are breaking the silence!

Hope steps out

On my morning walk.  Have just dropped Asha off at school.  Its 6.48 AM.  Which way to go?

Lets not take the path trodden yesterday.

As I walk away from the school, I pass busses disgorging children.  The school has at least 42 busses.  We reckon Asha and Enoch have 7200 other students studying in their alma mater.

The by-lanes I take have trickles of students coming towards me.  The green checked pinafores of the girls and the dark green shorts of the boys complement the cream shirts both wear.   Other school uniforms are also seen as kids are walking to school.

Its quiet and green.  The grey overhead sky decides not to drop rain.  I carry a small umbrella rolled up to defend me if it does.

My walk takes me to smaller lanes.  I want to find a way over a large walled unused plot.  I know there must be a way since there is a village behind it, nestled at the base of the green hills of the Sanjay Gandhi National Park.

photo by M. Appleby

My feet take me in the direction I expect a path to be.  I turn into a lane that looks like a dead end.  A man walks out.  Is he a resident of the lane, or has he come from a path?  I think I have made a mistake and am in a residential society, but I press on.

Yes!  In the corner of the compound there is an opening.  A few steps up and I am inside the compound.  Its huge - much bigger than I expected.  And so green.  Thick monsoonal grass covers most of it.  A set of dark cinder block roads snake their way across it - the path soon turns to the normal earthen one - snaking its way through lush green grass.  The brooding grey clouds behind bring out the dew-speckled greens so much the more.

I wonder at the large roofless concrete buildings I am passing.  Some kind of a factory was here.  Why did it stop?  Why is this land vacant?

Then I see what has remained in my mind all day.

A young school girl coming towards me.  As if she stepped out of another planet.  Immaculate uniform.

I know where she is coming from.  The 'village' is really a small shanty-town.  What home did she sleep in last night?  Who are her parents?  What hoops has she jumped to come so far?

And then she is not alone.  Ahead I see a group of young boys and another two girls walking down the mud path towards school, towards hope.

Its just past 7 AM now - but here is a generation that is seeking to step out of where they grew up.  Education gives some promise of making that step.  When they leave their shanty-town, and walk to the bus-stop for school or college, these young people blend in with all their fellows.

Looking at their immaculate grooming and crisp uniforms you will never know how many others shared a tiny 8 x 10 ft room with them.

As I continued walking my prayers went out to the homes I was now passing.  I had walked through a small breach in the wall and into the village where the kids came from.  The muddy lanes and the ramshackle shoddy buildings, the odd adult standing outside staring.  How many use alcohol to airbrush out their daily misery? 

And how many other young people from their village are fed up with school?  How many young girls have decided to start working in the homes of the posh apartments nearby - cleaning the floors and making chappattis in a series of homes in order to bring in cash.  How many boys are tired of being last since they do not get coaching - and have decided instead to hang out with their friends and earn the odd buck in odd and odder jobs?

I prayed for the people behind the brick and mud homes as I skirted the some of the outer parts of the village before going down to meet the main road again.

But I had seen hope.  Hope take steps.

Skeleton staff

There are two very sick HIV Positive Friends being looked after at the Jeevan Sahara Kendra tonight.

And that too while running the JSK Care Centre with but the most skeleton of skeleton staff.


But first the Positive Friends.  Tapesh is a 40 year old man who has known he has had HIV since 1998.  He has taken various treatments over the years - mainly from what we would call quacks who promised cures.  Now he is sick.  Very sick.  Sheba has diagnosed leptospirosis.  We are really not equipped to deal with such a disease and have asked the family to shift him to a higher centre.  They have refused.  His mother is the only one looking after him.  His brother says that he himself has a fever and cannot take Tapesh.  This intelligent and articulate man has high spikes of fever.  We are trying our level best.  And praying.

Stars on the JSK ceiling remind us of our Positive Friends
 who have died - we don't want to add Tapesh and
Karuna's names to this memorial....

Karuna is a widow with two small children.  Yesterday she came to a gospel meeting that our church holds on Sunday night.  She was shivering badly yesterday evening. We admitted her today. She is very sick.  Her platelet counts are dropping.  Does she have dengue fever?  Who will help her with blood transfusions if she needs them?  She does not have anyone with her at the hospital. Only two young children.

And on top of this our main nurse Agnes is sick with fever.  So Sashmita did a 12 hour shift from 6 AM.  And now has had to come back to do IV lines in the night.  Tomorrow she faces another 12 hour shift.  Pray that Agnes will get better.  Pray for Sashmita - and for Sunita our nurse-aide who is on duty tonight.

We need to have new people come along side us.  We cannot continue like this.

Sheba says that we will have to really spend time in prayer tonight.  I totally agree.

A doctor's work is never done

Pity Sheba.

At Jeevan Sahara Kendra she meets people who have been sick for years.  Who are often wasted away - physically and emotionally.  Who - like the man currently admitted at the JSK centre - are full of fear and negativity.

'How are you doing?'

"Doctor, I keep vomitting and have had multiple diarhoeas"   "Doctor, my son has just been coughing and coughing all night." "Doctor, the patient has vomitted after taking the medicines.  What shall we do?"

Patient.  Mother.  Nurse.  All with the same negative statements.

But then again, they are true.  This is the real condition that this man is going through.  Its not that he is hale and hearty and making up things so that he can be admitted to hospital and avoid his problems.  This man is a 40+ batchelor who has known about his HIV condition since 1998!  For 14 years he has lived with the disease - getting treatment from ayurvedic frauds (plenty of them - always ready to give a 'cure' for money - never around when the patient wastes away and dies).  So here he is at our centre in a very poor condition with a high spiking fever.

But Sheba does not just treat our patients as sick machines who need a little greasing here and a bit of a spark plug cleaning there (or even a gasket change for that matter).  What Sheba does besides diagnosis and prescription and monitoring is to deal with the inner person.  To listen and pray.  To help the person understand and see who they are and how our amazing caring God is working to change and shape them to be like Him.

We pray each time Sheba goes over to JSK.  So many times we see big and small answers to these prayers.

And then Sheba comes home.

For the last 3 days Enoch has had a fever.  It comes and goes.  Enoch is pretty cheerful - most of the time.  But to see your own child sick breaks any parent's heart.

Then last night I was queasy too.  Sitting at the dinner table my face was a fine shade of pale - mirroring what my stomache felt.  Another patient to sleep next to Enoch.

This morning I am better - but Enoch is not yet.

Here is how Asha sumarised it on our white board (she is the 'board monitor' at her school - allowing her to draw the whiteboard everyday - something she really likes):

I am obviously better in Asha's understanding.  Asha takes the role of the nurse - which she does well.  This morning she was comforting Enoch and made a small paper list of the patient's symptoms.

Being a Sunday morning we had to make a decision about who should / should not go to worship at our Sunday morning gathering at Bro Jolly and Sis Suma's home.  After Sheba came back from doing a morning visit to the patient at the JSK Centre, we decided that Sheba and Asha would go - and I would remain with Enoch here.  We are just about to have our own worship time together.

Here is a shot of our happy patient.  Or as Asha put in her picture - the patient patient.

But pity our dear doctor.

Even for herself things don't go easy.  Sheba has been living with a fairly large stone in her gall bladder for over a year now.  We recently did a raft of tests to see whether we should go in for surgery (jury still out on that).  Some medication was given to her.  She took it for some time, but then stopped - why take things that  she knows won't help.  The knowledge that a doctor has can be a double-edged sword.

So as we go into our worship time, we will be praying especially for our dear doctor - our hero and wonderful mother and wife - Sheba!

Choices

We admitted a dear friend of ours yesterday morning to the JSK Community Care Centre.  We will call her Indu.

Indu is HIV positive - as is her husband - and one child.  She has grown in God and is a blessing to others.  Late last year she took in an HIV positive teen-aged mother and her infant child into her home for some months.

Yesterday Indu came with pneumonia in both lungs. Her fever was high - over 102 F.  She was very sick.  For a person with HIV any illness can be the final one.  You just have to go around the bend and its the end.

But it wasn't the end of Indu.  Yet.

Sheba went over last night after we came back from the Bible study.  She told me to pray when she returned, saying that Indu was still ill.

This morning the fever had gone.  Indu seems to be turning a corner.  We are so grateful to God.

It has not been easy for Indu - but she has taken courage and told her local church about her status.  We are proud of her courage.

In addition, Indu has brought others to JSK whom she met at the government ART centre.  She has been blessed and is a blessing to others.

-----------------

Mohan (name changed of course) is the brother of a local policeman.  Mohan lives in another city in Maharasthra and has had HIV for some years now.  He is also addicted to alcohol.  His brother brought him to us some months ago.  We counselled him and told Mohan to start his Anti-Retroviral Therapy (ART) from his local govt. hospital.

Mohan refused.  He did not want others to know.  He insisted that he would stay with his brother here in Thane and that we should start.  We do not force anyone.  The choice is with the person living with HIV and their family members.  Since Mohan and his brother insisted on starting the medication here, we did the basic teaching on ART and reluctantly started.

Sadly our fears were well founded.  Mohan did not leave the bottle.  He left his ART medicines and went back to the town he came from.

Last week his policeman brother came to meet us.  Mohan has been very sick.  What should he do?  We told him to get him treated at a local hospital and ART centre.  The brother refused.

So we agreed to have Mohan come here - provided his brother would take responsibility for his treatment.  Mohan came.  He is very sick.  We wanted to admit him at the JSK centre immediately.  His brother had agreed to this before - in fact had requested it.  We urged admission.

But Mohan says 'no.'  

He says that his brother lives just around the corner and that he will come for treatment, but does not want to be admitted.  He claims to have been sober for 2 months now.  We suspect that the bottle is still too dear for Mohan.

Its unlikely that Mohan will survive long.  

Its a tragedy when resources are available and people continue in self-destructive choices.   

Interns

I spent a wonderful hour reviewing the past month with our 4 interns from the Union Biblical Seminary.  We started at 5 PM and several rounds of meditative sharings and an obligatory cup of chai each, we found that we managed to squeeze the hour till 6.30 before we finally broke off our conversation.

This batch of interns is the first under the new 3 month internship - their predecessors had 7 months with us at a time.  So we are now staring into the last month of Shibin, Renny, Limchung and Dilu's time with us.

What struck me was how deep and wholeistic their learning has been this past month.  Not only have they picked up multiple skills, they each expressed having been formed and shaped as disciples of their loving Master.

We are so much the richer for our short-term co-workers.  They bring with them a breath of fresh air - with their smiles and good humour and willingness to work.  They also bring fresh eyes to appreciate the work that is being done day in and day out.  As well as fresh lips to express concern for areas which we tend to overlook because of the day-in-and-day-out nature of working at something for a long time.

What comes to me again is the value of learning by doing.  By actually plunging in and helping people - and allowing ourselves to be shaped in the process.  These four young men are the leaders of tomorrow.  They are going to be setting things right-side-up again - and will be doing it having had a formative experience working with families affected by HIV.  What a privilege for us to be a part of this journey.

Dilu, Shibin, Limchung and Renny

As our friends finish off their time with us this month we are already preparing for the bitter-sweet experience of saying fare-well!