Tuesday, November 12

The Karigiri driver arrived earlier than expected and I had a mad dash to pack my washed clothes and head out the door.  It really was a very pleasant drive with very little traffic due to the festival of Dewali.  The countryside here is stunning.  We arrived at Karigiri at about 5:30.  As usual,  everyone makes you feel more than welcome...such a wonderful hospitable culture.  The hospital compound appears to be a sprawling complex, but I could not see many buildings due to the trees and undergrowth.  Tamil Nadu is a very lusciously green State and everything grows with wild abandon.  I was shown into the guest house and to my room...very nice...with a small communal kitchen.  Supper will be at 7:30....just enough time for me to gain my bearings.

It was pitch dark outside as I tried to find my way to the dining area...needless to say I turned right when I should have stayed straight and went crashing down an embankment...thankfully, I only had minor scratches, but it was quite a wake-up call!  I met two Indian Christian men who are members of the Christian Institute of Management.  They are here at Karigiri for a seminar...the speaker is an American...Jay Clark who is the Executive Director of the Kerusson Foundation. He is here to speak on Strategic Management and Leadership Development.  Hopefully, he will take the message of hope that is Karigiri back with him.

Wednesday, November 14: Karigiri

After breakfast, I walked down to the Administration building to speak with Karigiri's director, Dr. Ebenezer M. After a brief history about Karigiri, he gave me a basic picture of what Karigiri is all about.  There are basically five sections to the work.

1.  Service including reconstructive surgery and multi drug therapy

2.  Research

3.  Training of medical personnel

4.  Disease Control

5.  Rehabilitation including a vocational training center and reintegration in the community

6.  Preventative measures including awareness of the nature of leprosy and community education in basic hygiene

One project that encompasses most of the above, is the micro cellular rubber shoes made for leprosy patients. Two years of research went into this project.  It is a service rendered to the patient, it controls the complications often associated with the lack of sensation in the feet, especially ulcers that may cause the loss of toes, and it plays a small part in the rehabilitation process as it gives the patient greater freedom of movement without the risk of further injury or infection.

Today, Karigiri has expanded its work to include dermatology, ophthalmology, and other more general medical fields. In part, this was to make up for the lack if funding for their leprosy work. The hospital is basically 88% self sufficient...so 12% must come from outside sources.  But the leprosy unit, because of the lower socioeconomic status of the patients, is funded from outside sources by 75%...the further 25% must come via a subsidy from the hospital.  Much of the outside funding comes through the work of the American Leprosy Mission.

In 1997, the government of India began a national leprosy irradiation program.  In doing so, they dismantle the field units of the Karigiri work. Because if this, active case finding stopped. Based on these skewed figures, the government boasted that it had overcome leprosy...only to find that the figures of leprosy centers like Karigiri were 3 to 4 times higher than the figures reported by the government.  Someone had to save face.  And because leprosy is no longer considered a priority (AIDS, malaria, Tuberculosis, and others take precedence) government funding has dropped. Government funding is limited and something needs to be cut out...leprosy is not a high profile disease. It often remains undetected for long periods of time as there is no pain involved...many sufferers do not seek treatment themselves until the disease has progressed to the point of loss of limbs due to accidental injury caused by a lack of sensation.  As there is no longer an active case finding element the numbers remain low...but turning a blind eye may result in future catastrophe.

It is true that the numbers of patients at Karigiri have decreased significantly because of their amazing work here. And unfortunately, as many sources operate on an impact based budget, funding has been adversely effected.  As Dr. Ebenezer explained to me, regardless of the number of cases, the staff remain the same and thus the budget ought to remain the same.  While some of the staff are able to supplement their income by taking on more general work, others cannot, and so the % subsidized by the hospital is increasing.  Sadly, my mind could not comprehend all the figures quoted, but the long and the short of it all is that the leprosy work is underfunded.

At 9:30 Dr. M.V. Thomas took me to visit the Paul Brandt Integrated Health Center.  This is an outpatient facility for all patients. However, what is interesting about the IHC is the college they started here last year, with 6 different undergraduate courses. Most of the students are from the surrounding villages and are thus from the lower socioeconomic bracket of society.  The second and third year students (obviously there are not third year students right now) do practical work at Karigiri in the afternoons.  The most pressing need that I saw at this facility was the desperate need for medical text books. 

At 10:30 Dr. Thomas took me to the Gudiyathan Clinic.  Here I met with the doctors and a nurse, and, most importantly, with leprosy patients themselves. Two gentlemen were there to be refitted for the special rubber shoes...however, they were also there to have their feet examined and their festering ukcers cleaned and dressed.  While interviewing them, I made sure to touch them by shaking hands.  Apparently this simple act means so much to the patient. I went with them to see the nurse.  She showed me how she cleaned the wounds, cutting away dead skin and, in the one man's case, removing maggots. Not a very pretty sight and I couldn't help thinking that I was glad I had already had my lunch.  In spite of what was going in my mind, I stayed put throughout the ordeal chatting with the nurse and taking photographs...I'm not sure who I will be able to show these pictures too.  But the patients love me taking their photographs, so I take photograph and then show it to them.  They get a great kick of of seeing themselves on the camera screen. These two men are more fortunate than others as they are well taken care of. One man, an economics graduate, had property and a good income from farming, plus a pension from the government. He was thus able to save for the future. The other man had a small convenience store. We left the hospital to look at his store...neat and tidy with a fairly wide range of goods.  Apparently his clients have no problems taking the goods from his hands...a good sign that the education side of Karigiri has been effective in this area.

On the way back from this gentleman's shop, we witnessed a funeral....later we would see the funeral procession down the main street. The deceased was displayed on a bullock cart, surrounded by marigolds and jasmine and other flowers while the mourners played loud drums and other instruments and dance before the cart.  My first thought we that this displayed was rather bizarre until I remembered the Western custom of "the viewing"...

We then went on to visit various other patients with varying degrees of independence. While some had their own businesses (like a tailor I met), others were well taken care of by relatives...usually because they owned land or their own home...sad, but true.  I met the father of a man whose cure was so successful that he was now working in Singapore! Both father and son were cured and well rehabilitated.  The family had a beautiful home and were obviously fairly well off. But there are many others that are not so fortunate...apparently I will meet some tomorrow who have had to move into a community because their families have rejected them.

I wish I could take some of my friends and colleagues with me to see what I have seen.  Word and even pictures do not capture the many faceted reality of the disease, nor can they describe the greatness of the work done by the dedicated staff at Karigiri. One doctor is a young, attractive woman...what caused her to choose to do this oftentimes frustrating work?  In spite of the discouragement with willful political blindness, reluctant patients, unkind relatives, and the lack of adequate funding, they press on in their service to their diseased, disfigured, disowned fellowman.

As with my experience with the pastors of Odisha who willingly put the Gospel before personal safety, knowing firsthand what persecution really looks like and feels like, it is a truly humbling experience to meet with those who could be gainfully employed elsewhere, but who choose to stay so that those with leprosy may live fairly fulfilled lives.

A day well spent...Lord, in your mercy, hear my prayers.

Thursday, November 15: Karigiri

I have seen so much these past two days that I can hardly write about it all...in many ways, Karigiri is overwhelming.  There is such a great need both for those who are cared for as well as those who care for them.  Those whom work here are not paid a fraction of what others in the same fields are paid...they work here because they are called...they love because they are loved...the serve as Jesus served. Karigiri is at once heart breaking and heartwarming.  It is humbling to walk with those who serve and humbling to talk to those whom they serve...how can we complain when the odds staked against these marred and scarred images of God are so infinitely more complex than the greatest of our difficulties? It is humbling and yet also convicting.

So, let me try to convey to you what I experienced today.

At 8:30, Mrs. Geetha, the Public Relations Officer, took me on a tour of the hospital. She told me a bit of the history of Karigiri and then showed me around the general wards and introduced me to several staff members. It is amazing to see how multifaceted this relatively small hospital really is.  I met orthopedic surgeons, physiotherapists, those who create orthotics and prosthetics, pediatricians, psychologists, ophthalmologists, laboratory technicians, radiographers, social workers, counselors, nurses, and oh so many, many more...I simply could not take it all in. One very interesting part of Karigiri is their research unit...they use mice...3,521 mice. Apparently the foot pad of the mouse is a good medium for the cultivation of Mycobacterium leprae which has, as yet, not been cultivated in an artificial medium.  Mice bred in the research center are thymectomized at 4 to 8 weeks of age...three weeks later they are irradiated with 900 rads of cobalt rays and a syngenetic bone marrow transfusion is administered.  They are then injected with M. leprae...this whole process of destroying the mouse's immune system is because M. leprae cannot be cultivated in healthy mice.  To cut a very long and complex story short, the progression of the disease is then carefully studied in its growth in the mice...a layman's interpretation.  I'm sure you can Google it... :-)

Everyone here knows Lance and Sue Renault...I even found a cornerstone with Lace's name on it and saw a photograph of Sue with an older leprosy patient who still has the music box Sue gave her!

Mrs. Geetha then took me to a building where rubber is...what word do I use here?  Changed? Well made into the form used in making specifically designed shoes for those with leprosy to prevent injury.  From there we went first to the arts and crafts buildings were leprosy sufferers are taught to make various items for sale.  When I purchased two items, the sales lady kept thanking me even after we had left the building.  One wonders how many items they a truly sell.  There has to be someone in the States who would import some of these items.  Then we went on to the shoe and orthopedics manufacturing department...there I ordered a custom designed pair of sandals for myself...I had the sandals by 2:30 that afternoon.  Amazing.  There are many different kinds of shoes for all shapes and sizes of feet...or for those who no longer have any feet.

I met two men who had surgery to reverse the claw-like effect of leprosy in their hands.  Both men were ecstatic to have regained the use of the hands even though the nerve damage is still a factor...they simply have no sensation in their hands.  Because of this, the risk of injury is very high as they feel no pain and have to be educated in how to care for themselves. I also met a man whose food ulcer became so bad that he had his leg amputated...he will fitted with a custom designed artificial limb in due time. 

Somewhere during all these various activities...I have forgotten the sequence of events...I met Mrs. Valsa Augustine with whom I will dine tonight.  She is the social worker/counselor...the only one.  She asked me to see if there were any volunteers from the States who would come to help her as she has not been able to take a break for a very long time. Nevertheless her live for her patients keeps her going. Such devotion is very rare these days...

After lunch, Valsa took me to visit Shanthigramam, a community of aged leprosy sufferers who have been rejected by their families and their communities.  One dear old lady was crying because no one visited her on Dewali...no one brought her sweets.  Heartbreaking.  The deformities here are pronounced and yet a spirit of joy is more evident here than in any other place I have visited while in Karigiri.  I prayed with a larger group who then sang a chorus for me and then I visited a few shut-ins and prayed with them as well.  One man proudly showed me his vegetable and fruit garden...another his very, very neat, tidy and clean bungalow.  What these dear folks can do without fingers is simply astounding. Most of the residents have become Christians.  That, no doubt, a counts for the joy here.

After this life challenging visit I met with the Rev. T. Devadoss, the chaplain.  Deva is a handsome man who looks as if he is in his  twenties when he is really I his forties.  We chatted about our respective families and he told me about his multifaceted work at Karigiri. I spoke ti him about Alpha and he is very interested.  I have his contact information and will connect him with Alpha India.  Perhaps I could lead a GAT team here I the future...and, by God's grace, a few brethren in the medical field.  We had tea at the hospital canteen and while talking out in the yard, were $#%&$ upon by nesting crows.  Interesting thing to share. We returned to his office and I prayed for him.  Oh, how our dear Indian brethren need our prayers...as I've said before, Christianity means something here...it is costly and dear...it is never taken for granted.  Those who serve here serve for all the right reasons...

It is 7:30 and I am about to join Augustine and Valsa for dinner...how I will miss them all here.

Who am I, dear Lord, that you would bless me with such dear friends? How is it possible that one such as I would be found worthy to bask in the love of your saints? For this is what those who work here at Karigiri are...saints...they give all to you and for your kingdom...they literally walk in your sandals.  The world and all its trappings are far removed from them...they see your footprints, dear Savior, and they put their feet where your feet once walked.  You came to serve...you came to call us into that same service...how soon we forget what that call really means.  These children of yours have not forgotten that call.  Oh, dear sovereign King...you know their needs...how overwhelming it all seems to those who see with human eyes.  But to you who sees all things, knows all things, and for whom nothing is impossible, these overwhelming needs are merely opportunities for your children elsewhere in your world to serve as your Karigiri children serve.  Oh, Lord, grant that I may be found worthy to offer you and these saints service in raising up an army of supporters in both prayer and financial support.  Open up the store rooms of heaven and pour out upon Karigiri every blessing they need...every blessing, dear Father, without measure and beyond measure. Raise up the next generation of dedicated workers for the sake of these whom the world so easily rejects or worse...simply do not think about.  For who will go, Lord, if you do not call and send them?

Friday, November 16: Karigiri

Today I will leave Karigiri, but I wonder if one can really leave after visiting such a place? Will the faces etched into one's heart and mind not go with you wherever you go? How can one truly describe Karigiri to those who have non been here? But I must if I am to serve those who serve and those who are being served here. Lord, only you can prepare the hearts of those I will address and only you can lead me the right people. Help me, merciful Father.

I will meet with the Director one last time at 8 AM. After that Dr. Thomas will take me to more villages in the surrounding areas. More faces. More stories of triumph or tragedy.

Then it is back to my sheltered and privileged world. First the bustling city of Chennai, then on to Dubai, New York, Charlotte, and Greenville...and my darling Louise. How often have I not wished that she were by my side, seeing what I have seen...touching whom I have touched...being touched by those who have touched me. There is so much here that she would have understood better than me...I know that she would have been I her element here and I the villages...health and development...that has always been her passion.  But who knows how our Lord will lead us I the future...who knows? That remains to be seen.  For now my task seems clear...take this story back and tell it to those which have ears to hear and hearts to respond.