(Continued from home page)

Wednesday, January 17, 2007
Thursday, January 18, 2007
Friday, January 19, 2007
Saturday, January 20, 2007
Sunday, January 21, 2007
Wednesday, January 24, 2007
Tuesday, January 30, 2007
 

Tuesday, January 30    

Yesterday we visited with Dr. Suranjan Bhattacharji, head of the Rehabilitation Institute.

For many years Rehab was off by itself, across the highway from the main college campus. Now it is being rapidly surrounded by new CMC housing and the government-funded Stem Cell Research Center. Rehab itself has expanded greatly in the past three years. It is more or less twice the size it was when I first visited in January, 2002. Suranjan showed us the improved physiotherapy facilities, the Paul and Margaret Brand floor devoted to head injuries, and the new chapel (which we had already visited on our own last week.) We stopped briefly in the gait lab, which features equipment donated by Tracy McSheery of Phasespace Inc. of California. Rehab now has its own small stem cell lab. Suranjan explained that they were experimenting with cells found in the human nose and in bone marrow. The goal is to grow new nerve cells in severed spines that could repair the lost connections in paralyzed people. Even a small restoration of nerve activity could mean a huge difference in quality of life for many patients. The research is still in an early phase, but it shows promise.

Suranjan mentioned that support from the United States has been crucial to their research. ASHA funds have paid for equipment in the Basic Science Lab that they are using. A Senior Training Fellowship helped boost the skill level of a key employee. Dr. George K. Chandy of the University of California at Irvine helped arrange an important training opportunity.

Suranjan believes that doing research in the context of an institute where patients are being treated gives a special urgency and drive to the work. Paralyzed patients are following news of stem cell breakthroughs with great interest. When the Chinese were recently claiming a breakthrough, one patient asked Suranjan if it was time for him to sell his cow and buy a ticket to Beijing! Patients have been eager to help by donating their own cells.

As Suranjan gazed out his rear window, he points to the new government-funded stem cell lab now rising next door. Soon, he says, the “Mississippi” of stem cell research will be flowing past his back door and he hopes to catch a cup-full of technical resources now and then for his Rehab lab.

Indeed, the size of the Stem Cell Research building is impressive. It should open later this spring with great fanfare. Last week we had lunch with Dr. Alok Srivistava of Hematology. It has fallen to him to find the highly-skilled, specialized employees needed by the Center. This task is a major challenge, since much of the talent is living in the U.S. and Europe or in parts of India more attractive than Vellore. At a distance, CMC salaries appear especially small. It is difficult to convey the less tangible benefits of good schools, personal safety, recreational facilities, the sense of community and the delightful college campus, all of which make the terms of employment much more desirable. The U.S. Board may consider creating a small fund to subsidize visits by key job candidates in order to increase the chances they will take the plunge and joint CMC.

CMC will no doubt struggle for a long time with issues of compensation for its faulty and staff. Under present rules it is becoming increasingly difficult to meet the demands of over 1.5 million patients a year. There has been talk of shutting down one department because the staffing is so thin. With retirement mandated at 60, CMC loses its veteran faulty at the peak of their powers as teachers and clinicians. Many of the replacements will come, as always, from CMC’s own classrooms, but the flow will not be sufficient, especially if CMC expands as is now planned.
-LLK
 

Wednesday, January 24

Wednesday morning we met with Sarah Cherian and Jacob Inbanathan who are the principles in the new Development Office (DO).  We discussed the wide array of tasks that they should be prioritizing.  The conversation ranged over media relations, the possibility of media advertising, relations between the DO and the Directorate, mass mailing strategies, building networks of Friends of Vellore in Indian cities, becoming familiar with the USAID office in Delhi, and getting good stories and reports out of the institution, tailored for the different constituencies that CMC now has.  We will meet again next week to discuss a larger budget request than the $15,000 that has previously been agreed on.  The U.S. Board has already pledged to help with what should be a larger budget to provide for travel and other necessities.

One idea that excited us all was the prospect of building a database of all those who visit ‘CMC as students, volunteers or simply friends.  If the DO can start to draw this information together, possibly through the use of a “registration card” that each visitor would be asked to fill out, the DO could have a mailing list and e-mailing list of thousands within a short time.  This could also include information about patients who will be enjoying the new Private Block.  The previous day Edwina and I toured the construction site (next to the ASHA building) and were shown what will be truly luxury accommodations for high end patients.  All of these people should go on the mailing list.   

We also discussed training opportunities for DO staff and looking for development professionals who would be willing to come as volunteers for short-term work.   

Wednesday afternoon we met with Punitha Ezhilarasu who runs the Continuing Nursing Education Program.  Punitha is an old friend from the days when she was Dean of CON.  She is pursuing the agenda with great energy and focus.  CON offers seminars in research methodologies plus clinical workshops in different fields.  She is also heavily involved in the PhD consortium that has done a lot to further that degree in the field of nursing.  She is also in charge of the Journal published by CON, which is a peer-reviewed venue for research related to nursing.  She will be giving up her responsibilities related to the WHO Collaborating Center program.  That relationship is up for renewal this year, and someone else from the faculty will be in charge beyond this point.
-LLK 
 

Sunday, January 21

Sunday began with the 9:30 worship service at St. John’s Church (Church of South India). Located inside the old Vellore Fort, this parish is an English-speaking congregation containing many of the senior doctors and administrators of CMC. The worship service is similar to that of an Episcopal church in the U.S. Their prayer book was written specifically for this congregation within the past two decades. The language is clear and lively while retaining the dignity of traditional liturgies. I asked Dr. Sam Chittaranjan, who helped lead the service, if I could get a copy, but he seemed doubtful. Perhaps it is out of print.

After the service we greeted Dr. Mani Mani and Rebekah Mani, Drs. Abraham Joseph and Solochana Abraham, Dr. Sara Bhattacharji, Gillian Paterson, Prof. Shirley David and many other old friends. The homily was delivered by the Rev. Harris, a long-time member of the staff. For Ecumenical Sunday, he preached on the subject of peace and unity and proposed that the peace of God within us is the necessary prerequisite for unity.

Following lunch at the Big Bungalow, Edwina and I along with Rev. Connan from Australia walked to the fruit stand to buy citrus. We extended the stroll a bit to visit the new chapel in the Rehab Institute. It is a delightful in-the-round space that is designed perhaps more for personal meditation than organized worship. It is perfectly accessible to patients in wheel chairs or on gurneys, being designed with wide, step less entrances with no doors. The chapel creates the sensation of light and space with a skillfully placed reflecting pond and without the use of electricity.

Another five minutes on foot brought us to a new cluster of housing for CMC junior staff and graduate students. There are now several multi-story towers in the area, just steps away from the unfinished Stem Cell Research Center.

Later in the afternoon I caught Dr. Suresh Devasahayam at home. While eating a delightful South Indian confection of pineapple and coconut, I listened to an update on the new bioengineering department. Two graduate students have been admitted, but the search goes on for more faculty. Meanwhile work proceeds on gait analysis software with three people employed on the grant. Next week Suresh will be making a presentation on the Bombay-Vellore electric hand to an audience of hand surgeons, and I plan to be there. A number of improvements have been made to the design, but the challenge of marketing and manufacturing to meet demand have yet to be solved.

Six o’clock found us once again at worship, this time in the college chapel. The Rev. Connan was the preacher, and the service was the usual blend of beautiful singing and the magical moment of dusk in southern India. John’s text was Mark 12:38-44 and he preached on the widow and her mite. He noted the invisibility of the poor to most of us most of the time, and the fact that Jesus saw the poor and pointed to them as the most important people in the kingdom. While the powerful point to themselves, the poor point toward God.

Monday, January 22 I caught a morning trip into hospital on the staff bus. This allowed me to chat with the Rev. Graham Nichols, an Australian clergyman who is a close friend of George Chandy. For the past three years he has been coming for extended stays and has brought his enormous personal warmth and cheer to patients and staff alike. We talked of trying to institutionalize his role as a volunteer visiting clergy person so that others could be recruited. This year George has asked him to stay on beyond the cool season and to be active until George’s term as Director ends in September.

This was my first visit to the Directorate on this trip, and it was good to see Dr. Priya Abraham, Jacob Inbanathan and Prof. Shirley David at their posts. I will miss Priya after she steps down from the Directorate at the end of the month, and Shirley has only one year left on her assignment. I am glad we got a chance to know Priya’s replacement, Dr. Anna Pulimood, during her visit for the ASHA workshop this past fall.

Edwina, John Connan and I had lunch with Dr. Alok Srivastava, who is the point person for CMC on the new Stem Cell Research Center. Our proposal was chosen from a field of 100, and the government of India committed $5 million to get things up and running. The building and labs should be ready this spring. The great challenge, similar to that faced by Bioengineering, is to recruit the best possible staff. CMC salaries are very low, even for India, and it is sometimes hard to sell people on the other benefits of this place. Dr. Srivastava is pursuing two outstanding candidates who are Indians by birth and are now living in the United States. He thinks if people like these could be talked into visiting CMC, it would be easier to persuade them to come permanently. Edwina and I discussed the possibility that the Board could create a small fund to buy plane tickets for key candidates for this and perhaps other departments who face similar recruitment problems.

Dr. Srivastava was clear that the research will focus on adult stem cells. Embryonic stem cells will not be used, at least for the present. Adult stem cells actually promise to be more useful in the near future for finding practical applications, since a lot more work has been done on them here and elsewhere. He is encouraging discussion and debate about the possibility of using embryonic stem cells under appropriate guidelines.
-LLK

Saturday, January 20

This morning, we had a delightful meeting with the new Development Office and the Promotion Group. George Chandy was with us most of the time. He introduced the staff in attendance, which included the familiar faces of Priya Abraham, Shirley David, and Jacob Inbanathan. The new hands on deck include Sarah Cherian, a young former “Vellore kid” with financial training who was joined by Susan and Priscilla (didn’t get their last names), both of whom have experience in CMC promotional work and who are now part of the promotional team. John Sehar, head of the public relations office also was in attendance along with Annie Valsan and Shirley from the Directorate staff. Dr. Anna Pulimood, who will be taking over the ASHA portfolio from Priya Abraham, was also present.

On the Friends of Vellore side, in addition to Edwina and myself from the United States, we had Richard Smith from the United Kingdom, Rev. Wagner from Germany, the Rev. John Connan and Dr. Ian Roberts-Thomson from Australia.

We started with a presentation by Sarah Cherian of the plans and ambitions of the development office. These focused on the potential for fund raising in India, suggesting that a wide range of strategies will be given a try. The first year budget for the office is $15,000 US and evaluations were projected for the six month and one year mark.

Sarah’s presentation kicked off a lively discussion. We tended to wander a bit, since there were a number of things on the minds of people. I remarked along with others that the budget seemed small and could be increased using the commitment of the U.S. Board if nothing else. I also encouraged CMC to give the office at least two years before giving it a life or death evaluation.

We talked about web sites. I stated my hope that the CMC web site could be placed in the hands of the development office/promotion group, even if this meant spending time and money on staff training. I noted that the CMC web site was a very ambitious project that seemed to be suffering a little from neglect. Much of the information was old, and I suggested that the effort to represent all departments should be abandoned, since it would take an enormous effort to maintain all that information in an up to date form.

The group talked about questions and issues related to international visitors. The medical professionals, students and church members who find their way to CMC are the supporters for the next generation. They need to have a positive experience at CMC, and CMC needs to benefit from their presence both in a short-term and long-term way. All commend Prof. Shirley David for her leadership in this area. CMC would benefit from a defined strategy and goals in the area of international visitors of all types. The FOV in the UK is offering to pay for a full-time visitor coordinator. This offer goes along with the current plan to pay for a new housing facility adjacent to the Big Bungalow. It will add over 40 beds to the capacity for visitors.

George Chandy expressed his deep frustration at being unable to bring the public spotlight on the many great things being done at CMC. He dreams of the day when people such as Bill Clinton and Bill Gates will visit, bringing national and international coverage with them. Clearly, CMC deserves a more sophisticated public relations program, led by professionals. In the environment of CMC, with its tradition of relying on faculty doctors to manage things, there seems to be two ways to get this expertise: either contract with a PR firm or train people who come up through the ranks here at CMC. George noted that they tried using a PR firm during the presidential visit in late 2005 and it was a disaster. I mentioned the retired PR professional whom Pat Gass has introduced to us, Many Ayer. He lives in Chennai and seemed willing to consider a volunteer role with CMC when I met him last year. I hope to bring him out to CMC for lunch while I am here on this visit.

I remarked that the Development Office needed to have a “Janus” quality, facing both toward the institution and also facing the public. The face turned toward the institution must gather information that can be transformed into interesting and readable material for use by the Development Office and the FOVs.

The group also discussed a revived effort centered in Australia to create a new video about CMC. An experienced film maker, son of the Rev. Graham Nichols, is prepared to come and do it. The cost will be in the range of $40,000. John Connan said he will try to circulate a summary of the plan for the video for our comments and hopefully to encourage the participation of all FOV groups.
-LLK
 

Friday, January 19

 The Council entered its second day, , with a long delay. Apparently, there were talks continuing in an effort to bring reconciliation between the different parties in the admissions dispute. When things eventually got under way, after 10, we plunged into the financial pages of our agenda books. The bottom line: CMC continues to be a going enterprise, with funds coming in sufficient to meet operating costs and to lay aside significant amounts for future needs. For some reason, perhaps the by-laws, every capital expenditure of any size at all is brought to the full Council for its approval. So there is a lot of droning on as we plow through page after page of improvements of all types. Reading this material can give one a picture of the nuts and bolts of the place, but it seems a waste of time to go over it in a body of over 100.

The group of Friends of Vellore representatives from other countries was invited for the afternoon to RUHSA for a celebration of the 30th Anniversary of this rural program. This meant we had to leave the Council before it ended its deliberations. The last we knew was that a “clash of titans” was going on between Dr. Mathan and Dr. P. Zachariah over the wisdom of air conditioning the Scudder Auditorium.

Sometime before 2 we piled in to a CMC van for the forty-five minute drive to RUHSA. This is the most distant member of the CMC family of campuses. The program provides basic health services to a network of villages but has become best known as a community development training center. Both local villagers and students from national and international locations find their way to RUHSA for a variety of programs. It sits on a campus of over 35 acres with spartan lodging for several dozen students and a somewhat larger number of local trainees. Dr. K. R. John, the current head of RUHSA and a veteran community health department faculty member, welcomed us to the celebration. Several thousand people had gathered, attracted in large part by the prospect of seeing the Tamil Nadu minister of health. This distinguished politician had grown up in the RUHSA area and his presence was a source of great excitement.

The actual proceedings of the anniversary celebration were mostly in Tamil, so I cannot report much detail. It was clear, however, that the Health Minister was a charming and charismatic man. It was only during his speech that the crowd quieted down at all from its deafening chatter that sounded for all the world like an enormous gathering of starlings or mynahs in a great banyan tree. After his departure, we all were recruited to help distribute a variety of awards for achievement to students and self-help group members.

Dr. John convinced us to linger at RUHSA another hour to discuss his efforts to revitalize and grow the program. RUHSA has great potential as a training center for students of social work, community development and public health. On its campus students from Europe, the United States and urban India can mingle with village groups, all being involved in one form or another of training. Dr. John pointed out that RUHSA is the only part of CMC designed to make rural villagers comfortable. The entire rest of the institution is furnished only with western bathroom facilities, which many villagers have never encountered. Some tribal groups who are increasingly involved with RUHSA have never seen plumbing of any kind and need some orientation.

RUHSA has suffered from a sort of organizational isolation. Being somewhat remote from the day to day affairs of CMC, for many years it was allowed to go its own way. Now, after recent changes in leadership, it needs capital investment in revitalization and construction of new facilities along with a fresh and focused program. I will be writing more about RUHSA and its current activities in coming days.
-LLK

Thursday, January 18

The first day of the Council meeting, I rose early and breakfasted with Bishop Irenaeus of the Indian Orthodox Church. He gave me an overview of how his church fits in to the world of Orthodox Christianity. Trained at Princeton, he is a familiar figure at Council meetings and is now serving as vice chair.

The morning session featured a Power Point presentation about the vision for CMC for the coming decades by Drs. Sam Chittaranjan and Anand Job, both senior members of the faculty with major administrative responsibilities. The centerpiece is the new specialty hospital, now planned for a site a few miles outside town. The dream is to build a state of the art facility with 1,000 beds. Also somewhere on the drawing boards is a new secondary hospital designed to treat those who cannot pay for their care. Financing for this work will come in part from revenues earned by the specialty hospital and partly from philanthropic sources. A third chapter involves a network of revitalized Christian hospitals across India, an idea that Dr. Chittaranjan has been working on for several years.

After a bracing lunch of wonderful Kerala fish curry, the Council began a long debate about the way the admissions to the medical college were conducted last year. The subject of the admissions process is one that deserves a longer treatment at some future time, but allow me to provide a few basic facts. For many years public bodies, especially the state government have tried to gain control of the admissions process. Most frequently this comes as a demand that half the seats be filled with candidates the state would draw from lists of students who had taken standardized exams. CMC has been able to protect itself under the Indian constitution because the courts have been generally sympathetic to our cause. CMC is considered a minority institution, operated by and for the benefit of the Christian community in India, which is very much in the minority, constituting something like 2 or 3 per cent of the population.

Recently, public bodies in Tamil Nadu have attacked the CMC system of sponsorship of candidates by church organizations. A large proportion of each class of medical students as well as classes of nurses and allied health students is drawn from candidates sponsored by bishops and other officials of Christian denominations and organizations. This system goes back to the 1940’s and has been operating more or less unchanged since then. The government committee has questioned the transparency of the sponsorship process and accuses CMC of not relying solely on merit to select it classes.

A year ago, the CMC Council voted to abolish the sponsorship system and to accept applications for consideration from any student that could prove they were a part of a Christian worshipping community. Since then, Council members have had second thoughts and voted at a special meeting in November to go back to the sponsorship system, come what may. During the struggle over this issue, a variety of personal attacks were made on the conduct of CMC administrators. Hence, at the meeting yesterday, Dr. George M. Chandy provided a detailed history of the struggle in the courts, going back to 1993 and also provided an explanation for all actions of the Administration that satisfied 95% of those present. Many hours of Council time, on in to the evening, were spent trying to convince the other 5% to amicably withdraw their objections. Finally, they were voted down by a 95% majority of the 100 or so voting members present at 10 in the evening.

The one significant break in the day came at 7 p.m. when everyone gathered on the lawn of the Big Bungalow for dinner and brief presentations by the representatives of Friends of Vellore groups around the world, including yours truly and Mrs. Edwina Scudder-Youth, our chair. There were also people from Germany, the United Kingdom, Australia and Sweden. It was a welcome reminder of the global family of CMC supporters.

Also present throughout the day were Vellore Board member Dr. Susan Cherian and her husband, the Rev. Isaac Cherian. It is always a pleasure to see supporters from the U.S. take the trouble to visit, even if only for a few hours.
-LLK

Wednesday, January 17

We made it here to the Big Bungalow on schedule Wednesday morning (Tuesday evening U.S. time). The drive from Chennai airport to Vellore is now much faster with divided highway all the way once you are out of the Chennai metropolitan area.

This evening (Wednesday) we found Richard Smith of the FOV UK and Ian Roberts-Thomson and John Connan of FOV Australia at dinner. We will all be on the spot tomorrow night for one of the festive "on the lawn" events here at the Big Bungalow. Faculty are invited to join us for dinner, and we are expected to report briefly on FOV activity.

Dr. Priya Abraham provided all of us with a sheaf of papers to bring us up to date on the admissions controversy. It is expected to dominate the Council meeting the next two days.

The food at lunch, tasty as always, was hotter than I remembered it from previous visits. Perhaps around the time of Council meetings the seasoning is increased to meet Indian expectations, and then lowered at other times when western visitors occupy most of the rooms at BB.
-LLK