The Christian Doctor in India Today.

Introduction :

Christian doctors go back a long way. One of the very first followers of Jesus was Luke, a first century Greek physician. He used his excellent history taking skills to collect eyewitness accounts for his summary of Jesus’ life, recorded for posterity in the Gospel according to Luke. Since then the influence of Christians in medicine has been substantial. Christians started many of the early hospitals and hospices and many have not only survived until today but have made significant contribution in treating and welcoming those who are, poor, marginalized and the alien whom mainstream society often turns away from it gate.

Ethics and Worldview

A Christian doctor’s understanding of health, healing and health care comes from the scriptures. Necessary to the development of Scripture's view of medicine is a proper understanding of the way the world works. God created the world and actively sustains it. That is a tenet of Christian belief.. God tells us that he upholds, directs, disposes, and governs all creatures, actions and things. Psalm 104:10 makes it clear that God causes the springs to flow into the valley. Psalm 104:15 declares that grass grows and seeds sprout not because of certain temperature and moisture conditions, but rather because God causes the grass to grow, and ordinarily under certain conditions. Nothing happens automatically. Everything happens as a result of God's active hand. God's sovereignty is not reactive, merely the power to fix what happens. Disease, then, is not just disease. The fact of an illness cannot stand in isolation. It is always seen in terms of more basic principles.

If every patient is a multi-dimensional entity, then illness is the fragmentation of that multidimensional whole. Illness, whether a stubbed toe, cancer, or debilitating chronic health problem fractures the wholeness of the being, the physical, mental, social, and spiritual. What I as a doctor see before me in my patients are not just a lumps or infections, but fractured people who, because of their illness or problem, are disintegrated. My task then is to heal or put the fragmentation of their life back together again. The Greek word for healing or health is "soteria." It means, "To make whole." The word "salvation" comes from the same Greek word. We as healers are to make it possible for fractured human beings to be brought into wholeness. In other words, a physician's outcome should be an "integer" and not a bunch of fractions

Care:

The Christian ministry to the sick has a Biblical foundation. Christian medicine is caring medicine. It should be concerned with the poor, the orphan and the widow. Scripture teaches our duty to the sick. In Mt. 25:31-46, Christ teaches that at the final judgment, He will judge us by whether we clothed the naked, fed the hungry and thirsty, sheltered the stranger, and visited or comforted the sick. We will not necessarily be judged on how many were cured or how long we prolonged life, but whether we comforted the sick... Food ,water and treatment are priorities, but not super high-tech medical care. Comfort, yes. Caring, yes. The allure of the technology of medicine is powerful indeed. There is a romance with cure that is irresistible to most young doctors. But we need just as much to have a romance with care. It is at first sight less dramatic and less thrilling. Yet it brings us close to our patients in that most privileged of settings, where a fellow human being, stripped naked in pain, fear, distress, appeals to us for help.

Patients will not acquiesce to the ultimate alienation of being reduced to standardized objects. No one will accept for long being merely identified by their illness, or seen as nothing but an assemblage of broken down biologic parts. Patients crave a partnership with physicians who are as sensitive to their aching souls as to their malfunctioning anatomy. They yearn not for a tautly drafted business contract, but for a covenant of trust between equals earned by the doctor while exercising the art of caring. When cure rather than comfort becomes the focus, failure must result. Medical training forces the focus on cure. Morbidity and mortality conferences are only part of a system designed to reinforce that death or lack of cure means failure.

In medicine, we can expect machines to give us a lot of answers. But the questions our patients ask us, the biggest ones, call for a response, not from machines but from ourselves as fellow human beings. What are our greatest fears? What of our mortality? How much of life remains? Why are we being afflicted? Are we being, or will be, punished? Can we find comfort in the embrace of a greater, divine reality? Koenig shows in this small book that far from avoiding such questions, the doctor can readily engage with his/her patients with sensitivity and openness, and that whatever the clinical outcome, those in need will have had the solace and encouragement of being recognized and valued in their personhood. Doctors, too, will find that they are by no means excluded from the spiritual replenishment that such soul-to-soul contact invariably brings.

Involvement:

What does it mean to be a Christian doctor in India today ? The challenges are many and they stare at us in the face. There are hard facts available . One of the developments of the past decade or so is that the Government, traditionally the largest healthcare provider, is under pressure to meet the evolving and rising demand for healthcare services across the country. This demand-supply interaction has created conditions for increasing private/voluntary sector participation in the delivery of healthcare services, opening opportunities for both preventive and curative care. On the one hand corporate hospitals with state-of-the art facilities cater to the elite and attract foreign patients, creating medical tourism as a new economic entity that gets undue policy attention in the National Health Policy 2002. On the other hand the majority is left to market forces, and medical expenditure is the second highest cause of rural indebtedness. On the ethical front the practice of fee-splitting, the limited sense of accountability on the part of health-care providers, flaws in the informed consent process in medical settings, and the conduct of inappropriate procedures are becoming common place.

A striking feature of the medical care system in India is the apparent lack of planning. In the recent past, the government has planned by default. In other words, by failure of regulation, it has permitted private interests in medical education to offer those courses which are considered to be 'in demand'. The courses that are in demand, as dictated by the market, are those which are most lucrative in the private sector. Thus we find that at present, radiology, orthopedic surgery, cardiology and cardiac surgery are most sought after. Most doctors, having completed their basic medical education, try to acquire a specialist qualification. Having acquired this qualification, they must choose one of two options. If they choose the public sector, there is a great likelihood that they may not be able to utilize their skills due to lack of infrastructure or deliberate hurdles by the medical bureaucracy. If they choose the private sector, they will have to compete for the limited number of patients who can pay for private care. In today's world, it is a fact that as the skills required increase, so too do the technology and cost.

In a developing country such as India, the major disease burden is of infectious diseases. Even with the changing disease pattern the world over, infective and environmental diseases are likely to form 50% of the disease burden. These diseases require primarily non-pharmaceutical solutions such as clean drinking water, a pollution-free environment and adequate nutrition. No amount of vitamins is likely to help the patient. As for the remaining 50%, lifestyle diseases will cost the economy dearly, unless preventive strategies are put in place, but these preventive strategies are primarily non-pharmaceutical. For example, the increasing incidence of diabetes and hypertension

Cannot be controlled by increasing the production and marketing of insulin. While insulin production is necessary, it must be accompanied by improving health care education and making people aware of proper nutrition. However, we find increasing aggressive marketing of anti-diabetic drugs with little emphasis on preventive strategies.

What is a Christian doctor to do in these circumstances ? Obviously , there is no pat answer , though there are principles. A Christian doctor strives first to be a Christian, striving to please God in every area of life through his calling and vocation. A good Christian doctor has good training, keeps current in what he does, is reasonably caring, is as thorough as professionally needed, and is helpful to the patient. He exhibits common sense, wisdom, and decisiveness, though being willing to admit to it when defeated; and he is willing to direct the patient to second or other opinions or specialists. In short, he/she does as he/she would have it do unto himself/herself (the Christian "golden rule").

A Christian doctor serves God in serving his fellowman by listening to his complaints and ailments, by comforting his patient, teaching him about his illness, diagnosis and prognosis, and treatments; but most importantly, serve by reminding him that there is no comfort outside of Christ. A Christian doctor advises and counsels and rebukes on occasion. He sometimes uses drugs or other remedies, if they may benefit; but he use s nothing without thankfulness to God, asking for his blessing in its use. He seeks daily to see God's hand in his world. He recognizes that to ignore God's hand is to deny Him. A Christian doctor treats the patient as fallen, a sinner in need of redemption far more than he needs our medicine. He does not remember that the patient has responsibility for himself before God, that we cannot force others to pay for his care, nor can he. He remembers that resources are limited, and therefore diagnoses and prescribes judiciously.

Finally a Christian doctor will always believe that all humans are created in God's image, which means that they deserve respect, no matter what their abilities or situation in. Such a concern to see and reflect God’s image in peoples’ lives and in the institutions that churches run may be done in many ways. It can be reflected in care for unborn children or people with dementia, in genuine compassion for suffering patients, and in a commitment to do your best for them. Seeing all fellow humans as being made in the image of God can have a great effect on the way doctors relate to them. A Christian doctor sees people affected by disease or deformity as God's "flawed masterpieces"—marvels of creation, even though marred and perhaps only for a while..