REDEEMING HEALTHCARE | KAIROS GLOBAL | JUNE 2022

Author: Fr Mathew Abraham C.Ss.R

Intro: Fr Mathew Abraham C.Ss.R, the Director General of Catholic Health Association of India (CHAI) writes about his call, and the role of the Church in healthcare. 

Being a Catholic priest as well as a medical doctor is a rare combination, but a meaningful one indeed. 

An 18-year-old, who drifted into medical college. Like most youngsters from middle-class Keralite families of the 1980s, I too had predominantly two major career options – medicine or engineering. Social pressures set me adrift to medicine, to which I was more inclined for I preferred human beings over buildings and machines. Also the perks that came along with a medical career – financial security, social status, possibility of marriage to a beautiful girl from a wealthy family – too attracted me.  

Experiencing God as a friend. A charismatic retreat during my third year of medicine initiated changes regarding my idea and perception about God, and life in general. God was no more a scary distant person, but a good friend beside us, Emmanuel. God was no more vague, but an inspiring person with a face, Jesus Christ of Nazareth. I started discovering and experiencing deeper Catholic spirituality through the sacraments, Word of God, teachings of the Church, prayer, reflection, and active participation in the JY movement. During this process, I realised that God knew my unformed substance, that I was created in the image and likeness of God, for a purpose, and that I am a member of the larger family of God. These realisations, increased my self-respect, and my love and respect for my fellow beings, both men and women, irrespective of colour, caste, race, sickness, financial situation, and so on. I also became more reflective and started asking fundamental questions regarding career, success, marriage, healthcare practices, mission, and purpose of life. 

Deeper relationship with God and sense of mission. Initially, my experience of God was in the sacraments, Word of God, and prayer. Later, through my interactions with patients and their families, I started experiencing God in people, especially in the midst of sickness and suffering. During the first few years of this spiritual journey, I had expectations of marriage, and to become a missionary family. However, over time, my sense of mission grew and at some point of time, I felt that I needed to think beyond a small family, embrace the larger family of God, and dedicate myself fully for the sake of mission, with an undivided heart. Fortunately, in the Catholic Church we have a system for that – religious life and priesthood. 

Two major choices. This clarity evolved over a period of 3-4 years. I made two major choices during this period. First was a career choice, to move from hospital based medicine to community medicine that focuses more on primary healthcare. In a country like India, 80% of the population do not have access to essential healthcare, and are far removed from doctor-centred, hospital-centred healthcare. The second was a vocation choice, to think beyond marriage and a small family, and embrace the larger family as a religious priest in order to dedicate myself fully for the sake of the mission.  Those days, I had only a ‘sense’ of mission. Today, however, I have more ‘clarity’ of mission as well – providing leadership for the transformation of Catholic healthcare in India, towards compassionate, affordable and quality care. 

From small to a larger family. Marriage is a wonderful institution and I like all that is associated with it, especially conjugal love and parenting. However, family is also a full-time responsibility, where one has to invest a lot of emotional energy and time. Over a period of time, I felt God was calling me to dedicate myself fully for a mission, which I discovered in prayer and reflection, along with valuable inputs from elders and pastors.

The Congregation of the most Holy Redeemer. My family, close relatives and friends were initially surprised about my new way of thinking; eventually most of them supported my heart’s desire. Soon after my postgraduate studies in community medicine, I joined the Congregation of the Most Holy Redeemer (Redemptorists). Their charism, I felt would give me the necessary exposure and reach needed for the mission I was trying to follow. I was also influenced by one Redemptorist priest, who left a lasting impression on me regarding religious life, priesthood and mission. 

Health & healthcare. In general, people believe that health lies in the hands of doctors and hospitals. This is not fully true. We need doctors and hospitals, however, our body itself is the best physician. God has created us in such a way that most of the time, we can remain healthy without being dependent on doctors and hospitals. A balanced life with adequate sleep, work, food, physical exercise and emotional care, can keep us healthy most of the time. For example, whether we treat a viral fever or not, it will subside within a week. What we do with medication is to control fever, pain, and other symptoms. 80% of the time, we can manage with primary care, in 15%, we may need secondary care and about 5 % may need tertiary care. 

Distortions in healthcare. Unfortunately, 80% of our healthcare resources, including finances, healthcare professionals and infrastructure provide secondary and tertiary care to only 20% of the population, that too, mostly in the cities and towns. This is a distortion that has happened in the way healthcare is practised. Moreover, the past few decades has seen an increasing tendency to commercialise healthcare in India. There are several industries driving healthcare – pharmaceuticals, diagnostics, hospitals, and even medical education. When healthcare is driven by ‘profit-and-more profit’ motives, there can be tendencies to exploit, even in the midst of sickness and suffering. That is why unnecessary diagnostic procedures, medications, and interventions are being pushed. There is also documented evidence that in India, the second common cause of rural debt is medical expenses. There are millions of people being pushed below the poverty line due to medical expenses every year, in India. 

The cultural shock. As a medical student, I got an opportunity to visit a village in one of the states outside Kerala. There I saw a woman in her mid-twenties with cerebral malaria, lying on the floor in a small hut. She was left there to die, because the family neither knew what to do nor had resources to take her to the hospital, far away in town. That was a cultural shock for me, but it also strengthened my sense of mission. This is the situation in many countries, including India. Many who are brought up in Kerala (higher standard of living) or in the cities, may not be aware of this reality. Unfortunately, medical education in India happens in an artificial setting, completely isolated from these hard realities of the country.  We try to foster ‘life and life in its fullness’ (John 10:10). But, how can there be fullness of life, when life itself is at stake?  

The 3 healthcare systems in India. In India there are predominantly 3 healthcare systems – the government system, the for-profit system, and the not-for-profit system. The government system is good at some places, but not very functional in many places. The for-profit system includes the private hospitals run by individuals and corporates. They provide quality and efficient healthcare. However, their primary motive is profit and therefore, available mostly in the cities, accessible by the well-to-do. The not-for-profit system in India is predominantly Christian, both Catholic and Protestant. There are also a few other non-for-profit systems by other organisations and some motivated individuals, who may or may not believe in God. 

Love of neighbour. The essence of Christianity is ‘love of God and love of neighbour’. Following this principle, the Catholic Church as a corporate body expresses ‘love of neighbour’ in four concrete ways – healthcare, education, social work and pastoral care. All these ministries, directly or indirectly contribute to health from a holistic sense. 

Compassion. Barring few exceptions, most humans have the inherent capacity to be compassionate. Like our God-given abilities, compassion also is an ability that has to be discovered and fostered. Caring for those who are sick and suffering is a wonderful opportunity to discover our ability to be compassionate and to develop that potential. The more we unleash compassion, the more compassionate we become. Like developing any other ability or skill, compassion also needs conscious effort, and a lot of emotional and spiritual energy. Compassion comes from two Latin words – ‘com’ and ‘passio’ which mean ‘to suffer with’. Exercising compassion is both a painful and rewarding experience. It is also mutual; an experience for both – the one who is suffering and the one who is caring. 

There are two expressions, Christus Patiens and Christus Medicus. It combines two aspects of the message of the Gospel which characterise its special uniqueness of Christ who suffers and Christ who heals, at the same time. Those in healthcare ministry have an opportunity to experience these two dimensions of Christ, as they care for the sick and the suffering. 

Transforming healthcare. My mission is to contribute to bringing healthcare back to its original purpose – compassionate, affordable, quality care, especially to those at the margins of society. In achieving this mission, over a period of time, I have been led into a leadership role, mostly for the transformation of Catholic healthcare in India. Transformation is not easy, it is a long journey with several challenges. The Catholic healthcare system in India has its strengths and weaknesses. Our efforts are to build on these strengths and to transform the weaknesses and challenges into opportunities for sustaining the mission. 

What will a transformed Catholic healthcare look like? Let me share the story of Kalidasan, who was dying of tuberculosis (TB) and on the streets. An alcoholic, his family was broken and his children were out of school. Sr Philo (name changed) working in one of our hospitals, picked him up from the streets. Over a period of 9 months, he was cured of TB, was de-addicted, his family reunited, his children put back to school, and the family directed towards financial sustainability. This is holistic care. This is a concrete expression of ‘love of neighbour.’   

The Ray of hope. If we succeed in sustaining and transforming the Catholic healthcare system, it has the potential to become a ray of hope and consolation for millions of people in India, especially those at the margins. This transformed healthcare system will stand apart from the highly commercialised system and the government system, ‘as a lamp shining on the lampstand.’ 

As of now, in India, about 80% of the Catholic healthcare system is owned and managed by religious sisters. About 20% of our healthcare institutions are owned by dioceses and managed by priests. Both our sisters and priests will need a lot of help in areas of good governance, managing resources including finances, human resources, technology, land, and infrastructure. This is where lay people with competence and integrity can make a difference. 

The importance of lay collaboration. This transition has already happened to a great extent, in the US and Australia. Here, when the religious sisters realised that their novices were dwindling and that they themselves were getting older, started dialogue with competent lay people who were already part of their system. Over a period of time, some of these congregations came together and formed healthcare networks with the help of lay people and empowered them to continue their charism. To name some such networks: Common Spirit, Providence Health, and Ascension Health in the US and St Vincent’s Health, Cabrini Health, Mercy health in Australia. These healthcare networks are managed with a high level of professional expertise, are financially sustainable, and continue to practise some of the core values of Catholic healthcare. The Vatican has accepted this development as a new model, called Public Juridic Person (PJP) – a collaboration of religious and lay people to sustain the mission. 

The Asian and African Church may soon find themselves facing the same problems that the Church in the US and Australia did. We need not reinvent the wheel. We can learn much from their experience and probably achieve even greater things. It is important to sustain the Catholic healthcare ministry. If not, the next generation may see only a highly commercialised for-profit healthcare system that will focus on a small percentage of the rich in our country.  

Fr. Mathew is a Redemptorist Priest and medical doctor. He was the Health Secretary of the Catholic Bishops Conference of India from 2008 to 2015. Fr. Mathew is passionate about compassionate, affordable and quality healthcare for all, especially those at the margins of the society. He can be reached at frmathew@chai-india.org.