MEDICAL SERVICE VOL. 42 No. 2 FEBRUARY-1985.pdf
Media
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international research workshop: the family in a technological society • state
ment of international workshop on the family in a technological society •
the management consultation for health care.fields • noise pollution—-you'd
better believe it • you and your deaf child • dying with dignity?
medical
service
official house journal
of the catholic
hospital association of India
"the love of Christ
urges us" 2 cor 5 :14
vol 42
editorial board
dr c m francis
dr ravi narayan
dr prem chandran john
dr daleep mukarji
mr augustin veliyath
fr george lobo sj
prof george joseph
dr paul neelamkavil
fr edwin m j
contents
1
editorial
2
2
International research workshop—the family in
a technological society
dr sr Catherine bernard
4
statement of international workshop on the
family in a technological society
9
the management consultation for health care fields
anang r sanghavi
13
noise pollution—you'd better believe it I
carol c sides
17
you and your deaf child
kiranmayi r kamath
21
3
4
editor
fr john vattamattorn svd
5
6
cover design
p m isaac bangalore
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
february 1985
no 2
7
8
dying with dignity ?
sr mary c harvey
reiterating age-old truths
sterilization and its complications—moral
physical and psychological
dr john j brennan
25
27
„Artic!es and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"
EDITORIAL
“Genesis of a Great Initiative”
The title of this editorial “Genesis of a Great Initiative” was the head
line given by an editor at Thiruchirapally on the occasion of the foundation
of the Catholic Hospital Association of India by Sr. Mary Glowrey of the Sacred
Heart as far back as 1943; when the world was at war. Many things coincided
during this period. The inflow of war victims, both military and civilians from
Burma including victims of tropical disease and malnutrition was far beyond
the limited medical facilities could cope with. “I have never seen so much
pain and suffering, and we had so little with which to relieve it all” said a
British military nurse after the seige of Imphal. The need was there, no doubt,
for more medical facilities.
The appointment of The Health Survey and Development Committee,
known as the “Bhore Committee” in October 1943 the report of which was
published in 1946 which is still used as the basis for comparative statistical health
studies.
Then there was the ever increasing problem of lack of medical facilities
in the rural areas, all over the country, and particularly the experience of Sr.
Mary Glowrey of the Sacred Heart in the State of Andhra Pradesh. It was
in this background Sr. Mary Glowrey initiated the founding of the Catholic
Hospital Association of India, appealing to Catholic Hospitals in India to
organise and form an association with the opening words UNION GIVES
STRENGTH.
It was Pope Pis XI who said in his address during the Catholic Nurses’
Congress in Rome in 1935, “Nothing could be . more opportune or more
necessary, because it is in the nature of things, and God Himself, Creator of
all things, tells us that we must organise ourselves”.
Significant are the words of Sr. Mary Glowrey of the Sacred Heart when
she ended her welcome speech on the occasion of the second meeting of the
Catholic Hospital’s Association on April 22, 1944 at the Good Shepherd
Convent, Bangalore. She said “we now have a Catholic Hospital’s Association.
Let us make it, a POWER in the land so that if occasion arises, under the leader
ship of our Bishops, we may form a united body that can command a hearing.
Watch! Be on your guard ”
Today, after 42 years of existence the Catholic Hospital Association of
India has become a mighty organisation which could have a membership of more
than 2000 institutions if all our health care institutions under the auspices
of the CatholicChurch would become members. Really an army of dedicated
doctors, nurses, paramedicals and others are working in these institutions. I
am often reminded of this great strength of ours especially when I hear com
ments like, “What a powerful organisation you have”. “CHAI should take
lead in this, CHAI should take lead in that”, and so on. More often the
non Catholic friends and organisations recognise our strength. They even
envy this. But my little fear is, have we realised this our great strength? If
not, it is time for us to realise this our strength.
Today wc arc in a new situation, though somewhat similar to that at
the time of the founding of our Association. In the light of the Alma Ata
Declaration of Health For All by 2000 AD, the New Health Policy of the Go
vernment of India, and the realisation of our special role in the promotion of
primary health care, Community Health etc., wc are at a new historical point.
Wc need to recognise our new role and our strength. If we believe in the words
that “Union gives Strength”, what better strength can any one have in this
country in the field of health care when we consider the more than 2000 insti
tutions with a well established Medical College and the army of dedicated
persons in these institutions! All what we need is a realisation of our strength
and a willingness to cooperate with and help each other. For this we need
also the political will to change and readiness to accept the changes that come
for the common good. “To live is to Change” said Cardinal Newman,” and
to “live wisely is to have changed often”.
At this critical time of history, let us rc-discover our role not so much
as to what a single institution can do however efficient and prestigeous that
institution may be; but as a united body. Here we should be prepared to sink
any differences based on whatever considerations. Then, and then only this
Great Initiative which began in 1943 can emerge in to a POWER*that can meet
the challenges of today and tomorrow.
International Research Workshop
The Family in a Technological Society
—Dr. (Sr) Catherine Bernard
Introduction
The International Research Workshop ‘The
Family In A Technological Society’ held in Ma
dras, India from Dec. 8th—14th Dec. 1984, was
follow up of the First International Congress
for the Family also held in Madras in January
1983. The workshop was organised under the
auspices of the Tamil Nadu Family Develop
ment Centre—Asian Section— Madras. The
weeklong workshop provided a special week
of reflection, study, discussion and delibera
tions for nearly hundred participants, hailing
from as many as seventeen countries, inclu
ding those in Asia, Australia, Europe, Africa
and America. This was done by virtue of
real experts in the fields of Theology, Phychology. Industry, Communications, Medicine,
Demography and Sociology.
The Workshop commenced with a Eucharis
tic Celebration, presided over by His Grace
Archbishop R. Arulappa of Madras—Mylapore, concelebrated by His Excellency Bishop
Theotonius Gomes of Dinajpur—Bangladesh
and twenty five priests.
sage from His Holiness Pope John Paul II.
In His message, the Holy See encourages ail
those engaged in the task to persevere in their
dedicated services to the family.
The interdisciplinary approach of the Wor
kshop invited the expertspool their knowledge
on how the family is affected and how best
the family can cope with the problems, posed by a
technological culture, without being victimised
or become victims to the very technology that
is expected to be used by and for humankind.
Representation
Among the participants were representa
tives deputed by the Governments were State
Government of Tamil Nadu—India, The
University of Kabul—Afghanistan, Christian
Medical College and Hospital—Vellore, Depart
ment of Family Welfare, Government of Nepal.
Site Visit
The other major contribution of the Work
shop is that it offered opportunity for site
visits to the NFP projects of the TNFDC in
This coming together of different persona Madras- Archdiocese. The participants hailed
lities was unique in the sense that, it was this experience as one of the most interesting
Ecumenical. This union fostered dialogue aspects of the workshop. They met couples
among persons of different faiths, viz., Catho using NFP and were able to talk with them and
lics, other Christians denominations, Hindu, have first hand knowledge of how NFP is
Muslim and Buddhists, expressing great con accepted and welcome among people.
cern while identifying the complexity and
Nature and Deliberations of the Workshop
magnitude of problems that emnate owing to
The major topics presented as position in
the prevailing conditions which as a natural
groups with the guidance and expertise of the
corollary affects today’s family.
various resource persons and resource papers.
The Workshop
This sharing in groups offered an exchange of
At the Inauguration of the Workshop His
experiences, knowledge, etc., among the partici
Grace Archbishop R Arulappa, read a mes pants.
4
Medical Service
The deliberations focussed on the humani
zation of the person despite the onslaught of
a technologically oriented consumer society.
“Technology has affected a change of pace”,
opined Dr. Sr. Catherine Bernard, Director,
Tamil Nadu Family Development Centre, in
her welcome address. “The Workshop will
not provide solutions, but the facts and sha
ring of experience will enable the participants
to arrive at solutions that will bring hope”,
the Director noted.
The Workshop recognized that technology
attempted to change the life and life style of
not only the individuals, but even the family
as a unit and also environment, it also stated
that technology though developed by man for
the good of man can also be abused to fulfill
evil design of vested interests and the ulterior
motives of a powerful few.
The workshop further more examined some
of the technologies that have a direct bearing
on the family as a unit.. Industrial Technology
and Communications Technology and its
various remifications as related to family. In
the light of the discussions, the participants
recognised an urgent need for all to urgently
work towards strengthening the family by deve
loping inteipersonal communication, value orient
ed education, value clarification and sharing of
love among its members, thereby using techno
logy for amelioration rather than alienation and
destruction of its members, and humankind at
large.
The Workshop emphasized the need for
planning and execution of Programmes that
would develop better relationships among the
members of the family, among neighbours, and
among communities, which would be achieved
through better understanding and love though
better communication; and inter-personal re
lationships, openness, discernment and integra
tion within the frame work of one’s own cul
ture and freedom. In this context, the imperative
need for setting up of programmes such as
February 1985
marriage preparations, marriage counselling,
family life and youth counselling and guidance,
foster healthy and wholesome growth for
both parents and children, was expressed by
the participants.*
The Workshop also pointed out that Go
vernment in its anxiety to control the popula
tion, totally neglects the inputs for developing
qualitative aspects of population, and promul
gates programmes of fertility control, which
deal with fertility control merely as a biological
function and not as an outcome of husband—
wife relationship. In this connection, the Work
shop strongly recommended the recognition and
acceptance by Governments of Natural Family
Planning Programmes, which approach fertility
regulation through an integral and integrated
approach taking into consideration the in
dividual family in its totality, and procreation
as an outcome of responsible and meaningful
behaviour.
Dr. Billings, the initiator of the Billings Ovu
lation Method spoke of its applicability to
peoples of all countries, irrespective of religion
and social status and remarked that Natural
Family Planning is not only a method but a
way of life. Addressing the gathering, he asser
ted that society finds health and strength in
a stable, happy family life and the family is the
primary biological unit of society, the source
of love and life. He said that a tiny child in its
helplessness expressed the universal human need
to be loved and to give love, and in the
atmosphere of family love, experiences emotio
nal security and unconditional acceptance which
fosters psychological maturity.
The workshop felt that, regarding Natural
Family Planning, the. Church is yet to contri
bute a major efforts for a more realistic app
roach and intensive services. As Natural Family
Planning is definitely a solution to many pro
blems that menace the family today, it is the
task of the Church to stand up for those values,
when these principles and values are undermind
5
as in the case of ‘Artificial Fertility Control*
arid ‘Induced abortions’. The sanctity of life,
from the moment of conception, should be
made clear to the whole world, a participant
remarked. One of the groups, expressed that
the best health care, is the care which is mind*
ful of the totality of man. Therefore health
units especially Catholic health units must play
an important role in promoting Natural Family
Planning, the group suggested.
A workshop report on the impact of the
press said the religious papers must deal more
with common problems of man rather than
merely devotional topics. While assessing the
role of the press, a group said the press did not
always help in bringing about a change in social
attitudes like politics, business, advertisements,
films, sports and other sesational matters.
The workshop also highlighted the need to
assure the distributive practice in gains of tech*
nological development. Among the groups
that need to be involved are women and youth,
rural population, and the urban poor.
The participants recommended that as in
other fields, so also in the field of fertility regu
lation the Church and other enterprises foster
programmes of development and open up new
avenues for employment for all, including
women, development of youth, recognizing their
social responsibilities and provision of Educa
tion and services that works towards health
and wholeness for all.
In this valedictory address Fr. D.S. Amalorpavadass outlined the nature of the technologi
cal capitalised society as opposed to human
value. He said that Awareness and Freedom
are the two key, factors upholding human
dignity. He said ‘Authenticity to onself and
one’s culture maintains and retains the freedom
of the individual. We should welcome with
openness technological advancement, we should
also develop personal maturity and true inner
6
freedom, and participate in the process of hu
manisation.
Evaluation
Concluding the Workshop was the evalua
tion by Participants from some of the coun
tries represented.
Sr. Virginia Taran—Philli pines stated that
the Workshop was a positive help, 'enriched
her, widened her vision. A lot of what was
discussed by the participants from India were
relevant to her country.
Dr. Mary Daniel from Singapore stated the
programme was compact and wished to see
more lay and married participants represented.
Mrs. Sabina—of Kenya stated “It was a
wonderful workshop and was deeply moved by
the spiritual dimension that was part of it. She
said I came empty handed—but I am going
back with riches—rich in knowledge because
the discussions are of very high calibre”.
Fr. Baptist Menezes—said the discussions
were long, but not tiresome and congratulated
the organisers for the opportunity to partici
pate.
Mr. Anthony Devaraj also from India,
appreciated the Director and staff for the
wonderful organisation.
Dr. Francis Rosario of Bangladesh commen
ded the organisation and the experiences of
sharing by participants of different countries.
Dr. Malini Karkal was highly appreciative
of the organisational aspects and stated that
the Director and her staff, showed a higher
level of human behaviour.
The statement which emerged at the con
clusion of the workshop was unanumously
accepted by the participants, who hailed it as a
Medical Service
document of profound concern and vision in
a society dominated by technological competi
tion.
In her concluding remarks, the Director
Dr. Sr. Catherine Bernard called for commit
ment and dedication to the cause of the family,
fractured and fissured in todays society.
Conclusion
During the entire Workshop there was a
sense of seriousness, • indepth discussion and a
feeling of awakening and conviction to further
realities affecting family today. As each partici
pant decided on a plan of action on their return
to their respect places on a deep sense of having
been enriched by the Workshop also prevailed.
VOLUNTARY HEALTH ASSOCIATION OF INDIA
New Delhi
announces its 15 month course in
DIPLOMA IN COMMUNITY HEALTH MANAGEMENT
organised at the Rural Unit for Health and Social Affairs (RUHSA) of
Christian Medical College and Hospital, starting on 15th July, 1985.
Send Rs. 15/- by money order/postal order/demand draft to RUHSA,
RUHSA PO-632209, Vellore, North Arcot District, Tamil Nadu in favour
of Programme Director, for prospectus and application forms.
February 1985
7
Statement of International Workshop on the Family
in a Technological Society
Preamble
0.1 About a hundred participants hailing
from seventeen countries of the world met
together at the International Research Work
shop for the Family of Asia and Australia,
held at Madras 8th-14th December 1984 under
the auspices of the Tamil Nadu Family Deve
lopment Centre (TNFDC) to study and reflect
on the theme The Family in a Technological
Society; Participants were primarily from Asian
countries and Australia,.and also from Europe,
Africa and U.S.A., As a follow-up of the First
International Congress on the Family, this
Workshop focussed more specifically on the
sensitive issues and problems that face the
family subject to the impact of technology in
contemporary society.
0.2 This coming together of participants
offered a unique opportunity for an in-depth
search, in order to exchange ideas and infor
mation and to better identify the complexity
and magnitude of the problems which confront
the family in the world of today. The Work
shop enabled us to focus on the strengths and
weaknesses of the family affected by technology
and the impact of technological developments
on the structure of family life and its whole
garnet of relationships. It also took stock of the
activities and efforts already made for the pro
motion of the family and identified the diffe
rent need areas.
1. IN THE CONTEXT OF A GLOBAL
SOCIETY WITHIN THE INTERACTION
BETWEEN FAMILY AND TECHNOLOGY
1.1 The vision maintained throughout the
deliberations of the Workshop was a new world
which is being re-shaped by the scientific dis
February 1985
coveries and technological advances. This vision
included a vivid awareness of the inequality in
the distribution of the benefits of science and
technology. The chasm between the haves and
have-nots would only increase unless there is
greater social justice in the distribution of these
benefits. The main concern of the Workshop
was that the family should so cope with the
new situation as to be the basis of and contri
bute to the emergence of a more human, just
and ecologically balanced society. The concern
extended to encouraging the process for rea
lising univeral brotherhood in which equality
and freedom, fellowship and peace, the deepest
yearnings of humankind can be experienced
by all, inspite of several forces working to the
contrary.
1.2 The family is the oldest and most basic
human institution and unit of society. More
than any other institution it has been affected by
the profound and rapid changes witnessed by
the world today. Many families are struggling
to live in fidelity to authentically human values,
while some others have become totally be
wildered. Some even doubt if the institution has
anymore purpose at all. However there are
families which even amidist the crisis of the
present day society, remain faithful to the
demands of love, justice and solidarity. But the
danger of man becoming a victim of a certain
technological and consumer mentality is ever
present. In fact, the power of technology may
lead people to control and manipulate not only
the environment but also the very lives of others.
1.3 The situation in which the family'
finds itself has both bright and dark spots.
Sometimes one feels convinced that modem
times are better than bygone years, while at
other times the so-called progress seems to be
9
an illusion. On the one hand, we find greater tion with God in the ongoing creation and trans
sensitivity to an awareness of personal freedom, formation of our world becomes both privi
more meaningful relationships, and desire to lege and an obligation. Through technology,
build a more just society. On the other hand among others man exercises this privilege and
many fundamental values like the sanctity of fulfill this obligation.
human life, the inherent dignity of the human
person and the sense of responsibility for the 2. AMBIVALENCE OF TECHNOLOGY AND
world seem non-existent. The family is being NEED FOR DISCERNMENT BEFORE A
called upon at this hour to play new roles, and VISION OF HOPE
be prepared to meet new challenges. As an
2.1 The created reality as it comes from
enduring human institution and with its resilience
God’s hands is good. Man too, shares in this
beyond doubt it can fulfill 'this task.
goodness of creation. But the entire creation
1.4 Technology in all its forms is one of the including humankind has been affected by evil
major factors contributing to the present situa within man. Its foices and consequences are
visible in human activities and in the structures
tion of the family.
of society. This ambivalence colours every
1.5 Technology in the wider sense of the thing that man is and does. Thus technology
term is constituted by the manifold ways in too becomes ambivalent. At certain moments
which man tries to enrich himself, create a more and in certain situations, technology shows
just society, master his environment and make forth the greatness and goodness of man, while
this world a better place to live in. Thereby at other times it becomes immensely influenced
man ought to become more human. There are by the evil in man and seems to be one of the
families which even amidst the crisis ofthe forces that- seek to destroy or deform him. This
present day society, remain faithful to the de calls for a serious discernment both with regard
mands of love, justice and solidarity.
to the development of technology and its use.
1.6 God created man and woman accor
2.2 In this spectre we wonder whether our
ding to his image and likeness. The image is vision can be realised and our aspiration fulfilnot merely a reflection but a genuine sharing in . led when evil seems to be so Widespread and
the power of consciousness and freedom which insurmountable. Our hope is that God’s ul
God freely chose to communicate humankind* timate purpose with regard to the entire universe
As God’s likeness men and women are called and humankind will never be thwarted not
to become like Him and in the sense be divini only because God in his wisdom and fidelity
sed. The family, the community of a life-long to his promise guides humanity in its history
partnership of love and togetherness, is entrus towards its culmination but also because in
ted with the task of stewardship over Gods dividuals, groups and humanity as a whole
creation. As a fundamental unit it serves as a are moving towards the final realisation. Man’s
pattern and model of. this task of stewardship, collaboration in this task is indispensable
to be fulfilled by society and the entire human and possible.
kind.
2.3 This is based upon both the biblical vision
1.7 As the human person carries out this
and Hindu world view according to which the
task of transforming creation and building up a mystery of being, Life and Energy is one at
more just society, he not only reflects the whatever level it may be shared. The whole
image of God but grows into the very likeness world and all peoples are in one single process
of God. In fact the partnership and collabora of being awakened and growing into higher
10
Medical Service
on material productivity or the capacity to
produce and not on inter-personal dialogue.
This can easily lead to a a new kind of slavery
in which people are exploited for financial gain.
Such a society does not place a high premium
2.4 Today we arc witnesses to the fact that
on building and maintaining the family as
such a process is already taking place. The
one’s ‘home’ but merely as the provider of one’s
dormant state and low level of consciousness of
material needs.
several individuals and groups is being raised;
the isolated awareness are being interconnected
3.2.1. As the result of urbanisation and
and integrated. Such an awareness is being industrialisation many families are now nuclear.
multiplied, increased and spread all over the The parents of nuclear families have the full
world in spite of the ill effects of technology. responsibility for the support and guidance of
Our own International Workshop on the Family their children unlike previous generations. The
bears witness to this reality. Such a conscious press, radio, T.V. and video have become
ness is the basis of the whole man, and expe another force which competes with the parents
rience of peace and harmony in the emerging in the education of the young. The mass media,
new society where human persons are truly particularly T.V. invades our homes and brings
themselves; sisters and brothers—and where the world in. This widens our horizon but can
also insert unwelcome ideas. The consumerism
God is all in all.
which many programmes project can compete
3. ISSUES
with more interpersonal values to the point
From our discussions the issues which where the home may no longer be the site of
concern the interaction of technology and the re-energizing and fostering of relationships.
family, grouped themselves into four : (1) Work,
3.3.1. The most powerful human functions
(2) Mass media, (3) procreation, and (4) health.
are those of thinking, willing and- loving.
3.1.1. All human work is valuable, whe While education is designed to socialise children
ther jone is remunerated for it or not. Thus into the family, culture and nation, the recen
the work of the wife and mother in the home tly accepted population limitation policies have
and of all members of the family for the main sought to achieve a quick reduction of family
tenance of the home is worthy of respect. All size by a combination of mass media and actionpersons require the necessities of life. Those oriented programmes.
who are unable to provide for themselves
3.3.2. Because of the population problem,
whether for reasons of disability or unemploy
the value of human procreation has been
ment must be helped by society, first of all by
downgraded in the minds of many. This is a
creating employment opportunities. Currently
great loss, as it is in procreating a person who
the basic means of sustaining life are seldom
is our equal in dignity that we attain the
available for the unemployed.
summit of human creativity.
3.1.2. Some work places are so substan
3.3.3. The knowledge of a couple’s fertility
dard that people are depersonalised if not
has been scientifically verified, refined and
almost dehumanised. This is an inverse of priori
made precise. Couples can exercise procrea
ties, which demand that humans must hot be tive choice without altering their bodily functions
exploited for the sake of production.
with any technology. The teaching of NFP
levels of consciousness until tl\e whole of
humanity shares fully in the awareness of
God who is “pure Consciousness and the Cons
ciousness of all conscious beings.”
3.1.3. A technological society is one in
which, the basic relationships are often built
February 1985
includes not only scientifically valid reproduc
tive physiology, but the integration of this
11.
knowledge into the couple’s marriage, family,
culture, religion and society.
3.3.4. The freedom of conscience of every
person must be respected in the formation of
public policy. When there are substantial di
fferences in life issues such as sterilization and
abortion these cannot be directly or indirectly
imposed by any individual, group or authority
on anyone.
3.4.1. While sophisticated medical care is
within the reach of a few, comprehensive primary
health care is still not available to vast sec
tions of people.
3.4.2. As the recent.gas tragedy in Bhopal,
has shown, technological progress especially
in the industrial sector is often blind to health
hazards such as environmental pollution.
3.4.3 Advance in technology being insensitive
to human values has resulted in the prolifera
tion of nuclear arms which threaten to an
nihilate humanity itself.
RECOMMENDATIONS
4. To all who share our concern for the
family in a technological society, we recommend
that:
4.5 A comprehensive family life education
be given at all schools and colleges so that the
youth may be well equipped to accept their
responsibility in the society of tomorrow; and
research studies on the family be encouraged.
4.6 All people wake up to the insufficiently
met need for marriage preparation and family
life education so that a purely mechanical
approach to human intimacy may be avoided.
4.7 The equal status of woman in society be
recognized especially with regard to laws of
property, succession, wages and socialisation
within the family and society at large.
4.8 The scientific effectiveness of NFP be
brought to the attention of government officials
and other public authorities and that efforts
be made to familiarise doctors, nurses and
parents with its applicability.
4.9 Opportunities be made available to
families to help them evaluate the media and
its impact on family life, and use the media to
deepen communication within the family.
4.10 The UN incorporate family life educa
tion in its programmes for the International
Year of Youth 1985.
CONCLUSION
5.1 We participants of this workshop
commit ourselves to these recommendations
4.1 Every effort be made to create public and wish to involve ourselves towards their
forums and ensure participation of people to fulfilment.
voice their opinion about specific technological
5.2 The participants of the Workshop
choices, specially those affecting the country expressed their appreciation for the efforts made
and the people at large.
by both civil and religious bodies throughout
4.2 Technological advances with regard to the world to strengthen and enable families to
life’s basic necessities be directed less to the face up to the challenges of modern technology.
refinement of resources and more to an equitable They are happy to place on record the untiring
and dedicated service rendered by TNFDC to
distribution of available ones.
thousands of families in Tamil Nadu.
.4.3 Leaders from all walks of life be made
5.3 May the all powerful spirit of God
to realise the absolute need of value education
who guides the destiny of humankind and
with regard to technological developments.
history lead the families of Asia, Australia and
4.4 Young people especially be made the entire world to discover and regain their
aware of the manipulative use of technofbgy own inner resources in order to discern His
and be educated in ethical values the respect will amidst the fast changing technological
society of today.
for life, genuine love, truth and justice.
12
Medical Service
The Management Consultation for Health Care Fields
—Anang R. Sanghavi
The idea of management consultation for
health care field is of very recent origin. Many
people also think that in the service oriented
health care field, why this type of sonsultation
is required? Generally people associate mana
gement consultation with profit earning. As
there is an absence of profit motive in the
health care field, the Administrators and the
Medical Professionals or the Trustees do not
care for the management consulting in managing
the hospitals or launching upon a hospital
project.
pressure on the management to pay
more and more wages.
I am aware that in Catholic Hospitals there
is a dedicated and service minded staff
but increaxe in the cost of living index affects
everybody unanimously. There may not be
pressure of union movement but even on
the humanitarian ground it becomes obli
gatory on the management to increase the
wages proportionately.
(3)
Due to all round increases of prices
there is a big increase in the cost of elec
tricity which is being used in the hospitals
on a large scale. Being a consultant
attached to a few hospitals, I am aware
that the cost of electricity has increased
almost 100% between 1979 and 1983
in the city of Bombay. There were 3
increases and one more imminent at
any moment. In other cities also I don’t
think electricity is cheap. On the
contrary many breakdowns and discon
tinuance of the power supply and
large fluctuations in voltages necessita
tes the investment in disel generating
sets. There is also increase in cost of
kitchen and washing soap. Laundry and
Kitchen being primary incidental-ser
vices to hospital the increase in expen
ses on the above two items also affect
hospitals adversely.
(4)
The Donation and resources mobilisa
tion has become difficult. This is so
because the amount required is huge.
It is also difficult because the charity
mindedness of common people has
dried up due to the increase in cost of
In the light of above facts, I would like
to state my views as to why Management
Consultation is necessary in the health care
fields? There are .5 very valid reasons as to
why the Management Consultation is necessary:
(1) In the Health Care Fields, technolo
gical innovations are taking place very
fast. During the last decade the health
care industry has moved from the
use of radiology to non-invasive diag
nostic technology and now talking about
N.M.R. Technology. The day is not
very far when radiology will be out
moded. The equipments of radiology
at present, take up /10 lakhs at the
time of putting up a Hospital.
(2) Hospital is a service oriented industry
and therefore 45 to52% of its total
revenue budget is spent on salary and
wage bill of its employees. As there is
an increase in prices all round, the
cost of having index is going up. This
factor has led to formation of unions
amongst hospital staff in large cities.
The formation of union always increases
February 1985
13
(5)
living index. Our. Indian People are
large hearted people with a charity
orientation to such an extent that
from a loaf of bread they will share
even the half for a guest. But the
increase in cost of living index has not
allowed even the half loaf of bread in
the hands of common man.
care as against the total built-up area.
This is known as designing efficiency.
Some of the new hospitals the floor
space utilisation index comes out to as
low as 0.4. It seems that die building
cost of the hospital is 21/2 times than
what will be actually used for the
patient care.
The Capital Cost of new hospital now
runs into crdres. Even a small hospital
of 100 beds but with the latest diag
nostic facilities together with auto
matic pathological laboratory equip
ments costs more than a couple of
crores. Similarly the revenue expenses
of a hospital also run into millions of
rupees every year. The maintenance
of a hospital bed per day per patient
costs, not less than Rs. 60/- and Rs. 70/in a city like Bombay. In a very sophis
ticated hospital the cost of a higher class
bed runs into Rs. 300/- a day or even
more.
As regards the revenue expenditure
it is necessary to work out the re
quirements of lifts, the requirements of
passages which are minimum required.
As we are aware, lift consumes electri
city and needs a lift man because
hospital is a public place. The wide
. passages increases the requirement of
- cleaning staff as well as the expenses
on 'soaps, dusters, etc. The hospital
has to be maintained very clean and as
it is a public place lot of people visit
the same. Hence cleaning up also takes
up lot of cost. If there are unnecessary
wide passages the lighting and cleaning
will also take up lot of future re
venue expenditure.
The scientific management is necessary
where resources are sparse and requirements
are multifold. We have been as above that
the requirements are quite multifold and
the resources are really very sparse. Hence
application of principles of scientific manage
ment becomes obligatory. Here is below
we will have a casual glance as to how the
application of scientific management princi
ples reduces the capital cost of a hospital
or revenue expenditure in a hospital.
(a)
The application of scientific manage
ment principles at project level is
necessary to screen the hospital project
to reduce the capital cost as well as to
reduce the future revenue costs.
In scrutinising the design of an architect
for the hospital, we have to work out
the floor space utilisation index. This
floor space utilisation index is worked
out -from the area allotted to patient
14
(b)
The Government has declared import
duty of 160% on quite a number of
hospital requirements. The same Govern
ment also excludes some of the hospi
tals from the payment of customs duty
if they fulfil certain conditions. As the
hospital equipments runs into lakhs of
rupees, it is better. to procure such
exemptions to keep the capital cost of
the hospital within the limits.
The Government has also given cer
tain liberties in non-payment of excise
duties and sales-tax provided certain
conditions are fulfilled by the hospitals.
If all these planning is well-done it
always saves money for the capital cost
of the project. There are certain exemp
tions to the Donor. The coming hos
pital project has to avail of maximum
Medical Service
exemptions to the Donor which arc
feasible under the present tax law struc
ture.
all hospitals can check his/her efficiency
. by comparing the figures of other
hospitals.
(c)
Man Power Planning : Some of the
hospitals run quite smoothly having 1.8
staff per bed inclding the staff for the
■ diagnostic centres. However, some of
the hospitals face lot of difficulties even
though their staff is around 3 per bed.
This increases the expenses.
Similarly for health records also the
figure can be kept in a comparable
way. I have noted that in one of the
hospitals even the tooth extraction has
been included in operation to inflate
the figures of number of operations.
This is really ridiculous.
(d)
In running the various diagnostic centres
and the departments what is the mini
mum requirements of equipments has
to be studied. If we take more number
of equipments the maintenance and
depreciation expenses go on mounting
without equivalent work. Hence it is
necessary to find out what are the
optimum capacity of each machine and
what should be the number of equip
ments that are required’ for the said
quantum of work.
It is also necessary to keep a check on
the wastage such as spoilage of X-ray
plate. Now a days there is a shortage
of X-ray technicians (Radiographers).
This
shortages pressurises hospital
management to accept newly turned out
technicians whose spoilage of X-ray
Films is 6 % as against 1 % of a really
trained and experienced person.
(e)
It is also necessary that the various
statistics collected by hospitals become
comparable to each . other. In an
association like Catholic Hospitals
Association of India, if all hospitals
follow a uniform accounting pattern
and keep the fixed number of ledger
accounts and debit the expenses as
per the common rationale accepted by
all, the expenses of one .institution beco
mes comparable to the expenses in
other institutions. If this pattern is
followed the hospital administrators of
February 1985
Similarly for controlling costs it is neces
sary to keep uniform method of acco
unting. I have just narrated above the
cost of X-ray Films and such incidents
can be multipled.
The last point is to control expenses,
laundry and linen and other expendable
and what should be considered as
expendable and what should be con
sidered as capital cost items need also
a unanimity in the accounting procedu
res.
I would like to state that some of the
Catholic. Hospitals Associations mem
bers are only a primary health care
units and have nothing to do with the
above point?,which are connected with
the referral hospital. Hence I would
like to state something about the
primary Health care. The primary health
care deals with personal hygiene. In
the case of personal hygiene, our
country has a wide disparity from the
rural- people who are suffering from
non-availability of postable drinking
water, non-availability of even pit type
■ • toilets and no water, for bathing as
against the most affluent society staying
in a city having not only filtered and
boiled but areated water to drink and
twice a day bathing with 125 to 200
litres of water a time and scenting the
body with perfumes atleast half-a-
(f)
15
dozen times a day. To educate the rural
people for the personal hygiene and
the health care what type of minimum
infrastructural facilities including the
requirements of health care personal is
needed is a question that needs lot of
studies and attention. What sort of
antenatal care is required for the
effective mother and child health care
what nutrition is necessary are all pro
blems of primary health care. A better
planning with the most effectiveness will
suggest an easy solution to this Hima
layan problems.
Thus, I feel that the applying of scien
tific management principles in the field
of health care will increase the cost
effectiveness of a rupee spent and will
yield better results to the satisfaction
• of all concerned at the helm of affairs.
AM RUTH AY ANT
Communications Centre offers
a Two Weeks Advanced Training Course in
GROUP MEDIA IN DEVELOPMENT AND EVANGELIZATION
From July 1 - 13, 1985
This course will cover the following aspects:
— Methodology of group animation
— Group process and openendedness of media
— Symbolism of image and sound
— Experience of using various audiovisual media
— Diverse use of same medium (a single slide, a sequence or as a whole)
— Creating productions for group communication
Who may apply?
— Those who have done an introductory course in Audiovisual
— Those who are engaged in pastoral work or developments and have a
natural aptitude to integrate group media in pastoral communication work.
Limited Accommodation only
Apply before 31 May 1985
For prospectus and application forms write to:
Audiovisual Department
Amruthavani, P.O. Box 1588
50 Sebastian Road
Secunderabad 500 003 A. P.
16
Medical Service
Noise Pollution—You’d Better Believe It!
by Carol C. Sides
Noise in our industrialised society has rapidly
grown from a simple nuisance to a major cause
of concern. Unable to escape it, we’re busy
conducting research to learn more about it.
The most elementary facts about noise
concern its effect on the human ear. As
sound waves reach the eardrum, they are mag
nified; if too strong, they can injure delicate
ear mechanisms or even cause deafness. For
tunately, safeguards are built into this sensitive
part of our anatomy.
This is where the middle ear takes control.
The hammer, anvil, and stirrup are three tiny
bones that carry sound vibrations from the
eardrum to the inner ear. If the noise is very
loud, two sets of muscles are activated. One of
these tighten the eardrum, decreasing the sound
vibration; the other pulls back the stirrup,
releasing its tight hold on the inner ear. A
third safeguard, the Eustachian tube, connects
the middle ear to the mouth cavity and helps to
equalise air pressure.
The snail-shaped inner ear, filled with liquid,
lies deep inside our skull. As sound moves
through the middle ear, it creates waves in the
inner ear’s liquid. These waves stimulate tiny
hair cells to convert the movement into electri
cal impulses, which are sent to the brain’s
hearing centre.
Noise affects the heart and the blood vessels;
causes a change
in the heartbeat; increases the cholesterol
level in the blood;
and raises the blood pressure.
For scientific purposes sound >s measured
by decibels, a complicated system using the
February 1985
comparative ratios of loud sounds to softer
ones. For example, an increase from one to three
decibels means sound energy is doubled, but an
increase to 40 decibels means sound energy is
10,000 times greater. Table 1 shows the compa
rative energy increase for consecutivelO- decibel
increments. Sound and Hearing explains it
like this: “The decibel measure gives a rough
connection between the physical intensity of
sound and. the objective loudness it causes.”
Table I
Decibel Increase
Sound Energy Increase
20
100 x
30
1000 x
40
10000 x
50
100000 x
Let’s see how daily sounds affect us. The
average person hears well in a range from one
to about eighty decibels. Decibel measurements
for everyday sounds are listed in Table 2.
Researchers estimate that several hours of
daily exposure to noise above the 85-decibel
range can cause gradual loss of hearing. About
120 decibels, noise cause a tickling feeling in the
ear, and noise above 130 decibels may produce
pain.
At a Paris meeting about three years ago,
a twenty-two nation panel warned the Orga
nisation for Economic Cooperation and Deve
lopment about noise pollution. Modern technoogy and lifestyles have raised the average sound
level one decibel per year since 1949.
17
Table 2
Common Noise Sources
Decibel Ratings
Threshold of hearing
0
Soft whisper
20
Library sounds
30
Typewriter
40 •
Air-conditioner
50— 70
Ordinary conversation
(between 2 people)
60
Vacuum cleaner
70
Heavy traffic at 30 metres
70
Clothes washer
78
Home shop tools
70— 90
Garbage disposal .
80— 90
Food blender
88
Shout in the ears
90
Heavy traffic at 7.5 metres
Power mower
90
90— 100
Motorcycle at 15 metres
100— 110
Chain saw
114— 120
Rock band
114—120
Loud Sirens
120— 130
Jet takeoff
120— 130
Several millions are subjected to noise in
normal, everyday sound. What does this mean
to the average person? In addition to loss of
hearing,- side effects include changed endocrine
hormone secretion, abnormal kidney function^
ing, emotional upheaval, loss of sleep and a
slowing of the mental processes.
ing sounds included an alarm clock, an electric
razor, rush-hour traffic, and a television show.
In the afternoon they listened to cafeteria clatter,
a diesel generator, and a car radio. At night
time they heard an air conditioner’s hum,
chirping birds, and the drone of a lowflying
plane. Result? The monkey’s blood pressure
rose 43 per cent during a three-week period.
Although these statistics can’t be considered
accurate for humans, the researchers. Dr. Ernest
Peterson and Dr. Jeffrey Augenstein, of the
University of Miami School of Medicine, con
cluded that “everyday noise may be injurious
to people’s health.”
Human testing has demonstrated that noise
affects the heart and blood vessels. Loud
noise causes a change in heartbeat rhythm,
increases the cholesterol level in the blood, and
raises the blood pressure. Sudden sound at
lower t levels (such as firecrackers) cause even
higher pulse rates and blood pressure, along
with muscular contractions, increased perspi
ration, and a decreased flow of gastric juiesc and
saliva. Germany’s Dr. Gerd Jansen played recor
ded sounds at 55 decibels to determine their
effect on sleeping subjects. By measuring the
flow of blood in their fingers, he learned that
the sleeper’s blood vessels were contacted by
noise of even one second's duration, with
several minutes needed. for the veslsels to
reopen. He concluded, “Night sounds heard
while we sleep could further endanger ailing
hearts and arteries.”
It's* interesting to note that noise has the
opposite effect on the brain’s blood vessels,
causing them to dilate, which can result in hea
daches. Even low sounds can make ’ the eye
pupils dilate, and alter the natural rhythm of
brain waves.
*
What noise does to monkeys
Noise may cause birth defects
One interesting research project subjected
monekys to the daily noise experienced by a
typical blue-collar worker. The monkey’s morn
Some birth defects have been blamed on
noise. Dr. F. Nowell Jones, professor of psy
chology at the University of California, Los
18
Medical Service
Angeles, analysed more than 225,000 births in
the Los Angeles area between 1970 and 1972.
His findings showed a higher rate of birth de
fects in babies whose mothers lived near Los
Angeles International Airport than in those.
whose mothers lived in quieter sections of the
city. In a similar study John S Horner found a
high percentage of stillbirths in the area near
London‘s Heathrow Airport. About an unu
sually low birth weight was observed among
babies of mothers living near Osaka Aiiport
in Japan. Although these findings are not
conclusive evidence, they do suggest that foetal
development is adversely affected if the mother
is subjected to continuing noise stress during
pregnancy.
1. Use noisy appliances when family mem
bers (and neighbours) are normally awake.
According to MD Magazine, .growing evidence
suggests that stress resulting from exposure
to high decibel levels contributes to physical,
phychological and behavioural disorders. Wor
kmen in noisy surroundings tend to be aggres
sive and quarrelsome,' reporting twice as many
family problems as workers in quiet environ
ments. The real problem is hidden—people
have learned to adapt to noisy work conditions,
not seeing them as a potential cause of disor
ders. •
5. If you must turn your stereo high, close
the door so others won’t be bothered.
What you can do
• But what can an individual do to help
solve the problem? Try these suggestions.
February 1985
2. Install weather stripping (sound proof
material) on, doors and windows.
3. Use heavy drapes on noise-facing wind
ows and use soft-upholstered or inflated furni
ture.
4., If you live on a busy street and have
air conditioning, close your doors and windows
to outside air. (Highway traffic is quoted as
the most widespread and persistent source of
noise, though not necessarily the loudest.).
6. .Learn about potential legislation in your
area and support laws that will curb unneces
sarynoise without infringing on individual rights.
Noise is a necessary part of living, but uncon
trolled noise becomes pollution. Fortunately,
much noise pollution can be controlled. Learn
ing about the sources and effects of noise, and
being concerned for people around you, are
ways that, you can help.
Courtesy •: Herald of Health
19
You and Your Deaf Child
—by Kiranmayi R. Kamath
Every parent wishes to have healthy and
normal children. The sex of the children is of
secondary importance. It is easy to imagine the
reaction of the father and mother when they
find that their new-born child is unable to
hear—that it is deaf. Some people curse destiny.
Some go into a state of shock. But they should
realize that they are not the only ones who
are afflicted by the grief and anguish that this
situation brings about. The thought that there
have been many parents like them who have
suffered the same pain initially, yet they over
come it, should be a source of consolation
and courage. The parents of a child who is
deaf should be specially thankful, that he is
normal in all other aspects. Naturally it will
take some time for them to reconcile with the
idea of accepting this unfortunate situation into
the family. The shock may wear away slowly,
but several other questions keep cropping up
in the mind like. Will he ever hear? Talk ?
What will the child do for a living when he
grows up? Indulging in such negative thoughts,
and brooding over the matter may not help
in anyway. The real solution to the problem
lies in accepting the reality and finding some
suitable means to improve the child’s impaired
hearing.
It should be remembered that a deaf
child too can speak, his speech organs are all
right. He does not learn to speak because he
cannot hear. During the first five years of the
child’s growth most of the learning takes place
casually. As the child grows, he takes in eve
rything that goes on around him. He becomes
more communicative with parents who are
attentive, and who respond to his attempts to ex
press himself. This casual spur-of-the-moment
teaching and learning takes place whether the
February 1985
child is able to hear or not. Children, as a rule,
spend most of their time with their parents, espe
cially with the mother. So it is very impor
tant that to improve the condition of the child
with loss of hearing, the mother plays a major
role.
Making Sure
How does one suspect hearing loss in a
child? The surest way to know is when the
child does not respond to the noises around
him, however loud they may be. Further, he
becomes dull and inactive. When the child’s
hearing loss is detected at an early stage it can
be rectified. Nobody is really stone deaf.
There will be some hearing left in all cases.
If the child is suspected to be suffering from
deafness, he should be taken to an ENT (Ear,
nose and throat) specialist. Negligence on the
part of the parents may cause irrepairable
damage to the child’s future. Treatment given
for hearing loss at an early stage will yield
favourable results. The ENT specialist will
examine the child, measure the hearing left,
and also find out the cause for the child’s
impaired hearing.
For a child whose hearing loss cannot be
cured by medicines, the doctor may prescribe
a hearing aid.
Causes
What is the reason for deafness in children?
It cannot be categorically stated. Some of
the main, reasons for deafness are infection in
the early stages of pregnancy, anaemia, too
much intake of antibiotics, previous miscarria
ges, smallpox, German measles, forceps delivery,
etc.
21
Types of Deafness
Deafness is of three types : 1. Adventitous
deafness—deafness at any time after birth.
2. Congenital deafness—deafness at birth, and
3. Post lingual deafness—deafness occuring
after the baby has learnt to talk. Deafness,
again is classified into two types based on the
causative factors. One is due to conductive
hearing loss and the other is due to sensoryneural loss. Conductive hearing loss is caused
by partial or complete blockage of the outer
or middle ear. In the second type, the problem
is in the inner ear or beyond where the sound
is interpreted by the brain. The first type of
hearing loss could be cured with medicines or
by surgery. Antibiotics and sulpha compounds
now control and cure most middle ear infections.
With the advent of micro-surgery, very signifi
cant advances have been made in treating cases
of deafness. Sophisticated surgical instruments
and highly refined binocular microscopes
enable surgeons to perform delicate operations
in the tiny crowded ear chambers. But for
the second type of deafness, the use of a hea
ring aid is the only answer.
they are not free from further responsibilities.
The deaf child has to learn to understand
people by watching their lip movement. So
parents must talk to the child as often as possi
ble, for the young child is very much attached
to its parents. He keeps watching and reacting
to them. The child has to use his eyes a lot to
learn. The child must realize that a particu
lar lip-movement means something, and he
will try to imitate it. Holding the child near
your face at its eye-level is the best way to
encourage lip reading and speaking. Sometimes
the child does not realize that a person talking
to him is making sound even though the spea
ker may be moving his lips. Make the child
feel the vibration by putting his hands on
your cheeks and throat. The child must be
made to feel his own vibration when he babbles,
laughs or cries. The child will soon realise that
he has to produce a vibration to go with the
movement of the lips. This will be more effective
when the child changes his normal babble into
speech.
The parents must not feel that just because
the deaf child cannot hear, there is no point in
talking to him. On the contrary, they should
talk to him constantly—while bathing, dres
What is the Hearing Aid?
sing or feeding him, or merely sitting with
It is an instrument which makes the him, explaining things of interest to the child.
sound clearer and louder enough ‘for the child While talking to the deaf Child, of course, there
to hear. There are many organisations which is no need to shout. Speaking to the child
are manufacturing cheap hearing aids. These must be done normally. When the child attem
are to be avoided. Hearing aids should be pts to speak by making noises and by moving
bought only from government recognized lips, all his efforts should be encouraged. The
agents or companies. An inexpensive hearing deaf child should be exposed to the world, of
aid may not be useful, but at the same time, sound. Gradually the child may learn to re
there is no guarantee that costly aids are cognise different sounds. Care must be taken
suitable to all types of ears. The instrument to avoid loud sounds being made near the child.
should be first checked by the ENT specialist These may cause further damage to the ears.
Spend as much time as possible with the deaf
and then worn by the patient.
child. Teach him to read, write and speak. The
extra efforts made by parents of the deaf child
Parental Responsibilities
will, enable them to see their child blossom
Parents should very well remember that into a self-supporting personality in due
just by buying the hearing aid for the child, course.
22
Medical Service
Training Centres
Apart from giving home training, the parents
should take advantage of the training centres
specially meant for the deaf and the dumb.
There the children will be taught under the
guidance and supervision of trained speech
therapists. Continuing education in such
schools will help the child overcome the han
dicap of mutism. There are so many publically
and privately supported institutions in our
country which are exclusively devoted to the
education of the deaf, and also trying to
impart training to the parents of such children.
An American institution offers a free corres
pondence course to parents who need help.
The address is as follows.
JOHN TRACY CLINIC
806 WEST ADAMS BOULEVARD
LOS ANGELES, CALIFORNIA - 9007
U.S.A. Both young people and parents can find
constant inspiration in the example of Helen
Keller who in spite of being deaf, mute, an blind
achieved world renown for her contributions to
the betterment of the handicapped and to hu
manity in general.
-^Courtesy : HERALD OF HEALTH
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23
Dying with Dignity ?
Reiterating Age-Old Truths
St. Mary Cathlean Harvey
Your editorial in the February issue of the
Journal was indeed stimulating and thought
provoking. I appreciated your open attitude
and your invitation to initiate a discussion
on 'The Right to Die with Dignity/
Taking a stand against 'Mercy Killing' I
have nothing new to say regarding 'Dying
with Dignity'. Nevertheless I am of the
opinion that to reiterate age old truths
will not be out of place. All will agree on
the right to the dignity of every person, and
that every person has a basic right to 'die
with dignity/ But what is meant when
we speak of dying with dignity ? It would
appear that, in many minds there exists a
confusion of the meaning of 'dying with
dignity'.
Originally the word euthanasia was taken
to mean a 'good, honourable and dignified
death' Euthanasia has always referred to the
kindness and loving concern that physicians,
nurses and-others attending on the patient,
extended to help him to minimise physical
pain and mental anguish, and at the same
time to maximise his fortitude and serenity.
It is just in this century that euthanasia has
come to be understood as the direct, albeit
painless, termination of the life of the patient
considered to be terminally ill; and who
chooses to die without further delay and
further pain.
To die with dignity should simply mean
to pass away from this life peacefully, when
God the Author of life takes away that life.
Human life is unique and sacred. It is
Godgiven. Man is the custodian of his
. February 1985
life, and whilst everyone has the responsi
bility to live it well, and to achieve fulfil
ment, no one has the right to terminate it.
In other words, man's right over his own
life is not absolute. Neither the individual,
his relatives, his doctor, nor any arbitrary
state law should dare to abrogate this right
which belongs to God alone.
In order to die with dignity does anyone
have the right to decide the actual time
when he should die ? Is this not a supreme
dishonour to the Almighty, the Creator and
Lord of the Universe ? Can we consider
that any person who opts to die to avoid the
pain of living is truly choosing an honourable
and dignified exit from this life ?
Instead of 'mercy killing' could the doc
tor, the nurse and all those responsible for
the patient provide psychologipal and spiritual therapy, to enable the terminally ill
patient to 'live' life to the end ? Could we
not give to them a reason to live as well as a
reason to die victoriously, and in true
dignity?
When a person is in the throes of strug
gle, there is taking place in him, another
inner dialogue, a dialogue with God, even
if the person concerned thinks that he is an
unbeliever and supposes that he is wrestling
only with himself. There is often a conflict
between God's demands and the person's
resistance to these demands, a dialogue bet
ween the searching Voice of God and the
replies it demands.
The doctor and the nurse are there to
wage a battle against death, with all their
25
competence and dedication. They are there
to give inspiration and courage, to strengthen
the patient's will to live. To accomplish this
they should understand the healing power of
love, convey to the patient the feeling that
he is loved, appreciated and needed. They
should endeavour to create an optimism and
a desire for life.
We know that the patient's calmness and
inner peace can be a healing and life-giving
adjunct to medical efforts and this serenity
and peace of mind are decisive factors ena
bling the person to face life, even in physical
suffering. When death is inevitable the
patient is encouraged to confront it peace
fully. This is the zenith of personal freedom.
As we see the evening of life giving way
to the dark night, with a reverential awe at
the mystery of life and death, could we
ourselves face the prospect of our own death
and come to terms with it ? Then we may
be capable of helping others to die in peace
and dignity.
Abiding by the criteria of freedom and
peace, certainly we must do everything that
is possible to minimise suffering, physical
and psychological, whilst at the same time
helping the patient to use every conscious
minute to be ready to meet God. There are
so many ways open to us whereby we can
relieve human suffering and avoid resorting
to 'mercy killing'. Life and death are 'mercy'
and dying is actually a part of life-the culmi
nating part for those who believe in the
mystery.
Not all of us have the capacity to face
suffering with the same degree of equani
mity and dignity. Therefore it is important
that not only , the amelioration of physical
pain has to be considered, but even more
significant will be the comfort-psychological
and spiritual—that the nurse and the doctor,
as well as all those attending on the patient
can extend to him.
We have seen people transcend them
selves in faith and trust in a loving God.......
people who could endure great suffering and
whose lives have become radiant—a radiance
which surely came from their attachment to
God and to His will, and with the experience
that their friends still needed them. In the
suffering of such people, in spite of their
limitations by age or ill-health, some new
maturity blossoms. We have seen others
who have given way to despair and a refusal
to open themselves to the meaning of that
mystery of life and death.
To say "Yes" to God is also to say "Yes"
to life, even if that be a maimed or crippled
life. It is to turn from the negative to the
positive. To take up a negative attitude and
say 'No'will not compromise health and vitality
in its holistic concept. In the words of Dag
Hammerskjoeld : "Once I answered 'Yes' to
Someone-of Something-and from that hour
I was certain that existence is meaningful
and that therefore my life in surrender, has a
goal."
Readers are no doubt aware that in 1981,
there has been set up in Bombay, a Speciali
sed centre to study and to promote BioMedical Ethics, for the benefit of non-medical
people as well as for medical practitioners
and students. This centre has set up a task
force, consisting of doctors, lawyers, non
medical experts as well as paramedicals to
study the legislation of 'mercy killing'. This
Task Force on Euthanasia has gone into
several aspects of the question. It has found
that there is indeed some confusion where
terms and phrases are used, which tend to
cloud the issue. Hence it has set out clear
definition as well as guidelines. The cultural
aspects too have been studied. These have
brought out the fact that 'mercy killing' is
indeed abhorrent to our Indian culture and
(Contd. Page 31)
26
Medical Service
Sterilization and it’s Complications—Moral,
Physical and Psychological
By Dr. John J. Brennan
* While contraception prevents fertilization
by interfering with the individual sex act,
sterilization
leaves the
individual
act
untouched as it destroys the sexual faculty
itself.
The greatest gift we have is life. The
second greatest gift we have is the ability to
transmit that gift of life to the next genera
tion. Life itself does not belong to the indivi
dual, to his family, or to the State. Life is a
gift bestowed upon us by God to be returned
to him at some God-given time. So too, the
gift of transmitting life to the next generation
does not belong to the individual, his or her
spouse, the family, dr the State. The gift
belongs to God. It is given to each woman
to protect and use for an average of. thirty to
thrity-three years. In His wisdom, the gift
of transmitting life is returned to Him by each
woman before she reaches the age of fifty.
Each man retains the gift from adolescence
into his old age.
Sterilization may be permanent as with
hysterectomy, tubal ligation, or vasectomy.
It may be temporary as with contraceptive
pills or injections. During the thirty years
that I have delivered babies every week or
two a woman has inquired about postpartum
sterilization by tubal ligation. The fact that
no woman has even left my care because I
have refused to sterilize her shows how
ambivalent women are on this subject.
1 yell her that a doctor's highest calling is
to be a teacher and that I must teach her
how to live with her own reproductive
organs.
February 1985
A doctor cannot consider how he can
solve all human social problems with his
surgical instruments. If a woman said she
could not control her hands, that she was a
kleptomaniac, (a compulsive stealer) the
doctor would hardly use his surgical instru
ments to cut out her tougne. Even if she
couldn't control her appetite for food, the
good doctor would teach her about diet and
nutrition rather than perform an intestinal
bypass operation. The new car in the display
room and the gold bracelet in the jeweler's
showcase look attractive to all women. Yet
women must accept a discipline in which
they cannot have everything they desire.
With cars, jewels, clothes, and food—so too
with sex, life has a discipline.
Just as often-once every week or two a
woman asks me about the chance of having
a tubal ligation reversed. Most of these are
young, poor, black women who had a tubal
ligation performed after one or two babies as
a teenager.
Someone has cinvinced each
one that her reproductive organs are her
greatest libility and that she can "make
something of herself" if she becomes a
miniman. Suggestion and persuasion rather
that coercion or compulsion are the cause of
most tubal ligations in our country. Unfortunatley, most of these young women have
had their tubes burned out and tubal reversal
is impossible. In one recent year in which
our hospital had no maternal mortality we
did have one woman die of generalized
peritonitis after tubal ligation in another
hospital. The red hot poker used to destroy
the tubes must have burned a hole in her
bowel causing the disaster which resulted in
her death. .
27
Many a woman who has had tubes
burned by the age of twenty, has at the age
of twenty-five met a man who would like
her to become his wife and the mother of
his children. Such women have asked, "Why
couldn't I have met some like this when I
was seventeen or eighteen ?. The answer
is simple—they were looking in the wrong
place. They were looking for action in
the tavern while this young man was
studying in the library.
The question has been asked, "Is it possi
ble that tubal ligation may be performed in a
Catholic hospital ?". The answer is, "Yes
it is possible".
The traditional teaching of the Catholic
Church has condemned sterilization. Coope
ration in the act of another person requires
some clarification. There is distinction first
between formal and material cooperation.
Cooperation is any assistance in an act that
is a violation of the law of God. Formal
cooperation directly intends the wrongful
act of the principal agent. The act is directly
desired by the cooperator either as an end in
itself or as a means to an end. In material
cooperation the cooperator desires neither
the wrongful act for itself nor as a means of
anything else, but rather permits the wrong
ful act to occur.
Immediate
materia!
cooperation
is
cooperation in the wrongful act itself while
mediate materia! cooperation is cooperation
in one or more of the circumstances leading
up to the act. Mediate material circumstances
can either be proximal or remote, Necessary
coperation is that without which the wrong
ful act could not occur. Contingent coopera
tion is that which is not necessary for the
occurrence of the worngful act.
rating in a wrongful act one is viola
ting God's law (even though coope
ration is for another reason).
(3)
Mediate
material
cooperation is
permissible if the action of the
cooperator is not a violation of God's
law and providing cooperation is
done for a proportionately serious
reason.
In 1975 the Sacred Congregation for the
Doctrine of the Faith reiterated the traditional
teaching on sterilization. On 15 Sept. 77
in an explanation of the Sacred Congrega
tion's document the Administrative Board of
NCCB made it clear that a Catholic hospital
can in no way approve of a sterilization as
that would be formal cooperation. If a sterili
zation does take place serious scandal may
result. Therefore, the Bishop must be
involved in each decision. Material coopera
tion is possible but that means that the
reasons for allowing the sterilization must be
different from the reason for performing the
sterilization. Such a reason might be the
possible closing of the hospital. Such coope
ration is considered only mediate.
Some
hospitals have merged rather than close.
Certainly the problem is complex and the
result unfortunately, is what is sometimes
called "geographical .morality".
Some Catholic hospitals may allow tubal
ligations because they are under court order
and the alternative might be closure of the
hospital; and/or the hospital might be the
only hospital in area. Some catholic hos
pitals may be functioning in a Communist
controlled land where the Bishop may decide
that there is proportionate good coming in
remaining open while complying with orders
This results in three principles :
from above. So too in areas where secular
(1) Formal cooperation never permissible. humanism dominates federal funds may be
(2) Immediate material cooperation is withdrawn if the Bishop does not offer
mediate material cooperation.
never permissible because by coope
28
Medical Service
Sterilization dates back to ancient times.
Hippocrates recommended sterilization for
hereditary insanity. In 1834 Von Blundell
suggested tubal resection but it was not
until 1881 that the first tubal ligation was
performed in the United States by Dr.
Lungren. In 1935 Dr. William
Kroener,
Jr. reported on 1000 tubal ligations perfor
med by his father in Whittier, California.
Probably the series most characteristic
of the consequences of tubal ligation was
collected by Major James Tappan of Travis
Air Force Base in California after tubal liga
tion was allowed in military installations in
U.S.A. Of 404 tubal ligations 244 res
ponded—at a minimum of six months and an
average of nine months after surgery. 41%
had a heavier flow; 27% had a longer flow;
21% had a more painful flow; 9% were
more irregular; 10% had a lighter flow; 5%
had a less painful flow. 38% gained weight;
29% lost weight and 42% had no change.
12% of those who had tubal ligations for
social or economic reasons felt six to twelve
months later that they could now afford
another child. 15.5% desired another baby
six to twelve months after their tubal
ligation.
Most series seem to try to prove that the
physical consequences of tubal ligation are
so great that either a total hysterectomy
should be performed on the wife or a
vasectomy performed on the husband.
In 1954 Randall showed that after tubal
ligation 4.8% developed cancer of the
uterus, cervix and ovaries.
Lu and Chen in 1967 said that functional
menstural disturbances are common after
tubal ligation because of circulatory changes
within the terminal brances of uterine and
ovarian veins.
February 1985
In 1972 Muldoon from the University of
Dundee followed 374 patients for ten years
after tubal ligation. 43% needed further
gynecological treatment; 25% had further
major surgery. 70 had hysterectomies.
"A survey of the literature reveals that
relatively few followup studies have been
published on individuals who have under
gone voluntary sterilization. These studies
yield conflicting information on the psychi
atric complications of the procedure. The
psychological complication rate varies from
zero to 83%. Most of the studies are
unscientific and uncontrolled.
Eadey and
Bernstein reported that 95% of the males
and a slightly lower percentage of women
are "satisfied". The lower
percentage
among women is supposedly related to the
fact that some were sterilized for reasons of
medical necessity and that some of these
women were childless and wanted children."
"In India there has been indiscriminate
male sterilization in the past according to
Wig and associates. They reported that 36%
of their patients had symptoms related to
the operation and called them the "postvas
ectomy syndrome". These patients were
seen in psychiatry and urology clinics.
Kharna, who studied 500 couples after the
wives had salpingectomies, reported that the
psychiatric symptoms were usually hysterical
involvement of the voluntary nervous system
and face-saving rather than symptoms of
anxiety or depression, which are less accept
able in India. These patients showed altera
tions in motor function or sensation to
operation was satisfactory even though some
observed a. change in their sexual activitythat is, a decreased frequency of sexual
intercourse and a lessened ability to reach
orgasm. With these observations the authors
stated, "We should now be carried away with
our enthusiasm for the operation and with
our public spiritedness.
We must keep
29
foremost in mind the future happiness and
emotional stability of the patient/'
"In contrast to this article, Sturazaker, in
England, reported 99% of 1000 followed
patients to be pleased after vasectomy. This
finding may have meant that the patients
were "Happy being sterile” in spite of some
untoward side effects”.
"Horenstein and Houston, with interviews
and psychological tests, studied 20 vasectomized patients and Ne matched patients who
did not undergo vasectomy six and eighteen
months after surgery. They found that most
were satisfied with the surgery and that
their sex lives and marriages were better.
These results indicated that the psychologic
adjustment was adjusted but that the affect
varied with time and the patient's defensi
veness.
These investigators concluded that
the operation did not affect the patient's
self-concept and that on a superficial level
the patients were emotionally better but at a
deeper level were worse”.
"Componella and Wolf studied. women
two years after tubal occlusion and reported
no serious medical
or
psychological
problems but did notice some interesting
aspects in relation to age :
* Minor psychosomatic symptoms occured
in 40% of the younger subjects in the
first year and in 30% after two years.
* Menstrual irregularities occured in 25%
of the younger subjects in the first year
in 30% after two years.
♦ Ninety-five per cent of the older
women were satisfied with the opera
tion two years after surgery but only
75% of the younger women were
satisfied at that time”.
"Neil and co-workers compared a group
of women who had been sterilized to a
30
control group whose husbands had vasec
tomies, including more pain and flow, than
did the women whose husbands had vasecto
mies.
Those women with surgical steriliza
tion subsequently had 10 hysterectomies
whereas only—occured in the control group.
Seven percent of those women operated on
had psychiatric problems as compared to 3%
in the control group. Of those women
sterilized, 90% were happy with the surgery,
3% in retrospect would have had it done on
themselves. 3% in retrospect would have
had it done on their husbands and 4% would
not have undergone sterilization.”
Cox and Crozier studied 220 women who
had been sterilized 20 to 36 months earlier.
They found that 5.9% regretted the surgery
and 6.8% were uncertain. They also found
more satisfaction among those sterilized by
leproscopy than by abdominal tubal ligation.
The authors wondered if the small scar was
a factor in the satisfaction. They reported
that one patient lost her libido after steriliza
tion. She requested and obtained reversal
of the procedure and regained her libido.
They reported these complications: worsening
of sex life in 11, weight gain in 7, menorr
hagia in 7, guilty conscience in 3 and "nerv
ous trouble” in 2. Of the 13 who regretted
having had the surgery, 6 had strong medical
indications for sterilization and 5 were
sterilized for high parity. The important
observation is that those with the strongest
indications for sterilization felt the most
regret. This finding was also reported by
Thompson and Baird, and could be due to
the circumstances that lead to the operation
rather than to the operation itself. Barnes
and Zuspan found a high degree of complica
tions when sterilization was done along with
cesarean section. Over 25% regretted the
operation. Here the patient had little choice
in decision
making and little time to
consider.”
Medical Service
"Sachs abd Lacroix stated that young
couples with families who, despite ambi
valent or strong feelings against sterilization,
submit to the procedure because of medical
advice are
more likely to regret it later,
particularly if they have a poor understanding
of the need for the procedure”.
Neil
and
co-workers .followed 493
women. They found considerable more
menorrhagia and dusmenorrhea in women
who had laparoscopic tubal ligations than Fn
those who had tubal. ligation at interval
laparotomy and least menorrhagia, dysemenorrhea and dyspareunia among women
whose husbands had vasectomies.
There is no doubt that abortion destroys
human life. It is wrong not only because it
violates the fifth commandment, 'Thou shalt
not kill", but also because .it defies the first
commandment, "I am the Lord, thy God,
thous shalt not have strange gods before
me”. Abortions are "the strange gods of
the twentieth century". Only God gives life.
Only God takes life away.* Abortionists take
over the role of God by determining when an
individuals life should end. So too only,
God endows humans with the gift of trans
mitting life. In his plan sexual intercourse
is both unitive and provreative. Those who
burn tubes, who destroy the gift of trans
mitting human life are also "the strange gods
of the twentieth century”.
(Contd. from page 26)
traditions. It will be recalled that in 1981
when a Member of Parliament introduced a
Private Member's Bill, it was rejected in 1982.
The Prime Minister had said that it was not
in consonance with the cultural traditions of
our country. We can add that it is not
in harmony with Ahitnsa, the ideal so much
lived and promoted by our Mahatma.
Regarding public opinion, we have on
record several surveys taken up in Bombay to
assess the feelings and the opinion of people
on this issue. In 1982 one survey carried
out by C.J. Vas, showed that the average
person was not for it. In 1983 Shanbag
and Jha conducted a survey among the
poorest women in the slums of Bombay to
find out their attitude to this subject; 69%
were against 'mercy killing' 3% were for it,
the remaining 28% had no specific views.. In
1983 Bhattacharya conducted a random
survey in a rural area. Of this only 2% had
heard of 'Mercy Killing', 58% were against'
it, 12% in favour and 30% had no response.
Many of those interviewed were apparently
upset at having been asked the question,
whether they would like someone to die,
whether they would like to kill some. In the
detailed and scientific opinion survey carried
out recently by the FIAMC Bio-Medical Ethic
Centre at Goregaon, Bombay of 1210 indivi
duals 90% of those interviewed, from ail
faiths, ages and occupations were against
'Mercy Killing'. These views must surely be
taken into consideration and respected. If
legislation is intended for the small percent
age in favour, surely abuses can be expected
(cf. C.J. Vas, Medical Service, New Delhi,
1983).
Nurses, be at the bed-side of the termi
nally ill. Do what is possible to comfort them,
relieve pain and anxiety and maximise their
fortitude and hope. Show them your loving
concern and release for them the healing love
of God. For "the most beautiful thing in
life is the Mystery”. (Einstein).
References
Medicai Ethics, Bernard Haring,
Escape from Loneliness, Paul Tournier,
Respect Life CHAI Convention Theme
Publication Nov. 1983. Key-note Address:
CHAI Convention C.J. Vas, Respect Life.
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