DOCTOR GOOD GRAFT

Graft, or bribery, has been India’s bane. The graft that I am writing about is a boon to India’s suffering millions. It is called allograft, and its pioneer in India is Dr Astrid Lobo Gajiwala, the Head of the Tissue Bank at the Tata Memorial Hospital (TMH), Mumbai. Simply put, allograft is a process by which tissue from another human being is applied or implanted in the patient in need of it. This is different from an autograft, where the patient’s own bone or skin tissue is used.

The availability of autografts is limited. For example, in a child who is still growing, it would be clinically improper to take its own good bone tissue, to apply it somewhere else. Besides adding a surgical procedure, it is also traumatic for the child, and could even affect the future growth of its good bones. Similarly, if a patient has severe burns or ulcers, it would again be inadvisable to take some skin from the patient to apply it to the affected area.

On the other hand, some surgeons have experimented with biological tissues from pigs and cows (even heart valves), but they have a high degree of rejection by the human body’s immunological system. There are also religious inhibitions to such grafts. Synthetic tissues, or even metal prosthetics like hip or knee joints, are good to a degree. But they too degenerate through wear and tear, resulting in another replacement or replenishment.

Here is where Doctor Good Graft steps in, to literally stem the breach in the human anatomy – be it a gap in the bones caused by accident or infection, or covering large tracts of burnt skin.  A couple of months ago India Today, a leading weekly magazine, carried a story on Dr Astrid’s work. She was counted among the ten game changers of India; one whose work was dramatically changing peoples’ lives. Having read the story I decided to interview the game changer in her laboratory at TMH. This petite doctor (a Ph D in medicine) has an appetite for big things. She has transformed the lives of thousands of suffering patients through her research and its clinical applications. Going beyond borders, she was also the President of the Asia Pacific Association of Surgical Tissue Banks.

What is it about allografts that make them a game changer and a lifesaver? Autografts, synthetic or metal surgical implants (prosthetics) have their limitations; besides being painful, expensive and time consuming. The converse is true for allografts. They are cheap, quick and long lasting, as human tissue has the innate power to regenerate itself.

This raises two questions. From where does one get these allografts, and how safe are they? They are obtained from various sources – cadavers, amputated limbs or other surgical discards, within a particular time frame of death or surgery. Permission of the patient or next of kin is obtained for literally “recycling the body parts” as Dr Astrid observes with an infectious smile. Infection, ooh! That is eradicated by sterilization, radiation and other processes, to render the allografts completely safe for use on another person.

Bone tissue is a wonder worker for filling gaps in a bone after fracture, or holes caused by cysts, even in the jawbones. Dentists, infact, are among the major users of bone tissue. Since it regenerates naturally it serves as a platform or framework for natural bone to grow around it and thereby plug the gap. There are even cases of patients with bone cancer, who after an allograft, are walking again and living normal lives. 

Doctor Good Graft has another goodie in her kitty – amnion, another of nature’s wonders. The amniotic membrane is the inner lining of the sac that protects and envelops a baby while in its mother’s womb. After delivery or surgery it is either ejected or removed. This membrane is then clinically sterilized, processed and freeze dried. It is a gossamer-like membrane, like the wings of a dragonfly. In the case of severe burns, diabetic ulcers or bedsores it is not always possible to do a skin graft. But an amnion dressing can be easily applied. The beauty is that the surgeon can monitor the healing process because of the transparency of the membrane. He doesn’t have to apply or remove bandages that could even damage the delicately healing wound. And wonder of wonders, having done its work the amnion just dries up and falls off naturally, like a snake’s skin. Nature’s wonders and scientific achievements never cease.

This amniotic tissue can also be used for healing of skin reactions caused by radiation in cancer treatment. Since it is paper thin it assumes the body’s contours, and is even used on that most delicate organ of the human body, the eye.

Yet the work of this great game changer is relatively unknown outside the scientific fraternity. Even the widely circulated India Today story did not fuel interest in this scientific advancement; despite its painless benefits, cheaper process and faster healing. Hence I felt the need to make this story better known.

Incidentally, Astrid’s husband, Dr Kalpesh Gajiwala is himself a renowned plastic surgeon in Mumbai. He too has pioneered the use of tissue from his wife’s bank! It is not an issue with this couple, as together they strive to make this world a better place through wholeness, healing and the alleviation of suffering.

A coin must have two sides to be legal tender. So too with this activist for gender. Besides being a topnotch scientist she is also a feminist theologian. Her resume of church related activities, and positions held in the Catholic Church, runs into several pages. As a writer she has also received awards from The Examiner (Mumbai) and The New Leader (Chennai). Interviewing Astrid at TMH, I was able to go beyond the gossamer membrane (to get under the skin, in investigative journalism parlance), from the scientist to the feminist!

Sharing her thoughts on several burning or contentious issues she said that she did not find any incompatibility between faith and science. The latter was still fathoming the human body in a voyage of discovery. But scientists should not try to play God. Science, by virtue of its immense potential, cannot be left unbridled. It must have a purpose, and a code of ethics. Today any form of research on human beings, and even animals for that matter, has to be approved by an ethics committee; just like an industrial project requires environmental clearance.

For Astrid her work was an expression of her deep Christian faith. It was improving the quality of peoples’ lives, a fulfillment of what Jesus envisaged, in his reply to John The Baptist: “Go back and tell John what you have seen and heard: the blind see again, the lame walk, those suffering from virulent skin diseases are cleansed” (Lk 7:22).

On being queried if scientists or theologians could determine the exact moment when human life begins, she admitted that it was a nebulous state, with no scientifically precise answer. Life and death still had many unanswered questions. Though science and faith are not contradictory, if they both strive for truth, there could still be nebulous grey areas of conflict, especially where the biological sciences are concerned.

Contraception and abortion are some such areas. Astrid’s attention was drawn to the Catholic Church’s Canon Law that states, “A person who actually procures an abortion incurs a latae sententiae ex-communication” (Can 1398), that is one “that is automatically incurred on committing an offence, without intervention of a judge”. The reply was fast and furious. “Men don’t understand motherhood or conception. They make moral exceptions to justify war, which is also the taking of life. This is because both the theologians and the Generals are men. They understand the business of war, but they don’t understand motherhood”. If there can be situational ethics for war, then why not for abortion? Though in principle one is against abortion, there could be exceptional or mitigating circumstances where culpability is limited, she said. A cogent argument. It is along the same lines that Astrid debunked the Church’s unilateral rejection of any form of artificial contraception, which she felt was a better option, than having to resort to abortion.

Since Astrid is on several Church bodies and advisory committees she was asked about her experience in them. Was the hierarchy willing to listen to the voice of the laity? She had mixed reactions. A lot depended on one’s personal approach. It was like tight rope walking. One had to keep one’s balance. “If the hierarchy perceivers you as an opponent they will ostracize you, but if you are seen as one working for the good of the church they will listen to you”, she opined. She herself has been part of a feminist collective working on women’s issues. They act as a support group to each other, and do have an impact on the church.

She disagreed with the common perception that only those “who tow the party line” get appointed to church bodies. Her own experience was that she had often asked uncomfortable questions, but she still got called. She has just worked on a redressal mechanism for sexual abuse by church personnel, and a code of conduct. It has been submitted to the Catholic Bishops’ Conference of India. It remains to be seen if the bishops heed the advice of their women appointees.

This, despite another common perception, that our bishops are far more comfortable interacting with women, rather than male lay leaders. At this point Astrid felt that this may be because the bishops perceive women as more servile and subservient. As for another contentious issue, the ordination of women, Astrid said that she had actually lost interest, especially because of how priesthood is lived today – more institutional than people oriented.

She felt that a woman’s priorities are different – be it family, birth, or life. Women have much to contribute to the church, because they are more person, or relationship oriented, not structured like men. “It is a challenge to be a Christian, and even more as a woman in the church. But women shall not be found wanting” she affirmed.

Visiting Doctor Good Graft at her Tissue Bank at TMH was an enlightening and fascinating experience. Dr Astrid Lobo Gajiwala, the scientist, or the feminist, is in a league of her own. Wonder if her Tissue Bank could clone some of her own tissue, for the rest of us mortals to bank on? Indeed graft, allograft, is a boon for the country’s suffering millions.

OCTOBER 2013

COOL BISHOP IN HOT SEAT

With his boyish looks, dimpled cheeks and darting eyes, he looks a cool customer that belies his 55 years. Bishop Raphy Manjaly of Varanasi diocese was transferred to the hot seat of Allahabad, and installed as its bishop on 3^rd December, the feast of St Francis Xavier, as also World Disabled Day! The significance should not be lost on us. The hot seat of Allahabad needed a cool and able bishop to get it back on track, as the diocese’s track record speaks for itself (see table).

In the last 50 years Allahabad has almost always received a bishop transferred from another diocese. Bp Raymond D’mello came from Mangalore, Bp Alfred Fernandes from Shimla-Chandigarh, and Bp Baptist Mudartha from Jhansi. The sole exception was the previous incumbent, Bp Isidore Fernandes, who had to ignominiously resign earlier this year, for committing the cardinal error of consecrating a Protestant bishop. As per Canon 1382 this attracts a latae sententiae (no discussion) ex-communication. He got off rather lightly. In the 1970’s Bp Alfred Fernandes had also resigned from the see of Allahabad, perhaps because it was too hot to handle!

Why is Allahabad such a hot seat? Established in 1876, it is one of the oldest dioceses in the North. It covers 12 civil districts, which have a population of 31 million. Geographically, the diocese is 500 kms from one end to the other. The table below gives an idea of what the new bishop is up against. Will he be able to turn the tide?

Bp Raphy is the third of seven children of the late M.V. and Catherine Chacko of Trichur diocese in Kerala. He joined the Agra diocese and then became the rector of the regional seminary at Allahabad before becoming the bishop of Varanasi in 2007. Earlier he had done his doctoral studies from Rome.

I first met Raphy 37 years ago when he was still a teenaged seminarian. While studying philosophy he found Bultman’s rationalization of faith difficult to swallow. Questions went a begging. Another oddity was that the then archbishop of Agra, Dominic Athaide OFM Cap, expected all his seminarians to play the piano. That was not Raphy’s forte! So Abp Athaide sent him to Fr Augustine Deenabandhu OFM Cap at Jyotiniketan Ashram, Bareilly. That is where we met, and Raphy shared with me some of his doubts and hopes.

At that time we received a request to minister to some Catholics scattered in remote villages of neighbouring Shajahanpur and Pilibhit districts. These people were dalit migrants from Punjab, who had come as serfs of the rich Sikh farmers. We spent the next ten wintry days in their midst, accompanied by the catechist Garibdas. We had one cycle and the harmonium between us. It was a mutually enriching experience, as we traversed fields and streams, sharing God’s word and singing his praises. I recall a chilly night in Garibdas’ mud and straw hut adjacent to a stream. Since there was not enough bedding we had to cover ourselves with straw to keep warm. Shades of the Babe in Bethlehem. In the course of conversation Garibdas said that he would do anything I asked of him. Jokingly I asked him to go bathe in the freezing stream. He did so. Out of shame I too joined him. We then had to light a straw fire to get our circulation back. I would love to believe that this unique experience had a positive impact on the young Raphy.

Years later when he was on the staff of the Allahabad seminary I visited him, and asked him over breakfast, who the rector was. With a demure smile he pointed to himself. He was still a boyish 41. A couple of years later when I had a serious complaint against my errant parish priest, he took up the matter with the bishop, at my request. So I hold Bp Raphy in high esteem and believe that the Holy Spirit has chosen the right man for the hot seat of Allahabad. As Acharya Anildev IMS of Matridham Ashram, Varanasi says, “Bp Raphy is a noble and gentle soul”.

Why is Allahabad such a hot seat? The indices in the Table are indicative of the same. Despite an influx of migrants from Kerala and Chhotanagpur, and normal population growth, there has actually been negative growth of the Catholic population. In 2013 it is down to 11,180 from 12,540 in 2003 and 12,650 in 2005. This, despite a high priest to population ratio of 1:169, and an increase in the number of active clergy. According to Ignatian discernment one’s strength can become one’s weakness. Despite Vatican II’s call for destructuring and de-institutionalization, the diocese has doubled its institutional strength between 1969 and 2013. Conversely, the ratio of Catholic students has dropped by 75%. With a Catholic population of 11,180 the student population at 40% would be about 4,472, of which just 1,385 are in Catholic schools. This means that 7 out of 10 of the student population is not in our own schools. Isn’t this a wake up call?

Look at the figures for what were once flourishing mission stations like Dostpur and Mudila. There has been large-scale apostasy. The oldest extant church at Chunar, built in 1845, has just 77 Catholics after 168 years. Most of them would be migrants. The Catholic Directory of 1969 has the names of prominent lay leaders as directors of diocesan commissions. Not so today. Is the laity not to be trusted? Kanpur city alone accounts for 37% of the Catholics. There are hardly any in the numerous mission stations in rural areas. The Catholic Church’s presence is negligible.

Small wonder then that Bp Gerald Mathias from neighbouring Lucknow diocese observed that there are very few missionaries today, and those who are there, are poorly motivated. Earlier, Abp Salvatore Pinnacchio, the Papal Nuncio, had said, “the church grows by attraction”. What if there is no attraction? There won’t be any growth. And if growth is negative it means that there is revulsion to the church in its present form.

Thousands of people, bishops, priests and religious thronged the grounds of St Joseph’s College for the installation ceremony presided over by Abp Albert D’souza of Agra. The caretaker administrator, retired Bp Ignatius Menezes and his team had made elaborate arrangements for a meaningful celebration.

But we scribes (not pharisees) will always find something wrong somewhere! This was during the offertory procession, with symbols from different parts of the diocese. There was coal from the collieries adjoining Jharkhand, grain from a rural mission station, and workers’ tools from industrial Kanpur. Allahabad city offered Gangajal, the sacred waters of the Ganga. Allahabad is situated at the confluence (sangam) of the Ganga and Jamuna rivers, the venue of the biggest religious congregation in the world, the Mahakumbh. Many of the laity and clergy were askance at the offering of Gangajal in Catholic liturgy. I felt that it was an insult to Hinduism on the one hand, and contrary to the Christian understanding of salvation on the other.

Another incongruity. Pope Francis has asked priests and nuns to switch from big cars to cycles. There were several big cars parked, but I didn’t see any cycles. But I did see a Vijayanta tank and a MIG 21 fighter on the ground; gifts from college alumni, including Air Chief Marshal N.A.K. Browne. Should a “shepherd” be installed in the shadow of symbols of war? Would not the “sheep” run away?

The cool, able, gentle, noble Bp Raphy Manjaly has his task cut out for him, as he now settles in to the hot seat of Allahabad diocese. On behalf of the laity of the diocese this writer assures him of his full support and co-operation. Hopefully 3^rd December 2013 will be remembered in Allahabad diocese as the day of St Francis Xavier, the zealous missionary, and not as a disability.

Comparative Data on Allahabad Diocese

 From the Catholic Directories of 1969 & 2013

Head	1969	2013	Growth	Observations
Total Population	11,000,000	30,945,000	181%
Catholic Population	7,920	11,180	41%	1/4th of population growth above
Kanpur City	2495	4126	65%	1/3rd of population growth despite parishes increasing from 3 to 6
Allahabad City	1860	2042	10%	Nothing grows in the shadow of the oak tree
Dostpur Mission	2013	180	- 91%	Large scale apostasy
Mudila Mission	752	61	- 92%	Large scale apostasy
Theresapur Mission	38	1 family	- 90%	Help!
Lapta Mission	10	-	-	Apparently abandoned
Chunar Church	24	77	221%	Built in 1845
Active clergy	53	88	66%
Clergy/ Catholics Ratio	1:240	1:169	- 30%	Increasing clericalization
Schools	33	66	100%	Exceeds all other parameters
Students	13950	52804	278%	Disproportionately high
Catholic students	1033	1385	34%	Even less than growth of Catholic population
Percentage of Catholic students	7.5	2.6	- 65%	Increasingly being pushed to a corner

                                                                                       

HOW CHRISTMAS EVOLVED

This is not a cleverly googled piece on the evolution of Christmas trees, cards and Santa Claus. It is about how my own Christmases have evolved over the past 62 years of my existence. I am telling it as it was.

My childhood in Kanpur was a privileged one, as was Christmas then. At the tender age of 7 I was bundled off to an elite boarding school in the hills. After 9 months of jail we headed home in the first week of December for a three-month long winter vacation. In those days, unlike today, the schools in the plains also closed at about the same time, so we had enough time to “prepare” for Christmas.

Psychologists tell us that a child experiences love through receiving; and that was my childhood experience of Christmas, valid in itself. Other than the gifts, the enduring memory is of my mother and grandmother’s culinary skills, and the “collaboration” of my father together with us 4 kids.

My mother was a master chef, long before the term became au courant. Not just plum cake and plum pudding burnt with brandy; there were Turkish delights, lemon tarts, meringues, macaroons et al. Grandmother made the traditional Goan sweets like bebinca, dodol and chonechi dose. Long before the advent of glitzy malls, we had caviar, anchovy, pate de foie gras, Gorgonzola cheese and Firpos chocolates for Christmas. Dad’s contribution (he was 27 years older than my mother) was to sit in the sun with us kids pretending to clean the raisins and nuts for the cake, with a large quantity mysteriously disappearing enroute!

Psychologists further tell us that youth experience love through searching. For me it took the form of shikar. We had to have a graylag goose (a winter migrant from Siberia) for Christmas lunch. My uncle would also drive down in his Chevrolet V8 Fleetmaster to a remote village hundreds of miles away to get turkeys. I accompanied him one year. There were about a dozen turkeys in a basket on the carrier. When we stopped at a roadside tea stall some of the bemused villagers, who had never seen a turkey before, wondered where we were taking so many vultures! In those days shikar also meant getting bluebull meat for making hunter, a form of salt meat. There would also be a hind leg of pork soaked in beer for a month and pierced with cloves, to make succulent ham.

Christmas day was always hectic, with a constant stream of visitors. We seldom got to eat lunch, and still don’t. As I grew older I discovered that my mother also made an exotic array of wines and liqueurs. Sherry was the preferred wine, while Crème de Menthe, Green Chartreuse and Drambui were the choice of liqueurs. Ironically, Dad was a teetotaler.

As a teenager I gradually became aware that there was more to Christmas than feasting. From the bake I evolved to the Babe in Bethlehem with the eternal message “Peace to men of goodwill”. That is when I started making the crib, an elaborate affair with earth, grass and running water, depicting the birth of Jesus. It would take three days to construct. I took great pride in that crib, exhibiting it to all our visitors.

Life changed dramatically after my father died. I was still a teenager. A year later I moved to Mumbai, as I had fallen in love with a girl, and consequently fallen out with my mother. My first salary in Mumbai, in the shadow of the Bangladesh war, was a princely Rs 100/-. With that I bought gifts for others. I was discovering that as an adult love meant not just receiving or searching, but now it was sharing. The next Christmas my mother invited me home. That was 1972. I rode my Bullet 350 cc from Mumbai to Kanpur (1300 kms) in the bitter cold. Back then there were no mobiles, GPS systems, or even petrol pumps. It was both risky and adventurous, as my life then was. When I reached home after two days of hard riding I was so stiff with the cold that it took me 24 hours to straighten up. It was a thrilling ride and a chilling Christmas.

Life took another dramatic turn 3 years later, when I met Jesus. Till then I had been “exhibiting” him at Christmas. I was now beginning to experience him. I left home again to live for 7 years in a Christian ashram in a village outside Bareilly. The ashram had no electricity; it had mud walls and floors, asbestos sheet roofing, and wire meshing instead of windows. Winter was bitterly cold, but Christmas there set my heart on fire. At midnight we would trudge to the small chapel holding our kerosene lanterns and huddled in blankets. We experienced the stark poverty of the Manger, surrounded by straw and cattle, and the shepherds minding their flocks. Christmas was a real incarnation of the divine. Together with the local youth I would organize a Christmas tableau in the neighbouring villages. We had two petromax lanterns for arc lights, and a durrie for our stage. Under the canopy of the stars, Christmas was truly a silent night.

Life then took another turn, as I had to return home to sort out family problems. I settled in like a domesticated fowl. In 1990 I was elected the National President of the All India Catholic Union, in which capacity I led a lakh-plus rally at the Boat Club lawns in Delhi, demanding equal rights for Dalit Christians. I made a clarion call that if the Govt did not concede our legitimate demands by Christmas, we would not celebrate it that year. So we had the Christmas Satyagrah, eschewing all form of celebrations, with the money thus saved going to the Dalit Christian cause. That Christmas was a fight for justice.

Two years later it was the demolition of the Babri Masjid. Till then, our tenants, some of whom paid as little as Rs 7/- per month by way of rent, always came together with a basket of fruit to wish us. They were a mix of Hindus and Muslims. Post Babri, they came separately! The communal divide was complete.

Christmas kept evolving for me. I now began to feel that the message of peace and harmony needed to be emphasized. I got a huge star erected, with the central hexagon painted in the tricolour, with just one word – Peace – written in Hindi, Urdu and English. One year, seeing the bright lights, a cycling duo from Europe rode in, mistaking our house for a church, and seeking shelter for the night. They were treated to a Christmas repast. How could we say to them, “There is no place in the inn”?

Through the Kanpur Catholic Association I now began organizing a Christmas Milan, which was an interfaith prayer for peace, with Hindus, Muslims, Buddhists, Sikhs, Parsis and even Bahais participating. We used the occasion to confer “Shanti Sewak Samman” awards on citizens who had contributed to society. These Milans were mutually enriching.

My saddest Christmas was 3 years ago, when a fictitious criminal case was filed against me over a property dispute. I had to go underground until I obtained a stay order from the High Court. I could not even go to church that year, and had to keep the house locked. That Christmas reminded me of the killing of the innocents by King Herod, and the subsequent flight into Egypt.

Now that most of our friends are civic or social activists, our Christmas menu has also evolved in the changed circumstances. So if you visit us this Christmas you may be served piping hot chhola bhatura and gajar halwa, as we gather around a crackling bonfire. There is something about the cold and Christmas; people are compelled to come closer together to keep warm. As my wife mischievously says, the only reason she got married was to have a warm bed in winter! Ever wondered how those poor souls in the Southern Hemisphere celebrate Christmas in the heat of summer? I pity them!

In life, as in love, the only thing that is constant is change, or evolution. This Christmas be a game changer. Do something different. Think out of the box. Change the parameters. You will have no regrets. Peace be to you and your dear ones at Christmas and the New Year. PEACE – SHANTI – SHALOM – AMMAN.

DECEMBER 2013