In 1947, six nuns from Kentucky set off for Bihar, India, to build a hospital in the small town of Mokama on the banks of the Ganges. None of them spoke Hindi, or any other Indian language. None of them had ever left the United States before. Some had nursing qualifications and experience, but none had run a hospital before. Yet they hopped on trains to New York and thence on a long trip by ship to Bombay. Some of them then took a train through India, while the others took another ship all the way around India until they met again in Calcutta. From Calcutta, they took another train which finally dropped them off at Mokama Junction, where their new Sisters of Charity hospital would be established.
It was a shell, a series of empty rooms, and contained no tangible evidence that it was meant to be a hospital. There were no hospital beds; no medicines; no electricity; no source of running water; no doctors, nurses or other trained staff.
A mere two years later, the hospital was running and functional, a remarkable feat chronicled by Jyoti Thottam in Sisters of Mokama: The Pioneering Women who Brought Hope and Healing to India. The hospital at that point employed 30 people, including a doctor and seven nurses. One of the nuns eventually started a treatment center for Hansen’s DIsease (leprosy). And, significantly for the author of this book, they started a nursing school: Thottam’s mother Elsy was one of the early students at this school, and eventually migrated to the United States where the author grew up.
The first hospital helper was a young ‘tribal’ Bihari woman, Celine Minj (named by Belgian missionaries) who was determined to study, and sought out the opportunity at Mokama. Celine was an invaluable asset immediately, since she could translate for the nuns. It was very pleasing to read that she did eventually obtain a nursing certificate, worked as a nurse for Indian Oil, married and had children.
The first doctor was Anglo-Indian, Eric Lazaro. Much was demanded of doctors in rural outposts: the ability to treat whatever came their way, from cholera to malaria to wounds to birthing complications. Lazaro also did autopsies when required, and sometimes operated by lantern-light. And all this without running water! It is a huge relief when they get piped water, electricity and even a telephone by 1955.
Thottam is a senior journalist at the New York Times and it shows. The book is solidly researched, with a detailed list of primary sources, a list of interviews, and over 100 pages of footnotes — very satisfying to a persnicketty reader such as myself.
Several chapters provide background about the history of India and partition, which seemed like a bit too much background, and was occasionally confusing. Writing about the 1960s and 70s, Thottam says
if Partition had cleaved India in two, this wave of people moved back and forth between village and city the way a weaver moves his shuttle through the weft of a fabric. It would never be enough to heal the wounds of Partition, but it helped to bind India together so it could continue. The women of Nazareth kept moving.
After Independence the migration of people has been rural to urban, in India as everywhere else. And indeed, the nurses of Nazareth also migrated to cities and abroad, so the comment about moving back and forth is puzzling.
Thottam spends a good number of pages on Sir Joseph Bhore’s 1943 report on the miserable status of healthcare in India. India at the time had miserable statistics on child mortality, on the number of doctors per 10,000 residents, on the facilities available to Indians, and on pretty much every healthcare metric. Bhore recommended a huge increase in the number of doctors and nurses to fulfill the healthcare needs of India going forward.
Yet, the Nazareth hospital in Mokama was completely independent of the Bhore report. It was envisioned by an ambitious missionary, and eventually brought to fruition by the American nuns. It certainly contributed to an increase in available care for the Biharis in the region, but does not appear to have been a huge medical facility that drew patients from around the country. This is not to downplay the importance of the Mokama Nazareth hospital, but just to put it in perspective, the Christian Medical College in Vellore (referenced a couple of times in this book) was started in 1900 by an American missionary who got her medical degree from Cornell in 1899, and started a college of nursing in 1946. Wikipedia says that
In 1871, the first school of nursing was started in Government General Hospital, Madras with a six-month diploma midwives programme with four students. The first nursing school for women was started at Kanpur‘s Saint Catherine’s Hospital by Dr Alice Marval.
The quality of nurses from these colleges may have been substandard, as Thottam says, but it would have been useful to include more about the other contemporary nursing colleges in India for perspective.
The personal history of the six original nuns, the first American woman missionary doctor, and the first few nurses are explored in some detail. The nuns’ stories and backgrounds began to blur for me, and I found the history of the nurses more interesting; how and why did these young Catholic Syrian-Christian women from Kerala go all the way to Bihar to study? Bridget Kappalumakal was from landed gentry, an impatient, determined young girl who was determined to become a nun. Rose’s father was a drunkard; raised by her grandparents, she realized she needed to make her own living, and nursing was one of the few professions she knew of. Elsy, too, had a father who abandoned the family, and had grown up as the child of a single mother.
What was life like for the Kerala transplants? They mostly interacted with Sister Florence Joseph, who could be ‘temperamental and sometimes unreasonably strict.” They weren’t allowed to ‘walk holding hands, or with their hands on each others’ shoulders’ (common among Indians). They were homesick, especially for the rice they had grown up eating. (For some reasons the novices were given rice, while the student nurses were not). There were language issues:
The one rule that the young nurses could not abide was Florence Joseph’s insistence on speaking English. The American sisters had spent so many difficult months learning Hindi, thinking it would bring them closer to the people of India. And yet here was a group of Indian women speaking a completely different language, unrelated to both Hindi and English. […] The girls struggled to turn their rote knowledge of Hindi into useful conversations with patients, or to speak English well enough to talk freely with the sisters.
Despite their hardships, the girls appreciated the opportunity to train and become self-sufficient. Thottam writes of the deep gratitude and admiration they expressed for one of the nuns at a reunion meeting decades later in America.
Interesting though this book was, it left me with some unanswered questions. The hospital was self-sufficient in a couple of years, its funding obtained by charging the patients. Were all patients charged the same or was it a sliding scale, so that the rich landowners were subsidizing the poor? What were the charges, and what did they do if someone could not pay? One nun indicates some frustration with patients who first tried home remedies, but could that be because the home remedies were cheaper and more accessible?
There were some examples of the operations performed, but very little about the patients: what was the distribution of medical problems? Did the hospital get sufficient medical supplies? What was the tone of the nuns’ interactions with the patients? Were people willing to bring their girl children as well as boy children for treatment? Did the presence of Celine encouraged more ‘tribals’ to come to the hospital?
Many of the nurses, once trained, headed off for better-paying jobs in the cities. Some, like Thottam’s mother, took an additional step and got jobs in American hospitals. Excerpts from their letters home over the years would have been a lovely addition to round out the book.
Still, it is a valid authorial choice to focus the book more narrowly on the nuns of Mokama, and as such it is detailed, solidly researched, and well written.
Sounds such an interesting book. I share your sense of awe/wonder at the spirit of these women who set off with so little, knowing so little, to perform a difficult task. Faith moves mountains, they say. These women’s faith clearly sustained them amazingly.