Happy Birthday Mary!

Happy Birthday Mary! In honour of your birthday, I want to post an article that you wrote way back in 1992. I read it then, loved it then and have loved it ever since.

By Mary Chandapillai

MY first impression of the Shanti Avedna Ashram was that of a convent. It sits in an affluent part of Bombay's Bandra suburb, opposite Mount Mary Basilica and next to the Shrine of the Blessed Virgin. The kind of serenity that the crescent-shaped structure exudes in the glow of the streetlights can only come from artefacts of religious significance.

I attached no further importance to it until my companion told me of the "half-way house" nature of the place. In Bombay, a city bursting at the seams with its 13 million people, there is an oasis where those who have terminal cancer could go to die. It is a sort of three-star hotel for the sick poor who otherwise would have to face the end alone, in pain, in hunger, and possibly, without a roof over their heads.

This "hotel" has no pre-determined check-out time. It has comfortable beds, good food, television sets, clean toilets and wide ramps for wheelchairs, and boasts a pain-free existence and a whole lot of tender loving care.

And to this "hotel", Death is a daily visitor. No one knows the hour he'd call, but call he would without fail. Night-time under a November Bombay sky eases in as early as 6 o'clock, and in its shrouded glow I could see shadowed palms and a terraced landscape.

In front of me, on the cream-coloured wall written in red and brightly lit, were the words: "Where there is love, there is no pain." Within the circle of these words, one palm reached out to hold another.

If I had entertained doubts as to the wisdom of entering a house of death at that hour of the evening, they were quickly dispelled. The three nuns who greeted me in the cheery spacious reception area made it seem that a foreigner's request to see the ashram and hear of their work was a daily occurrence.

Sister Bosco, one of the nine nuns who run the ashram, took me up the stairs, patiently answering my questions. The name, she explained, meant Peace (Shanti) Without Pain (Avedna) Place of Rest (Ashram). The philosophy crystallised herein was that pain and death were inevitable parts of the human existence. So, if medicine could not add days to life, the human touch must add life to days.

The ashram is the "love-child" of Dr Luzito de Souza, a surgeon with the Tata Memorial Cancer Hospital in Bombay, and managing trustee and honorary medical director of this hospice. Faced with the constant "Doctor, please don't send me home" cries of his terminally-ill patients, Dr de Souza found it necessary to consider the "quality of death" of those whose end was inevitable.

It was not hardheartedness for relatives to beg that their own not be sent home. Often they had no room, no food, no money and no one to provide full-time care. It is estimated that at any one time in India, there are about 120,000 patients in various stages of cancer - the most common being head and neck cancer, followed by abdomen, breast and genital tract cancer.

The psychological and economic implications of caring for advanced terminal cancer patients had to be considered. The solution - the kind of care that Mother Teresa offers. But to adequately relieve the distressing symptoms of advanced cancer, compassion had to be combined with competence - the ideal hospice care.

So with the help of the Sisters of the Holy Cross, the Archdiocese of Bombay, and a concerned public, Dr de Souza's idea mooted in 1977 became a reality on Nov 2, 1986. Since the ashram's opening, the sisters have helped 1,500 terminally-ill cancer patients between the ages of nine and 70, from 23 States of India, take that final step from life to death.

"Someone dies every day. Sometimes there are three deaths in a day," said Sister Bosco. "Some live only one night after they are admitted. Others a few days, some a month. Only one patient we've had, lived for a year-and-a-half after coming here."

To be admitted to the ashram, however, a patient must be beyond the stage of active treatment. Preference is given to those in need of urgent relief of distressing symptoms. Colour, race, religion, nationality are no bar.

Could a Malaysian find the same care here, I ventured. "We accept anyone who is in need of care." She hastened to add: "We don't treat the cancer here. Our care is palliative. We give them drugs to kill the pain, keep their wounds clean, and help prepare them to meet death at peace with God and themselves. Many of them who come here don't even know what is wrong with them. We break the news to them and help them accept it. Then we do everything we can to make their last days more comfortable."

The wards were indeed comfortable. The floors were clean and potted plants were everywhere. Nuns and attendants propped pillows, changed sheets and dispensed medicine. On the walls were posters which gave comfort and hope. One that stood out read: "Go to sleep now. God is awake."

The five-level building has two wings to house male and female patients. The wards have provisions to accommodate 50 beds. There are also six rooms allocated for patients whose spouses or relatives want to stay with them. These rooms come with attached bathrooms.

To help, the sisters have a staff of 18 girls, all hand-picked from Kottiyam in Kerala, the south Indian State where the Sisters of the Holy Cross have their mother house. I couldn't help but marvel at the kind of dedication and love for mankind that must come into play to be able to give comfort and hope to those who had none.

At that moment we passed a gaunt, 50-year-old man gasping for breath. A nun stood close, watching for signs of further distress. "He won't make it through the night," said Sister Bosco.

In another part of the ward, a man lay watching television, seemingly oblivious of the reality that was ever close. Opposite sat a 47-year-old, in light-hearted banter with his visitors.

"He was admitted this morning. He has a seven-year-old son. His wife was inconsolable when they came in. They had used up all their savings for treatment and even after that he was still going to die," said Sister Bosco.

Upstairs in the women's wing, five nuns and two helpers huddled round a frail woman. They were draining the blood that kept flowing out of her nose and mouth. "She'll die soon," Sister Bosco murmured.

As we passed, I saw a nun hold the dying woman's lifeless hand and whisper words of comfort. A little away sat the patient's sister bent in grief, her body turned away from the scene of death before her.

Walking back we stopped at the bed of a 25-year-old. She had a large tumour growing from her left cheek forcing its way out through her mouth. Seeing us the woman smiled and raised her hands in a Namastee.

"Look at her," Sister Bosco said, "when she came in she was crying in pain. Now she is happy."

One-third of the ashram's patients die without their families around them. But they don't die alone and they meet death peacefully. I witnessed that for I had come face-to-face with death and yet had sensed no fear in the air, just a strange peace, as if the passing on was just a walk into sleep.

"Some of the patients who come here want to die in their own homes so we discharge them, and give them what medication we can to help with the pain in their last hours. Eighty-five per cent die here. The bodies are then washed and taken to the prayer room downstairs. The funeral rites are performed according to the religion of the person," Sister Bosco said, showing me the prayer room.

I was expecting a chapel, but found a room with cushioned stools lining the walls on either side. On the wood panelling facing the visitor was a septagon joining seven metal blocks on which were symbols of the different religions practised in India.

As if sensing my surprise, Sister Bosco said: "We try to help everyone who comes here find peace with his Maker according to his own convictions."

How much does all this care cost the patient? Not a dime! The ashram is run purely on donations. "We need at least 20,000 rupees a month. The medicines are very expensive," I was told.

The pain-killer is morphine which is also donated. The ashram is managed by a board of trustees and sustained by the generosity of people who care and believe that here is a much-needed project. But being a practical organisation, it is working towards setting up a minimum corpus fund of 50 lakhs.

The Shanti Avedna Ashram is testimony to one man's conviction that it is better to light one candle than to curse the darkness. It was a dream nurtured in faith and kept alive by a burning desire to give back to others something that had so amply been given him.

Today, the Shanti Avedna Ashram has two branches, one in Goa and another in Delhi. That night, as I walked away from the ashram, knowing that the two people I had seen in the throes of death would be no more by night's end, I fully understood the wisdom in a quote I'd heard not long ago:

"...Every man's death diminishes me
For I am part of mankind.
Therefore ask not for whom the bells toll
They toll, my brother, for thee ..."