Legacy of Health and Caregiving Institutions

Law and Christian Witness

The Legacy of Health and Caregiving Institutions

John Amalraj K

Published in ‘Christian Manager’ Feb-Mar 2019

An unbelieving Greek writer Lucian who lived in the second century (120-200 AD) wrote that ‘It is incredible to see the fervour with which the people of that religion help each other in their wants. They spare nothing. Their first legislator (Jesus) has put it in to their heads that they are brethren’. What a beautiful description of the Christians by an unbeliever. Tertullian, one of the early Church fathers, during the same period writes, ‘It is our care for the helpless, our practice of loving kindness that brands us in the eyes of many of our opponents. Look (they say) how they love one another, look how they are prepared to die for one another’. This is our faith legacy.

Matthew records that when Jesus saw a large crowd, He was moved with compassion – the people were harassed, distressed, helpless and dispirited like sheep without a shepherd (Mt 14:13-21). Moved with compassion, He preached and taught, fed the hungry, healed the blind, lepers, raised the dead and cast out demons. Jesus broke the religious mould and traditions in the Jewish society by reaching out to the outcasts – doing good and healing all who were under the power of the devil. (Acts 10:38)

Luke describing the community life of the early Christian believers says, there were no needy persons among them (4:34). The early Christian believers made a special effort to care for those who fell through the cracks of society — widows and orphans. In the patriarchal society of Rome, women without husbands were often forced into poverty. The apostles were engrossed into the ministry of caring for the widows although it triggered a crisis which the leadership handled well to institute the ministry of deacons into the church (Acts 6). In Joppa, there was a disciple named Tabitha (Dorcas in Greek); she was always doing good and helping the poor. Peter raised her back to life so that she could continue the ministry of compassion to the needy (9:36-42). This ministry was built on the scriptural foundations of God’s concern for the poor, the stranger, and others whom society had forgotten or simply ignored.

Movement Vs Institutions

The compassionate ministry of Jesus and that of the disciples flourished outside the existing Jewish religious institutions. It was a movement not an institution. It was after more than three centuries that institutions came into being. Institutions often fail in its purpose or decline in its impact over the years. Movements continue to grow beyond institutions. Our loyalty ultimately should be to the call of God than merely to institutions. Institutions do not always accomplish God’s plan. It is the people of God who use institutions as an instrument to accomplish God’s greater purposes. The promise of a new heaven and a new earth helps us to diminish our unnecessary concern for creating and maintaining existing institutions and organisations just for the sake of it. Rather, our priority should be to focus on building strong faith communities within institutional structures and not the other way round. This will enable us to continue our ministry with or without an institutional structure.

Impact of Christian Institutions in India

It is a well known fact that Christian institutions in the field of education, health care, community care and social welfare have significantly contributed to the building of the nation as we see it today. Indian political leaders from the time of Independence have openly acknowledged with gratitude the contribution of the Indian Christian community through its institutions. The origin of Christian institutions in India has a legacy that goes back to the times of the western missionaries.

RL Rawat, in his History of Indian Education, suggests that India will forever be indebted to the missionaries for the production of textbooks, dictionaries, and grammar books, and for their zealous pursuit of educational advancement. The Jesuits followed by the protestant missionaries like Ziegenbalg, Carey, Swartz, Wilson and Alexander Duff established formal schools for Indian boys. Later, schools for girls were opened by the wives of missionaries and hundreds of single women missionaries across the country. Soon post secondary higher education institutions were founded, including universities run by the governments. These educational institutions played an important role in producing Indian leadership for the Independence movement and eventually for post-independence governance. Christian teachers have set a high standard of discipline that is valued by the society. Today, Christian educational institutions still attract students from all faith.

Health care is another field where institutions were set up by missionaries around the country. Institutions from primary health care clinics to advanced medical care and education were first established by Christian missionaries. Ida Scudder who founded roadside clinics went on to establish two institutions – Christian Medical College and Hospitals – that continue to excel in health care. Church of South India, Church of North India, Methodist Church of India and other major denominations now manage many hospitals across the country. Emmanuel Hospital Association with a network of 20 hospitals and 42 community development projects in North and Central India serves in remote rural areas giving health care for the poor and marginalised. Christian Medical Association of India networks more than 350 mission hospitals across the country along with 12000 health care professionals. Christian mission hospitals are still the first choice for the poor masses. Christian doctors, nurses and other paramedics have become role models in the health care sector.

Caregiving institutions like orphanages, homes, rehabilitation centres is another field where Christian missionaries have pioneered. The Dohnavur Fellowship instituted by Amy Carmichael to run an orphanage in Tamil Nadu and a home for the abandoned, orphaned girls and widows in Maharashtra by Pandita Ramabai, have few comparisons. The Sharp Memorial School for the Blind in Dehradun is a pioneer along with the Schools for the deaf and dumb in many other parts of the country. Sanatoriums for those suffering with tuberculosis, leprosy and their rehabilitation are another area where Christian missionaries have pioneered to set up institutions. Missionaries of Charities founded by Mother Teresa has left an impression on the Indian mind for showing the compassion of Christ to orphans and the dying persons on the streets of Kolkata. Today, caregiving institutions have gone beyond to rescuing and rehabilitating commercial sex workers, caring for victims of AIDS, polio, substance abuse, and others diseases. The compassion that is shown by Christians has broken the age-old religious superstitions that discriminated and exploited the voiceless population who often suffer in silent.

Social reform has been another major area where Christian missionaries laboured hard specially with regard to abolishing of the practice of Sati, temple prostitution and the upliftment of the untouchables, dalits and tribals. Institutions in the form of mission compounds were set up exclusively to rehabilitate the abused women and men. Although there were successes in enacting laws for such social reforms – the battle on the deep-rooted caste system is yet to be won. Today advocacy for abolishing child labour, bonded labour, human trafficking and controlling corruption and environmental concerns, etc., are led by many individual Christians and few mission agencies and institutions.

Mandatory Registrations for Institutions

All schools, colleges, vocational training centres, orphanages, rehabilitation centres, homes, clinics and hospitals have to seek appropriate registrations. There are several authorities such as the State Education Board, Central Board of Secondary Education (CBSE), Council for Indian School Certificate Examinations (CISCE), All India Council for Technical Education (AICTE), University Grants Commission (UGC), the Bar Council of India (BCI), the Distance Education Council (DEC), the Dental Council of India (DCI), the Indian Nursing Council (INC), the Medical Council of India (MCI), the National Council for Teacher Education (NCTE), the Pharmacy Council of India (PCI), Ministry of Health & Family Welfare (Clinical Establishment – Registration and Regulation Act, 1910), Ministry of Women and Child Development for all Child Care institutions and adoption units (Juvenile Justice Act 2016), Child Welfare Committees, Social Welfare Departments, Rehabilitation Council of India (RCI), Shops and Establishments Acts, etc. A society registration or a trust registration alone is not sufficient. If an institution is run without registration, the government is obliged to take action. There are now mandatory inspections and registration renewals for all institutions.

All registrations require basic infrastructure in terms of buildings, furniture, equipments and professionally trained staff. For example, setting up of a hospital, clinic, diagnostic centre, etc., requires land, building, furniture, medical equipments and instruments, computers and above all certified medical professionals. Every department in a hospital needs to adhere to various government regulations and obtain certifications. If one wants to set up a rehabilitation home, orphanage, half way home for substance abuse victims, rescue centres for human trafficking victims, etc., they all require licenses and certifications under various laws and multiple government departments. The risk of running unregistered ‘clinic or home’ may cause the government to take criminal action under the various laws. Medical camps organised in rural areas also require permission from appropriate authorities.

Governance

The challenge of governance in Christian institutions is beginning to affect our witness in the society. Many historical educational institutions especially in large cities have become ‘elite’ institutions that generate money for the affiliating church denominations or other institutions. They have lost their original vision of providing education for the poor. At the same time, due to inadequate governance, health care institutions and other caregiving institutions suffer from lack of finances to maintain their basic services to the community around them.

Multiple Models

There are many approaches to governance. When an institution is founded – the founders and his or her close associates assume the governance role along with the management functions. However as the institution grows, a need for a formal governance structure is realised. There are multiple models of governance for ‘not for profit’ institutions. Jeremy Barlow in his blog lists the following: Advisory Boards, Patron Boards, Cooperative Boards, Management team model and Policy Board. (https://www.boardeffect.com/blog/board-governance-models-a-comprehensive-list/)

Governance boards are formed traditionally as a representative of major stakeholders like large donors, founding church leadership or other agencies and those who are involved in the management of the institutions. There is often a power struggle in the governance of institutions as there is no clarity as to the role of the board. Many of the institutions are now moving towards the policy governance model as advocated by John Carver. It has its limitations for a Christian ‘non-profit’ institution as it is likely to distance the board from the management artificially. The relationship based governance as advocated by Dr Les Stahlke is a more balanced approach (www.relationshipmodel.com). Dr Stahlke states that ‘an organisation is like a tree and a healthy tree bears healthy fruit’. Governance as required by the Societies Registration Act 1860 and The Indian Trusts Act, 1882 provide very basic structures to ensure the minimum compliance required under these laws. However, the Maharashtra Public Trusts Act, 1950, Gujarat Public Trust Act, 1950 and Rajasthan Public Trust Act, 1959 provide for Charity Commissioners who exercise quasi-judicial functions to regulate the management of all societies and trusts in their states. Christian institutions must go beyond what the law requires in terms of governance and management. A governance manual describing the role, powers and functions of the Boards and the chief functionary and their relationships must be adopted by every institution. The vision, mission, values and the expected outcomes of the institution must also be adopted as part of the manual. These can be reviewed periodically. The most important part of the governance is to distinguish governance issues from day to day management issues. A board normally should not interfere with the day to day affairs, but set policies and boundaries of authorities for the staff to implement. This will enable best practices in governance of institutions and will help to maintain the Christian witness in a changing context.

 

Management

Managing educational, health care and other caregiving institutions is no longer a simple task. Legal compliances with regard to physical infrastructure facilities, equipments and the employees have to be followed strictly. Day to day administration of these institutions takes away a lot of energy and often compliance deadlines are overlooked. In the long term, these lapses by staff can land an institution into deep trouble with the registration and licensing authorities. The penalties and consequences are serious. Management must come up with systems and periodic audits to ensure all compliances are complied by the institution. Audits should not be restricted to finances but extend to other facilities, equipments and employees.

Working Hours

It is a typical Indian mindset that working for long hours means that an employee is quite hard working and has more than 100 percent commitment. The other perspective is that an employee who regularly sits late in the office does not know to manage time. The Indian culture of being relational means that during the working hours there is a lot of conversation that takes place among the staff that are not work related.  In fact there is more socialisation that happens in the workplace even though it is good in one sense it may not be healthy for an institution. This affects the productivity as compared to a commercial establishment like a factory where the supervision and accountability of time is very high. Often workers are not aware of the vision and mission of the institution. The casual workers (unskilled manual workers) in an institution often are the ones who do not see their role in fulfilling the larger vision of the institution. Vision, mission and values are good motivators across all sections of employees in an institution. The senior management must take the initiative to communicate and motivate the lower level staff.  Outsourcing some of the non-critical activities in an institution to contractors following due diligence and compliance improves productivity.

Care for the Caregivers

The role of teachers, doctors, nurses, paramedics, counselors, wardens, matrons and social workers are energy sapping both physically and emotionally, since they function as the caregivers in an institution. They end up bearing the primary load of the ‘mission’ of the institution because they understand the vision and are expected to work towards the same. The other employees who function in a supporting role seldom share the vision. They end up to work to earn their living and care for their own families. Those who carry the load eventually are affected by ‘compassion fatigue’ that undermines their performance in the workplace and also the quality of life in their homes. Ensuring that all employees utilise the legally mandated weekly off, holidays and paid leaves will go a long way in preventive care. Organising spiritual retreats, in-house training sessions and prayer fellowships help to care for needs that may not be voiced.

Sabbath Rest

Employees in Christian institutions who function as primary caregivers need a sabbatical leave once every six years. Christian Institutions often ignore the Sabbath rest mandate because of the compulsion of the ministry needs. Matthew Sleeth, an emergency room doctor, hospital chief and emergency services director in the US has authored the book, 24/6 - A Prescription for a Healthier, Happier Life. He describes our symptoms, clarifies the signs, diagnoses the illness, and lays out a simple plan for living a healthier, more God-centred life in a digitally-dazed, always on world. He calls the Church to recapture the gift of Sabbath as a weekly reminder of the joyful reign of God in the midst of a broken world. Being a workaholic sounds very spiritual or highly committed to the task but it mars God’s design for life. Christian institutions need to heed this call to revive the Sabbath rest to care for the caregivers.

Financial Resources

Financial resource is another issue in managing institutions. Legal compliance to Income Tax Act and Foreign Contribution Regulation Act in a timely manner is required. Christian institutions are not profit centres. All the institutions come under charitable status and therefore any excess of income over expenses which in commercial establishment may be considered as ‘profit’ will be considered as ‘surplus’. This surplus can be utilised only for the objectives of the institution that benefit the larger community and not for the benefit of the board members, society members, trustees or even employees and staff. The ‘surplus’ cannot be donated to other societies or trusts. Financial systems that inculcate transparency in all transactions, accountability at every level and efficient budget controls are essential to the survival of an institution. Charges are for services rendered in the form of fees is an important source of revenue for educational and health care institutions. However, other caregiving institutions like orphanages, rescue centres will primarily operate by providing free services. Fundraising for infrastructures like buildings, furniture and equipment is a necessity to maintain the service of the institution.  We need to make ends meet and run our institutions efficiently with the income we can generate through our services without compromising our mission of serving the poor and marginalized.

Charitable Status

Any institution created for the advancement of education, promotion of public health, relief of poverty, etc. regarded as charitable in law is considered as a public charitable trust whether they are registered as a society, trust or even as a not for profit company. Though it doesn’t have a definition of its own, public charitable trust must be created for the benefit of the public. All health care and community care institutions can register for charitable status under the Income Tax Act through their registered society or trust provided these are part of the objectives in the memorandum of association or trust deed.

To look into what laws apply to public charitable trusts in India, we need to understand what charitable purpose means. Under Section 2(15) of The Income Tax Act expression of, charitable purpose is in an inclusive manner. Charitable purpose under Section 2(15) of the Income Tax Act includes relief for the poor, education, medical relief and the advancement of any other object of general public utility. The aforesaid definition is not exhaustive and therefore, purpose similar to the purposes mentioned in the aforesaid definition will also constitute charitable purpose. The charitable activities must be for the benefit of a community or a section of the community and not for individuals. It is also important that the constitution of the institution must provide for these activities in their aims and objectives. Only public religious trusts and societies can claim exemptions from income tax.

Responding to Public Opinion

Many years ago, in an interview with Kushwant Singh, RSS Leader MS Golwalkar said, ‘We have nothing against the Christians except their methods of gaining converts. When they give medicines to the sick or bread to the hungry, they should not exploit the situation by propagating their religion to those people.’ (Khushwant Singh, Ed., Mala Dayal, Me, The Jokerman: Enthusiasms, Rants & Obsessions, New Delhi: Aleph Book Company, 2016).

The recent political atmosphere of religious and communal polarisation has attributed motives to the management of Christian institutions. The mischievous false allegation that Christian institutions established for charitable activities are used for ‘conversion’ to Christianity must be opposed through our continued ‘good works’ showing God’s compassion.

The Indian context has seen many changes in the running of institutions. Commercial profit oriented educational institutions, health care providers and care givers with huge private investment stand in direct competition to our calling to serve with compassion. Our unique selling point (USP) is our brand of love and compassionate service.  Christian institutions serve a greater purpose. It is to show God’s love to the world through our acts of kindness, deliverance, forgiveness, restoration and healing for those who are marginalised in the society.

John Amalraj served as staff with India Missions Association (1993-2005) and Interserve India (2006-2017). Presently as a mission field Partner of Interserve, he is involved in mobilising churches for missions, mentoring leaders, enabling strategic thinking and envisioning Christ’s disciples to witness in the marketplace. John is married to Jessie who serves as an English Language trainer. They are blessed with two sons, Jason (26) and Joash (17).

The earlier articles published in Christian Manager on this series: ‘Law and Christian Witness’ are: “What Is Our Vehicle for Ministry” - April-May 2018, “Why Must We Pay Taxes?” - June-July 2018, “Why Do We Need Labour Laws?” - Aug-Sept 2018, “Asserting Our Constitutional Rights” - Oct-Nov 2018, “The Legacy of Educational Institutions” - Dec ’18-Jan ’19.