Few regions in India can boast a history of both cultural and material wealth like Bihar. From the Magadha Empire of Ashoka and the great territories of the Guptas, shaped by the teachings of the Buddha and Mahavira, to the crucible in which Gandhi carried out some of his most consequential experiments, Bihar tells a fascinating story. But few places were brought as low as Bihar by the ruthless exploitation of the British, who destroyed its cultural and economic backbone, clearing its forests, killing its traditional agriculture, and uprooting home-grown ways of living and thriving in the land fed by the mighty Ganga. Add to this deadly mix the violence and disruption of Partition, with millions of refugees streaming in from Bengal and even from West Pakistan, and you have a picture of a truly blighted land. Anarchy is a word that comes to mind.
A small group of American Jesuits were active in Bihar near a village called Mokama in the early 1940s. It was situated by the banks of the Ganga and not far from a railway line. Criminal gangs of Bhumihars had filled the vacuum the fleeing British had left, and the Delhi-based government was a rumour few took seriously at the time. Fishing for souls in these murky waters, the Jesuits hit upon the idea of setting up a hospital. They contacted fellow Christians back home, and thus, the idea of a hospital in the Bihar badlands took shape.
Thottam tells this story with the meticulousness of a seasoned reporter. But such is her care in filling out the details, particularly with regard to background information, that she has achieved what only the best journalism achieves – a work of lasting value, one that is a work of history, not just reportage.
The Jesuit priests who originally came up with the idea of setting up a hospital in Mokama were clearly motivated by missionary zeal. They assumed that once such a setup was in place and began serving the people of the locality, they, the priests, would be seen as god-sends, people who provided the kind of succour that no one else could deliver. Then, they reckoned, it would be easier to convert not just a few people attracted to Christianity, but whole families and clans, perhaps entire castes.
Groups of people around Mokama, they realised, often acted together. The Jesuit priests were assiduous in courting the locals. They would appeal, cajole, nudge, and make offers to every group to get them to be part of their mission—from the poor, who benefited most, to the rather snooty landlords, whose vanity the priests targeted with success.
They persuaded a convent in Louisville, Kentucky, to extend their charity work to India. Six missionary nuns, also trained nurses, sailed to India with all the equipment needed to establish an American-style hospital. Setting up the hospital was the most formidable of tasks. But the missionary zeal and the work ethic the nuns brought with them enabled them to overcome every obstacle, from the lack of a good building to the shortage of doctors and nurses. A big problem was finding good candidates for nurses or at least suitable girls who could be trained to be American-style nurses, with the same professional standards.
This is what brings together two of the most unlikely parts of the world — post-war Louisville and Palai, the small town at the heart of Christian Kerala. A network of priests, relatives, and friends helped eager girls from Kerala get to Mokama. Here, they coped with a harshness none of them had encountered before, from the severity of the climate to the austerity the American sisters imposed on all. Braving the extremes and the brutality of the conditions, the Kerala girls emerged as confident and able nurses, at ease with American standards of hospital care. The hospital, named Nazareth Hospital after the order of sisters from Louisville, never turned away anyone who walked through their front door looking for help.
The priests had tried everything they could think of to bring over new believers. But the repair of bodies and the soothing of minds took precedence over saving souls once the nuns took over.
What they did was to usher in a whole new way of treating ill health and disease. This was science-based. The sisters never compromised on this. They wanted the same standards they had witnessed in the nursing schools in Kentucky to be adopted here, from the organisation of the buildings and facilities to the treatments offered and the operating room procedures. This was revolutionary. As the nursing school they set up began to function, the same rigorous standards were applied there too. This brought about a sea change not just in Mokama but in the whole region. Little by little, a revolution in healthcare took root in Mokama and then spread out to encompass much of northern India.
From day one, the sisters innovated and adapted to stay abreast of the challenges Mokama threw up. A leprosy clinic was opened, and a disease feared and loathed in India was tackled with ease. A new drug had been discovered, and it cured what was once thought of as a curse or the effects of karma. The nuns even opened isolation wards on two small islands in the Ganga and put in place a practical solution to ensure that patients returned for regular doses of the drug that cured it.
Even when the challenges of keeping the hospital running appeared insurmountable, the sisters were looking for ways to expand and offer new facilities. Operation theaters, labs, specialties, radiation treatment, and so on were added with amazing regularity. People as dedicated as the sisters were found to run all the clinics and other departments. And, as Americans do so well, meticulous records of all these were maintained. The parent organisation in Kentucky archived everything, and Thottam’s book was made possible partly by her being able to access all the material and trace those still living whom she could interview.
Thottam includes sections on the state of Indian medicine that, at first sight, might not seem important. The most significant of these is the section on the role of Joseph William Bhore, an Indian Civil Service (ICS) officer who came out of retirement in England in 1943 to head a committee examining the state of public health in India. His meticulous collection of data and clear recommendations placed the burden of public health on the government. The report was forgotten in the imbroglio of World War II and the depredations of Partition, until then Prime Minister Jawaharlal Nehru used it as a model to lift Indian healthcare to world standards. Everything from setting up primary health centres to All India Institute Of Medical Sciences (AIIMS) was outlined in this report.
The sisters of Mokama were, unknown to themselves, doing what Bhore had recommended. The narrative is special for a unique reason: Thottam’s fidelity to describing a totally unglamorous world. She does not embellish, decorate, or exaggerate. There is no romanticisation. Instead, she is focused on the drabness and the dullness. The cleaning, the wiping, the washing, the removal of pus from a suppurating wound, the mending of a dress or shoe, the getting rid of lice, the stench and the filth that only the toughest of people could put up with—all are described with a coolness that is rare, commendable, and unselfconscious.
The sheer enormity of the task of running a hospital and a nursing school in rural Bihar is mind-numbingly dull. But Thottam is up to the challenge of describing it. And therein lies a very significant insight. The truly valuable work in keeping communities and civilisations going is done by the unglamorous, the unfashionable, and the unsung. Thottam’s world is not one that nods even once to celebrity culture or the deification of the rich. There is a steadfast refusal to hide facts, to call routine and drabness by any other name. It is, ironically, of heroic proportion. This is the world of the small woman doing big things by getting the smallest detail right — day in and day out, with little thought of rewards or returns.
Thottam is true to the first requirement of journalism: being honest. There is no striving for effect, no mirror anyone is holding up to admire themselves. This makes Sisters of Mokama an extraordinary and exemplary work.
Real-world heroes, actually heroines, stoical and Gandhian as they are, came with an unostentatious devotion and a not-for-display compassion more deeply rooted than contemporary culture would have us believe is possible.
Thottam’s narrative is detailed until about the mid-1960s, but she does extend her story to the Covid years. India and Bihar have changed enormously. A good number of hospitals now serve the area around Mokama. But those who are poor and helpless still knock on the doors of Nazareth Hospital, and the sisters keep up their tradition of quality service. A wellness centre, a counselling unit, and even an ayurvedic clinic have appeared in recent times. The sisters are keeping up with the Ayush Joneses but still providing good, evidence-based medical care.
Thottam’s mother’s story — Elsy, a fifteen-year-old who left Kerala to learn nursing and English — is mentioned only in passing. Elsy would later work in Delhi and then migrate to the United States, her nursing diploma taking her out of her village in Kerala to a place where she was respected for the work she did, not her birth into a certain circle.
Not everything is sweet and light. In Mokama, as everywhere else, all the ills that flesh is heir to—suspicion, jealousy, the hostility of local bone setters and other traditional healers, unrealistic expectations, minor issues among the staff (at one point, the Kerala sisters threaten to go on strike, leaving the American nuns flummoxed), even xenophobia—play a part in making things near-impossible to manage. A Bhumihar child, taken home against medical advice, dies, and a furious landowning sect sends goons to seek revenge. The sisters are forced to go to court. Eventually, they win the case, but the threat of violence and retribution was constant and morale-sapping. Thottam notes wryly that the sisters often got exasperated with the locals; with the poor because they preferred magic and faith healing to the treatment the hospital gave and often came to the sisters too late to make a difference; with the rich because they were stingy, mean, and ungrateful.
But the overall picture is not bleak. It is a sober look at how a set of determined and dedicated women could lift a community and a land up and transform a near-medieval place into a near-modern one. A number of subthemes light up the narrative: the role of English as a medium of communication and an agent of change; the need that even the dispossessed feel to break out of stifling traditions; the love for freedom and dignity that lies deep in all; the need for standards in professions; how cussedness and feelings of exceptionalism can appear where one least expects it; of exile and relocation; and, above all, how the ordinary can turn into the extraordinary when pushed by desperation and need.
In a sense, the book’s three themes are gods (the Christian god of the sisters, the various gods of their Indian patients), guns (not a day passes without the sisters treating some local for gunshot or stab wounds), and, of course, missionaries, who are central to the story. But this is a tale told with the equanimity of a historian, not the strident tone of an activist. This mini-epic is a valuable addition to a little-known but important category of books that one can enjoy and learn from at the same time — the literature of fact. It is a book to treasure.
‘Sisters of Mokama: The Pioneering Women who Brought Hope and Healing to India’ by Jyoti
Thottam is published by Viking, New York and is priced at Rs 899/
P Vijaya Kumar, a native of Thiruvananthapuram, is a retired lecturer.