Why a doctor couple gave up their lives in Tamil Nadu for a poor, tribal settlement in Assam

In 1993, a young doctor couple landed in Assam’s Karimganj district, leaving behind a comfortable life in urban Tamil Nadu, only to find a decrepit, run-down establishment in a place beset by poverty, illiteracy and multiple socio-economic issues.

Electricity was a dim flicker and running water a luxury at the Makunda Christian Leprosy and General Hospital in Karimganj that Dr Vijay Anand Ismavel and Dr Ann had chosen to be their home for the next three decades.

In their twenties back in the early 1990s, the practising doctors had success, money and the means to live a contented life. The two, however, ached to leave the city realising that their skills were required to not just save lives, but to also transform them.

Their quest to bring about a transformational change landed them at the doors of the Makunda Hospital that catered mostly to a tribal population.

The issues that stood in their way were not just logistical. The Ismavels also faced rebellious staff, encroachers and the lack of general patients as the hospital back then had just 60 leprosy patients.

The couple would have found the task more difficult than it already was, had help not come in from Delhi-based Emmanuel Hospital Association. It was, in fact, the Association which paved the way for the Ismavels to follow their heart’s bidding to serve the marginalised living in far-flung neglected areas with little to no medical facilities.

“We were looking for a place where we would be able to have the greatest transformational impact,” says Dr Vijay.

This is what led them to Makunda, a leprosy hospital started by the American Baptist Mid-Mission in the 1950s. Lack of doctors, shortage of means and money, however, forced the hospital to shut down in the early 1980s.

A new beginning

The Association wanted to revive the hospital, which was shut for 10 years, under a 30-year plan and turn it into one of the most sought-after destinations for high-quality and affordable medical care in Northeast India.

The project was envisaged when the Emmanuel Hospital Association was approached to make Makunda Christian Leprosy and General Hospital one of its members. The Association, however, wanted to send in a doctor or a doctor couple who would stay the course to ‘bring about the transformation’.

“We were asked whether we would stay until retirement,” says Dr Vijay, who retired in January 2022.

A full 30 years after Dr Vijay and Dr Ann undertook the work, Makunda Christian Leprosy and General Hospital is a 200-bed facility with dedicated departments of surgery, anaesthesia, medicine, paediatrics, obstetrics, orthopaedics and psychiatry. In 2019, the year before Covid struck, the hospital saw 1,26,382 outpatients, admitted 15,297 inpatients, performed 8,710 surgeries and conducted 6,750 deliveries.

“We were moving from relatively comfortable lives in urban Tamil Nadu to a difficult life in rural Northeast India,” he says.

“A senior doctor I had earlier visited in Maharashtra saw Makunda and suggested that we visit the place. They wanted us to give a nearly 30-year commitment (till I was 58) and we agreed,” he says.

Once in Karimganj, the couple knew they had no time to lose. They had 30 years at hand but the enormity of the work needed them to move fast.

Together with the Emmanuel Hospital Association, the Ismavels prepared a plan using SWOT (strengths, weaknesses, opportunities, and threats) analysis, problem statements and individual plans for each issue they identified.

They came up with a three-phased plan, each 10 years long. The first phase involved making the hospital self-sustainable, resolving local issues, introducing an ethics-based work model, and studying the area in the vicinity of the hospital and Northeast at large to formulate the plan for the next phase.

Since the project was always aimed at helping those most in need, a number of innovations were introduced to ensure the hospital catered to the poor.

The Ismavels spent the first few years in community observations and solving local problems to create stability in the area.

Based on the surveys conducted in the first phase, three projects were identified for phase 2.

“We wanted to develop these projects and make them self-sustaining before we retired so that they would not be a burden for the team that took over from us,” he says.

Once the couple had put in place a plan that could thrive on its own, they began to prepare for a handover.

“We started handing over the work at Makunda to the next set of leaders in 2017. Second and third line leaders were also groomed. In 2021, Dr Nalli Chandan MS (Ortho) took over as the hospital’s medical superintendent and CEO. We have completed our commitment to the hospital and I have joined CMC Vellore as Missions Network Consultant. I am now able to help many mission hospitals across India. Ann will also join me at CMC later this year,” Dr Vijay says.

Looking back, Dr Vijay recounts the travails he faced along with his partner when the two set off on the mission to give lives a healing touch.

“Life was not easy in the early days and we faced numerous problems. I had a heart attack and developed leprosy because of coming in contact with the patients that we were treating at that time. Subsequently, I had reactions and drug-related problems. The locals who were eyeing the hospital land also created a lot of problems with false cases and an assault on me,” he says.

For 14 years, the couple struggled to provide electricity to staff quarters, including their own.

“However, we remember all these only as temporary trivial inconveniences because we have been privileged to see so much transformation at Makunda,” says the doctor who not just pursued his passion in medical science but also in wildlife during his stay in Assam.

A citizen scientist

While working as a full-time paediatric surgeon and CEO of the hospital, Dr Vijay also played a citizen scientist and managed to dedicate time to the biodiversity documentation, field and research works.

He, in fact, discovered a new species of ghost moth from Assam, which represents the first new species of Endoclita described for India in the last 60 years. And, going by his dedication for his work, Dr Vijay Anand named the new moth species as Endoclita Makundae, after the hospital where the moth was found.

His interest in wildlife had a rather interesting, albeit different origin. “In October 2008, at the age of 44, I had a heart attack at the Makunda Christian Leprosy and General Hospital. Following this, I was asked to go for daily morning walks to keep myself physically fit. As I walked through our campus, I developed an interest in the wildlife spread over the 350-acre forested campus. Although I had been living and working there since 1993, I was looking at things with a fresh perspective – filled with curiosity and wonder at what I was seeing,” he says in his blog.

And the wonder in his eyes for the place and his work isn’t over yet. “The pressure on doctors nowadays is to ‘succeed’ in the worldly sense. This forces them to just complete their education and focus on earning well. The mad race prevents them from considering alternative careers like working among the poor and in remote parts of the country. This is where the real needs of the country are and many young people miss out on these opportunities.”

Despite various inconveniences, Dr Vijay Anand adds, one’s life is full of excitement if it leads to a positive transformation for others.