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When Covid spread from urban centres to the villages of India, the country’s healthcare systems were challenged and confused. Owing to fear and uncertainty about managing within such contexts, many private healthcare providers closed their facilities. Government-run systems, which were overwhelmed and challenged even before the pandemic, struggled to respond to increasing numbers of patients. Christian mission hospitals across rural and urban India have been the most reliable frontline during Covid. We found that their leaders have been effective in guiding their people to address the different challenges they face daily.

Christian mission hospitals, referred to simply as mission hospitals, are at the frontline of healthcare wherever they are. They are the first and often only point of access to healthcare for their communities. We found that about 90 per cent of the network, comprising 273 mission institutions across India under the umbrella of the Christian Medical Association of India (CMAI), continues to provide effective and compassionate care even now.

We learnt this through our conversations with the CEOs of 165 mission hospitals. Amid uncertain and complex contexts, we heard and saw them lead their institutions through daily challenges using these five leadership principles.

Leading from vulnerability and brokenness

First, they amplified their relevance in a broken environment. The pandemic brought uncertainty about the future to an already vulnerable network serving the poor and marginalised in remote parts of India with limited resources and inadequate manpower. In this already vulnerable and broken context, increasing infections among the community as well as staff caused fear and panic.

But, based on their previous experiences of being in challenging contexts, they knew where to turn. They looked within their institution, staff and community for pre-existing strengths and added to them by gathering knowledge from various sources and training their staff in-house, thus gaining their confidence and support. They mended broken systems beyond their own sphere, mobilising resources to provide food, support and other necessities to communities of migrants coming back from locked-down cities. As they filled the gap left by closed-up private setups and supported the government in every way possible, they reinforced the reason for being where they were.

They recognised the many harassed and helpless among their community and were moved by a compassion which was shown by Jesus himself: ‘When he saw the crowds, he had compassion on them, because they were harassed and helpless, like sheep without a shepherd.’ (Matthew 9:36)

But, like Paul, they also recognised that it is God who gives the ability to care for others in spite of brokenness and vulnerability. ‘… We have this treasure in jars of clay to show that this all-surpassing power is from God and not from us.’ (2 Corinthians 4:7)

Leading with dependence and interdependence

Second, in order to achieve their greater purpose, they role-modelled a giving-up of self and a holding of hands. Led by their own vulnerability and brokenness, they became dependent and interdependent leaders. They first depended on God even more than before, prioritising prayer and worship times within their communities, thus gaining stability in unstable times. Then they reached out to the government, local and regional mission hospital networks, other NGOs and corporate agencies to both give and receive support. Many of them were used to working alone and in their silos and had to learn to create synergy by holding hands with others. This interdependence proved to be a stronger and more synergised model for appropriate, timely and affordable healthcare delivery.

In this way, they lived out the love of the kingdom community as commanded by Jesus: ‘By this everyone will know that you are my disciples if you love one another.’ (John 13:35) They tried to follow the footsteps of their master who role-modelled self-giving. ‘… Have the same mindset as Christ Jesus: Who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death – even death on a cross.’ (Philippians 2:5-8)

Leading by innovating, adapting and improvising

Third, they adapted their own systems to accommodate Covid-19 protocols. Hospital staff used the lull of the lockdown period prior to the full storm of the pandemic to prepare their own PPE, innovate cost-effective techniques for sterilisation and prevent the spread of the virus. They set aside time to engage with staff and innovate ways to keep them motivated. This prevented discouragement and anxiety. Among the wonderful innovations we saw in our network were PPEs made out of raincoats, thousands of masks for staff and community made by mask-stitching communities, masks and gowns stitched by church groups, intubation protection shields made out of baby incubators, face protection made out of plastic water cans and so on.

These creative innovations were an expression of the image of God. ‘Then God said, “Let us make mankind in our image, in our likeness, so that they may rule over the fish in the sea and the birds in the sky, over the livestock and all the wild animals, and over all the creatures that move along the ground.” So God created mankind in his own image, in the image of God he created them …’ (Genesis 1:26-27)

Leading with tenacity and a long-term perspective

Fourth, they developed a long-term response and perspective even while living in the realities of the present. The leadership had by now recognised that the coronavirus pandemic would be around for a long time. So, they started preparing each other for a marathon. They looked ahead and prepared for the long haul, setting up systems and teams to ensure that Covid and non-Covid systems could be housed within the same institution. When many private and state systems were not even willing to open their doors, mission hospitals and their leaders were preparing for the long journey onward, not reacting to the situation but responding with relevant strategies out of reflective thinking and planning.

As Jeremiah told the Israelites exiled in Babylon: ‘Build houses and settle down; plant gardens and eat what they produce. Marry and have sons and daughters; find wives for your sons and give your daughters in marriage, so that they too may have sons and daughters. Increase in number there, do not decrease. Also, seek the peace and prosperity of the city to which I have carried you in exile. Pray to the Lord for it, because if it prospers, you too will prosper.’ (Jeremiah 29:5-7)

Agile leadership amid Volatility, Uncertainty, Complexity and Ambiguity (VUCA)

Lastly, they took the challenge of Volatility, Uncertainty, Complexity and Ambiguity (VUCA) head on. The environment around them was dynamic and change was everywhere. Management protocols were changing frequently, expectations from stakeholders were changing every other day, government reporting formats were changing frequently, testing algorithms were being refined every week and many key staff were being infected. Many young and not-so-young leaders surveyed the regions, understood the felt need and made meticulous plans with proper knowledge and protocols in order to fit those needs. At the same time, they were agile and dynamic, aligning and realigning systems to the fast-changing contexts and their expectations.

They recognised that like Esther they were where they were for ‘such a time as this’! (Esther 4:14)

Relevant to the context and agile, the foundations of our leaders were:

  • A deep sense of surety that the sovereign Lord controls not just the past, but also the present and the future.
  • An ability to learn from the stories and experiences of the past, to hold on with tenacity in the present and look ahead with confidence to a future – all held by God.
  • An understanding that their mandate for the present is to support and engage with each other effectively.

Being led as triumphant captives, they are spreading the fragrance of the knowledge of Christ. (2 Corinthians 2:14)

Dr Priya John is General Secretary of the Christian Medical Association of India (CMAI) and Dr Santhosh Mathew is Regional Secretary for ICMDA’s South Asia region.

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