Christian Hospital Taxila, Pakistan


This is a busy hospital

Six babies a day are being delivered in an obstetrics unit designed for two. It is for the treatment of eyes, though, that the hospital is internationally famous. Over the twenty years since 1969, the number of cataract operations performed has exceeded one hundred and twenty-five thousand. The annual total over that period has risen from just under sever thousand to thirteen thousand. The present Superintendent, Dr. Ernest Lall, and his wife Pramila have served there for more than forty years. Their work, carrying on an established tradition of focusing on the needs of the poor, has constantly struggled to keep costs within the reach of very poor people. Yet its standards are remarkably high and infections after surgery very rare. Taxila Hospital has been, in this year of writing, approved by the Government of Pakistan as an ophthalmic teaching hospital for the College of Physicians and Surgeons.
People come to it by bus and rail and on foot from the Frontier and from Afghanistan, from the hill states and territories of Dir, Gilgit, Chitral, Swat, Hazara and Hunza and from the hill Punjab even as far as the Sindh. Occasionally, people with Mongolian features from Kashgar and Sinkiang China will turn up. It is known as the “eye hospital” throughout mountain areas of the Karakorums and the Pamir Knot. Its charges to the patients are some of the lowest in the world, and it has no government subsidy. Friendly overseas organizations finance a continuous building program.
How did it all start?

The Sialkot Mission works in much of the northern area of' the Pun- jab drained by the three most westerly of the five rivers-the Jhelum, the Chenab and the Ravi. In addition, it works in areas drained by the Indus to the west of them.
At the end of the first world war, there was a searching reappraisal of the activities of the Mission. Mission reconds observe:
The Jhelum river marks the division between two mark- edly different types of work. To the west of the Jhelum lies considerably more than half our territory and we have only two occupied stations, Jhelum and Rawalpindi, in a predominantly Muslim area marked by roadless territory, inadequate forces and equipment. Only three percent of the people are literate.
The era is marked by:
hard times, the high cost of administration, debts of the mission board, restraints in expenditure that amount to retrenchment and a feverish rush to raise funds.
There is a call for more prayer for this field of mission, and the church at home in the States begins to respond. In 1920, the greatest number of new missionaries in any one year arrive-twenty-one. New funds begin to arrive.
The next year sees the move out westward from Rawalpindi along the Grand Trunk Road to Taxila, a railway junction about twenty miles nearer the Indus. The apostle Thomas is reputed to have preached the gospel here to King Gondophares. The Sialkot Mission has approved the location. A mile or so along the Grand Trunk Road, beyond the obelisk of Nicholson’s Monu- ment is an old caravansarai. Several furlongs to the northeast, just short of the ruins of a Buddhist civilization that flourished here in pre-Christian days, is the site selected. A mission hospital is to be established. The land--thirty acres-is bought from twenty-three different owners gathered together at the same place and time to receive their payments in silver rupees from Dr. Greg Martin.
About nine miles beyond the rail junction at Taxila is a junction of roads. Straight on northwestward is the Indus river crossing and then Peshawar and the Khyber. To the right is the road to Abbottabad, and beyond that city are the upper Indus valleys. Beyond the Indus, the road from the north---from Swat, Dir and Chitral- meets the Grand Trunk at Nowshera. Taxila is a stra- tegic location for roads to the roof of the world.
Inevitably, the early years mark the struggle to build up the hospital. The first major operation is performed in a tent.
The 1930s Depression leads to hard times for missions. The hospital needs to become and remain self -supporting. Special gifts from all over the world designated for the hospital’s work become a major source of addi- tional income, permitting the purchase of equipment and the construction of buildings. Missionary doctors are few, and there are not many Indian Chris- tian doctors yet available. Associates from other missions- Bergsma, Vroon and Karsgaard- help out.
In 1948, a young American general practitioner and his nurse wife who have been helping with refugee relief join the staff. Language and surgical skills grow together. They have a summer of language study in India under their belts but can hardly be fluent in communicating with patients who do not speak the language they have been learning. Medical school also nevertaught Norval what he now finds he’s needing in surgical skills. Like a hawk watching prey, he watches Andy Karsgaard as he operates, hoping he will forget nothing of what he is seeing. He is an apt student. His skills and repu- tation burgeon as the years pass. Andy leaves, and OA Brown pairs with Norval. Later, another brilliant surgeon, an Indian woman, Pramila Lall, joins Norval. By the time Norval becomes certified in 1968 as an ophthal- mologist, he is performing hundreds of operations weekly. Most of them are cataract surgeries, and his total so far is close to twenty-five thousand, less than a quarter of the final total when he retires in 1986.
Let another member of that early team, Marie herself, describe what happens at this remarkable medical establishment that she calls and continues through her life to consider home:

Spring and fall herald the eye season. When it is neither too hot nor too cold and the accompanying men folk are free from their urgent agricultural labors, thousands of patients flock to the hospital for cataract surgery. They come in battered buses, by train or by walking for many many miles. They are required to bring their own bedding and someone to care for them and cook their meals while they are at the hospital.
When the wards are full, beds are placed on verandahs and in tents, even under trees-anywhere a bed will fit. Latrine facilities are an almost impossible challenge to people, both relatives and patients, who are accustomed to the great outdoors and village customs. Cataract surgery, as it flows, deals with sixteen to twenty patients an hour. Lying on old fashioned operating tables in the clothes they arrived in, patients’ eyes are washed and their faces draped with sterile towels. The surgeons, Norval and Pramila, alternating surgery day-by-day, use the intra- capsular method to remove cataracts. With this procedure, the clouded lens and capsule surrounding it are removed together:
It used to be in the early days that we would try to immobilize the patient’s head to avoid an eye hemorrhage. They would be carried on stretchers back to the eye ward. However: their prayers of thankfulness would be accompanied by body and head motions in the Muslim fashion. To ou surprise, infection or hemorrhage was extremely rare, and now patients get off the operating table and their wait- ing relatives walk them back to their beds. Ken’s work on building the new operating theater begins at 7 a.m., but at 3:30 each morning, he joins us in the oper- ating theater to wash patient’s eyes and lift early morning patients on and off the tables until he has to leave when his construction crew arrive.
When Norval was fifteen, at New Wilmington Missionary conference in Pennsylvania, he committed himself to bc willing “to do anything the Lord wanted me to do.” Alter his retirement from Pakistan, he continued to serve the world’s blind in his role as an ophthalmic surgical consultant, making many trips to China to train eye surgeons.
If you know Him
In the wasteland seeking shelter
I cry for aid and stumble on,
I thirst for drink but can’t drink brine
And starve for bread but can't eat stone.

I am tired of all this teaching.
How can it ever make me whole?
I am tired of all this searching
It’s time for home but where to go?

Doctrines deaden, laws condemn me,
They bring no comfort in my need
They are buttresses around you
How can l know you cry like me?

Don't just serve me, come and love me
And put your arms right round me, friend.
Show me Jesus if you know Him
And if you do not, don't pretend.

Eye Patients at Taxila
I drop down from the steel frame of the operating block that we are erect- ing and wander over to the adjacent men’s eye ward. I stand outside among the relatives and others looking in as the doctor leads his entourage past the beds. There is no wall between what goes on within the ward and those of us outside. On cold nights, bamboo chicks (curtains) are unrollcd. The string beds are almost touching side by side, and the heads of the patients are toward the center aisle. Norval is approaching. With him is the nurse (today it is his wife Dorothy), another carrying charts and behind them oth- ers with drops and dressings for the patients' eyes and two others who do the re-bandaging.
There are abrupt pauses in the low murmur of conversation in half a dozen languages going on among the bystanders. The patients have brought their own bedding and food and a relative to care for them. For $10 they are getting an eye examination, a cataract operation and up to ten days stay at the hospital. Very occasionally, a patient from the other side of the Karakorums will stump the various linguists among the hospital staff. The relative will be called for and additional attempts made to communicate with the patient. Almost all of the patients are at various stages of recovery from eye surgery – cataract extractions, most of them. Dr. Norval examines the eye for signs of infection or inflammation and notes the progress of healing. Dorothy gives information from the patient’s chart and awaits to write an additional doctor’s comment.
The doctor lifts his hand in front of the patient, and all fall silent. The routine is well known. Everyone waits to hear. You can hear a pin drop. This is a precious moment, repeated hundreds of times during the morning rounds, when suddenly you realize what the words “a common humanity” mean. You are meeting it face to face; that you are Christian and white and they are Muslim and brown has suddenly become irrelevant.
You quickly look round. Pathans and Afghans, Punjabis and Hazaras rich and poor, men and women, literate and illiterate, old and young – you are an unnoticeable part of a merged cluster that has lost individual identity;. All are listening as if the only thing in the world they, and you, want and need to hear is the right answer to the question that confused old Swati from beyond Kalam is trying to articulate. You suddenly realize you have a lump in your throat, and your own eyes are watering. “Come on, Baba; you can see, you can see. Try a little harder, you can see!”
Everyone who stands around is silently willing the old man on. Is matters not that they have never been anywhere near where he has come from or that he speaks a different language, that before a moment or so previously, they didn’t know he existed. He is everyone’s father, son, brother, husband. He has to see. “Come on Baba, you can do it, please! Please, God, let him see!”
Norval is holding up three fingers a couple of feet or so from the old man’s face. His other hand covers the good eye so that it cannot assist. “How many fingers can you see, Babaji?” His voice is kindly and patient. He may have several hundred to see, but for this old man, as for all of the others, he has just now all the time in the world.
This old man has perhaps walker several days, leaning on his stick or the shoulder of his son until he gets eventually past the landslide to Bahrein and the then the series of buses to Mingora and Malakand and Mardan and Nowshera and then by train to Taxila. He has never seen a train before, but he has heard about trains from others; and his son is with him and reassures him. They have waited until the harvest is in and his son is free to accompany him.
Back home in the hills, across the Indus and to the north, his wife, almost as blind as he, waits and prays. If it works fro him – this immense journey – he has promised to take her also to Taxila and give her the same opportunity that he is getting to see once more. He’ll try it out first, and then it will be her turn.
You take another quick look around you. The others are also holding their breath, almost as though they are afraid to exhale lest they disturb the old man’s concentration. The old man has not seen through this eye for years. He is having a little difficulty. Through the blurriness, he can see something. He blinks to try to clear his vision, but his eye has no lens. There is something there, moving slowly, waving in front of him like twigs in a light breeze. He ventures an answer, uncertainly. “Three?”
“Shabash, Babaji, very good, now once more. How many this time?”
He is no more sure than previously.
The collective sigh of relief tells the old man what he needs to know—he has passed the test. Soon, with a green bandage over his eye held in place by steel-rimmed, thick-lensed cataract glasses, he’ll be on that train going back to Nowshera. For scores of miles around, cataract patients bound for or leaving from Taxila can be recognized instantly by those who know. Norval moves on and his circus follows him.
The crowds are no longer strangers. We look around, congratulating each other and the old man by our relieved smiles, but fall silent almost immediately as once more, at the head of different bed, Norval raises his hand, sticks out figers, and asks a question.

It is Sunday morning. We are in chapel. Padri Anwar Allah Rasi is preaching and is in the middle of his sermon. The chapel is full, for most of the staff of the hospital are Christian. The door to the outside, at the opposite end to the pulpit, has been left open. There is a stir in the congregation. Our heads turn. Standing in the doorway is a Pathan tribesman wearing his distinctive puggree headgear and a purple waistcoat. It is apparent at once he has not come to create disruption or exercise violence. He is wearing no bandolier of bullets. In his lefthand, held by the two feet, is a live chicken. The pastor’s voice trails off into silence.
The visitor walks forward with long strides and steady tread until he is immediately below where the pastor stands. He is completely relaxed and assured in an alien environment. No one else moves. Not a word is being uttered by anyone now that the pastor is silent. The stranger stretches out his hand towards the pastor. The chicken flutters its wings and looks around anxiously. The pastor responds and takes the chicken from the visitor. The visitor turns on his heel and without a word, walks back down the aisle of church, does not look back, and is gone. An elder comes forward and enables the pastor to continue with his sermon as if there has been no occasion for a break in it. There is no need for words. They are superfluous. This particular Muslim has wanted to say and has said publicly to the Christians in Taxila, “You have a different faith than mine, but thanks you for your service to a member of my family. I am grateful.”

The full total of cataract surgeries at this quiet little hospital, from its tiny beginnings in 1922 o this year of 2005, is 400,000, and they are only part of the total surgical load. The single constraining principle behind it all is the compassion of Christ for those in need.

Text corrected on Feed Back From Mr. Tim Old (

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