|HISTORY OF MEDICINE
|Year : 2017 | Volume
| Issue : 2 | Page : 148-152
Dr. Mary Verghese: Wheelchair surgeon and pioneer of physical medicine and rehabilitation in India
Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Web Publication||18-May-2017|
Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore - 632 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
The history of Physical Medicine and Rehabilitation (PM&R) in India is intertwined with the personal story of Dr. Mary Verghese. The tragedy of a road traffic accident that rendered her paraplegic inspired her to establish a department of PM&R in Vellore and a Rehabilitation Institute, the first of its kind in the country. The Rehabilitation Institute which she pioneered is today one of the premier institutes for the rehabilitation of people with disabilities and stands as a testimony to the transforming power of her faith and resilience.
Keywords: Mary verghese, physical medicine and rehabilitation, rehabilitation institute
|How to cite this article:|
Thomas R. Dr. Mary Verghese: Wheelchair surgeon and pioneer of physical medicine and rehabilitation in India. Curr Med Issues 2017;15:148-52
| Introduction|| |
The field of Physical Medicine and Rehabilitation (PM&R), which deals with comprehensive care for persons with disabilities, had its origins in the middle of the twentieth century during the Second World War when the need arose for long-term rehabilitation of the wounded. Gradually, this nascent field of care grew to include rehabilitation of those with disabilities from other causes, and the specialty of PM&R was born. In India, the history and growth of PM&R are intertwined inextricably with the life and story of Dr. Mary Verghese [Figure 1], who was instrumental in the establishment of the first Rehabilitation Institute in the country. She spearheaded several innovative initiatives that have served to promote the development of this field. The story of Dr. Mary Verghese is the story of how God uses what looks like unjust and unfair suffering to achieve greater glory, of God's grace working in a very ordinary human being, in spite of all her weaknesses.
| Mary Verghese|| |
Mary Verghese was born on May 26, 1925, one of the eight children born to a fairly prosperous plantation owner and his strict but kindly wife in a village called Cherai in Cochin, Kerala, South India. Shy but fiercely independent, young Mary set out to prove that she was as competent as her brothers in scholarly achievement in an age when most girls settled for marriage and domestic duties. Blessed with a keen intellect and a hard-working nature, she excelled in school and went on to complete a BA degree at Maharajah's College in Ernakulam, Kerala. It was at the end of her 2nd year BA that she decided to be a doctor and captivated by the story of the pioneering medical missionary, Ida Scudder, joined the Christian Medical College in Vellore, graduating in 1952. It was Mary's desire to specialize in Gynecology after completing her training and 2 years of residency, but subsequent events in her life were to steer her in a totally unexpected direction.
January 30, 1954, was a day that would change and define the course of this young doctor's life and lives of countless multitudes who would benefit from its consequences. On that day, the motor car carrying some medical students and doctors including Mary to a picnic tumbled over in a major road traffic accident. Mary was one among the two who were seriously injured. Her face was badly smashed in, and an irreparable spinal injury rendered her paraplegic. This was to be followed by a long period of recovery and rehabilitation. Dr. Paul Brand, who attended to her during the grueling days that followed the injury, described the period as a series of three battles – first, a battle for life, then a battle for activity, and finally a battle for faith. When Mary had recovered enough to understand the full extent of her injury and learned that her limbs were paralyzed, she faced blank despair - “Why,” she silently prayed, “Couldn't God have let me die?” She had wanted to serve as a doctor but now faced the prospect of spending the rest of her life being served instead of serving others.,
A road traffic accident rendered her paraplegic. She had wanted to serve as a doctor but now faced the prospect of spending the rest of her life being served instead of serving others.
| Wheelchair Surgeon|| |
Yet, in the midst of the threatening darkness, her faith provided resilience and a “peace that passes understanding” that enabled her to get through the initial days. With determination, she practiced sitting up with support and moving from bed to wheelchair. Skin breakdown resulting in abscesses and fever confined her to bed on many occasions, yet she persisted. Despite her determination and the progress she made in sitting unaided, young Mary still faced an uncertain future as a doctor. Dr. Paul Brand, a pioneering surgeon in the field of rehabilitative surgery in leprosy, and her teacher in Orthopedics, however, saw potential in the broken individual and suggested that she consider a field of medicine different from what she had planned. He invited her to join his department to be trained in operations on the hands of leprosy patients, which could be done while seated on a chair. Quiet by nature, she did not respond initially to this startling possibility and took her time to think it over before finally agreeing to give it a try. She attended clinics, did ward rounds, and was soon performing surgeries in the operation theater. She was then probably the only paraplegic surgeon actually performing operations anywhere in the world. She operated from a wheelchair that had been modified for the purpose after a period of training to overcome the difficulties involved in scrubbing, using instruments and maintaining sterility.
She was then probably the only paraplegic surgeon actually performing operations anywhere in the world.
It was with constant pain that she moved about in the wheelchair, operated on patients, and cheered up the desperate. Even with these limitations, she carried a full working load. Despite her limitations, or perhaps because of them, she was soon commanding respect and admiration of her patients, inspiring them in a way no one else could. In the words of Dr. Paul Brand, “When it came to the matter of her relationships with the disabled patients themselves, it was a victory from the very start. There was no doubt that her physical limitations were a very positive advantage in her ability to inspire the leprosy patients. They used to look at their own deformities and be depressed. With Mary, they saw a person who was more paralyzed than they were, and yet she could operate and do a wonderful job. If she could do so well, then they could too. The deformity of her face was more obvious than their own facial marks. Her feet were more useless than their damaged feet. There was hope for them too.”
Her friends marveled because she never seemed too busy to listen to her patients' troubles. She had a very personal way of dealing with her patients and their faces would often brighten at the very sight of her. There was often a temptation to cut short her daily rounds to discourage the petty complaints with which her patients greeted her. However, seeing the tortured faces lighten at her coming, and remembering her own loneliness, she could never do so [Figure 2]. Personally, she experienced moments of deep despair, no doubt engendered by the constant pain she lived with and the complications that accompanied paraplegia, but the power of faith and her determination sustained her.
In Mary, the leprosy patients saw a person who was more paralyzed than them. If she could do so well, then they could too. There was hope for them too.
| Genesis of an Idea|| |
In 1957, she underwent rehabilitation at the Rehabilitation Centre of Royal Perth Hospital in Australia, learning skills which made her increasingly independent. The center was a revelation to young Mary, with its innovative techniques, recreational activities for the disabled, and even some training for the Paralympics. It was during this period that an idea began to form in her mind that a similar department should be started at Vellore. The rehabilitation and exercises that had helped her so much could prove to be beneficial to the multitudes of disabled individuals back in her country.
With this in mind, she applied for a fellowship to be trained under Dr. Howard Rusk (Institute of Physical Medicine and Rehabilitation, New York), a leader in the field of Physical Medicine. This would qualify her to start the department in Vellore. She was awarded a fellowship by the World Rehabilitation Fund and enrolled for a 2-year course. Mary used every available moment outside her full schedule of hospital duties for studying in the library. She took heavy volumes of lecture notes, theses, and other materials to bed with her as the range of knowledge covered by the examinations would be wide, slowly mastering the skills, and knowledge needed to be a physiatrist. “If the patient has the will, nothing is too tough” - was one of the rehabilitation axioms that she imbibed. She spent hours studying the various self-help devices, many of them simple and ingenious and pored over the designs of braces, wheelchairs, and artificial limbs to see how they could be made simple and inexpensive. She knew that in India, patients could not afford the price of various appliances.
In 1962, Mary Verghese faced the comprehensive examinations held by the American Board of PM&R in Chicago. Following this, she spent time visiting Rehabilitation Centers in the UK and then returned to her new work in Vellore. In 1964, she won a membership of the American Board of PM&R.
| Physical Medicine and Rehabilitation Department and Rehabilitation Institute|| |
When she returned to Vellore, the Department of PM&R was officially opened by Dr. Sarvepalli Radhakrishnan, the President of India, on January 5, 1963. Three years later, her dream of a center for rehabilitating those suffering from disabilities was realized and the Rehabilitation Institute was officially opened on November 26, 1966. The institute was envisioned as a center for healing, restoring, and reaching out to those with disabilities resulting from polio, leprosy, stroke, trauma, and other causes, emphasizing on medical rather than on vocational rehabilitation.
The Rehabilitation Institute was officially opened on the November 26, 1966. It was the first institute of its kind in India.
In the PM&R department, while working with people with disabilities, Mary Verghese realized that the solutions designed for such persons in the developed Western world were often unsuitable for Indian needs. She realized that she would have to innovate to provide appliances and orthotic devices that would serve in an Indian context. Among the simple innovations of the department was a low wooden trolley from which a seated patient could learn tailoring, working a sewing-machine on a low table, etc. Long-handled “pickers” were made too so that patients could pick up objects from the floor or from high shelves, close a window, or turn off a light [Figure 3]. Calipers, splints, and wheelchairs were redesigned so that they could be made more affordable to the people with disabilities, the vast majority of whom were financially disabled as well. Her observations, conclusions, and techniques were published in a landmark publication entitled, “Investigation of methods suitable to village conditions for the rehabilitation of paraplegics and quadriplegics.”
|Figure 3: (a) Innovations for the Indian scenario - Trolley for a paraplegic patient. Note also the “picker” in his hand. (b) Innovations for the Indian scenario - Walking trolley to carry heavy objects.|
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The innovations at the Rehabilitation Institute were not confined to medical therapy and devices; they extended to other aspects of rehabilitation that were new to the country. One among them was the annual sports meet for the disabled, which started in 1964, where busloads of disabled individuals from different cities got together to compete in wheelchair races, crutch races, and other events that served to instill a sense of confidence among the participants.
| Rehabilitation|| |
In the Rehabilitation Institute, individuals with disabilities were given comprehensive medical, physical, and vocational rehabilitation so that they were enabled to integrate back into the society from which they had come. This requires the active involvement of a multidisciplinary team including the physiatrists, nurses, physiotherapists, occupational therapists, social workers, prosthetists and orthotists, psychologists, speech therapists, and engineers along with the patient and family to achieve the best possible outcomes. Weekly meetings help to coordinate the efforts of all the team members and to understand the needs and aspirations of the patients. The philosophy of rehabilitation today goes beyond physical and vocational needs to addressing needs that are psychological and social. Social workers are involved in helping individuals and families cope with the issues resulting from the disability in their villages through home visits and community-based rehabilitation. Mary Verghese's spirit of innovation continues today and rehabilitation of people with disabilities includes sports therapy, support groups, health education, recreational therapy, annual picnics, and art therapy as well as innovative follow-up methods such as the annual Rehab melas. Research into various aspects of therapy, gait analysis, and spinal cord regeneration are pursued in the Rehabilitation Institute.
| Awards and Recognition|| |
For her pioneering work in the field of rehabilitation, the Indian Government conferred on her the Padma Shri, honoring her determination to offer a better life to the patients with disabilities in 1972. Later, in 1973, the Indian Council of Medical Research honored her with the Dr. P. N. Raju Oration award for her original research on rehabilitation of paraplegics and quadriplegics. This was the first time such an award was given in the field of rehabilitation in India.
| Mary Verghese – the Person|| |
Mary Verghese was a good administrator and impressed others by her punctuality and close observation of every aspect of the department. She was strict while dealing with official matters, yet her determination arose from a very sincere and loving mind. She had a very personal approach to patients, and her presence was almost always a comfort to patients. Her own example of overcoming overwhelming odds was inspirational and gave many a new goal and a new spirit to face life. Her efforts were aimed at making individuals with disabilities as independent as possible, whether in rural or urban areas. She insisted on their vocational training which made them useful citizens. She encouraged them in word and deed - just the sight of Mary in her wheelchair, full of patience and courage, showed them by example that life need not end for a person with disability [Figure 4].
| Last Days|| |
In 1976, she retired from CMC Vellore and returned to Kerala after struggling for more than 2 years with repeated bouts of fever. However, far from disappearing into oblivion, she returned 2 years later to Vellore to continue her crusade for the disabled. In 1980, she had the vision to establish a Home for patients with disabilities, particularly for people with paraplegia through the Mary Verghese trust for the physically disabled which was registered in 1981. The World Vision awarded her the Edward Pierce Award for 1985 and the cheque of 10,000 dollars, which came with the award, was donated to the trust for the construction of the home. With the consent of her brother, she bequeathed all her properties to the trust. Her life has inspired several books; chief among them was her biography by the American writer Dorothy Clarke Wilson titled, “Take my hands.”
Mary Verghese was called home to her Creator on December 17, 1986. People of all ages, positions, languages, and cultural backgrounds paid their last homage to Dr. Mary, thus ended a life of faith, courage, endurance, and faithfulness. Her personal pain gave her an extraordinary sensitivity to the deep agony of the patients, and she responded to such feelings with an unusual courage and love. When asked what strengthened her in her daily life, she used to say with a gracious smile “Trusting in God's love and grace, all things work together for the good of those who love Him.”
The remarkable story of Dr. Mary Verghese of Vellore is a witness to the redemption and transformation of suffering and crippling personal tragedy into something beautiful.
| the Rehabilitation Institute Today|| |
The Rehabilitation Institute which she pioneered is today one of the premier institutes for the rehabilitation of people with disabilities and stands as a testimony to the transforming power of her faith and resilience. This department, which celebrated its Golden Jubilee in 2016, is now the WHO Collaborating Centre for Development of Rehabilitation Technology, Capacity Building, and Disability Prevention. Various courses are conducted in the department including MD in PM&R, Master in Physiotherapy, Bachelor of Physiotherapy, Bachelor of Occupational Therapy, and Bachelor and Diploma course in Prosthetics and Orthotics. The original 40-bedded Rehab Institute was expanded in 2005 to its current capacity of 85 beds and is set to expand further [Figure 5].
This project and the various programs that have evolved around it over the years probably would not have been set in motion without the stimulation of Dr. Mary's accident. Today, her legacy continues in the institute she has inspired and several thousands of patients and their families continue to benefit from the services offered. The remarkable story of Dr. Mary Verghese of Vellore is a witness to the redemption and transformation of suffering and crippling personal tragedy into something beautiful, to build and to heal.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Wilson DC. Take My Hands-The Remarkable Story of Dr. Mary Verghese of Vellore, London: Hodder & Stoughton; 1967
Brand P, editor. Magnified Grace: Dr Mary Verghese, Wheelchair Doctor. Vellore: Mary Verghese Trust; 1981.
Clifford J. Wheel Chair Surgeon – The Story of Mary Verghese. Exeter: Religious and Moral Education Press; 1986.
Verghese M. Investigation of methods suitable to village conditions for the rehabilitation of paraplegics and quadriplegics. Vellore: Department of Physical Medicine and Rehabilitation and Rehabilitation Institute; 1976.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]