Nineteen Sixty-four is a research blog for the Center for Applied Research in the Apostolate (CARA) at Georgetown University edited by Mark M. Gray. CARA is a non-profit research center that conducts social scientific studies about the Catholic Church. Founded in 1964, CARA has three major dimensions to its mission: to increase the Catholic Church's self understanding; to serve the applied research needs of Church decision-makers; and to advance scholarly research on religion, particularly Catholicism. Follow CARA on Twitter at: caracatholic.


Care of Elderly and Infirm Sisters

Catholic women’s religious institutes—globally experiencing  a 22.1% decline in numbers globally—face tenuous futures. Mitigating these trends to survive and thrive may depend upon learning from each other, across continents and cultures, to address their greatest mutual challenge: Aging, infirm populations.

This is the premise of a two-year research project (May 2021 to May 2023) CARA conducted in collaboration with Kenyan and Mexican researchers. Funding was provided by the Conrad N. Hilton Foundation’s Catholic Sisters’ Initiative for  supporting this research.

In Kenya, Assumption Sisters of Nairobi Sister Candida Mukundi, Director of the Center for Research in Religious Life & Apostolate (CERRA-Africa), coordinated researchers working in Zambia, Kenya, Ghana and Uganda (Malawi reports are forthcoming). Missionaries of the Holy Spirit priest Father Luis Falco of the order’s Proyecto Cruces Missioneros del Epiritu Santu or the Holy Spirit Missionary Crosses Project led the team conducting research in Mexico.

Beyond the valuable information the studies uncovered, this research was noteworthy because, as we noted in the CARA  September 2022 special report “Care of Elderly and Infirm Sisters among Catholic Sisters,” little has been documented about the care provided to older sisters.

This partnership’s international and intercultural nature also distinguishes the initiative. In their report “The Needs of Elder Sisters in Mexico's Women Religious Congregations,” researchers describe this approach’s value: “Working in this international team has been a great enrichment because some approaches, questioned issues and perspectives are quite similar and even complementary, in some other cases, the perspectives are different, and each team has valued their own differences.”

It’s also important to note while numbers of women religious worldwide are declining generally, in Africa, the number of women joining religious institutes has grown more than 49 percent. This increase almost offsets the precipitous decline of North American sisters of more than 51 percent.

This context informed the research’s three objectives:

1.     To document institutes’ perceived needs to care for their elderly, infirm members in order to manifest the institutes’ current and projected needs more broadly;

2.     To document number of people entering religious institutes in 2021 and 2022 and identify their demographics in order to encourage institutes to become more proactive in their vocation efforts;

3.     To form Advisory Committees in Kenya and Mexico to recommend next research steps or suggest activities or programs to deal with identified needs. These committees will help engender greater awareness of the challenges facing elderly sisters and foster activities and programs that are developed, funded and implemented to remediate these challenges.

Because little has been documented about the care of older, infirm sisters, it isn’t surprising women’s religious institutions haven’t been, with some prominent exceptions, proactive, intentional or foresighted in planning for the care  for their elderly members. This is perhaps this research’s most salient conclusion.

In Africa, institutes may not focus on the elderly sisters as much as they should because they have relatively fewer older members. Among these nations, Zambia,  where 24 percent of sisters are older than 71, is something of an outlier. In Kenya, Uganda and Ghana, fewer than 15 percent of sisters are older than 71.

Mexican researchers note the pace of aging among religious sisters has accelerated faster than the general population, and  39 percent of sisters are older than 71, their average age is 62 and slightly more than half are older than 60.

Yet, concerning the impact accelerated aging has upon their institutes,  as “The Needs of Elder Sisters in Mexico’s Women Religious Congregations” notes:  “Congregations are hardly willing to talk about it.  Leadership is only seeing the tip of the iceberg without considering the phenomenon.” “Long term policies, plans and strategies designed for the care of the elderly are highly scarce among women religious in Mexico, which leads to wasting resources.”

In the developing African nations, a much more challenging  picture of efforts to care for older, infirm sisters emerges.  Despite the relative gulf of resources and the continental divide, a Ghanaian sister expresses what many believe is the mindset sisters must adapt globally to meet the challenges of their aging populations better. “I think it is about time,” she says,  “we put in a lot of thinking in taking care of our elderly sisters. We need to train more sisters in health care to be able to take proper care of them, we also need to collaborate with other groups to take care of them. Planning for old age should  begin now.”

Training younger sisters to care for their elders, fostering greater cooperation and collaboration among institutes that could create a global network are among the innovative solutions researchers surfaced to help elderly sisters. They also hope the Conrad N. Hilton Foundation and others will invest in these solutions. Others include: Central offices dedicated to elderly issues, a fund to help pay sisters’ medical expenses and inter-congregational hospitals to care for older sisters and generate income.

Financial investment into feasible solutions that achieve results are crucial to assure Catholic religious institutes’ sustainable futures. Nothing is more important to that future, however, than the sisters’ reconnecting with a scriptural understanding: New wine is best poured into fresh wineskins.

This post was written by CARA Associate Chris Byrd.



Dr. Sister or Sr. Doctor? Charting the rise of sisters who minister as medical doctors in India

In a land where hearts beat strong and true, Emerges a sisterhood, a remarkable crew.
They wear their white coats with pride and grace, sister doctors, healers in every case.
In rural villages, far and wide, they journey on, bridging the divide.
Reaching the underserved, the ones in need, sister doctor plant a caring seed
- Poem by Sister doctor

In an age where health care is increasingly looked upon only as profitable business, an encouraging trend has emerged in India of Catholic religious congregations educating their sisters to study medicine and become Sister Doctors. In the United States, and also in India, it is difficult to get medical doctors to practice in rural areas and to get health care institutions to serve those without the financial means to pay full price for treatments. Countering this trend, 85% of India’s Catholic Sister Doctors serve in rural areas in facilities often supported by their congregations as these are areas where the institutions are unlikely to bring in enough capital to meet their bills without some outside sources of funding, such as the central, North East, Andhra Pradesh, Telangana, Karnataka, Tamil Nadu and Kerala regions.

These Sister Doctors provide curative, promotive and palliative care service and thus contribute to restore the health and wholeness of the people who live in the medically underserved areas of our great nation. They follow the footsteps of the divine healer with great passion for God and compassion for humanity. In addition, they usually work with Sister Nurses from the same congregation and they live and work together.

The trend is for the number of Sister Doctors to rise.  In 2013, according to the Sister Doctors Forum in India there were 537 registered.  In 2023, they report 723, an increase of 35%.

As my current research at CARA has been finding, it is the congregations themselves who have spurred this growth. Although it is a preliminary finding, at present, 77% of the Sister Doctors I have been interviewing say they were asked by their congregations to study medicine and become doctors, rather than having entered religious life wanting to be doctors. As one Sister Doctor notify: “To me personally had no desire to be a doctor, my desire is to become a nurse to serve the sick and suffering, but I was asked by my authority to become a doctor and work in a rural area. I said ‘Yes’. Became a doctor and working in a remote rural area serving the poor. I am very happy in my ministry”.

The ministry of sister doctors is true evangelization.  Christians in India make up only 2.5% of the total population. Such a statistic can be deceiving, however. In 2021, there were 1.4 billion Indians, making for an estimated 35 million Catholics. Frequently serving the poorest of the poor, the health care they provide is most often to people of other faiths (Hindu and Muslim patients).  

Breaking free from societal expectations and traditional gender roles, these extraordinary women have embarked on a path less traveled, paving the way for a brighter, more inclusive future. Their rise not only represents a significant shift in the gender dynamics of the medical profession but also highlights the immense potential and determination of women in Indian society. As one Sister Doctor I interviewed noted: “I think that passion is the secret ingredient that drives hard work and excellence”.

The Sister Doctors have specialized in various fields of Medicine like Cardiology, General Medicine, Surgery, Pediatrics, Gynecology & Obstetrics, Radiology, Psychiatry, Pathology, Family Medicine, and Public Health Medicine and other streams like AYUSH, and Naturopathy.

They also face challenges being Catholic and serving in public hospitals, being asked to perform procedures not approved by the Catholic Church as One Sister Doctor described it: To follow Church obligations vs governments laws are very difficult.

Being both a sister and a doctor presents some unique challenges, however, being on call and treating a patient overnight and being expected to participate in the prayer, social, and communal life of one’s community where they live and work can pose real problems for the Sister Doctors. As one noted: No leave, no outing, 365 days’ work, have to participate in all religious activities and work, so no our own time, no updates. I find it difficult to spend quality time in prayer while I'm able to work day and night unceasingly. So, in the process I compromise on prayer in exchange for work.  That leaves a deep dent in my conscience and in my commitment.

That said, 87% of the Sister Doctors I have surveyed up to present say they would again choose to be religious sisters and be doctors if they had the choice. According to our preliminary findings, over all, almost all sister doctors are satisfied with their ministry as a medical doctor. Nine in ten of the responding sister doctors have a sense of contribution to the larger purpose, a sense of personal accomplishment, and are satisfied with support they receive for their current ministry.

As this is an upward trend, we think you’ll be hearing more about Sister Doctors in the future as their presence, ministry, and impact continues to influence. India, the world’s most populous nation and thus the world at large.

This blog was written by CARA Visiting Scholar Sr. Mini Joseph, JMJ.

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