January-February 1998

Adriana Ferranti, who runs FPMT’s Maitri Leprosy Center in Bodhgaya, India, talked to Ven. Robina Courtin about her life and work.

I was born in Italy. My father was from central Italy and was a civil servant, my mother a housewife. They met in the north, where my mother was from. They were married during the war and my father was sent down to Sicily, where I was born. After three months, my mother left because it was pretty dangerous. She went to Rome where my father’s family was, and so I was baptized at St. Peter’s. Very auspicious!

She moved back to her home town, Trieste, and I was brought up there. I had a very good start in education: high school, then the university where I studied languages. During those years I came to the US as a foreign-exchange student.

I didn’t have a career. I just went to work because at one point I didn’t want to continue studying. So I ended up doing exactly what I always knew I shouldn’t be doing: office work. Oh, I hated it! That, among other things, contributed to my downfall into neurosis. My twenties were pure hell! I even contemplated suicide. I couldn’t bear the thought of becoming old having the life that most people had, including marriage.

And then something happened and I changed my life completely; overnight I defeated the neurosis. It just went. Then I began my search: I was looking for the meaning of life, the truth. My first revelation, which was a turning point, was that to make my life meaningful I had to work for others. But I didn’t know what on earth I could possibly do because I had no particular skill. It took me eight years to discover my inspiration to work within the field of leprosy.

Also, I experienced a re-conversion to Christianity, which I’d given up along the way. I hadn’t listened to my heart: that was part of my unhappiness. I got caught up in all the intellectual questioning and then had drifted away from the church. In fact I had had a very strong calling but my intellect hadn’t accepted it.

Then something happened, and I just accepted. I was in the center of Italy for a conference, at a place called L’Aquila, an ancient town on top of mountains. Apparently St. Bernadino de Sienna, who was a Franciscan, was born there in the fifteenth century, and it’s where he died. He was a preacher and went all over Italy carrying a tile with the name of Christ on it, like a mantra. Actually there are many parts of Italy where you find this on main portals: the holy name of Christ. Now there is a beautiful cathedral, pure Renaissance, and it is where his relics and his holy body are kept.

I knew there was a calling and after that I started wearing the cross. That was 1977 and I was 35. It was a very strong experience and my relationship with the church changed completely. I have always had this incredible respect for priest and ordained people.

Nevertheless, I was still looking for answers. One day I found a book called Reincarnation and Karma and wow! That was it! It was written by an Indian yogi. I had also some books about Tibet and Tibetan Buddhism and I had this very powerful attraction towards Tibet. One day I heard a tape of tantric pujas, which blew my mind completely.

I needed to find a place to go for teachings, but there are so many places in Milan doing spiritual things. Early in ’79 I saw a poster about Ghe Pel Ling and Gonsar Rinpoche. I thought, “Where have I heard this name before?” I already had an engagement that night but I knew I had to go to that teaching. As soon as I saw the lamas I knew that it was exactly what I wanted.

In the summer I met Nick Ribush when he gave a course in Milan and I went to the center to help. He suggested that I go to Pomaia, to Istituto Lama Tzong Khapa. That was July 17, 1979. I took refuge, received initiations and did retreat. For about a year and a half I really didn’t do much but my practice.

Nevertheless, I still felt this calling from Christ, so I went on pilgrimage to Rome, to St. Peter’s. You see, part of me felt that Buddhism was just an episode in my life. When I did retreat it was Buddhist retreat, and it was blissful, perfect, but I related to Christ as well. I related to all the deities with no problem, but also I had this devotion for the Virgin Mary; when I did Chenrezig retreat I saw him as the Virgin Mary.

Anyway, in Rome I experienced something very powerful, which is impossible to put it into words; there is only the knowledge. I knew before I left the institute that Lama Zopa Rinpoche was to come in a few months, and as soon as I had this experience the thought came, “What about Rinpoche?” Immediately I realized there was no way that I could leave Rinpoche.

The following year, 1980, I got the inspiration to do leprosy work. I knew that I had to do it, but where? How? It was difficult, because I had no job. But at one point, because of that experience in Rome, I thought that my life might end up more on the mystical side, so I did a retreat that Rinpoche asked me to do. It was for healing, and it was unbelievable, beautiful, peaceful. That is when I knew that in this lifetime I had to do service.

In fact, I cherish my solitude. I like to be alone. I like silence. I used to practice silence when I was in Milan and it was so peaceful. This part of me is really strong. I don’t have to really search for it; it is there. It is always there. It is waiting, waiting.

When did you start working for lepers?

In 1983 Rinpoche told me that I should work in Bombay. I had done a course earlier and after that I went all over India to various centers looking for a place, and then I was to come back to see Rinpoche before I decided. For six months I tried to go to Bombay but it just didn’t work.

Then Nick Ribush asked me to organize a leprosy colony they were taking care of in Delhi as part of the work of Tushita Mahayana Meditation Center, the FPMT center there that he was director of. But there were many difficulties and that didn’t work, either. (During that period I served as director of Istituto Tzong Khapa for two and a half years.)

Eventually, in 1987, I started preparing the whole thing. We found land but it took me two years to get the authorization and to actually start. That same year I went to a research center in south India where Gandhi had had his ashram, because I wasn’t sure how I wanted to proceed. Of course, there was the idea of a leprosy colony but I wasn’t so keen on that. I knew that there were other ways of taking care of lepers so I spent a couple of months there, researching my ideas and up-dating on the disease.

It was then that I decided to do what we are doing now. I had our name and the symbol and I started meeting with Rinpoche. But at that point I also saw that leprosy shouldn’t be the only thing because there are so many miseries in India. Rinpoche agreed, but said it should be later. And I think the later on is just beginning to come.

What’s the difference between a leprosy colony and what you are doing?

What we’re doing is healing and preventative work and we work with people in their villages. When you enter a leprosy colony you will never be able to leave it because you have a stigma, which is the big problem. It has been perceived throughout human history as a curse. In India people believe that those with leprosy had committed very heinous crimes in past lives. Or it’s seen as a curse from God.

Our program is called National Leprosy Elimination Program of India. It’s based on another program, which is actually applied worldwide, called Survey, Education and Treatment – S.E.T.

Survey is the field work. You are assigned an area by the government and then you are assigned about 20-25,000 population per one worker. He has to be trained, and then off he goes to serve the entire population. You have re-surveys and you have the contact survey, which means when you find an infectious case, then you have to go back to his family to check if other members have developed this disease. But you have to service the entire population.

And then there is health education related to leprosy, which means explaining to people in order to destroy the stigma, because the stigma is the reason why people don’t come forward and why they hide the disease. This comes from ignorance, basically. And so that’s another aspect. And there is treatment, the cure.

But there are other important aspects, such as physical and social education. The patients who get deformities can improve their condition, which means we need to have people with special training. There is surgery, for example; there is social rehabilitation, which is meant for those patients who had such deformities that they cannot continue with their normal work. This is a very important aspect because, depending on the way you do it, you can affect the whole community.

What is leprosy?

There are two types, one infectious and one not. It is a communicable disease, an infection. They haven’t been able to raise the bacillus in the lab yet, and this is the reason why there is no vaccine. There is some sort of vaccine that they have been trying but nothing has happened. It is the same bacillus as tuberculosis.

Leprosy isn’t the worst of diseases, but because of the way it ravages the body it deforms you but doesn’t kill you. It affects the nerves. It is wrongly considered a skin disease, although it has some skin manifestations. It is the nerves that are destroyed but not all nerves. Parts of the body don’t fall off, although it appears that way! What happens is called absorption; it means that the bone disintegrates. The bacilli are in the blood stream and go everywhere, including into the bone marrow. It is an intense inflammation that destroys the nerves. It’s not that they eat up the nerves. They are inside there and they multiply. If the disease is caught in time, at the onset, it can be prevented. And this is why we need more health education.

Roughly how many people suffer from leprosy? Is it a huge disease in India?

Particularly in south India they had the highest incidence of the infectious type, and it was there that all the efforts of the leprosy organizations were concentrated for so many years. The north seemed to have less of a problem. Now in the south the situation has dramatically improved, whereas in the north it is pretty bad. We are in the north.

Numbers are very difficult. Ten years ago they were talking in terms of four million. It is just a shot in the dark.

What areas do you work in?

I applied to the government to have what’s called the Bodhgaya Block, which has a population of 100,000, which includes lots of towns. In India a “block” is within a district (like a state) and is formed from panchayats. Each panchayat is composed of a number of villages, not fixed.

The number of inhabitants in a panchayat is somewhere between 20,000 and 25,000. Roughly, it is three panchayats to each paramedical worker, which I assign. They have to live and work in the area and sector that I give. I have communication with them at the end of each month, a meeting. Keeping their records properly is a big deal.

How many patients have you treated over the years?

We have had 3,101 detected cases, out of whom 2,927 have been registered with us for treatment. Of these patients, 454 are from outside the Bodhgaya block. Approximately 358 are currently under treatment while 2,136 have been released from treatment. We release them after a certain period of time and then we follow them for some time. The number of patients that we treat every month fluctuates because we are constantly releasing from treatment and we are constantly registering new patients.

What specific cases do you treat?

For example, there are 68 patients with ulcers and on average 36 of them are being treated by physiotechnicians and paramedical workers. Forty-two have been healed both in the field and in referral hospitals. However, ulcers are reforming. More success is achieved with claw hand patients, where the result is permanent: two cases were rehabilitated through surgery and five through physiotherapy. Foot drops are the same: two were rehabilitated through surgery and eight through physiotherapy. Twenty-one patients affected by anesthesia in hands and feet have recovered sensation through multi-drug therapy.

If all the people you have treated had not had treatment, they’d have full-blown leprosy by now?

That depends because there are different degrees of leprosy. The manifestations are very different. For treatment purposes we differentiate only two main groups — infectious and non-infectious. There are some that are borderline, and why it is important to follow the patient.

We treat tuberculosis, too: 60 people have been registered for treatment, of whom 34 have been released from treatment. Twenty-six are still under our care, seven of whom are being supported with food, supplements and other things.

Give us a picture of what you have got existing at the moment.

The main activity is the field activity: the survey and the treatment. We have 6 paramedical workers and three other specially trained people: a health educator, a smear technician and a physiotherapy technician.

How do you decide on where you will send your paramedical workers to do this survey?

They decide; they have to organize their work. I assign them an area given by the government. This is the only program where you have to get the authorization from the government to operate. If I want to open a hospital or start a leprosy colony, say, I can do it, I don’t need to ask. But if I want to do National Leprosy Elimination Program and have people in the field and all that, then I have to be authorized by the government. We have to sign monthly reports and all our work is monitored.

We have also a medical supervisor, a man who supervises the workers, which is incredible relief for me because it was very difficult for me to handle that, finding the time to go and see what they were doing. We had a doctor working part-time, but he recently left, so I have been organizing everything by myself. We have 19 clinics, 10 outings a month.

What is a clinic?

It is wherever we are: we load our supplies, which we keep in the office, in the jeep and we go to a fixed point of an area. The doctor goes, and the supervisor and sometime I go.

We meet the paramedical worker there. It can be under the big trees, the porch of a school, and then the local people come. It happens every four weeks. The paramedical worker goes two days earlier to all the patients to remind them that they have to come to be checked. And new patients as well. And then we move to another clinic; we do maybe two or three clinics in the morning.

So, what expansion means is more paramedical workers and more and more blocks.

Right. I hope to get at least two more blocks, but the government administration here is virtually absent. If we had two more blocks we could reach people in less fortunate areas than Bodhgaya; here everyone is a little better off because of the presence of foreign organizations and volunteers. In surrounding areas, however, there is nothing. This way people would know that someone cares, that someone wants to help.

But to do all the things I want to do, including rehabilitation, we do need a physical place, which is what we are building now. I had this clear picture of it in my mind – somebody told me I was a visionary! We are building an outpatient clinic with offices, a hospital, the house where I live and then a garage, with a flat for the driver. We have built a kennel for the dogs. There will be a cow shed. The shed is now being used for storage. Eventually I would like lots of trees.

One important thing is that we are using mud for the buildings instead of the horrible fire bricks, which are too expensive. You use soil for the bricks and put in a pinch of lime and maybe cement and they you have to cure them for a short time. They are much harder than fire bricks. The mortar is just mud. If you just do a one-story house, the foundations are very simple. Houses made with mud bricks are so much cooler to live in.

We will also have a lab, the physical therapy unit, which I think is the most important thing, actually. In a sense, it is a hospital; it will have offices and beds. There’s also a home for homeless and quarters for myself and staff. And there’ll be a hostel for guests, for people who come to work. They come to spend a year, for example.

There should be a temple in the middle. Rinpoche has given me instructions on hundreds of statues and other objects. The religious temple is my idea and Rinpoche approved it. He wants life-size statues but I don’t think he realizes the size of the temple!

In the long run I hope to include general medicine at the center. We offer some medicine to our patients, but not yet to general public. That is what I am aiming at. And this is why it could go on for so many years without structure, just an office where we keep the charts, the records. Then we also have a small laboratory because we take smears. Actually the idea is that once the leprosy is eradicated then you just wind up. But that is a long way off, I think.

Another idea I have is mother-and-child care, which would have to be located at the center. I hope to work with a local female gynecologist – it must be a woman. She would then train village midwives in basic health and hygiene skills. Atrocious things happen in village births, especially if there is some emergency, so many women and children could be helped. Also, in the case of a serious emergency, a doctor would be available to help. This involves more general medicine, so it may take some time to develop.

I also hope to work for dogs. I have developed a particular liking for dogs over the past 30 years. (My dog, Lakshmi, has had four new puppies, which I’m considering calling Karma (the female one) and Gelug, Sakya and Nyima. And Adi and Tara are pregnant, too.)

I have much concern for the dogs of the area. They have developed a lot of skin diseases, particularly mange. You see dogs with horrible conditions and they die in a very awful manner, slowly. Mange is spreading and it is very difficult to stop. The dogs are stray and are out on the streets and nobody watches them, and so it goes from one to the other. One dog who would come to my gate had developed skin disease and I was concerned for the puppies. I couldn’t treat her because she wouldn’t let me touch her. By chance I got some medicine and it worked; I gave it to her for a month.

There are the cattle, too. But it’s going to require a lot of effort; this is another long-term plan. I would like to have a minimum of one veterinarian to come for at least 6 months and to go out to the villages. Two things could happen: one is with the village people and the other is with the doctor.

And another thing, I try to do something when I see a dying animal. You find dogs on the road all the time, which have been run over by trucks and buses. There is nobody to take care of the animals.

Isn’t the idea of taking care of animals a bit foreign in India?

They have cattle and cattle means money, so you can start from there.

At this point we have not yet moved to the new center as there are structural and workman obstacles. My main focus in general now is not the leprosy work itself but on the center land development. It has been a long time since we began construction and still more difficulties come. I asked Rinpoche to check if there is some naga harm; he checked and said yes, there is. Construction continues at a very slow pace, however, and I don’t give up. But despite these difficulties, this land is very special. Everyone who comes here remarks on how beautiful and peaceful it is, even though there is nothing around.

How much do you think everything will cost?

At first we estimated $500,000, but I think now it will be well over that.

Since you began, the majority of your funds have come from foundations?

Yes. All incredible people, all volunteers. More than half of the initial amount for our new place was raised by a few different organizations and individuals. A Spanish organization called Manos Unidas offered money for construction supplies and costs, and a Belgian organization, the Damien Foundation, donated money to pay for the land. They are Catholic organizations. Then there is a Dutch organization, a TV company called Vildergansen: what they do is raise funds through a program broadcast by radio and television, and they match money offered by others. We have also received money recently from some Italian individuals and groups.

Where will you get the rest of the money?

Absolutely no idea! Right now I don’t know where I am going to find the money to run all this. I have nothing. It’s an act of faith every day. I have been running on faith in divine providence for the past twenty years!

What other sources of funds have you had since you began Maitri? You have any individual benefactors? Donors?

Yes. There is an Italian lady who has sent money regularly over ten years. A lot of the money comes through the FPMT. People send donations from the US, for example. Perhaps 200 people altogether have given donations: it can be from $20 to $1,000; one time I got $3,000.

I have a group in Italy who have an organization who have registered so they can get a post account so that people can send money into an account. This is how we manage. But it is a struggle because you never know what is coming next. When we run out of money it will be a disaster. That’s my act of faith. It’s not easy. So many times I have been really worried and I push the thought away because otherwise I know I would go crazy.

Is Maitri respected by the government, by the local people?

Definitely, very much so.

You’ve made some amazing progress in six years.

You think?

Your future?

As far as I am concerned I have made a commitment. Bodhgaya is one of the most difficult places to be, but in my heart it is my commitment. I know that what I am doing is just a drop in the ocean, so how can I feel satisfied? I think that it is very important to see the usefulness of what one does. One has to think that it is useful.

I think that if you, as a Buddhist organization, were eventually able to do more in the area of social service, in the fields of education, health and counseling for the resolution of family and community problems, it would be of great benefit…It would not be done as a Buddhist or Dharma activity, but simply to serve and benefit humanity…I think that would be very beneficial and very useful.

His Holiness the Dalai lama to the FPMT, Dharamsala, 1995