At the rear of St. Antony’s House of Refuge in the village of Edakunnu, some 25 miles north of Kerala’s commercial center of Ernakulam, the twin bed in a private room reserved for hospice care is again occupied. The silk draperies dressing the small window are drawn. Caregivers move about deliberately. Visitors enter discreetly. With hushed voices, they say their last goodbyes to 90-year-old Mary P.M. Puthusey, holding the dying woman’s hand and caressing her gently.

As she is anointed with oil for the last time, an aura of sanctified calm fills this space of final respite. A silver cross hangs from the wooden bedpost above her head. Pinned to the opposite post is a laminated icon of the Virgin Mary. From another wall looms a calendar, dominated by an image of Jesus, which reads in big block letters, “I am the way, the truth, the life.”

These words have long been at the core of the dying woman’s being. She and the 43 remaining residents of St. Antony’s chose the religious life long ago in their early adulthood. Mary P.M. arrived in 1949, shortly after the Sisters of Nazareth, a congregation of the Syro-Malabar Catholic Church, established St. Antony’s for young women who, in the words of Father Augustine Thenayan, director of the Nazareth Institutions, “wanted to lead pious lives and become sisters, but who had no education.” Young no longer, the residents today are gray-haired, frail, often ill and dying one by one.

Hovering by the woman’s bedside is St. Antony’s resident caregiver, Mary P.L. Taking on a nurse’s role, Mary P.L. monitors the patient’s tubing, cleans her bedpan and adjusts her blanket. She rubs the back of Mary P.M.’s grieving younger sister and fellow resident, Rosakkutty. And, she spends countless hours sitting beside the dying woman, talking to her and praying with her for a “happy death.”

“As with all who have gone before her, I try to take away her pain and keep her as happy as can be,” explained Mary P.L. “God has given me this gift. I try to use it.”

Mary P.L. arrived at St. Antony’s in 1972 after enduring a string of setbacks. In early childhood, she developed a life-threatening disease that left her bedridden. Not until age 9 did she learn to walk, and then with an uneven gait. Back in those days, Keralite society was unforgiving when it came to a perceived deformity or difference. Mary P.L. dreamed of becoming a nurse, but her disability prevented her from going to school.

“Finally, I told my priest I wanted to give my life to God. He told me to visit Nazareth.”

For many years now, Mary P.L. has served as St. Antony’s de facto nurse.

“I’m happiest when busiest,” she said beaming. Fortunately, for St. Antony’s many elderly and sick residents, Mary P.L. enjoys her role.

St. Antony’s is just one of several facilities that make up Nazareth. Clustered together on an unmarked 80-acre estate off a tortuous country road several miles from the region’s main highway, the complex of buildings is hidden among rubber tree farms, coconut orchards and rice paddies. By design, it is not the kind of place upon which one just stumbles.

Run by the Sisters of Nazareth, whose charism is to work for the welfare of needy families, Nazareth is a sprawling sanctuary for Kerala’s marginalized. The complex comprises a hospital, church and graveyard, motherhouse and convent, various income-generating industries and six “Houses of Refuge,” each serving a different, marginalized social group.

Whereas St. Antony’s was established for women without means or education who wanted to lead a religious life, St. Magdalene’s accommodated young single mothers or expectant mothers, disgraced in the eyes of their families and communities. By the 1970’s, many of St. Magdalene’s original residents had grown old and required special care even as younger women continued to arrive at the home. To better serve these distinct groups, the sisters restricted St. Magdalene’s to aging single mothers and established a new, separate house, Mathru Sisu Bhavan, for younger women.

The other houses of refuge include: Infant Jesus, which cares for orphaned babies scheduled for adoption; Bala Bhavan, a residence for some 50 girls — orphaned or belonging to poor local families — who attend the nearby Nazareth School; and St. Ann’s, which houses and cares for women with physical or mental disabilities. St. Ann’s is the only facility where the residents’ families pay for the care provided.

Whether elderly or newborn, mother or child, the life story of every resident undeniably begins in pain or misfortune. But thanks to the 40 sisters and the dozen or so novices who live and work among them, their stories do not end there.

The newly renovated motherhouse and convent sits fittingly at the center of the Nazareth compound. Day and night, these women attend to the residents’ many and varied needs, alternating shifts at the different houses of refuge. They visit the sick at the compound’s Stella Maris Hospital. They check in on the retired priests at the adjacent St. Paul’s Home. And they oversee all income-generating activities: weaving, tailoring, rubber making and dairy farming.

“We don’t retire,” said Sister Gladys, the community’s provincial superior, when describing their strong work ethic. “We work until we fall down.”

The sisters also do what they can to instill the Nazareth Institutions’ current 200 residents with a similar work ethic and sense of responsibility. Everyone is expected to contribute to the best of their abilities and to the greater welfare of the community. Though for the elderly women, “best of their abilities” equates to part time at most.

“In the early days, residents used to work in the fields, tap rubber trees and weave to support the community,” recalled Father Thenayan. “But now, most are old, ill, bedridden or otherwise unable to work.

“We’re finding it very hard to manage,” he added.

In recent years, the number of young, able-bodied women arriving at Nazareth has declined sharply, making the compound’s income-generating activities difficult to sustain. Since their creation in 1948, St. Antony’s, St. Magdalene’s and St. Ann’s have admitted more than 1,200 women. Today, the houses accommodate just 130 women — all seniors.

“The social setup has changed,” said Sister Gladys. “More than before, these women — disabled or single and expectant — are accepted by their families. And they’re getting a better education. So new women are not coming … this need is dying out.”

Moreover, shifts in the marketplace have taken a toll on the compound’s income-generating activities.

“There have been fast changes in society: social, economic, spiritual, educational,” said Father Thenayan. “Now, agriculture no longer yields a profit. That is the big change. Coconuts used to yield a good income. The paddy is now running at a loss. The price of rubber has dropped. And medical expenses have become a heavy burden. … We’re facing serious financial difficulties.”

Despite earnest efforts, neither the Sisters of Nazareth nor the Syro-Malabar Archeparchy of Ernakulam-Angamaly have been able to come up with a viable, long-range plan to return the compound to economic self-sufficiency.

One thing is certain: It is out of the question that the Sisters of Nazareth will abdicate responsibility for their aging wards. “These women have worked their whole life for the community,” said Sister Gladys, who recently petitioned the archbishop for financial aid. “Now it’s our turn to take care of them.”

At the Infant Jesus House, Sister Joicy, who administers adoptions, pointed to what appeared to be an enamored young mother in a maternity gown cradling her newborn baby.

“That’s not her baby,” she said. “She gave her baby up for adoption 15 months ago.”

The unmarried 17-year-old woman, named Sheela, first came to Nazareth at the tender age of 15. According to Sister Joicy, after Sheela failed her sophomore year, her parents enrolled her in a trade school for tailoring. On the daily bus ride to the workshop, she became romantically involved with the bus driver’s assistant, a young man in his late 20’s.

When Sheela became pregnant, the man promised to marry her. Believing him, she hid her pregnancy by wearing a girdle. But after six months, and no wedding, she could no longer hide it from her family.

“Mothers know their daughters,” said Sister Joicy.

“The family went looking for the father, but he was gone,” she continued. “That’s when Sheela finally understood that this man had abandoned her.”

While Sheela may not have fully grasped the magnitude of her dilemma until it was too late, her Hindu family understood how being a single mother in traditional Keralite society could affect her future.

“You know,” said Sister Joicy, “it’s not acceptable for a good family to do this. Kerala’s culture is very strict.

“The mother told me,’ continued the nun, “that when Sheela’s brother found out, he beat her many times.”

“Unwed mothers are not accepted in our society,” said Sister Carolyn, councilor of the Sisters of Nazareth. “Children born out of wedlock are considered illegitimate.

“In Kerala, it’s an arranged marriage system, so parents find and decide who’s to be married to whom. If this doesn’t happen, and pregnancy happens, then they’re out from the home. They must disappear.”

“In Kerala, to be an unmarried pregnant woman is an abomination at home,” said Father Paul Thelakkat, editor in chief of Sathyadeepam Publications and spokesperson for the Major Archeparchy of Ernakulam-Angamaly.

“Society condemns them. The girl’s life is lost forever. It’s a big problem, but it’s the social ethos in which we live.”

Faced with this grim prospect, Sheela’s family rushed Sheela to the local medical college for an abortion. Being nearly seven months pregnant, the doctors refused. When doctors at a second clinic declined their request, they directed the family to Mathru Sisu Bhavan at Nazareth.

Before long, Sheela, her mother and brother were knocking at Sister Joicy’s door.

“They were very reserved, not explaining anything, not sure how to explain,” recalled Sister Joicy about her first encounter with the family.

Soon after the family’s visit, Sheela entered the house, the mission of which, said Father Thelakkat, “is to give asylum to these girls, let them stay anonymously, protect their dignity, give medical aid and after delivery, let them be free to take or leave their child.”

Within a week, Sheela grew comfortable with her surroundings. She ate better, chatted with the other young women sharing her fate, looked after the babies and shared her bottled-up feelings with Sister Joicy.

Two months later, Sheela gave birth. The baby was breech. The doctors performed a Caesarean section, which left a scar emblazoned on her stomach.

Before Sheela was admitted to Mathru Sisu Bhavan, her parents had decided she should put the baby up for adoption.

“Two weeks after Sheela gave birth, we talked to her and asked her what she wanted,“ Sister Joicy said. “Sheela replied, ‘I’m not willing to look after this baby,’ and surrendered the child.“

Two months later, on her mother’s request, Sheela returned to her village. But soon Sheela began to realize her life would never be the same.

“So many marriage proposals were being made. She was very afraid of being found out,” Sister Joicy continued. “After a month and a half, her mother called us and told us that Sheela wanted to come live with us. She hoped that maybe, someday, a disabled boy or man on a second marriage would accept her. We took Sheela back and gave her training to look after babies. She’s so happy to be here.”

Sheela’s story is not unusual. At present, Mathru Sisu Bhavan houses 12 young single mothers, and more than 600 have passed through its or St. Magdalene’s doors in the last 50 years. Currently, 20 newborns await adoption, either locally or internationally. And, there are no signs the numbers are declining.

“There are more such pregnancies nowadays, more than before,” said Sister Gladys. “So many more interactions. So many more chances for social contact. Girls mix freely. But with more freedoms come more problems.”

In recent years, she added, society in Kerala has become more tolerant. In the past, families permanently banished these women. These days, banishment is only “temporary, so long as they leave the child here.” But, she said, the children carry a stigma.

“Mothers can go lead a normal life today,” she added, “but they may be burning inside.”

The heavy, still air of the hot summer afternoon fits the solemn mood among the residents at Nazareth. A limp black mourning flag hangs lifelessly over the entrance to St. Antony’s, its exterior courtyard, empty. Inside, however, residents fill the parlor. The funeral service for Mary P.M. is about to begin.

At the front of the room, the deceased lies in repose. Sunflowers and roses line her casket. A crown of pearls adorns her hair. Crosses and prayer cards rest on her chest.

In tearful grief, 79-year-old Rosakkutty stands over her older sister’s body — alone, but not for long.

A group of nuns in the front row collect their prayer books, rise from their seats and, one by one, join Rosakkutty by her side. Then on cue, the residents, sisters and family members stand in unison to pray. The strength of this tight-knit community seems to give Rosakkutty the strength to hold herself together.

As the prayers turn to song, some 50 girls from Bala Bhavan emerge from the crowd of mourners. Palms pressed together, they file slowly to the casket. Though too young to have known Mary P.M., the girls are not too young to pay their respects — at least as far as the nuns rearing them are concerned.

Father Thenayan celebrates a brief liturgy before leading the procession of mourners to the cemetery. They pass the church where Mary P.M. used to pray, the field of rubber trees where she used to toil and enter the cemetery where she herself once put old friends and family to rest. Loved ones say their final goodbyes. All in all, it is a dignified end for this simple and pious woman.

Later that evening, the sound of music fills the compound. The girls from Bala Bhavan, back in the flow of youth being lived, are practicing traditional Keralite dance. The day-to-day routine resumes. And, as usual, a sister will order the girls to cut the music and to hit the books before dinner. When night falls, she will then shepherd them to bed for a good night’s sleep.

Award-winning journalist Peter Lemieux reports from Africa and India for ONE.