Nirmala Joshi of the first Sisters of the institute to head a foreign mission when she went to Panama. In 1976, Joshi started the contemplative branch of the Missionaries of Charity and remained at its head until 1997, when she was elected to succeed Mother Teresa as Superior General of the institute. The government of India bestowed the Padma Vibhushan, the second highest civilian award, on Sister Joshi on Republic Day (26 January) 2009 for her services to the nation. Her term as Superior General ended on 25 March 2009, and she was succeeded by German born Sister Mary Prema Pierick. Joshi
Missionaries of Charity of a sterilizable needle and syringe was estimated in 1995 to be between 50 and 200 injections depending on the hardness of local water. Nonetheless, the controversy remains due to the charities not sterilizing needles and failing to make proper diagnoses, as put by Dr. Jack Preger, "If one wants to give love, understanding and care, one uses sterile needles. All institutions that the Missionaries of Charity run in India are to be inspected following allegations that staff at a Jharkhand home sold babies for adoption. A nun and a social worker employed there were arrested. Sister Konsalia Balsa and