Three new hospitals !

Anna and I were at Vellore a few days ago to attend the funeral of a dear friend and A former colleague! 

During the in betwehen time, we were able to go to Chittoor to visit the Chittor campus of CMC, Vellore. The last time we were at this site was about two years back. Since then, the place is brimming with activity providing high quality care for local residents and others visiting from far away places. 

The Out-patient area had about 200 people waiting to be seen and even other areas we were able to visit, which did not need prior permission from the authorities, indicated the significance it has earned in health care in that town and the state. The roads connecting the different buildings had cars parked as the parking are was overflowing. 

The bulletin board at the entrance displayed all the services offered in the hospital, which was impressive as most of these facilities have come up in the last five years since it started the services probably eight years ago. 

What inspired me was the building under construction, visible from the gate and from far away on the way to Chittor campus, the Nursing College. It seems to be the first of the other education institutions that might come up in the years to come. 

This campus came into being when the late, Mr Y S Reddy, the chief minister of Andhra Pradesh offered this land, which CMC purchased to develop a health care facility. Now that Mr Jagan, the son of Mr YSR is the chief minister of Andhra Pradesh, hopefully more developments could take place faster! 

I was desperate to take photos of the campus buildings, facilities and people's movements, but refrained to do so, as I did not take permission earlier! It is a place worth visiting! It is changing the health profile of Chittoor already from the comments I heard from a few visitors whom we happened to meet in the gate outside. 

The second site we visited was the Kanigapuram campus of CMC Vellore which is under construction to offer out patient services and inpatient care. A hospital with a focus on trauma and advanced facilities in all the higher specialties hopefully would be complete for occupation in 2020. It started as a project to decongest the town campus of the main hospital, but is now destined to be a hospital of future for 1500 inpatients from the little I hear about it from friends. A large residential complex is also coming up behind the hospital. The site is under security cover, which denied me an opportunity to enter the campus and feel the ambience of this new environment at this time of the finishing touches to the exterior. This photo from the high way gives away its impressive and intriguing presence. Good wishes for making this hospital for the next century in the hundred and twentieth year of CMC hospital. 

Along with this transition of a part of the current town hospital moving to the new Kanigapuram campus, there are renovations going on in the town campus to make it more user friendly. The old student nurses hostel would soon be a fully furnished out-patient facility, ICU and a theatre complex for the Orthopaedics department.  

The buz is that a plan is in evolution for a children's hospital in the Kanigapuram campus in the near future. That has been a long felt need. 

This new hospital has many promises to keep. The top most being is to guard the hospital to conform to the motto of the institution, 'not to be ministered unto but to mister'!

The third new hospital initiative in Vellore town is a super specialty hospital in Vellore town about half a kilometre from CMC hospital, by the Vellore Institute of Technology university, in collaboration with the Ford foundation. The VIT having become a centre of excellence, one among ten private institution in the country, under the recent award of honour by the University Grant commission, it is likely that this hospital woeful be a destination for all those who seek the corporate culture, hospitality and technologically advanced health care facility. What I heard was that some alumni of CMC are likely to be in the leadership of the new hospital, which is due for commissioning in 2021.

The sleepy town of Vellore has become a city with many new additions. It is not the place to which Dr Ida Scudder came to provide health care for women who lived in the 'enclosed' corners of their houses.  It is now a place of some historic sights and scenes with its story intimately connected with the decision of Aunt Ida to become a doctor and return to India because she experienced three women die in child birth in Vellore one night for want of a lady doctor!

I hope all hospitals would be places of hospitality. I have had some anxious moments recently for which I have had to go to seek help from professionals. What I received was an affirming approach which lifted my spirit and quietened my anxiety!

I hope that would be the same for all who come to CMC Vellore!

M.C.Mathew(text and photo)  

2. Memorable photographs-2016-expereince

First pre-internship clinical orientation for a month !

M.C.Mathew(text and photo)

Remembering the beginning!

Dr. P Zachariah, former professor of Physiology at Christian Medical College was the one who conceived the idea of having an international consultation at CMC Vellore once in ten years for strategic thinking and collective engagement on priorities for the institution. 

The four such consultations have guided the institution through its different stages of development in the last four decades. 

At the fifth consultation which was held in October, Dr. Ajit Bhatt who was one of his students, while presenting a momento, said this of  his mentor, 'there are only a few people who walk with you all the way... Dr. Zac is one such rare mentors'!

I thought that was an apt tribute to him. While working at CMC, I was a regular visitor to his home. Those conversations and reflections gave a lot of insight into the early years of  mission of CMC! Dr. Zac is brilliant in generating thoughts that are wholesome, creative and pathfinding. He is active and is connected to realities as before. He writes in newspapers to create a dialogue!

M.C.Mathew(text and photo)

A new initiative at CMC Vellore

The Christian Medical College, Vellore is now in its 116th year of service! The college would enter into its hundredth year in medical education in 2018.

The architect's drawing of the new hospital complex shown here would have facilities for over 1000 in-patients. Hopefully the hospital would be ready for occupation in 2018, all being well.

At the 'turning of the sod' function I heard different people mention about this project as a sign of 'God's gift to CMC'!

It continues to amaze me every time I visit CMC, as how much what happens in the college campus is a smooth flow of caring provided by many inspite of the daily attendance of about 8000 patients in the out-patient departments. The current hospital complex is highly congested. It was Dr. George Chandy, when he was the director who foresaw this need twelve years back. The current director Dr. Sunil Chandy took this forward to facilitate the commencement of its construction!

CMC Vellore is in transition and I believe that the latter years would be even better for CMC!

Dedication of Nursing Hostel!

The College of Nursing, at Vellore dedicated the undergraduate and post graduate nursing hostels on the second day of the council meeting of the Christian Medical College.

It was a colourful event. The building in the background where the students would stay has an unusual colour complexion different from the other building in the campus. To match the colour on the exterior of the building the students were dressed colourfully with matching balloons which they released it the air after the prayer of dedication.  

It was a well organised function with a spirit of festivity and celebration. The students thus far lived in crowded rooms and now they can look forward to more comfortable facilities. 

For all of us who witnessed this happy occasion it was a special event because the premier institution in Nursing education with more than one hundred years of history has added one more facility to add to its uniqueness!

The facilities the Christian Medical college provides for its students is of high standard, although fees collected is less than what schools collect from their students!

M.C.Mathew(text and photo) 

A call that inspires!

I listened to a moving story of Drs Shoba and Naveen last week in a meeting at Bangalore (seen standing in this photo, email: siloameh@yahoo.com) where some concerned about the future of the mission hospitals in India, held a consultation with the Moderator of Church of South India, initiated by the Christian Medical College, Vellore and Bangalore Baptist hospital.

Shoba and Naveen, working at Madanapallee in the Telengana region with an NGO started by them, was invited by the local Bishop of Church of South india a year back, to revive the 102 years old Madanapalle Mission Hospital. They having served their sponsorship obligation in this hospital and feeling disturbed by the decline of the hospital decided to respond to this invitation. 

Naveen an Orthopaedician and Shoba an ophthalmologist got started by  renovating the building, getting essential equipment for the laboratory and diagnostic services and enthusing the handful of staff left in the hospital, to transform the place into a place of welcome for patients. They have had debts to pay to restart the pharmacy and the laboratory. They and their friends contributed towards this. They received some respite from the government to pay the pending provident funds due to the government, which the church offered to pay. They were surprised by the goodwill from the people of the town, although the hospital is surrounded by other nursing homes. The cheer and response of the local people made then continue the efforts to make it into a community hospital.

After a year, the hospital is fast recovering and is already into its next phase of expansion. 

What moved me is the cheer and enthusiasm with which Shoba and Naveen spoke about their experience. They motivated us by their story to believe that some hospitals struggling to exist, situated in needy areas too have the prospects of renewal if there are people with a sense of calling and purpose at the leadership. 

Well done, Shoba and Naveen. Yours is a story of God’s faithfulness and your responsiveness to God’s promptings in your lives. 

We shall walk with you in your calling, because you show the way for rest of us!

M.C.Mathew(text and photo)

Transitions in health care!

I was albe to attend the inauguration of the Alpha clinic at the Christian Medical College Vellore, two weeks back, which is a new facility deliberately created to attend to the needs of the local community resident at Vellore. 

The highlight of this facility is that consultants offer voluntarily to be available in this clinic when they are free. This gives them an opportunity to offer more personalised care to those who would need regular consultations. This is a patent friendly ambience when consultants would have time to offer holistic health care. 

One special need is to offer life style changes to people who have non- communicable diseases. We are almost in an alarming situation of more younger people being diagnosed with coronary heart diseases, hypertension, Diabetes, psycho-somatic illness, sleep disorders, anxiety state, etc. All of these have a direct association with stressful life style. 

Health care is acquiring a new dimension of monitoring and modifying the life style of people. This is true for children  as well. This would call for modifying diet, including physical exercise in the daily rhythm, ensuring minimum sleep, avoiding substances which are addictive, living emotionally well and engaging in leisure time activities and hobbies. 

How can we make life style change education more popular! It is as crucial as immunisation for children to prevent some illnesses. 

One way is  for us to form life style groups who would come together once a month to help each other in changing practices and adopting new ways of living.

M.C.Mathew(text and photo)   

A Children's hospital in the making.

I was recently at a meeting of the senior consultants of the department of child health at the Christian Medical college, Vellore, when they presented or referred to the activities about 13 sub-specialties in child health, which offer services currently in the hospital. A few specialities have formal or informal training programme and others are in the process of starting one. What a delight to hear these specialists and sense their excitement about developing these specialities into fully recognised training departments! 

I tried recalling if I have come across about twenty five sub-spcialists who are young and have a long term commitment in any other institutions in India! In that sense the Child health department at the Christian Medical College, Vellore, is unique and vibrant. 

This department is about to celebrate the history of its fifty years leadership in post-graduate training for which they are holding its alumni gathering in September, 2013 at Vellore. 

This department has pursued the vision of sub-specialising for the last twenty five years, Neonatology and Endocrinology being the initial ones. It has a history of inclusive health care policy, which ensures that every child with a treatable clinical condition would receive treatment irrespective of the paying capacity of the families. Some of the research contributions of this department were original and path breaking, which have received international recognition. The emphasis of this department has been to train at least two consultants in each sub-specialty to provide stability and continuity. 

I feel that the department is now ready to 'launch out into the deep' by becoming a children's hospital. Some experiments of developing children's hospital in India have brought forth better quality of services and integration of services. 

Children need a different ambience than what traditional adult hospital provide. If a hospital has to become a 'home or school' for children during their hospital visit or stay, it is good to envision a child friendly hospital setting. Some of the issues of children and families, need a different style of approach and response than what we practice in adult hospitals. 

Let me encourage the team at the child health department at CMC Vellore to dream that they have what it takes to be a leading Children's Hospital in India to show the way for innovative and contemporary approaches to Child Life and Health! .    

M.C.Mathew (text and photo)

Turning obstacles into an opportunity

Amy and Arpit gifted this book to Anna on her birthday in 2012. I returned to this book several times during the last six months. 

It is a story of a British Nurse, Janet, who was brought up in Quaker tradition, living in Titmoh, a village in Jarkhand, formerly in Bihar, for ten years to experience the realities people face in their day to day life. 

Janet got deeply involved to create a primary health care for humans and animals in this village. In her attempt to make a difference, she came across the powerful in the society who exploited the weak  and became rich. The money lenders were one such group. 

It is written in a story form, easy to read and to connect with rural India. The stories create anger and shame within us as it is litany of  stories of insensitivity and callousness  of those in authority, whether it is health care professionals or animal husbandry professionals. 

The ten years she spent from 1975 was different as the development mantra that we hear today had not  surfaced in the India polity at that time. People lived at the mercy of a heath care system which was rudimentary in Indian villages especially in Bihar. 

What she left behind when she returned to Britain, was a mud hut in the village, where a dispensary was established with the help of a doctor from Calcutta and several living memories of her insistent pursuit to make a change in the social and health care setting of the community.

The question we often ask is, 'what can an individual do in a system that is resistant to change'? I hear this echoed among the christian heath care professionals working in rural India. Most of the rural hospitals in the Christian hospitals net work are through rough times, of late, with health care professionals disregarding this opportunity. One organisation needs fifty new doctors for its hospitals, but there are only one or two applicants.

Let me commend this book because it revives the call to rural India for partnering with people in their struggle  to progress. The book was published by Penguin in 2005.

M.C.Mathew(text and photo) 

Tell me before you decide

 Let me share an experience which helped me to revise the way I practice Medicine.

This 7 year old chid, used to come for consultations with her parents. After she has been through a long spell of using muscle relaxants and undergoing the prescribed exercises, she was still struggling to walk due to stiffness in the muscles. They returned during her summer holidays, for the next phase of her treatment, which was,  applying a cast of plaster of paris on her legs and keep changing it to new ones every three days till her muscles had relaxed well. She would then be on further muscle relaxing exercises and regular use of some stabilizing ankle support to keep the muscle in normal tone after the cast was removed.  

That was what happened and the family returned for a consultation after the cast was put. The girl looked unsettled, non-communicative and did not establish any social contact  with me unlike her usual pattern. She even refused to answer any question. As I persisted trying to reach out to her,  she shouted at me with these words, 'Tell me before you do anything to  me'. 

I was lost for words. It was true that I had not explained to her about the plan to put her legs in plaster cast or any of our thoughts or rationale behind doing this. Her parents did not explain to her anything either. So she protested, while the cast was put on her and the resident doctor told her to comply with the 'order' of the senior doctor. So there were several slips from the medical team by failing to solicit the willingness of the child or taking time to explain the process and procedure. 

It took a while for me to recover from this terribly embarrassing situation. The parents too were in a state of shock on account of what and how she communicated her anger and distress. Later I realized that she was looking forward to her holidays to spend time with her friends. We took away that opportunity from her, with no effort made to prepare her to cope with her  disappointment. Everything was imposed on her without seeking her consent.

In hindsight, I realized that I often left most of the explanations about therapeutic procedures to parents. It was only when I observed her distress, I realized the need to take responsibility for some of the preparatory conversations with a child, before any procedure is planned. 

We as clinicians, violate the autonomy of an individual, by not making joint decisions for therapeutic procedures. It is important to let even a child be given an opportunity to express his or her feelings, which I feel would be crucial before any final decisions is taken for the treatment plan. I remember this child mentioning to me later that, she missed being with three of her friends on their birthdays because parents decided to come away for her treatment, without consulting her.

I feel, that clinicians  have a long way to go, to involve a patient while making decisions for treatment. I am glad, that it is now mandatory to have informed consent from patients including from children, when therapeutic procedures are considered.

We have no rights over our patients; they have right of information about the plans we make for them. Let us move towards participatory decision making in clinical practice!

M.C.Mathew (text and photo)            

Comfort of patients during transit

I was waiting in a hospital campus for a meeting to begin. Seeing a patient being shifted, I turned to a senior nurse who was standing next to me and asked, does it appear that all good practices are followed while shifting this patent ! 

This nurse needed three surgeries in the last there years and mentioned to me that the comforts of the patient is not always at the heart of planning for shifting. We often pay attention to keep the monitors and equipment safe and secure during transfer of a patient. She recalled her experience.

She was awake from anesthesia while being shifted. She felt cold while being shifted and was not covered with a blanket. The trolly was terribly shaky and she felt  pain acutely in her raw wounds. The trolly was pushed in a jerky way which aggravated her pain. When there was an elevation on the floor,  she was pushed so fast that she felt that she would slip out of the trolly. She tried establishing an eye contact with someone handling the trolly, but none looked at her or talked to her, leave alone asking for her comfort. When she had to be shifted to her room, it was not well co-ordinated that her IV canula came out of her wrist. It took another half an hour before she was given an analgesic. She mentioned, ‘I wish I do not have to be in such a position again’.

I was well cared for when I was moved out of theatre after a surgery. The comfort of patient even during an emergency transfer is central to good health care practice. It needs even more attention.

M.C.Mathew(text and photo)

Generational gap in health care team

In my clinical work during the last forty years, I have had to get used to computer based technology in diagnostics, health care delivery, communication, managements of patients in the intensive care, etc. I found some easy and some difficult. It took a long while, before I got used to digital EEG, and other digital neuro-physiological procedures. 

The older people have to adapt to newer technology; parents have to adapt to the way children view life; leaders have to consent to the enthusiasm of younger people. The older people are to change if they want to feel needed.

A young doctor who is finishing his two years of work in a rural hospital spoke to me at length about some of his experiences, most of which made him feel suffocated, discouraged and negative. The hospital leaderships in rural hospitals still tend to view young health care professionals as subordinates, trainees, and temporary staff. Instead, they are valuable colleagues, people we are called to mentor in a self giving way  and professionals with potential leadership skills.

Young people are drawn towards rural hospitals only if the leadership is willing to transcend their experiences of their training years, which was very different, and accept and accommodate the needs of the new generation of younger professionals. 

The needs of young people are, acceptance, empowering, giving opportunities to express their creative skills, periodic break from work for respite and recovery, predetermined holidays, consideration for the spouse and children, etc.

The litany of complaints about young health care professionals, 'that they do not care or do not want to work in rural hospitals' need to be replaced with a challenge, 'how can we prepare him or her for a long term work in that hospital'! 

This calls for seniors and those in leadership to move out of their generational view to life, work and calling. For the sake of the thousands of patients who still depend on the rural hospitals, let us make every change possible to get younger people to gravitate to rural hospital. 

 M.C.Mathew