INSTITUTIONS

A century of service

The year-long centenary celebrations of the Christian Medical College and Hospital, Vellore, begin on December 9.

ASHA KRISHNAKUMAR
in Vellore

WHEN on January 1, 1900, Dr. Ida Sophia Scudder converted her modest house in Vellore, in the then Madras Province, into a one-bed clinic, she would have scarcely imagined that it would grow into a 2,000-bed hospital - the Christian Medical College and H ospital, or CMC Vellore. At present the hospital has 55 clinical departments and treats one lakh in-patients and 12 lakh out-patients a year. CMC's year-long centenary celebrations begin on December 9, the day Ida Scudder was born.

One of the first women to be trained at the Cornell Medical School in the United States, Ida returned to Vellore - where her father had spent a lifetime - to provide medical care to women who, because of religious and social taboos, would not get treated by male doctors. In her zeal to reach medicare to remote villages and to reluctant patients, Ida Scudder set up "roadside clinics", by carrying medicines to villages in a bullock cart. Thanks to a donation, she built the 40-bed Mary Taber Schell Memoria l Hospital (named after the donor) in 1902, which subsequently became CMC.

Realising the medical needs of the women of the area and her own inability to serve all of them, Ida Scudder began training compounders in 1903, and set up a school of nursing in 1909. Her dream of establishing a medical school for women, which trained l icentiates, materialised in 1918. The medical school became a medical college in 1942, and it began admitting male students in 1947. To provide medical aid to the rural poor, the Community Health and Development (CHAD) unit, with 80 beds, was started in 1955 and the Rural Unit for Health and Social Affairs (RUHSA), with 40 beds in 1977. A 40-bed low-cost effective care unit was opened for the urban poor in 1983.

The medical and teaching facilities at CMC grew with the addition of various specialities from time to time, most of them pioneering efforts. Today, CMC offers 90 recognised training programmes in medical, nursing and allied specialisations.

CMC is run by the Vellore Christian Medical College Association, a registered charitable society with the involvement of over 50 Indian Protestant churches and other Christian organisations. It is administered by a governing council consisting of represe ntatives of the Association and of some 30 other organisations based in India and abroad.

CMC's work is broadly divided into four areas: patient care, teaching, out-reach and research. All faculty members are expected to contribute to each of the four areas. All the 620 doctors, 182 members of the teaching staff, 1,314 nurses and students sta y on the four campuses.

Although the pay structure is low in CMC compared to other institutions, the doctors have continued to work. This, according to CMC Hospital Medical Superintendent Dr. George Chandy, is because ''they derive tremendous job satisfaction as they can teach, treat, carry on research and participate in out-reach programmes."

In the heart of Vellore town is the 27-acre (10.8-hectare) main hospital campus, which also houses the College of Nursing and the residences of some essential clinical staff. Close by is another campus, where Ida Scudder set up her 40-bed hospital; it ho uses the Schell Eye Hospital and the Ida Scudder ward, which provides free medical treatment for the urban poor. The 106-acre college campus at Bagayam, 7 km from the town, accommodates the hostels of students and the quarters of the staff of the colleg e. It also houses the base hospital for CHAD, the Mental Health Centre and the Rehabilitation Institute. The RUHSA Hospital is at K.V. Kuppam, 30 km from the town. The main hospital has 16 operation theatres where over 45 major surgical operations are pe rformed every day.

CMC has several firsts to its credit: it performed the first successful open-heart surgery in India (1948), the first reconstructive surgery for leprosy patients in the world (1948), the country's first middle-ear microsurgery for deafness (1961), the fi rst kidney transplant in India (1971), the first gastrointestinal endoscopy (1972), the first carotid bifurcation stenting in India (1996), the first transeptal carotid stenting in the world (1996), and the first transjugular mitral valvuloplasty in th e world (1996). Its other achievements include the setting up of the first neurological sciences department in South Asia (1948) and the first rehabilitation institute (1966) and the first virology department (1978) in the country.

CMC reaches health care to the poor while keeping abreast of technology. It is one of the best-equipped hospitals in the country. According to the hospital's director Dr. Joyce Ponnaiya, "the hospital acquires only need-based equipment and the facilities available are comparable to those used in any major hospital in the country." About 400 open-heart surgical procedures, 100 kidney transplants, 40 bone marrow transplants and 900 angiocardiograms and cardiac catheterisations are among a variety of diagn oses and treatment performed every year in the hospital.

K. PICHUMANI
CMC Vellore. Excelling in patient care, teaching, outreach and research.

About 77 per cent of the beds in the main hospital are in the general ward, where treatment is subsidised. About 15 per cent of the patients here are treated free of cost. In 1998, the underwritten medical costs of the poor were Rs.11.8 crores. The recur ring costs for 1998-99 were Rs.84.5 crores. In addition, CMC spent a total of Rs.4.64 crores on research activities and scholarships for poor students.

The cost of treatment ranges from rates comparable to those charged by corporate hospitals, to practically nothing, depending on the economic status of the patients. However, according to Dr. Chandy, "there is no difference between the treatment given to patients who pay and to those who are not charged a fee."

THE specialised departments of CMC do not operate as profit centres; they cross-subsidise each other. Each department has set high standards for itself.

The Developmental Paediatrics Unit, headed by Dr. M.C. Mathew, focusses on identifying the neuro-developmental needs of children and helping them develop learning skills. It trains doctors and health workers in early childhood development and undertakes research work. It is the only department in any medical college in the country that trains doctors in this area.

The Rehabilitation Department, set up in 1966 by Dr. Mary Verghese, a student of CMC who became a paraplegic after an accident, initially rehabilitated victims with spinal cord injuries. By the early 1970s, it began providing trauma care and treated case s of tuberculosis, cancer, diabetes, cerebral palsy and viral infection of the central nervous system (CNS).

It is a comprehensive facility providing physiotherapy and vocational and occupational therapy. The department collaborates in research with experts from the fields of bio-medical engineering and electronics and professionals from institution, such as In dian Institute of Technology's (Chennai) Composite Structures Department. Its workshop, one of the oldest in the country, has designed and developed low-cost aids such as calipers, wheel-chairs and special shoes with locally available materials. Its staf f include rehabilitated patients. The unit also runs an out-reach vocational rehabilitation programme in a 100-km radius around the hospital.

Dr. Jacob John of the Virology Department was the first to detect an HIV (human immunodeficiency virus) positive patient in the country - in 1986. The department's activities include conventional cell-culture-based virus identification, antibody tests an d antigen detection, molecular diagnostics of eight viruses and the study of opportunistic viral infections, HIV and hepatitis. Identified as a referral centre for HIV patients, the unit, headed by Dr. G. Sridharan, works in association with the National AIDS Control Organisation.

The Cardiology Department, started in 1955, has done pioneering work. In 1997, it developed a balloon, which costs Rs.16,000 and can be used up to 20 times to correct the narrowing of the mitral valve. (Rheumatic fever narrows the mitral valve, thereby b locking blood flow. Earlier balloons from Japan, each costing Rs.75,000, were used to clear the block. These were not reusable.) CMC has done over 600 procedures using this balloon.

This department was the first in India to treat aneurysms without surgery. The department, under Dr. V. Jacob Jose and Dr. George Joseph, also treats children - even babies - with congenital heart diseases.

The Reproductive Medicine Department, set up in 1995, employs state-of-the-art techniques - blastocyst transfer and assisted hatching and procedures such as in-vitro fertilisation (IVF), gamete intra-fallopian transfer (GIFT) and intra-cytoplasmic sperm injection (ICSI) to treat male and female infertility. CMC does not accept donor sperms or eggs for fertilisation.

Started in 1986 to treat blood disorders, the Haematology Department has carried out 216 bone marrow transplants, including 102 bone marrow transplants in patients with thalassemia (for a genetic disorder in which adequate haemoglobin is not produced), the hightest number in each case in the country. It recently did a transplant on a six-month-old baby with Wiscott-Aldrich Syndrome, an immune deficiency disorder.

The department, headed by Dr. Mammen Chandy, also treats aplastic anaemia (bone marrow failure); haemophilia (a bleeding disorder); and leukaemia. It also performs peripheral stem cell transplants.

CMC was the first college to start a super-speciality training course in blood diseases. Among its major research work is a study on Glanzmann's disease, a bleeding disorder, common among communities with consanguineous marriages.

K. PICHUMANI
At the magnetic resonance imaging facility.

Apart from routine procedures and treatment, the ENT Department, headed by Dr. Anand Job, does functional endoscopic sinus surgery pertaining to nasal polyps and sinusitis. The department recently acquired a micro debrider, which is used to remove the po lyps and bones, with minimum bleeding.

The department treats patients with vertigo and snoring problems, and reconstructs the ear. It was one of the first in the country to remove laryngeal tumours without loss of the voice box.

Set up in 1902, the Department of Surgery, the oldest in the country, was upgraded to a post-graduate training department in 1950. The department, now headed by Dr. Bannerji Jesudason, is one of the best in terms of manpower and technology. It performed a liver transplant recently.

The Department of Urology does 100 renal transplants a year and has started doing nephrectomies laparoscopically.

Started in 1948, the Neurology/Neurosurgery Department was the first such in the country. In 1952, it started performing surgical operations on epileptic patients. The department, headed by Dr. Chandran Gnanamuthu, has pioneered several techniques and is the only facility doing intra-operative brain monitoring in the country.

THE Mental Health Centre was started in the early 1950s. Its unique aspect is that it insists on the members of family staying with the patients on the campus, which has a number of small dwelling units - 20 private and 40 general units and 12 dormitorie s.

The centre has 90 beds and caters to all age-groups. It has several facilities - child and adult psychiatry units, a learning disability centre, a school for the mentally challenged children and therapy centres for various age groups.

The department, under Dr. Pratap Tharayan, also counsels AIDS (Acquired Immune Deficiency Syn-drome) patients. It has been funded by the National AIDS Control Organisation, the AIDS Prevention and Control Project (APAC) based at the Voluntary Health Serv ices Hospital, Chennai, and the Ford Foundation to train counsellors. More than 1,000 people have been trained until now. It also conducts programmes aimed at commercial sex workers, looks after the children whose parents have succumbed to AIDS, and netw orks with non-governmental organisations in the country.

The department set up in 1978 the Nambikkai Nilayam (house of trust) to train mentally retarded children and their parents. This is also a residential training centre concentrating on behavioural therapy and coping mechanisms for children and is headed b y Dr. Paul R. The centre accommodates up to 60 children and there is usually a waiting time of one year. The unit has also set up a self-help group of parents which works outside the hospital but with its active involvement.

Other departments include the Department of Nuclear Medicine, Radiation Oncology, Gastroenterology, Endocrinology, Hepatology and Nephrology.

CHAD was set up as a pioneering hospital-based socio-economic programme. Known for its innovative approach, CHAD bagged the World Health Organisation's (WHO) "Best programme in South Asia" award in 1998 for providing primary and secondary health care to the rural poor.

The focus of CHAD's activities is the villages. CHAD has a base hospital at Bagayam with 80 beds. On an average 50,000 out-patients and 6,000 in-patients are treated there every year. The hospital has a high-risk obstetrics clinic, a nutrition rehabilita tion centre, a leprosy care unit, an operation theatre, a laboratory, a pharmacy and a communication and monitoring department.

CHAD does yeoman service through its health teams operating in 68 villages of Kaniyambadi block, covering a population of 100,000. The programme has achieved 100 per cent immunisation in these villages: infant mortality, malnutrition and perinatal mortal ity have been brought down significantly.

CHAD also offers technical support and advice in animal husbandry and agriculture. It runs 26 balwadis, or day-care centres for children under five, and has set up a Community Development Society (CODES) to help women take up income-generating activity. There are also centres such as SHARE (Self-help Association for Rural Education and Employment) which, after being under CODES for several years, are now on their own. SHARE has an annual turnover of Rs.35 lakhs.

The RUHSA programme covers 39 panchayats of the K.V. Kuppam block with a population of 120,000. It concentrates on improving social, economic and educational conditions, and has organised 118 women's self-help groups.

K. PICHUMANI
Handicapped children at Nambikkai Nilayam, which was set up in 1978 to train mentally challenged children and their parents.

CMC's research activity has become integral to its other services. For instance, in 1998, 29 projects were sponsored by the Department of Biotechnology of the Government of India, the Indian Council for Medical Research (ICMR), the Council for Scientific and Industrial Research (CSIR), the Wellcome Trust and the Community Based Rehabilitation Forum. Fluid research grants from CMC, amounting to Rs.15 lakhs, were sanctioned for 81 new projects; besides, such grants support 144 ongoing projects.

The treatment of over two crore out-patients and 12 lakh in-patients in the last 100 years has generated an enormous quantity of data, which are stored since 1989 in the Computerised Hospital Information Processing System (CHIPS). Now any information - from details about out-patients to laboratory test results and surgical procedures - is readily accessible. Records of in-patients are maintained for 25 years and those of out-patients for five years.

CMC has undertaken a number of epidemiological research projects. It has conducted studies on the patterns of Hepatitis C, HIV and AIDS, gastrointestinal and diarrhoeal disorders, rehabilitation methods, leukaemia and metabolic disorders, and on bone mar row transplants.

AN important part of the curriculum of the medical college is community medicine, which entails staying in a village for several weeks each year. After graduation, those students who have gained admission on the basis of sponsorship by chruches, serve fo r at least two years in hospitals run by the sponsor.

The college, which has an impressive infrastructure, admits 60 students, at least 25 of them women, at the undergraduate level. Churches sponsor 45 students. Preference is given to students who are willing to return to the rural areas, poor students (who comprise 15 of the sponsored ones), and students belonging to the backward classes. The students are required to serve in India at least for four years.

Dr. George Mathew, vice-principal of the college, said: "The fees at CMC is the lowest in the country. We charge Rs.3,000 for a year for the undergraduation course. Scholarships are available for students who cannot afford the fee. The hospital subsidise s the college activity."

The college offers 24 post-graduate courses (90 students are admitted every year), 12 superspecialities, and a large number of para-medical training courses such as laboratory technician and nursing courses.

Dr. George Mathew said that most of the students joined the hospital after completing their graduation. Even students who went elsewhere for advanced training courses returned to CMC.

Ida Scudder died in 1960 at the age of 90, but the spirit with which she set up CMC is not dead. It will continue to serve the community just as well in the new millennium.