Spotlight

Southern Care and Comfort

Even before quality and medical tourism became buzz words in the industry, the Christian Medical College, Vellore had been following them from way back in 1970. Nayantara Som gives an insight

For Vellore-based Christian Medical College (CMC), innovation and breakthroughs are something that is close to its heart. Even during pre-Independence, founder Dr Ida Sophia Scudder sought innovative ways to teach students to distinguish between nerves, veins and arteries through various colours. She then graduated to using the Global Positioning System (GPS) to track medical histories of people in rural India. She set up the Medical College in 1918 and started the MBBS course in 1942. Unusual methods has been one of the reason how the college has managed to establish its name as a not-for-profit organisation, and creating a name with innumerable firsts to its credit, while providing surgeries at a subsidised cost to its large middle-class clientele. Today, CMC is a 2,340-bed hospital, a stupendous growth from a 40-bed hospital in 1902, housing 5,910 employees and looking after the needs of at least 4,000 outpatients per day.

Brand

"A large number of patients paying Rs 10 is equivalent to one patient paying Rs 4,000" - Dr George Chandy Director CMC, Vellore

According to a report by the US Department of State, Bureau of South and Central Asian Affairs, about 28 per cent of the Indian population live below the poverty line, but there is a large and growing middle class of 325-350 million whose need requires looking into, as they have the maximum amount of disposable income. CMC aims to cater to this growing populace without plunging into concepts like branding and marketing, as it is understood today. Says Dr Samuel Chittaranjan, Professor, Department of Orthopaedics, CMC, Vellore, "We do not wish to identify ourselves as a marketing brand. We have been here for almost 107 years to serve people and have a strong sense of commitment. That has already established CMC as a brand."

Interestingly, it charts its own path of branding. The subsidies in terms of cost, medical and educational have got it word-of-mouth branding. "We get large number of patients every day. Many patient paying Rs 10 can be termed equivalent to one patient paying Rs 4,000," says Dr George Chandy, Director, CMC. Even the students pay a mere Rs 3,000, which is nominal as compared to other medical colleges. Says Dr Mammen Chandy, Professor, Department of Haematology, CMC, "We do not function as a capitation medical educational centre. Our income is utilised towards medical education."

Perhaps, the logo of CMC says it all. The logo (see page 45) is a branch of encircling ferns with a lamp at the bottom, a hand and a pair of wings at the centre with two intertwined snakes. Dr G Chandy says, "The ferns indicate CMC embraces its patients in a spirit of care. The lamp implies our mission to spread the light of care with the hands engulfing all the patients." In fact, the tagline 'to minister and not to be ministered unto' is more assertive in its mission to serve and not to be served. CMC's "Both-And" philosophy focuses on the poor, the marginalised and the underprivileged, to provide them low cost, effective care with the help of money raised by looking after paying patients.

Competition

CMC focuses on social outreach programmes for the marginalised section

Branding and competition go together. But CMC believes it has gained its place without these accessories. "We don't need to compete with anyone. We provide the best care to all our patients. As long as we maintain that excellence, competing will not be our strategy," points out Dr G Chandy. The concept might sound utopian considering the competitive world hospitals thrive in, but a closer look proves it has reaped fruits for the hospital. Dr M Chandy says, "Our forte is all our disciplines under one roof. A patient can expect accurate diagnosis because all the disciplines work hand in hand."

Hard work has indeed paid off. Last fiscal, CMC's turnover stood at Rs 225 crore. This is then utilised for noble causes. "Of Rs 225 crore, Rs 42 crore was spent on community outreach programmes and helping poor patients, while Rs 24 crore went into educational subsidies," adds Dr G Chandy.

CMC offers education courses for MBBS, postgraduate diploma courses in 11 specialities, postgraduate degree courses in 21 specialities, nursing courses up to PhD level and 27 allied health science diploma programmes, as well as a distance education programmes. Around Rs 24 crore is regularly spent on education alone. The growth graph altogether has also been astounding where in the last four years saw a rise from 50 per cent to 200 per cent.

Outreach Programmes

Besides offering a host of facilities to its patients, CMC has its social outreach programmes for the rural and marginalised section of society. Programmes include the Community Health and Development (CHAD) Programme, College of Nursing Community Health Programme (CONCH), Low Cost Effective Care Unit (LCECU), and the Rural Unit for Health and Social Affairs (RUHSA).

Based at Bagayam, about five kilometre from Vellore, CHAD is a part of the Community Health Department of CMC. It provides primary healthcare for nearly 2,50,000 people in nearby rural, urban and tribal communities and provides training in the principles and practice of community-based healthcare for medical, nursing and paramedical students, postgraduates and staff from CMC itself. Dr G Chandy says this programme has been in practice for the last 50 years. "In fact, The National Rural Health Mission that the Government is planning to implement, is based on the lines of this programme." Outpatient services include special clinics for antenatal patients, high-risk infants, tuberculosis, leprosy and ENT diseases, in addition to daily general clinics. On an average, doctors at the OPD see 180 patients a day.

The CONCH programme, started in 1987, is extended to 62,989 people in 20 villages and semi-urban areas. "Nurses from CMC go out, visits homes, conduct regular check-ups and bring people to the hospital," says Dr Chandy.

Regular services such as maternal and child health clinics, morbidity clinics, school health and mothers' programmes are also a part of this. Periodic dental and eye check-up clinics are conducted with the help of the dental and ophthalmology departments of CMC. The LCECU, set up in 1982, meets the health needs of the urban poor, especially in the slum areas of Vellore. The treatment cost is kept low without compromising on the quality of care. Available technology is used for simple but appropriate tests. The emphasis is placed on 'clinical acumen' and the use of relatives in the nursing care to keep the costs down.

The RUHSA unit is situated in the KV Kuppam block in Vellore district, which caters to 120,000 people in 39 Panchayats with the primary purpose of social and economic uplift. "Students go into these villages and provide each family with a cow, a goat, and teach them various skills," says Dr G Chandy. The RUHSA Community College provides six-month courses for students in vocational skills. RUHSA has promoted more than 365 women's self-help groups. The women are involved in a number of income generating activities such as marketing their produce. RUHSA has various programmes for the elderly being implemented at the community level. RUHSA has been actively involved with NGOs in Orissa in controlling malaria.

Milestones

1948 - First reconstructive surgery on leprosy patients in the world.   - First Eye camp. 1961 - First Successful open heart surgery in India   - First middle-ear microsurgery for deafness in India. 1966 - First Rehabilitation Institute in India. 1971 - First kidney transplant in India. 1976 - Artificial kidney Unit. 1977 - Rural Unit for Health & Social Affairs. 1986 - National AIDS Reference and Surveillance Centre.   - Bone Marrow Transplant. 1990 - Infant Open Heart Surgery.   - 1000th live donor Kidney transplantation. 1992 - 10,000th open heart surgery. 1996 - First carotid bifurcation stenting procedure in India.   - First trans-septal carotid stenting procedure in the world.   - First trans-jugular mitral valvuloplasty procedure in the world. 1998 - First Bone Marrow Transplant in a 6 month old baby. 2003 - Palliative Care Unit.   - Vellore-Bombay Artificial Limb.   - India's Best Employer Award. 2005 - First live donor liver transplant.   - First Surgical Ventricular Restoration (SVR).

Quality and Training

What is of utmost importance to CMC is the fact that in all its activities, quality takes precedence. Ideas like the constitution of an infection control committee, audits and documentation have been in practice for long. An infection control committee was set up as early as 1970, testing for hepatitis, models and guidelines for antibiotics, quality control measures, et al.

CMC reported the first case for HIV/AIDS in India. Recalls Dr G Chandy, "Nobody believed the reports at that time. But looking at this case, we knew that few years down the line, this is going to wreak havoc in the country." In the aspect of education also, CMC has been bestowed with the highest rating by the NAAC of UGC for its quality courses.

The strict quality control measures are reflected in the innumerable firsts it has to its credit. The first open heart surgery, the first kidney transplant surgery, the first home care system in a mental hospital were all initiated by CMC. (for more, see box on milestones). It is believed that former Principal Dr Jacob Chandy said, 'If there is anything in the world that is good and advanced, it must be at CMC.'

"In our department, spinal surgery, limb reconstruction, surgeries for bone tumour and paediatric orthopaedics are performed. Lately, we have performed a hand surgery where the nerves did not work. Our technique is making the bones grow so that the hand can move," informs Dr Chittaranjan. In addition, CMC has come up with a 'Vellore-Bombay' hand - something similar to the 'Jaipur Foot'. For its outreach programmes, the Global Positioning System (GPS) has been used whereby adjoining villages and rural areas have been connected to the main centre at CMC and thus the medical history of each and every villager is tapped. "We also have PACS which covers the entire campus and an advanced HIS software," informs Dr G Chandy.

Updated technology and high-end surgeries requires skilled employees. It imparts regular training to employees. A formal five-day training programme is held for all trainees. Three days are allotted to teaching trainees and the remaining two days for these trainees to practice with senior employees.

Medical Tourism and International Tie-ups

For CMC, medical tourism has a different connotation altogether. Over the years, CMC has seen myriad patients coming in mainly from the North and North-East. "Medical tourism is not new to us. For the past 50 years, even before it became a concept, people from across the country come in for treatment and then visit areas like Tirupati and Sabrimalai," adds Dr G Chandy.

Dr Chittaranjan says, "Patients come in from Jharkhand, West Bengal, North-East even Andhra Pradesh and Karnataka."

CMC has MoUs with around 20 top-notch universities like the Cornell University, USA, John Hopkins University, University of Adelaide, University of South Australia, University of California and three universities in Europe. Exchange programmes of students as well as teachers are held for research, training education and teaching purposes.

The Future

So how does the future look? It is setting up a medicity. "The area will be enlarged to make Vellore a medicity and we have purchased 100 acres of land for the purpose," says Dr G Chandy. In fact, CMC has various technology-savvy challenges to face . We have been doing the balancing act of bringing in the latest available technology and at the same time making it available in a country largely predominated by a middle-class society. To be relevant in an industry dominated by international and corporate groups is one of the target aims for CMC. Till then there is never a full stop to the principles of care and commitment services to its clientele.

nayantara.som@expressindia.com