by Bhargavi and Rakesh
The Institute Hospital (www.hospital.iitm.ac.in), started in 1969, is responsible for providing health care services to about 8000 students and an almost equal number of employees and their family members. Like every other unit of the Institute, the hospital is funded out of the government grants given to the Institute. There are also some earnings by way of fees collected and health insurance claims – which don’t go directly to the hospital but are absorbed by the Institute to partially offset the running costs. Over the years, there have been many upgrades and renovations made to the hospital and its facilities and infrastructure.
Since we were looking for the perspectives of all the people involved, we decided to start by speaking to the Dean of Administration. We inquired about the steps taken by the administration to improve the infrastructure and facilities in the hospital. The biggest move made by the administration has been to outsource wherever possible, starting with doctors, he says. Given that Chennai is well known for its medical services, he feels it makes sense to tap into that vast resource pool in order to provide affordable medical care without compromising on quality. The hospital has about 10 staff doctors and about 30 consultants. While staff doctors operate the usual shifts and provide the first level of services, the consultants are typically available in multiple 3 hour slots spread through the week.
When we asked for more on the outsourcing, he tells us that the pharmacy is outsourced to Apollo and the diagnostics (except X-ray and ultrasound) to Lister Metropolis, both leaders in their respective market segments. He also talks about recent ties with leading (external) speciality service providers for dental and ophthalmological services. This was done in order to give the hospital additional flexibility and reliability in providing these services. For about ten years now, there has been an operating health insurance scheme for students and employees/dependants. This provides hospitalisation coverage that supplements the services at the Institute hospital. He indicates that there is also a plan to expand the in-patient (bed) capacity at the hospital, but it does not have high priority with the insurance schemes in operation currently at the hospital.
We asked him about the recruitment procedure adopted to recruit new staff members. He answers by describing a rigorous procedure the administration employs, which involves the usual required government procedure of advertising, forming a selection committee, interviews etc. For empanelling consultants, there is a team of medical officers, comprising eleven doctors on the staff, which works with referrals from reputed practitioners in and around the city.
We follow up by inquiring about the staff who are already a part of the hospital. He tells us that there are 24 consultants, specialists in their fields, who come in whenever required. He also mentions a hospital advisory committee, that he feels has been somewhat dormant in recent years. Once or twice a year, a review of the doctor-wise patient data is conducted in order to determine the areas of service that need expansion. He explains by taking the example of the increase in the number of sports-related injuries, caused due to growth in number of students involved in sports and athletics and improved awareness and access to resources related to physical fitness. So, the administration has expanded the physiotherapy unit and are considering further related expansions.
The Fifth Estate recently conducted a survey about the Institute Hospital, which saw a large number of responses which were both specific in nature and mixed in terms of opinion of the same. Most people seem to use the Institute Hospital very rarely, and only for minor health issues. While the latter were very satisfied with the quality of service provided and personnel, those who seeked treatment for more serious health issues expressed disappointment. The survey responses included several complaints regarding the amount of time a patient has to wait before he or she is able to meet the doctor. Some even questioned the professionality of the hospital staff, labelling the doctors as “cold” and “rude”.
There were a few complaints that the doctors really don’t seem to check the patient well enough before prescribing medicines. There also seems to be the issue regarding the availability of specialist doctors. Some students have questioned the ability of the hospital regarding the diagnosis of serious diseases, such as Dengue or Typhoid. Many opine that paracetamol tablets are prescribed for nearly any complaint ranging from mild headaches and body-pains to severe fevers. Patients with skin problems report that the ointments prescribed by the specialist are very ineffective. Numerous people feel there should be a pharmacy open 24×7.
When it came to the cleanliness and hygiene of the premises, the students rated the Institute Hospital quite highly. Except for a couple of reports of mosquitos in the in-patient rooms, the hospital seems to be a very healthy and hygienic place on the whole.
Everyone is super-busy at the hospital, as is to be expected. We wait for an hour and a half before Nurse Saramma Rai finds the time to sit down “just for ten minutes” and answer our questions. Even then we are sporadically interrupted by people who rush in to her office with questions and doubts. One gets the impression that nothing would run without her help. But, of course, every staff member at a hospital is as crucial to its functioning as she is.
Saramma Rai has been working at the hospital for 30 years now. There are totally 13 nurses on the staff, but only 8 who are working as of now. She works eight hours a day, even now, but thankfully does not need to take the night shift. Some of the newer nurses have night shifts in addition to long working days.
We ask her to tell us about the most critical cases she’s seen, she frowns and says there were many, all of them critical in their own ways. Some of them—like a patient with typhoid whose intestines were perforated—are treated in the Institute Hospital itself. Others are sent to Malar Hospital or Apollo Hospital or the Sundaram Medical Foundation, with which the Institute Hospital has tie-ups. Dengue is treated in the hospital itself, Saramma Rai says. If the fever stays above 103 degrees for a few days, the patient is sent to Apollo.
Complex surgeries, such as eye surgeries, or surgeries for poly-traumatic injuries (serious injuries to many parts of the body), are not done at the Institute Hospital. Fractures and such are treated here, however. The hospital has an OPD ward to handle deliveries and caesarians. There are two gynaecologists and one anaesthecist on the team. The other doctors, eight of them, are General Practitioners.
There were two psychiatrists on the staff of the hospital, but one was on medical leave at the time the interview and the hospital was in the process of finding a new one. We asked the Chief Medical Officer, Dr. Mahalakshmi Ravi, how many patients visited the psychiatrists on average. Some months are leaner than others, with April, unsurprisingly, having the highest number of patients visiting the psychiatrist. Around 40-50 visits are made every month, on average. These statistics do not account for repeat visits made within the month by the same student. The common problem that students face seems to be coping with academics.
The Institute Hospital gets 8000 patients a month, the CMO says. That is a staggering number considering that the entire student body is probably no larger. But the hospital does not only cater to students and teaching facility. Blue-collar workers in the institute are also entitled to use the hospital facilities. Plus, the hospital handles emergency cases even if the patient is not working/studying in the institute or a relative of one.
We ask Saramma Rai what happens when animals are injured on campus. There used to be two vets working in the hospital, the nurse says, but nowadays the hospital doesn’t employ vets. Injured animals are transported to the Gandhi Mandapam that adjoins the IIT campus for treatment.
There are two ambulances always ready and waiting in the institute. One is the institute ambulance and the other the trauma care one. The trauma care ambulance transports patients to hospitals outside IIT. While it does so, another ambulance is sent to IIT so that there is at least one ambulance within IIT, ready for any emergency, at all times.
What are the most common cases that she sees? Bronchitis, wheezing cough, diarrhoea, viral fever, and accident cases, Saramma Rai says. As she seems to want to get back to work again—another staff member hurries in to confabulate with her about medicine for a patient—we say thank you and leave. For all the criticism of its functioning that we’re accustomed to hearing from our peers, the Institute Hospital seems to be functioning quite well.