Men And Medicine In Madras

• Manas Dasgupta, 40, a Calcutta-based bank employee, has congenital myopia. Three years back, he travelled all the way down to Sankara Netralaya, an eyecare institute in Chennai, where he started treatment. His vision is now improving and he's back for the third time now.
• Thangaraj, 55, a farmworker, had a nightmare surgery in a Tirunelveli hospital: surgeons left behind a surgical knife by mistake. A follow-up operation made matters worse. Shifted to the ISO-9002 GIB or the 'gastro-intestinal bleeding' ward in Chennai's government-run Stanley Medical College, he is now on his way to recovery, thanks to Team Stanley's persistence and patience for over three months
• Oral cancer has made Yelumalai, 60, lose most of his speech and he can't afford expensive treatment. But he can expect to be treated free and like any other paying patient at the Adyar Cancer Institute: with precision cure under the linear accelerator with multi-leaf collimator.

When it comes to quality healthcare, all roads now lead to Chennai. And far from a devil-and-deep-sea choice between a dirty, derelict government hospital and a costly five-star private clinic, in India's health capital, rich or poor, you get the best treatment in the country.

So, if you are well-off, you can go to the Madras Institute of Orthopaedics and Trauma-care (MIOT)—one of the most modern Indian hospitals on a 14-acre site with landscaped gardens—or to Apollo, which promises a free ride in its state-of-the-art emergency ambulance from any hospital in Chennai (all you need to do is dial 1066.) The poor can avail hi-tech succour for free or low costs at hospitals like the Institute of Child Health or Stanley's GIB ward.

But whether you're paying lakhs at Apollo or nothing at Stanley, the professionalism, dedication and commitment of the medical staff—doctors, nurses or maintenance personnel—sets Chennai apart. Says Dr Monica De, consultant anaesthetologist at Apollo: "It's a combination of serious work ethic and commitment of doctors and modern facilities that makes the city the chosen destination for good, modern, affordable healthcare."

True. Every day, Dr R. Surendran, the man behind Stanley's ISO-certified GIB ward, after fulfilling commitments at his alma mater, turns consultant at Apollo where he treats the rich the same way he did the poor before 3 pm. "Whether at Stanley or Apollo, patients must be made to feel the facilities are for them," he says. And his achievements speak for themselves. "Two years ago we started this as a pilot project: a 20-bed surgical ward to treat liver, pancreatic, intestinal cases. Patients are ideally expected to pay a lump-sum of Rs 5,000 to the Tamil Nadu Medical Services Commission, but 50 per cent of our cases (mostly rickshaw-pullers and port labourers with alcohol troubles) are handled free."

Since its medical infrastructure is as good as a five-star hospital's, Stanley has been drawing back the middle class. "Instead of paying Rs 5 lakh in the corporate sector for hepatectomy (removal of affected liver) and a whipples operation for pancreatic cancer, it can be done here as effectively for Rs 5,000," says Surendran.

But expensive though it might be, the 450-bed Apollo attracts patients from the Gulf countries and Far East. The hospital does 10 cardiac surgeries a day. Since 1983 it has completed over 15,000 surgeries—the largest number of coronary bypass operations done in India in one place—with a success rate of 98.5 per cent. Besides, Apollo-Chennai has performed over 2,000 angioplasties. But it is with its kidney unit, headed by Dr M.K. Mani and with over 1,000 transplants to its credit, that the Chennai unit beats Apollos elsewhere. The success rate has been 88 per cent.

Another frequented institution is the Sankara Netralaya, which attracts 1,300 patients a day, and naturally has a waitlist of up to three months. Dasgupta cribs a bit about this long wait at India's "best ophthalmic hospital", but doesn't mind. "I came here first in 1999 for my cataract problem. Then last November to rectify 'retinal detachment' when I suddenly lost my sight during a trip to Goa. This January I returned for a check-up. And I am here now to get the 'silicon oil' they put in my eye removed." It's cost him Rs 34,000 and travel from Calcutta. But, as he says, "The difference is in the approach. Here it is more about the system and the institution and less about individuals."

Netralaya (estd. 1978) is a non-profit charitable institution where anyone with a monthly income of less than

Rs 1,750 can avail free treatment; their Willingdon Hospital complex caters exclusively to these patients. "They account for 42 per cent of the total. But we have a single standard for all," says Dr T.S. Surendran, medical director. Netralaya also has special packages like Swadeshi lens, for cataract-affected at Rs 7,000, "ideal for pensioners".

Paediatric care is another field where Chennai hospitals excel. The Child Trust Hospital in Nungambakkam began as a four-bed venture in 1979. Managed by the Kanchi Kamakoti Math since 1999, the hospital works strictly on a non-profit motive. Its neonatal ICU ward for less than 28-day-old infants (mostly premature) has eight hi-tech Neonatal Open Care Systems or infant beds. Each bed—with 16 electrical outlets that connect the bed to everything, from an infant ventilator (Rs 6 lakh) and infusion pumps, to a monitor— costs Rs 10-12 lakh. Once better, the babies are shifted to a low-dependency ward with 32 beds. "Despite getting babies that sometimes weigh less than a kg (a normal baby weighs 2.5 kg), we maintain an overall survival rate of 96 per cent," says Dr R. Shanmugasundaram, additional medical director. And the costs of keeping a baby on the ventilator here are cheaper than in most private hospitals.

For the poor though, there is the Institute of Child Health (ICH) where director Dr C.S. Rex Sargunam lets you browse the visitors' book. "This is the first free paediatric ICU I've seen in my visit to 30 countries, developed and developing," a who delegate from China has written in a remark. And free doesn't mean poor facilities; this 1958 vintage hospital offers the best paediatric care under one roof.

The 537-bed ICH attracts some 2,000 outpatients per day, and not just the poor from in and around Chennai but also from Andhra. "Some bronchoscopy patients come from Orissa too," says Dr V. Vijay Kumar. Most cases ICH attends to in its neonatal ICU relate to hypothermia, asphyxia, infection and low birth weight.

Commitment clearly is not in short supply at ICH. At its paediatric cardiology unit, Dr V.S. Manoharan performs up to two major surgeries overnight. It's also what drove Dr P.S. Srimathy to lobby with the Japanese International Cooperation Agency for a Rs 22-crore aid in 1998. "With this, ICH acquired a cardiac catheter lab and a CT scan. An MRI and a gamma camera will be acquired in the next phase of the aid," says Sargunam.

The best of hi-tech care at subsidised rates is available also for cancer patients in Chennai. At the Cancer Institute (CI) in Adyar—a non-profit centre where 297 of its 428 beds are free—surgical and radiation oncology are as old as the institute (estd. 1954). In fact, CI has several firsts to its name. It was the first to establish the department of Nuclear Medical Oncology in 1956, six years before the Department of Atomic Energy established its isotope division; and in 1976 was the first to acquire a linear accelerator (which costs Rs 5 crore and involves annual maintenance cost of Rs 10 lakh) in India.Says Dr P. Mahadev of the institute: "Our linear accelerators have a multi-leaf collimator which ensures more precise treatment by focusing on the exact shape of the tumour."

For transplants, Chennai has the Institute of Cardio-Vascular Diseases (better known as the Madras Medical Mission), where Dr K.M. Cherian has pioneered cadaver transplants. A heart transplant here costs Rs 1 lakh-Rs 1.5 lakh and the "rejection treatment" (for the body to accept the new organ) is Rs 3,000 a month. Recently, Balamurugan Williams, a 30-year-old lathe machine worker, underwent a lung transplant here and the hospital helped his family mobilise half of the Rs 8 lakh cost.

Besides, the Chennai healthcare industry is also exploring innovative hospital-run insurance schemes. While Apollo leads the way with Dost, its accident insurance plan, Child Trust is planning to launch one "so that we don't have to deny care for want of money", says Shanmugasundaram. Parents would be required to take a policy of Rs 200 to Rs 500 at the antenatal stage. Apollo's Dost (available in other cities too) targets the middle and lower middle-income groups and is open to anyone from 5 to 70 years, for an annual premium of Rs 170 for individuals and Rs 600 for family or group of four. So, in case of an accident, you don't need to pay for an MRI or CT scan or surgery, or even hospital fees. Apollo's inpatient care is assured right from the ambulance stage for up to Rs 50,000 and another Rs 50,000 personal accident insurance. So, if you have to fall sick, it better be in Chennai