Focus
The Mahatma and the medics
KAVERY NAMBISAN
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In Sevagram, a medical institution continues to put Gandhi's precepts into practice.
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In Sevagram there is an in-built ethic which does away with insensitivity towards patients.
PHOTO: THE HINDU PHOTO LIBRARY
A different ethic: Dr. Sushila Nayar.
I WAS a final year medical student when I read Gandhiji's autobiography. I liked it so much I decided to borrow permanently the khadi-bound copy from the family bookshelf. Sadly, the book is no longer with me but I rate it — along with Thoreau's Walden — as a perfect example of the elegance of honesty in the written word. Last month I was fortunate to be able to visit the one medical institute which was founded on Gandhi's precepts and has remained true to them.
The Mahatma Gandhi Institute of Medical Sciences (MGIMS) was established in Sevagram near Wardha by Dr. Sushila Nayar, the Health Minister of India in the early 1960s. In 1938 she had been deputed to Sevagram to attend to Gandhi's medical needs. (Her brother Pyarelal was then Gandhi's secretary.) Sevagram, a small village eight kilometres from Wardha, had problems typical of Indian villages. Gandhi encouraged the young doctor to help the villagers.
In 1942, a 15-bedded Kasturba Hospital was started near the ashram and later expanded to 50 beds. Inspired by Gandhi's practical wisdom, Dr. Nayar understood how preventing illness through sanitation and health education was more effective than attempting a cure once a person was afflicted. During her stay in Sevagram she trained young villagers as nurse midwives, compounders and dressers and built a team of workers who were in tune with local needs.
Much later, as Health Minister, Dr. Nayar saw how few doctors went to work in the villages. Dr. Nayar suggested to Prime Minister Shastri that a medical college be started in a rural area. She hoped that doctors trained in a rural setting would understand the problems of local people and be more willing to work there.
A dream takes shape
After many hurdles, the Government finally approved an institution in Sevagram. In 1969, the centenary year of the births of Kasturba and Gandhi, the first batch of students was admitted. From the beginning, Dr. Nayar ensured that the faculty and students worked with professional excellence coupled with compassion, the two cornerstones of a good medical practice.
The medical college and the 650-bed hospital of MGIMS remain unpretentious, without the cement-and-steel grandiosity now considered to raise the stature of an institution. It has 21 teaching and research departments, 17 recognised post-graduate specialities, 119 members of faculty, a nursing school and college, and a new trauma care centre.
Seeing the wards, clinics, research centres, the library and dissection hall, trying to keep pace with the two professors who showed me around, I was impressed by the institute's quality and the pervasive atmosphere of efficiency and courtesy. There are a few hundred medical colleges in India and many of them match MGIMS in efficiency and may indeed be considered superior, judging by the "ratings" splashed in the media. What makes this rural-based institute special?
The mere facts that it was established by a Gandhian and is located in Sevagram do not make it so. What struck me was the genuine air of warmth which reached out not only to visitors like me but to patients, and was evident between staff members. Modern hospitals are more like railway stations with patients trying to find the nth department they've been directed to, while harried doctors and nurses shrug away their questions. The veneer of sterile efficiency over such callousness makes every visit a punishment.
In Sevagram there is an in-built ethic which does away with such insensitivity. Even senior faculty members retain a youthful enthusiasm in everything they do and cooperate instead of playing politics. Doctors in community health first see every patient who attends. This allows simple problems to be dealt with and necessary referrals to be made.
It is little wonder that patients come from neighbouring States. Dr. Dilip Gupta, Head of the Department of Surgery, told me how much it costs a poor patient to travel by train from Andhra Pradesh. These costs are factored into the hospital's own charges. Those charges too belong to a simpler era. Patients' relations are housed in dormitories at Rs. 5 per night, or two-bedded rooms that cost Rs 20.
Here general surgeons efficiently handle urology, paediatrics, thoracic and cancer surgery. At a time when super-specialisation has become so popular, there is a real need for all-round surgeons and physicians. It is comforting to know that there is at least one such hospital. Simplicity is valued too. Dr. Gupta told me how the Government was surprised that the new trauma care centre cost merely Rs. 6 crore, while similar centres they had funded elsewhere cost four times as much.
The research work being done at MGIMS is on par with the best in the country. Research on the filarial parasite and on the tubercle bacillus is at an advanced stage. But research and medical technology require expensive equipment. Half the funds come from the Union Government, a quarter from the State and the rest from the Kasturba Trust. Jamnalal Bajaj made the original donation of land to Sevagram and the family continues to be generous. At MGIMS, every purchase has to be justified; the department must show how many patients will benefit from its use each year.
Refreshingly different
The training of medical students here is refreshingly different from that in any other institution I know of. An essay on Gandhian Thought is required in the entrance exam. The 60 students who are admitted each year spend their first fortnight at Gandhi's ashram, living like the ashramites. Through the first three medical years every student is attached to one family in a nearby village. She lives with them for some days and thereafter visits every month; she is in charge of their health. Gandhian Thought is taught during the medical years; after MBBS, every student does two years of rural service at centres chosen by the medical college.
And then they're free to choose their path — rural, city-based or whatever. In the single day I spent at MGIMS, I met several doctors who started as medical students and stayed on to become faculty members. Professor Narang and the Dean, Mrs. Narang left their jobs in AIIMS and Lady Hardinge respectively to join MGIMS in 1973. Dr. Mrs. Narang (like Dr. Nayar and Dr. Harinath, now Professor of Biochemistry and former Dean) is a winner of the B.C. Roy Award, the most prestigious given to a medical professional in India. Dr. Gupta, whose father is still Professor Emeritus of Medicine here, did work in Delhi for a few years but returned to Sevagram. He states simply that Dr. Nayar inspired him. Are they happy? "Very much so" and "No regrets" are the common answers.
Sevagram itself lives an understatement of which Gandhi would have approved. There are no cheap displays of its heritage, and no signs of making it a tourist attraction. Among the things Gandhi abhorred were "Science without Humanity" and "Wealth without Work". At MGIMS can be seen the positive side of those mottoes, a credo that may yet resurrect the profession.
Kavery Nambisan is a surgeon and novelist. Her e-mail ID is wallden@sancharnet.in.
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