Hospital with no differences

Latha, a 42-year-old mother of three children from a remote village near Kondotty in North Kerala, sat up on her bed, in the critical care unit of the cardiology wing of the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST). She was recovering from a non-surgical balloon valvoplasty that was done to open up her rheumatic fever-affected heart valves.

Clad in a blue surgical gown, Latha looked down at the injection port on her hand and said: “I just can’t believe I am here in this big hospital and that I could manage to get the procedure done. I come from a very poor background; my husband is a daily wage labourer and there was no way we could pay for this.”

Egalitarian healthcare, highly advanced and sophisticated treatment facilities that are accessible to the common man, even the poor and under-served, are what gives SCTIMST a unique place in the health scenario of the country. Perhaps, this is the only hospital where the affluent and the poorest share the same ward. Patients are categorised into four on the basis of their income and those with the lowest get their treatment free of cost.

An amalgamation of founder-director Dr M S Valiathan’s vision—with the focused approach of a team of dedicated staff, be it in neurology, cardiology, radiology, public health, research or nursing care—has seen the hospital emerge as one of the best centres in the country for cardiology and neurology.

Concentrating on two super specialties and the sub-specialties within them and being a tertiary referral centre helps the institute achieve high quality patient care and medical education on par with European standards, says director Dr K Radhakrishnan. “The comprehensive epilepsy care at our institute is considered one of the best in the country, so is our comprehensive movement disorders care,’’ he said.

The hospital’s epilepsy management, medical as well as surgical, and the unique registry for epilepsy and pregnancy cannot find a parallel in the country. In fact, the epilepsy-pregnancy register, a programme dedicated to women with epilepsy that was established in 1998, was the third in the world, ahead of many developing countries. Among the developed nations, Europe followed only in 1999 while Australia in 2000.

“The programme deals with special issues connected with women like risk of infertility, how seizures may affect hormonal balance, malformation of the baby, loss of hair and so on,” said Dr Sanjeev Thomas, professor of neurology, who is also doing a lot of pioneering research in the area. Together with Dr Shyam, Dr Thomas has extended the services of this programme to the government-run Women and Child Hospital at Thycaud, where they hold a clinic every Tuesday morning.

The number of epilepsy surgeries have touched nearly 1,300 and the number of patients from outside the state approaching the hospital for the intervention is on the rise.

The neurology department also runs a clinic for memory disorders like Alzheimer’s and dementia, under Dr. Mathuranath.

This clinic is probably the first to do a series of field studies conducting door-to-door surveys of a population for over 10 years, looking for those little tell-tale signs that might ultimately lead to dementia. Likewise, the sleep clinic looks for solutions for those suffering from sleep apnea, and the stroke care centre serves a whole lot of people in South India.

Built up from a corpus fund that was gifted by the Travancore royal family, the hospital was initially the Sree Chithra Tirunal Medical Centre, as the board at the reception will tell you. It now has a public health wing in an adjacent campus and a biomedical technology research wing too, functioning in the historical Satelmond Palace at Poojappura, that was again gifted by the royal family. The hospital was declared an Institute of National Importance (in health) at a time when AIIMS Delhi and PGIMER Chandigarh were the only other two institutes of national importance in the country.

Interestingly, this is the only hospital in the country to be under the Department of Science and Technology, Government of India. The research wing at Satelmond Palace developed the country’s own heart valve at a time when the imported valves were unaffordable to many, just as they developed the indigenous blood bags, membrane oxygenator, ventriculoperitoneal shunt and dental filling material among others.

Smitha Suresh, a housewife from Thrissur, was the second patient to be fitted with a Chitra valve in January 1991, after the first one on a videographer from Thrissur named Muraleedharan on December 6, 1990.

Cardiac surgeon Dr Sanker Kumar, also medical superintendent of the hospital, said the first 40 cases were the most difficult and after 300 cases, Chitra valves were accepted all over the country. “I would say it is the success of team-work. The post-surgical care is equally or even more important and efforts of everyone from a doctor to an attender contributes to the recovery of the patient,” he said. Sree Chitra does not allow any by-standers in the hospitals except for a very few epilepsy patients.

The cardiology department offers both surgical and non-surgical approach to cardiac problems. The valve surgeries, vascular surgeries, aneurysm surgeries and paediatric surgeries are done on routine. The paediatric cardiology division is popular and deals with foetus, neonates, infants and children with congenital and acquired heart defects and adults with congenital heart defects. Both the departments of cardiology and neurology are strongly supported by a highly advanced imaging department.

Now, SCTIMST is on an expansion mode with plans to establish a centre at Wayanad in collaboration with the Government of Kerala and ICMR to evolve community-based strategies for cardiac and neurological care.