Tamil Nadu - Healthcare role model

My heart swells in pride to shout at the top of my voice that TN-Tamil Nadu (where I was born) has been declared a ROLE MODEL for Healthcare by WHO circa 2014. [http://www.deccanchronicle.com/140808/nation-current-affairs/article/tamil-nadu-healthcare-role-model-world-who] The reasons behind this success are uniquely Indian, which I dissect here. What happens in TN can/should happen in the ROW-rest of the world too. The load is heavy but with each of your shoulders we will lift healthcare, locally then globally! 

Centrally purchasing drugs with a robust IT system in place gives purchasing power to drive down costs. Enforcing quality generic drug usage within the system weeds out corruption and unholy nexus between prescriber and manufacturer/supplier. Local empowerment and ownership makes the PoC-point of Care autonomous. Local manpower have sense of ownership, which anyway is high in rural settings. Urban living unfortunately forces strangers to live side by side. Participatory leadership with everyone clearly seeing the cathedral that is getting built means there is pride in the work done. Banavaram [ http://www.thehindu.com/todays-paper/tp-opinion/a-model-that-delivers/article4477096.ece ] and Nandivaram [ http://www.thehindu.com/news/cities/chennai/health-centre-near-chennai-achieves-over-100-rise-in-births/article5437244.ece] are examples of such work. 

Tamil values system put in place in ancient times, effectively reinforced (by the likes of Tiruvalluvar) at frequent intervals has given the Tamil a unique rigmarole of living a disciplined life. Modern distractions do swing aam aadmi away to frivolous pursuits such as fast food, malls and never ending wants to keep the market based economy humming but the values are there, if one wants to uncover. I believe in the uniquely Indian-Hindu concept of life in 4 stages - balya, brahmachari, grihastha and sanyasa. If man lives a 100 years 12, 25, 50, 100 are the milestones for which one has to prepare in every stage. Notice how the periods double but the thing that caught my eye was that you should renounce worldly living by 50 and spend half of your life for Society. True wisdom emanates from one who has no want...Buddha, Mahavira, Jesus, Gandhi are all examples of this. This was practiced by all in ancient times, even by the Great Emperor Chandargupta Maurya, Emperor Ashoka's grandfather. He renounced his throne to come and live in Sravanabelagola (in Karnataka today) where a hill is named Chandragiri after him. How much discipline it must have taken for one to give up an Emperor's throne to live the life of a mendicant?

miracles still happen

I was witness to a miracle that unfolded in front of my eyes this morning. A tiny fighter (4 months old weighing just 4.5 kg) came in for VSD (hole in heart) repair. The way a dedicated team of clinicians went about performing an open heart procedure on this handful of a baby brought tears to my eyes. In earlier times he wouldn't have lasted beyond school, dying of heart failure/respiratory infections but now he will probably outlive me! Wah...yeah hui na baath?

Medical work is noble, spiritual, unique in that the skills mean difference between life and death...literally. To accomplish such feats a team of clinicians, technicians and healthcare miracle workers has to synchronize and work together with clockwork precision. Like a relay race the baton passes from one to another seamlessly, communication is subtle and in gestures mostly. A hand reaches out to have the correct instrument placed at the right angle with the right things included, which then goes on to become an extension of the surgeon's fingers to deftly weave his magic on the tiny heart.

When the sheets came off in the end for him to be transferred out of the OT, the tiny fighter caught my attention by his sheer smallness. As the team lifted him onto the transport incubator there were many tubes and lines, which I gladly extended a hand to lift.

 BTW-by the way this too happened in a corporate hospital.

head injury wonder

a RTA patient was admitted to one of the teaching hospitals GCS - 4/15 with SAH, LOC. In the corporate world this patient might end up with a huge bill (running into several lakhs), teaching hospital environment is different. Here the the team endeavours to practise medicine in an ethical way per hippocratic oath. Indiginisation runs in our veins as we grew up tinkering with ambassador car/lambretta scooters where repair is default, replace a luxury. Even the manufacturer is astonished to learn how much juice we can extract from a fruit :)

Patient went through HPE, FAST, airway secured, line access opened and neurosurgeon requested to assist. SAH was successfully evacuated. An intensivist team took over from here and gradually brought the patient back to GCS 15/15 to go home walking. Psychiatrist consultation was sought early to keep mental equilibrium as swings in mood during acute trauma are expected. Today he has been returned to the community by this wonderful team of medics, who work out of passion to serve. A refreshing change from a world, where even breast milk is sold and uterus hired like a bank vault!

Medicine is service...full stop.