|Two years ago when I visited St. Joseph's Hospital at Baramulla in Jammu and Kashmir on a snowy day, I found its corridors filled with expectant mothers and women holding babies. They were waiting for their turns to consult a gynaecologist, whom I wanted to interview. Given the crowd, I found it prudent to make a retreat, than to annoy the doctor and her patients.
At that time, I had written in these columns about the hospital, which the Pakistanis had attacked in their first bid to annex the Valley and killed six persons on its campus, including a European nun and a Malayali nurse. The pillage turned out to be the greatest blunder they committed, as reports in the Western Press about the 'rape' and murder of the nun caused international anger. Jawaharlal Nehru and other leaders, who visited the hospital after the Pakistanis were evicted, used the incident to drive the Pakistanis into a corner.
Six graves in the hospital compound commemorate the attack. While five of them sport the cross, one has the Om symbol because one of the killed was a Hindu, Mrs Motia Devi Kapoor. It took me a while to make a round of the campus where I first saw a real Christmas tree. When it was time for tea, the priest in charge took me to the convent where I met the gynaecologist, one of the most popular persons in Baramulla, having facilitated the delivery of thousands of children.
She was a Catholic nun and product of St. John's Medical College, Bangalore. I had once met a similar doctor serving in an interior area in Arunachal Pradesh. She, too, was an alumnus of St. John's. In fact, most of the nuns serving as doctors and nurses in the remote areas of the country are products of this great institution, which is turning 50 this year.
When the Catholic Bishops Conference of India (CBCI) decided to set up a medical college, the then Pope John XXIII allowed it to be named after John the Baptist, his patron saint, as a mark of his approval. I am sure readers would know this Pope as one of the most popular Popes, who organized the Second Ecumenical Council known as Vatican II, which he even named a "new Pentecost".
The idea of a Catholic medical college was originally mooted by Dr. Sr. Mary Glowrey of the Sacred Heart, an Australian missionary, as far back as in 1943. However, it took 20 years for the idea to fructify.
The college was opened at the St. Mary's Industrial School and Orphanage, Cox Town, in Bangalore where the pioneer batch of 1963 was admitted. The Sisters of the Good Shepherd offered their hospital, St. Martha's, for clinical teaching and the first year of undergraduate training, known as pre-professional course, was conducted at St. Joseph's College in the city.
The college was allotted 140 acres of land by the Government of Mysore to build its own infrastructure. During the 38th Eucharistic Congress in Bombay in December 1964, Pope Paul VI declared St. John's Medical College as a memorial of the Congress and blessed the corner stone for the new building.
I realized the importance of the Pope's visit to India because my grandfather -- a non-Catholic -- had taken the trouble of going all the way to Bombay to see him. It was his first visit outside of Kerala and he had numerous stories to tell us all about his journey and the large crowd that had assembled to hear the Pope. His companions in the train were the accompanists of an upcoming singer called Kattassery Joseph Yesudas and they made sure that my grandfather did not have to pay for his food. We would tease him for being a freeloader.
Having heard a lot about St. John's, I was keen to visit it, when I recently got an opportunity to visit Bangalore as a guest of cbm, a 105-year-old organization that supports programmes for the differently abled all over the world. When I mentioned the desire to Dr Deepti N. Shanbhag of the Department of Community Medicine of St. John's, she was quick in fixing an appointment with Fr Lawrence D'Souza, Director of St. John's National Academy of Health Sciences, the new name of the medical college.
A large map of India hung from the wall in the parlour of the Director's office. It showed the various places where the alumni of St. John's served. They are all places, which many of us would not have even heard of. As I waited for a while, I recalled the contributions of Christians to medicine, not just in India but the world over.
As Rosie Beal-Preston in her small but profusely-illustrated book Christian Contribution to Medicine that can be accessed free on the Internet says, "The Graeco-Roman world in which Christianity appeared was often cruel and inhumane. The weak and the sick were despised. Abortion, infanticide and poisoning were widely practised. The doctor was often a sorcerer as well as being a healer and the power to heal equally conferred the power to kill.
"Among the pagans of the classical world only the Hippocratic band of physicians had a different attitude to their fellow human beings. They swore oaths to heal and not to harm and to carry out their duty of care to the sick." The situation in India was not very different, though it had a rich tradition of indigenous medical systems like Ayurveda.
Few people know that the first modern hospital in India was set up by a Jesuit, Fr. Henry Henriques, at Punnaikayal in Tamil Nadu as early as 1550. In fact, the first hospitals, be they in Amritsar, Delhi, Vellore or Ludhiana, were set up by Christian missionaries. The stories of how the Christian medical colleges in Ludhiana and Vellore came up are indeed stories of "attempting great things for God and expecting great things from God" to paraphrase William Carey. He was a humble cobbler, who was truly a "Friend of India", the first newspaper he founded in 1818, and which became The Statesman.
In the 18th and 19th centuries, medicine was a monopoly of the Christians because of casteism and the aversion for dissection, particularly of dead bodies, which prevented Hindus from taking it up. In fact, until late into the 20th century, only Christian girls took up nursing as a profession. I found it amusing that one of my nieces, who passed out with flying colours from the Christian Medical College, Ludhiana, could never score more marks in surgery than a Jain classmate. "Oh, he has amazing skills in surgery", that is how she explained the situation. This was unthinkable a century ago.
Today medicine is big business in India with corporates setting up ultramodern hospitals, where more money is spent on non-essentials than human resources. For instance, when I visited a relative admitted to a five-star hospital in Gurgaon, I found him holding three remote controllers in his hand, one to control his bed, another to control temperature in the room and yet another to control the large HD television set. Unfortunately, there was no remote to control the use of the bedpan for which a nurse had to be summoned.
St. John's is different from other medical colleges, even those run by the Catholic Church. "Ours is the only one run directly by the CBCI. It was set up with a purpose and that purpose was to provide medical services in remote regions of the country where medical facilities did not exist", said Fr Lawrence D'Souza, who was happy to hear that I wrote for the Indian Currents.
The inspiration for the college came from the Biblical teaching, "Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me". The Director was very excited about telling me about the various programmes that had been drawn up to celebrate the Golden Jubilee of St. John's. "We hope to raise Rs 25 crore to raise a Golden Jubilee block to improve the infrastructure facilities".
Over the last 50 years, the college has expanded. The number of beds has increased to 1200 and the number of outpatients ranges from 2500 to 3000 every day. Yet, it remains the same, retaining its old values. It may appear curious that the college admits the same number of students to its MBBS course that it did 50 years ago.
"We have a very strict admission procedure for the 60 seats, out of which one is nominated by the Government of India from the candidates from Union Territories like Daman and Diu. Thirty seats are reserved for girls, out of which 15 are given to the religious. There is a well-defined formula in which seats are allotted and it has won the appreciation of even the Supreme Court. There has never been a complaint that we violated the statutes.
"Without the reservation for the nuns, we would not have been able to achieve the objective of providing medical care to the people in the far-flung areas of the country", said Fr D'Souza. What he said made sense to me. Today thousands of women in Baramulla benefit from the services of a lady doctor who does not bother about her convenience while attending to her patients. "Teaching women alone is not sufficient because I find that some of them give up practicing medicine when they get married. That is why we have this reservation for nuns from the Christian quota".
Service before self is not just a slogan in St. John's. The Director felt proud telling me about the initiative taken by some doctors to take special care of disabled children brought from Sangli in Maharashtra. "Because of the practice of marriage between blood relatives, a relatively large number of children with deformities are born there. They are brought here for operations performed free of cost by these doctors, who also pool their resources to meet the cost".
Every MBBS student at St. John's has to serve in a rural medical centre approved by the college as part of his/her course. For postgraduate admission, preference is given to those who have completed serving for at least two years in a rural area. "Today, about 500 sister doctors serve in the rural areas of the country".
St. John's is in two minds on the question of increasing the number of admissions to the MBBS course. It has the infrastructure necessary to double or even treble the present intake of 60 but the college may have to pay a price as the autonomy it enjoys may get whittled down in the process. It is a call the management has to take in this Golden Jubilee year.
The college has a strong alumni network in North America, which had its annual reunion recently in Chicago, and another in the UK, which are in the forefront in raising resources for the new block under construction which would, hopefully, be completed by August next, in time for the grand finale of the Jubilee celebrations.
Fr D'Souza told me about how a state-of-the-art oncology centre would come up this year and about the linear accelerator that had already been inaugurated. I found the story of how the college acquired the equipment quite fascinating. The costly machine was donated by one Leslie Fernandes in memory of his wife, Cynthia Fernandes, who succumbed to cancer a few years ago. The honour of inaugurating the new facility was given to the generous husband.
How one wishes people had perpetuated the memory of their loved ones in similar ways! It was time for me to leave as a group of staff members had arrived for a meeting with the Director.
As I leave, my attention is focused on a wall hanging in his office. It has a picture of Swami Vivekananda with the following inscription: "They alone live who live for others, the rest are more dead than alive". The college has turned 50 but its focus remains the same -- reaching the unreached in the vast hinterland of India.
The writer can be reached at
Photo caption: St. John's Medical College Hospital, Bangalore
Courtesy: Indian Currents
A robotic-surgery device called the da Vinci Surgical System is linked to "an overall increasing trend in the rate of injury and death reports" since 2004, according to a draft analysis of such events reported to the Food and Drug Administration. draft analysis, by the chief of adult cardiac surgery at Rush University Medical Center and co-authors from the University of Illinois and Massachusetts Institute of Technology, focused on all adverse-event reports made to the FDA from January 2000 through last December. The da Vinci device is made by Intuitive Surgical Inc., ISRG -0.21% of Sunnyvale, Calif.
The company disagreed with the analysis. "Our analysis shows the rate of death is essentially flat, and that the rate of injury varies over time, but that there isn't any statistically significant trend," said Dave Rosa, Intuitive's senior vice president for scientific affairs.
Jai Raman, a Rush surgeon, and co-authors found that 4,798 adverse events were reported in the U.S., including 85 deaths, 414 patient injuries and 3,402 device malfunctions. While the overall rate of events, including malfunctions, declined over the period studied, there was a sharp increase in the injury and death rate to about 50 reports per 100,000 U.S. procedures in 2012, from 13.3 in 2004, the authors concluded. They plan to present their analysis at a medical meeting early next year. The draft analysis was made available to The Wall Street Journal by the authors.
"We found that the rate of injury and death adverse events has actually gone up. That's the most striking thing," said Dr. Raman. He said many hospitals that bought the robotic-surgery device did small numbers of hysterectomies, prostatectomies and other operations, and that as a consequence some surgeons haven't become proficient enough.
FDA officials said they were uncertain as to whether the adverse events represented a true increase in clinical problems or simply an increase in the rate of reporting as the device drew more attention. The FDA said it hasn't checked medical databases, such as those of insurance companies or of the Department of Veterans Affairs, to discern the reason for the increase.
The FDA grew interested in Intuitive Surgical adverse events in 2011, leading to an inspection this year of the company and a warning letter from the agency. The FDA's warning letter said the company had made safety changes in the recommended handling of the device because of adverse-event reports but hadn't reported the changes to the FDA prior to the agency's inspection this year.
The company said in a recent federal filing that it is correcting any violations that the FDA detected.
Intuitive Surgical said in a government filing that as of Sept. 30 it was defending "about 50" product-liability lawsuits over alleged injuries or deaths from robotic surgery. It said that the number of world-wide robotic surgery procedures grew to 450,000 in 2012 from 360,000 a year earlier. The robotic system sells for between $1 million and $2.3 million.
"We have been monitoring the company and the product," said William Maisel, chief scientist at the FDA's center for medical devices. "We believe the products can be used more safely."
A report in September in the European Journal of Obstetrics & Gynecology and Reproductive Biology raised another issue with the robotic surgery—its cost. "When considering overall medical care, the use of robotic-assisted surgery was found to be 1.6 times more expensive than conventional surgery," wrote the authors, from the departments of gynecology and obstetrics at Francois-Rabelais University in Tours, France.
That followed a February report in the Journal of the American Medical Association concluding that a robotic hysterectomy cost a hospital $8,868 on average compared with approximately $6,600 for conventional surgery.
Hi all !
The Golden Jubilee year is into its first quarter, it was lovely having some of you with us at the inaugural in August, hope to see you again sometime soon.
I write with a brief update on Geriatrics at St John's.
a. Blessing and inauguration of the Division of Geriatric Medicine
We are pleased to announce the establishment of the Division of Geriatric Medicine at St Johns Medical College and Hospital. The division will function under the Department of Medicine to start with, till it can be converted into an independent department. The division has been granted space in the OPD in room no 56, the area formerly occupied by the department of Pain and Palliative care located next to Radiology and ultrasound. The place has been spruced up, and outpatient clinics are poised to begin thrice weekly (up from once weekly at present), on Mondays, Wednesdays and Fridays, starting Monday 25th November. Dr Betsy Mathew, Additional Professor of Medicine will head the division, assisted by Dr Steve Paul, Senior resident. As time goes by, we hope that the division will recruit more staff, commensurate with the need.
A small blessing ceremony will be conducted at 11 am on Friday the 22nd of November, and services will commence thereafter. A formal inauguration is scheduled to be held on Tuesday 17th December 2013, in the presence of the representatives of the Governing board of SJNAHS.
Outreach services (rural clinics, home health services and institutional support) will continue to be provided by the Senior Citizen Health Service, which will continue to be under the Department of Community Health, with Dr Pretesh and myself being in charge.
If at all any of you are planning a visit around this time, it will be a pleasure to have you at the inaugural ceremony, please do visit and meet with us / Dr Betsy anytime.
b. KARGERICON - 2013
The newly formed division of Geriatric Medicine and the Senior Citizen Health Service, St Johns Medical College will be hosting the annual conference of the Karnataka state chapter of the Indian Academy of Geriatrics on the 5th,6th and 7th of December 2013. We intend making this conference as much of a practical learning experience as possible, so the first day is a pre conference CME on topics like "An older person with BP 170/100 and Random sugar 315 mg/dl walks into your clinic - what do you do ?". The second and third days are the conference proper, which is dedicated to the theme "Identifying solutions to challenges in Geriatrics". We will send you a copy of the brochure shortly.
c. Routine activity
Our routine activity of weekly rural clinics, home health services and institutional support go on as usual. I have handed over charge of the headship of the Department of Community Health to the able Dr Bobby Joseph, and now intend to focus on building the senior citizen health service up to a greater extent that I could these past four years.
I have also been invited to be a member of the India National "Think tank" on care of the elderly, an initiative of the Planning Commission. They have invited members to contribute thoughts on things needed to effectively improve the quality of life of the Indian elderly, which fits perfectly with our own small local mission ! Will update on this as we go on.
As the season approaches, warm greetings from the Geriatric group at St John's - your support and goodwill are very important to us ! We look forward to staying in touch and to your continued guidance and blessings. Do forward this update to others whom you think are interested in the cause of Geriatrics at St Johns.
Dr Arvind Kasthuri MD DNB DGM
Department of Community Health
St Johns Medical College
Bangalore 560 034
Why is it that Doctors have it so bad? Right from the day we joined Med School through the days when we graduate and continue into Residency, life is anything but a bed of roses.... the whole world had warned us, I mean those who are in the system already, but then, I wanted to help humanity....
I'm actually completing an old draft that I started writing a few months ago, but left it incomplete. Now that I am in Clinical Medicine, I get to see, how my juniors, colleagues and seniors work hard and are living a life of constant fatigue, on the verge of burnout, most of them. Most of the conversations are about, how bad the last call was, how busy the wards are, how complex and how very ill the patients on the current list are etc. etc.
Is this how life is meant to be? I mean as a Doctor? I was given to understand that as a Doctor you will be a blessing to others, and hence you should be in some kind of bliss. But, the reality seemed to be far from it.
I got permission from my ward boss for an early day off the other day (for the first time, since I've now mustered enough courage and confidence to ask for such a thing), as my daughter was down with stomach flu, and guess what, since the list was really short I got off right after my rounds, and as I was walking out, the scene outside really gave me an opportunity to see the reality that I always knew existed, but a not really witnessed that often. I always knew that we Doctors start work really early, but I had not actually seen this in a long time....
When I am almost done with a substantial part of my routine, the rest of the world is only beginning to wake up.... and getting ready for the day! And our work does not seem to end even when the rest of the world is back home watching their fav soaps etc. judging by the bits and pieces of conversations that fall on my ear drums the next day....
The world thinks, the minute they hear I am a Doctor, that I am earning a fortune and living in some condominium, while the reality is as a junior doctor, (a lowly MO) I spend most of my waking hours in the wards and have to plan attend my daughter's school events months in advance and I actually live in a humble apartment close enough for me so that it is easy for me to travel to the hospital and close enough to my daughter's Child Care Centre.
Calls. The value of sleep, and the value of food. Calls are those very real and tangible hours when you really really contemplate as to whether you did the right thing by choosing Medicine over Information Science/Electronics and Communications/Automobile Engineering or even Law/Pure Sciences, all of which were other options available to me when I was at the cross-roads.
Why can't I have a normal job where I can just work 9-5 and sleep like a normal human being and not be worried if anyone is going to die while I am at work. It is the feeling when you are responsible for a particular sector of the hospital and you are just hoping no one's going to desaturate, go hypotensive etc, in short, hoping that no one's going to die while under your care....
That is a terrible feeling even when you're covering a fairly so-called stable sector. You don't want to be initiating ACLS protocols and activating the Air-way Team while you're on call.... All this while you're thirsty, hungry, sleep-deprived sometimes with a distended bladder which has been awaiting an opportunity to be decompressed.
Medicine is not easy. But, someone has to do it. IMHO, the reason why we doctors, have it so bad is, that someone has to do this job else who is going to do it? All of us who chose Medicine when we did, for whatever reason did not know what was in store for us, even though there were a lot of other things that we could have done, and excelled at. Some people would have warned us, but we never cared, we just thought "saving lives" is what we wanted to do.
Destiny has it that we have been chosen for this life.
All of us know someone who has quit Med School or after graduating quit Clinical Medicine for something easier, lighter, something "normal". But some of us continue to remain in this field for whatever reasons; we have been chosen for Medicine, and we did not chose Medicine. This is the reason for an indefinite duration of time to come, in spite of whatever might happen to Medicine, as long as Doctors remain responsible for the lives of people, so there will be appreciation, prayers and blessings of the people we care for, and hence respect and gratitude.And that I believe is the strength from where we derive our drive to continue to push, and that is the strength that is hidden in the tiny thread that hold us to the system we are all a part of.