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Every baby's hospital

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The warmth of Dr Evita Fernandez’s sunny smile has radiated to thousands of newborn babies. Ask any mother who has delivered her baby under Dr Fernandez’s care and she will tell you she felt special and safe.

“Be kinder than necessary because everyone you meet is fighting some kind of battle,” says a message on a pinup board in Dr Fernandez’s office, mirroring her philosophy.

Fernandez Hospital in Hyderabad is her battleground. Through her untiring efforts she has shown how a private healthcare facility can provide high quality service to women from all strata of society and contribute to public health as well. Dr Fernandez says childbirth is the most beautiful and magical happening in the world and she practices medicine to keep it that way.

She was eight years old when she decided she must become a doctor. At 16, she was sure all she wanted to do was to look after pregnant women who bring babies into this world. “That was the only subject I wanted to study even in college though for some reason I didn’t get my highest marks in obstetrics!” she grins.

She also chose to remain single so that her only passion would be work. Evita (she likes to be called only by her first name) says she saw how her parents struggled to cope as doctors and caregivers to their four children. And yet her mother was her inspiration.Her parents started Fernandez Nursing Home in 1948, opposite their home in Bogulkunta in Hyderabad, as a two-bed facility. Evita nurtured it into a 225-bed facility. “Not the kind of numbers you would probably be impressed by,” she smiles. “But then corporate expansion into a network of hospitals was not our motive. I just wanted to provide honest healthcare. I did not want to run the hospital as a proprietary concern. This is a place where patients come, not for an individual doctor, but because of their trust in the institution. And we achieve that by focussing on standardising procedures and protocols.”Evita and her siblings – two sisters and a brother – were initiated early into the world of doctors. Her elder brother was a surgeon till he died of brain haemorrhage at the age of 36 in 1985. In the same year, Evita took over the reins of the hospital.She says she inherited not just the hospital from her parents but ethics, the right way of doing everything. “St Johns in Bangalore, where I studied between 1969 and 1975, was one of the few colleges that had a paper on ethical medical care. Internship at St Martha’s taught that in practice.”

From there to the government-run Gandhi Hospital in Hyderabad was a culture shock, Evita confesses. The numbers of patients there was so large. Resources were overstretched. “When I went to the hospital, my coat pockets used to be stuffed with bandages and syringes from home,” recalls Evita. “But numbers need not overwhelm you. You are a doctor and must provide the healing touch. That is what I learnt from Dr Suvarna who served at the government hospital for decades.”A stint at the Royal College in England taught her the importance of systems, protocols and standards. That is what Evita brought back to her hospital in 1985. It wasn’t easy. Evita recalls how she checked a pregnant lady for over half an hour and told her she did not need any medicines as she was perfectly fine. The patient’s mother got really upset. “What kind of a doctor are you if you do not even write a prescription?” she asked and complained about Evita’s ‘inexperience’ to her mother.That did not deter Evita. No unnecessary medicines or treatment continues to be her hospital’s philosophy. Representatives of pharma companies are not encouraged at Fernandez Hospital. An expecting mother, Shirley, confides this was the reason she chose Fernandez Hospital. “I was told they will let you give birth naturally and a C-section is only carried out if it is an unavoidable option unlike other private hospitals.”

Shiv and Karuna confess having their baby girl at Fernandez Hospital was the experience of a lifetime. “My sister in Delhi delivered at a top-notch hospital but her husband was not allowed to be by her side when their baby was born. But Dr Evita encouraged Shiv to be with me,” says Karuna. Shiv nods in agreement. “For us it was our first baby so there was a lot of excitement. What amazed me was the kind of interest and positive energy Dr Evita would radiate to her patients. Both doctors and paramedical staff worked in synergy.”Dr Evita credits that to teamwork and transparency. It has earned her acceptance and respect from colleagues and patients.By 1992 Fernandez Hospital found itself grappling with a rush of patients. Dr Evita had to take the emotional and financially difficult decision of demolishing the old nursing home and building a new hospital in its place.Raising `4 crore rupees to build the new hospital was not easy. But Dr Evita believes in miracles. And she says that is what happened. An ethical bank financed the expansion of the hospital.

A decade later, demand grew even more. This time a decision was taken to start a second, state-of-the-art facility, for high-risk cases. Dr Evita found in Dr Pramod, a paediatrician and colleague for 16 years, a leader who shared her values and beliefs. He helped her set up a full-fledged neonatal facility with an intensive care unit (ICU). The facility cost `41 crore and opened in the Hyderguda area in January 2011. It has so far handled 2,000 deliveries.Fernandez Hospital has patients from all social strata. HIV positive mothers are treated free of cost. The ground floor treats those who can’t afford to pay. Those on the third and fourth floors cross-subside them. But the quality of care is the same.

“We never want to send away a patient from our hospital because he or she cannot afford to pay. The biggest challenge is to be accessed by the entire spectrum of society,” says Evita.In fact recently, ‘paying’ patients were turned away from Fernandez’s second facility at Hyderguda when two babies, whose parents could not pay, had to be kept on ventilators. The ‘paying’ patients were referred to other hospitals because the hospital’s basic philosophy could not be compromised.Dr Evita and Dr Pramod share the concern that hi-tech care is neither affordable nor accessible to many in the country although the highest numbers of low-birth weight babies in the world are born in India. That is why Fernandez Hospital has taken the lead in implementing the practice of kangaroo mother care (KMC) where the mother’s bosom is advocated as the best place for very tiny babies.

Sudha has come from Karimnagar and is at Fernandez’s KMC ward. Her baby is a little over 1 kg in weight. After 10 days in the neonatal ICU, the baby is now strapped to her mother, skin-to-skin, virtually round-the-clock. Dr Pramod explains that this does not require equipment or great expertise. There is the added advantage of these babies doing well in cognitive development and parental bonding. “That is why we strongly need to promote KMC,” he says.Fernandez hospital has also evolved into an institute of learning and research. There are regular teaching sessions for post-graduates and workshop programmes for practicing clinicians. Evita says money from such activities is used to fund travel to medical conferences so that dependence on sponsors like pharma companies is avoided. The hospital is recognized for its two-year post-doctoral fellowship in high-risk pregnancies and perinatology.

Evita has invested her time, money and energy in training nurses and midwives. The hospital has a professional two-year midwifery programme introduced in 2011.“I want this cadre of midwives to provide their services to urban health centres so that they can reduce the load on tertiary centres by taking care of low risk cases. India needs trained midwives to be part of the health system,” explains Evita. She says some of the midwives are as well trained as doctors .In 2008, the Fernandez School of Nursing began admitting tribal girls from backward areas of Maharashtra and Gujarat. They were given free education, boarding and lodging. Out of 170 students who have been sponsored, 120 are from tribal regions. The first batch of 21 tribal women are now working as staff nurses in the hospital.

Evita feels strongly about women’s empowerment. She has been a vocal voice against sex selection and unethical practices at ultrasound centres and hospitals. In her own hospital, two-thirds of the staff are women.



A tribute to Dr Chandrasekhar:

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Tribute to Dr. M K Chandrasekhara

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Dr M K Chandrashekara was the most complete pediatrician I got to see from close quarters for more than 25 years. My first encounter with Dr. Chandrashekara was way back in 1979 when I was a registrar in pediatrics at St.John’s Medical college which housed one unit of pediatrics and was manned by me and Dr.Padmini Urs. She happened to be on leave and was told that a pediatrician from St. Martha’s Hospital would come and take rounds. He came and stood at the entrance of the general ward and asked me what was the first case – I had not yet worked it up and I said so. Without going near the patient or taking a history he said it was a case of Spinal Muscular Atrophy- Wordnig Hoffman disease. I was not sure whether he was serious but indeed he was correct and instantly my respect for him grew high.

He had everlasting stamina, his rounds would start at 10 Am and go on till 3 PM- without a break. His passion for seeking details, keen interest in interpreting ECGs. He would insist on a walk through lab to see peripheral smears and sessions in radiology department to discuss x-rays as part of routine clinical work made him an all rounder.

In the early days we had facilities for ECHO only in Sindhi hospital. He would put all RHD cases in his car and personally take them for ECHO(M-Mode) and discuss with the cardiologists.He was very particular with medical records and he had a unique way of storing the data based on patients date of birth. This he did even in his private clinic and would always tell me that he needs to analyze all the patient data especially with reference to physical growth.

He kept up with recent advances and encouraged juniors like me to actively read and update. He was not far behind with regard to technology, his research with computer software “Ekalavya” in collaboration with IIT Madras developed probably one of the earliest medical softwares to help peripheral health workers to diagnose and treat simple pediatric disorders.

I can never forget how he drove me to the hospital and dropped me home for a whole month when I was operated for appendicitis. He had confessed that he memory was poor for anything other than patient care …. He had put a placard in the dash board behind his steering wheel “ Pick up and drop Subba rao” so that he would not forget.

His personal attire was special, always came in full suit – his favourite one a bottle green suit and of course on off days he would come with his favourite blue and white checkered pant and a T shirt. He would throw a party without any excuse and fellowship was always free flowing and sponsored by him.

His baby friendly approach to children- sitting on the patients couch, making funny faces, carrying them around with him on rounds made him the best person to emulate.

Dr.MKC …. I will miss you a lot….. may your soul rest in peace.

Dr.Subba Rao,
Ex Professor of Pediatrics, St John’s Medical College
Consultant Pediatrician, Malathi Manipal hospital

Tribute to Dr. M K Chandrasekhara

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Dr. MK Chandrashekar, better known as MKC, was my teacher and mentor both at St. Martha’s Hospital and later at St Johns Medical College and Hospital.He headed the Department of Pediatrics for many years at both places and has been responsible for laying such a strong foundation for the Pediatric Department at St John’s and for shaping many a budding paediatricians career including mine.

He had multiple areas of interest: Neonatology, Cardiology, Nephrology, Genetics. He could “ smell Klebsiella when he came into the NICU, he would diagnose failure to thrive by “rib count “, to him every dysmorphic baby was a FLK : funny looking kid, never a dysmorphic baby, he was famous for reading and teaching ECG’s at 2 PM when everyone was hypoglycemic at the end of rounds. 

He had a little blackboard in his office room at St John’s on which he would scribble his work that needed to be done with target dates : he would be extremely happy after the target date was over ( irrespective of whether work was completed or not ). He was extremely meticulous, almost obsessive of his case records and expected others to do the same. 

MKC was extremely baby friendly, his life revolved around his little patients. He would have been happy to be a pied piper for his little patients !!He was fun loving but strict, a disciplinarian but soft hearted, punctual but there was no time limit for finishing OPD/ rounds/ discussions !!! It was great being trained by him, it was a privilege working with him and was a pleasure knowing him. 

Will miss you sir! 

Dr. Swarna Rekha

Salve for the silver innings.Dr Radha Murthy

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Whether it's medical care or day care services for the elderly, her company caters to the needs of senior citizens in many ways

Dr Radha S Murthy (62) Co-founder, Nightingales Medical Trust
In 1996, when Dr Radha S Murthy was working with a hospital in Sadashivnagar as a general practitioner, she saw how difficult it was for elderly patients to get medical help. That got her thinking about offering healthcare to senior citizens at their doorstep. When the hospital she was working in wasn't keen on pursuing it, she got together with her colleague Prem Kumar Raja, to start Nightingales Home Health Services.
With a "minimal budget" of around Rs 10 lakh, they bought an ambulance, some medical equipment, and got two nurses and one driver on board and launched out of Dr Murthy's house in Sadashivnagar. "We would cater mainly to those within eight kilometers of Sadashivanagar," she recalls.
But the biggest task was convincing people. "Although people wanted the convenience of medical services at home, they were sceptical about the concept," she says. While Dr Murthy looked after the medical aspects, Raja took care of the administration. To spread the word, the two would go around the locality distributing leaflets. Within six months, emergency calls started pouring in.
As they started going to patients' houses, Dr Murthy realised that along with health issues, the elderly were in need of emotional and financial support. That's how the Nightingales Medical Trust and day care centre Sandhya Kiran was started. "Actually we prefer calling it an enrichment centre. That's because we organise activities with their peer groups which keep the elderly busy," she says. They also conduct vocational classes where the attendees make paper bags that are sold to places such as HOPCOMS, and organise an annual 60+ job mela.
Last year, they organised street plays from Kolar to Bangalore to create awareness about dementia. "We just gave them an outline of a script. But we were surprised to find them putting up the performance with such ease," she says. Today, Nightingales Home Health Services has two branches — Kasturinagar and RT Nagar — across the city, offering its at-home medical services to elderly patients within eight km of each branch.
So Dr Murthy's biggest satisfaction is when people come up to her saying they want to settle down in a particular area just to be located close to Nightingales. Still, she feels there's much more that has to be done for the elderly. "The government has to wake up to the needs of the elderly. Or at least, the younger generation needs to be sensitised to their needs," she says. With Nightingales around, that will hopefully happen soon.

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