From ONE Magazine
Healing Keralas Health Care
text and photographs by Peter Lemieux
As the sun rises over the Amala Hospital and Research Center grounds in Trichur, Kerala, lay and religious doctors, nurses and other staff gather in the adjoining chapel for a brief liturgy before a hard days work. The institutions former director and current head of its board of trustees, Father Paul Achandy, leads the prayers.
With a busy 1,000–bed hospital and medical institute to oversee, the Carmelite priest keeps a close eye on the clock. After the celebration, he promptly closes the liturgy with a few words of wisdom. He also requests prayers for this years crop of students in the hospitals nursing program who will take their final exams that afternoon. He then reminds the group that the day is the feast of Our Lady of the Immaculate Conception, to whom the Amala Hospital is dedicated.
To celebrate, Father Paul encourages them to join a rosary procession that evening, which will begin at the chapel, wind through the institutions rolling campus and end at the grotto near its edge, where he will hold a candlelit vigil.
As the staff files out of the chapel, a recorded hymn sounds through the hospital speaker system. The music reminds staff and patients in the hospital the liturgy has ended and that Father Paul will begin offering the Eucharist to bedridden patients.
With an oil lamp in one hand and a list of the patients in the other, a sister accompanies the priest from the chapel and down a long hallway leading to the 210–bed intensive care unit. Awaiting their arrival, a nurse joins them and briskly guides the priest to the room of the first patient on the list. She opens the door and stands back. Without pause, Father Paul hurries into the room, warmly greets an elderly man lying in bed and quickly gives him Communion. The nurse then directs him to other patients on the list.
For the next 15 minutes, the priest rushes through the multistory facility, distributing Communion to more than 30 patients in various wards.
Here, prayer is so much a part of the culture, explains Father Paul. But in a hospital setting, its a very fast pace. If you dont deliver things in time, its a problem. Time is critical. If were delayed for even a minute, lives are threatened.
Established in 1978 by the Carmelites of Mary Immaculate — the first and largest religious congregation for men in the Syro–Malabar Catholic Church — the institution consists of a full–service general hospital, a homeopathic hospital, a 100–bed ayurvedic (or traditional Indian medicine) hospital, a cancer research center, a cardiac center as well as a medical school and a nursing college.
The facility offers diagnostic treatment in almost every specialization and boasts the latest medical equipment and information technology, 25 surgical operating rooms and a state–of–the–art radiology department, which most recently acquired a new linear particle accelerator.
The medical school and nursing college together enroll 1,200 students from all over India. In total, more than 2,000 medical professionals and their families reside on the campus.
As a first–rate, nonprofit and holistic health care institution, Amala Hospital and Research Center stands out as exemplary in Keralas fast–changing and increasingly inequitable health care system.
Since the mid–20th century, when the states Marxist–led government implemented sweeping social reforms, including universal health care, Kerala has consistently ranked ahead of other Indian states in education and health care. Today, the states health–related human development indicators, such as infant mortality rate and life expectancy, rival those in developed nations. For decades, Indians as well as international health care specialists have heralded Keralas health care system for its affordability and wide accessibility to all residents — rich and poor.
However, in recent years, cracks have appeared in Keralas long–prized health care model. Though Kerala continues to lead other states in terms of remarkably low rates of poverty–related mortality and illness, its morbidity rate is the highest in the country. That is to say, its population per capita suffers more than in any other state from chronic illnesses associated with unhealthy lifestyle choices, such as obesity and type–2 diabetes, and old age.
In spite of government subsidies, public health care institutions struggle to meet the ever–rising costs of infrastructure, medical equipment and supplies and prescription drugs.
There are two mafias in Keralas health care industry: the pharmaceutical companies and the diagnostic equipment manufacturers, says Father Paul. Both have easy access to doctors and influence the system of treatment. They create serious hospital management challenges, especially in the corporate sector.
In addition, these days Keralites themselves are demanding greater and more immediate specialized care. Kerala has a high education level and people are more and more health conscious, continues Father Paul. People read. People are aware, especially of medical improvements and new treatment options. Just pick up any newspaper and youll see news on health and medicine. So when they come to the hospital, they want to see a specialist right away.
These combined pressures strain all of Keralas health care providers — public, private and Catholic.
The promise of high earnings and the availability of advanced medical technologies have prompted many doctors to open their own private, specialized practices. In recent years, countless private practices have cropped up in all corners of the state.
The poor and working class, however, cannot afford these comparatively expensive clinics and hospitals, which cater to an affluent and middle–class clientele. By the same token, this surge in private health care has made it more difficult for the public health care providers — which have always relied on revenue from patients able to pay for treatment — to serve the needy crowding their waiting rooms each day.
For their part, the more than 400 Catholic–run health care providers operating in Kerala face tougher choices than ever. On the one hand, they are striving to be at the forefront of quality health care, which attracts affluent patients and revenue; on the other hand, they try to stay true to their mission in Christ to serve the poor.
Money is the lifeline for any kind of activity to survive and grow, explains Father Paul. To be effective, we must keep up with science and the times. There are three models to choose from: one driven by profit; one where the institution breaks even by charging reasonable rates; or one thats a charitable institution and relies on donations, which is how this hospital started. The challenge is to strike a balance between affordability and charity, and sustainability and maintaining quality, modern services.
While the Amala Hospital and Research Center manages to flourish in Keralas new health care climate, other church–run institutions have not weathered the changes nearly as well.
St. Georges Hospital, located about 25 miles northeast of Ernakulam, for instance, has been hit especially hard. Operated by the Syro– Malabar Catholic Medical Sisters of St. Joseph, the 75–bed facility has drastically scaled back its services in recent years, after a new, private multispecialty hospital opened a few miles away.
Five years ago, an average of 300 patients a day would visit the facilitys outpatient clinic. Today, the staff never sees more than 100 patients on any given day. At present, patients occupy only six of the hospitals 75 beds.
We have just one unit now, says Sister Cincy Joseph, one of 12 sisters who work at the hospital, along with a lean but committed group of medical professionals.
We cant get new doctors nowadays, she sighs. They want such high salaries, more so now than in the past. Patients go to nearby hospitals with specialty doctors. Were not closing our doors, but how can we improve without money? What can we do?
The aging facility desperately needs major renovations. Some walls have deep cracks and none have seen a new coat of paint in decades. This is a 50–year–old building. Its not falling down, but its leaking everywhere, says Sister Cincy, as she points into an empty ward and at its ceiling, where a thick bed of mold grows along a deep fissure.
I pray, but prayer alone cant help. The diocese has to take some action. Someone has to step in and improve our hospital.
With limited resources, the sisters do what they can. These days, the hospital mostly cares for terminally ill cancer patients.
Sister Cincy enters one such patients room. She walks to the bed and takes the womans hand, checking her vitals. The woman, Daisy John, hardly notices. She is in her final hours. Around the bed stand Mr. John, the couples son and extended family members. The room is itself spartan: no sophisticated medical equipment, just an assortment of basic medical supplies. Sister Cincy visits with the family briefly and then exits the room.
After their treatment elsewhere — chemotherapy and radiation — they suffer a great deal of pain, Sister Cincy explains. We give them free accommodations and medication. We try to help relieve their suffering.
Many of Keralas Catholic–run institutions similarly have trouble with both keeping up with the newer, for–profit facilities and keeping down the cost of the services they provide. Fortunately, however, most fare much better than St. Georges Hospital.
In the heart of Ernakulams bustling downtown, about 40 miles south of Trichur, Father Paul Moonjely, the new director of Lisie Hospital, sits at his desk in his office, hard at work. Though already 7:30 in evening, a time when most of his fellow priests are enjoying dinner in the rectory, he wrestles with some of the hospitals many day–to–day problems.
Built in 1956, the Syro–Malabar Catholic–run facility is one of the oldest multispecialty hospitals in Kerala. Once the citys premier hospital, in recent years, it has lagged behind newer and larger for–profit hospitals. The hospital visibly needs some structural upgrades, better information systems and new equipment.
On a regular basis, Father Moonjely and the hospitals trustees grapple with what to tackle first and how to finance it.
Notwithstanding these difficulties, Lisie Hospital remains a pillar of greater Ernakulams health care network. It employs a large team of highly qualified medical professionals, including a full range of specialist doctors. Each day, its workforce delivers affordable, high–quality and life–saving care to thousands of patients. Annually, the hospital treats more than 370,000 outpatients and 42,600 inpatients.
The basic objective of Catholic health care is sharing in the healing ministry of Jesus Christ, begins Father Moonjely. Jesus went about doing good, healing people, curing the disabled. And as disciples of Jesus, we are today continuing the very same mission to serve the poorest of the poor as well as the ordinary person who cannot afford todays health care costs. For us, its not a corporate business strategy. For us, its a social mission. Its a social responsibility that involves the values and mission that we have received from Christ.
At the same time, health care is becoming very expensive with all these specializations and expensive procedures, diagnostic equipment and life–saving drugs. We stand for quality, as well as affordability. We strive to provide the same health care that a wealthy person can afford in a private hospital. The same quality care is accessible to the average person in our hospitals, without compromise.
In Lisie Hospitals surgery ward, a few steps from Father Moonjelys office, the truth of the priests words rings loud and clear. Poor and working–class patients occupy all available beds. Doctors and other medical professionals diligently move from one patient to the next, weaving through their loved ones who crowd the area.
Social worker Cijo Pullappally stands at the bedside of 65–year–old Anandavally Vishuambharan, along with members of his family. Mr. Vishuambharan suffers from diabetes–related kidney disease and is recovering from kidney surgery. However, his condition has not only caused him great pain but also has devastated his family financially.
The surgery and medicines will cost about 50,000 rupees [$1,125], says Asha Mohanan, his 40–year–old daughter, her arms draped over her mothers shoulders. To help pay for it, we sold all our gold and we are going to sell our house.
How much land do you have? asks Mr. Pullappally. Four cents [247 cents comprise one hectare], replies Mrs. Mohanan. Mr. Pullappally nods his head in
Though only 29 years old, Mr. Pullappally has dealt with similar tragic cases many times before. Thats about half the size of this room. Thats nothing, he explains. Once they sell their home, theyll wind up a destitute family on the streets. This is what theyre facing. It is a heartbreaking situation.
Though of little comfort to the family, they are not alone in their predicament. According to a 2004 report by the World Health Organization, health care–related expenses represent the second leading source of household debt in India.
So many people cant afford their immediate health care needs. People have to spend most of their direct income to pay for treatment, concurs Father Moonjely.
Kerala has an advantage that 50 to 60 percent of the population is middle class. So their affordability level is higher compared to other states, insists the priest. But it is still very much true. A serious illness often ruins a family financially. They often have to sell their properties or get new mortgages from banks, which they cannot pay back.
Fortunately for patients at Lisie Hospital, the institution prides itself in making its services as affordable as possible. Our hospital is already the cheapest hospital in the area. Lisie is known for its affordability, says Father Moonjely. On top of that, we often reduce patients bills — by 10, 20 or even 50 percent. Were a Christian hospital. We stand with the people. We stand for the people.
Award–winning journalist Peter Lemieux reports from Africa and India for ONE.