HOLISTIC HEALTH CARE

Like any enterprise Holistic health care requires initial basic inputs of both human and material resources. If you want to do farming you have to invest in land, seed, water and manure, apart from insecticides and weedicides as well as taking care it from predators. Even then the harvest will depend on how well the land is prepared, how good the seed is and not to forget the season. It is only then that the farmer begins to live off the land. When the harvest is good , he can sell the surplus in the market and become sustainable.    

Instead of giving a lecture on the subject, I will share our experience at Padhar hospital in Betul District of Madhya Pradesh in India. My father Dr. Victor Choudhrie a CMC graduate (batch of ‘53) and a Fellow of the British Royal Colleges of Surgeons, came to Padhar in 1969 and started working in a converted cow shed. Being a versatile surgeon he was the first one in the state to do mitrals, lobectomies, pneumonectomies esophagectomies, Commandos, partial hip replacements, Transurethrals, Upper GI endoscopies and installed the first and only Cobalt radiotherapy unit in any village in India. Caesareans, hysterectomies, gastro-jejunostomies and intestinal obstruction, massive goitre and road traffic trauma, wild animal bites were daily fodder.

However, having worked with all-time greats like Dr. Victor Rambo, a pioneer of eye camps and Dr. Paul Brand who developed surgery for deformed face, hands and feet of Leprosy patients, he was able to think outside the box (hospital). Sometimes in the evenings he would visit the surrounding villages inhabited by tribal Gonds. There he found abject poverty where Kwashiorkor (protein calorie deficiency), post-polio paralysis, neonatal tetanus (due to cutting the cord with dirty sickle), and of course water borne diseases like cholera, typhoid, diarrhoea, hepatitis, worm infestation etc. due to drinking polluted water from local streams, were rampant. The infant mortality rate in the first year was 30% and 70% by the time they reached five years. Added to this was drowning their sorrows in tobacco and alcohol. There were no healthcare facilities until Padhar hospital came about, the district hospital being too far away for them.  The entire health care was dependent on the witch doctors and local Dais (illiterate mothers who took care of deliveries). The treatment was expensive as the fees demanded where chickens, goats, grains and alcohol. 

Being medicos, our first step was to immunize all children that took care of Polio, Small pox, Tetanus etc. We trained Dais from the village and gave them a small packet containing a small bottle of Tincture Iodine, a sterile razor blade and cotton and thread to take of the deliveries in the village. This took care of the neonatal Tetanus. The packet cost us just a few cents. We also taught them how to identify complicated deliveries and bring them to the hospital. That substantially reduced the neonatal deaths. Next, we opened a ward for the severely affected Kwashiorkor affected children and fed them with protein calorie rich diet with dramatic results. However, when they got back home, many were lost because the economic situation had not changed.

We realized that this was not the solution as every child that we admitted, there were thousands out there who were staring at the same fate. We had no resources to feed all those hungry mouths. So come rainy season, we planted thousands of basic fruit trees in their backyards which included Papayas (full of Vitamin A&D), Guavas (vitamins, minerals and fibre), Lemons (Vit C), Jackfruit, Mangoes and Drum stick etc. We got all these for free from government nursery. This turned out be a disaster as the Tribals did not take care of the plants and during the hot summer months, they all dried up. Next year we got wise and planted them where the family washed their dishes and clothes. So, the survival rate of the plants dramatically improved and he presto there were papayas everywhere. In fact, my father came to be known as Papaya Choudhrie in the villages. This greatly improved their health profile, especially rampant blindness due to Vit A deficiency.    

However, the protein deficiency remained a huge challenge. So my father went to Vellore to the mote around the Fort and got Tilapia which is a very hardy fish and grows rapidly in all kinds of situation. He brought them by train and had to pump air into the can all night to keep the fish alive. The government at the time was building many dams and reservoirs on small streams. The fish thrived and everyone now had fish to eat as often as they wanted to. We then got drillings rigs and dug tube well and installed pumps in all the villages which eliminated all the water borne diseases. Later we added deaddiction centres in the villages which made considerable impact. All these and other development projects completely changed the health profile of the region with minimum investment. With these cost-effective and simple methods  in our community health project, we probably saved more lives than we cured in the hospital situation.

Overtime many departments opened up such as general medicine, Gyne/Obstetrics, Orthopaedics, Urology, Ophthalmology, Paediatrics, ENT and Dentistry etc along with supportive units such Pathology, Blood bank, Radiology (Xray, Ultrasound, CT scan, Physiotherapy including a limb fitting centre, dialysis centre, ICU, Oxygen generators etc. Our Ophthalmic dept. does over a thousand cataracts a year. Our Pathology dept reports on biopsies from several hospitals.

We then began to come across other health issues. In the hospital we began to see an influx of all kinds of cancer patients. Cancer of the cervix was common among rural women who had many children and cancer of breast among urban women who had few children. in the rural population, we did not see many cases of cholelithiasis as there was hardly any fat in their diet nor did we see much colon-rectal cancer as they could not afford refined food like wheat or rice but mostly lived off coarse grains like millets which have large amount of roughage. However, in the next generation we expect to see more life-style diseases as their mode of life and diet changes take place.

Not surprisingly, cancer of the buccal mucosa was common both among men and women. This is because there is culture of chewing tobacco with lime, a potent irritant.  In early cases hemimandibulectomy solved the problem but most cases came rather late with fungating and foul-smelling lesions. We had to resort to extensive Commandos but since micro-vascular surgery had not caught on, repair was done in stages. This was extremely discomforting to the patient as he had a deformed face with saliva dripping all over. This is not the case now as now we have a dedicated team that takes care of such cases with vascularized flaps at one go. We also felt the need for medical and radiation oncology. In 1983 we installed the first Cobalt radiotherapy unit. As there were no other units even in some of the big cities, we were treating as many as 100 cases a day. Later, Caesium needles were added for Carcinoma of Cervix.

In the year…. we orchestrated a team of superspecialists, most of them being my class buddies, including those from Australia and separated conjoint twins, the first ever in a rural mission hospital. This was broadcast by Australian television. (Video clip)

As an Onco-plastic surgeon, my special interest has been to repair simple and complicated congenital lip and palate deformities. We partnered with Smile Train that funds free treatment of such children. So far, my team has operated on over 5000 of these cases free of cost.

At the peak of Covid 19 pandemic, we were handling as many as 100 patients with many of them on Oxygen. Fortunately, we had our own Oxygen concentrator which could not cope with the demand but nevertheless saved many lives. We now have an additional unit that can cope with any future needs. We not only provided curative services but sometime body disposal services as well and families refused to take care of their relatives.

Pad paragraphs above with video clips and pictures.

Our financial policy is that we do not refuse treatment to anyone just because he cannot afford it. However, we do follow Robinhood policy of robbing the rich to take care of the poor. In recent years the government has come up with Ayushman programme through which we can offer inpatients free treatment to card holders, which is then reimbursed by the government. This is easier said than done, as it is easier to get water out of the rock than to get money out of the government. We could do with a few charitable organizations so that we can offer more subsidized treatment to deserving patients. Our greatest need however remains which is essential equipment so that we can provide state of art care to the patients, which are often beyond our capacity to buy.

Padhar hospital is a model of a holistic health centre. Being faith based, it takes care of body, mind and spirit. It combines 1. Prevention by doing cancer and other disease detection camps, 2. Curative services in the hospital and 3. Rehabilitation for the incurables we run a school for the blind and the differently abled where we teach them life skills including a trade so that they can earn a living that restores their dignity as human beings.

Gone are the days of the converted cowshed. We now have a very modern operation theatre complex with piped Oxygen and Nitrous Oxide. A well-equipped ICU and well trained and dedicated staff. So, are we there? No never will be as there is always room for improvement especially as the medical world goes more and more digital. We have a nursing school where we train nurses. We also offer some technical courses such as ………. Our next goal would be to become a training centre for Specialists such as surgeons, physicians, gynaecologists, paediatricians, orthopods, ophthalmologists and so on, who can go and reproduce what we are doing, in other remote places. To some extent we have been doing that already but now we would like to considerably scale that up. This will require additional infra structure in terms of staff, equipment and buildings. You are welcome to join us in this journey.