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Visionary doctor's legacy

By N.S. Murali

Dr. K.S. Sanjivi

Dr. K.S. Sanjivi, a doyen of the medical profession and Professor of Medicine, Madras Medical College, brought about a major change in the medical scenario, by visualising a new concept of preventive and promotive health care rather than emphasis on curative care. He felt that the common people had to be better educated about hygiene and public health, so that, in a country with so many avoidable diseases and deaths, serious illnesses could be prevented and minor or day-to-day ones comparatively excluded.

He realised that medical services in the government set-up as well as corporate hospitals both left a lot to be desired, even though they cater to the two extremes of population. He therefore envisaged the concept of doctors voluntarily providing their time for both urban and rural populations of Tamil Nadu.

Born in 1903, Krishnaswami Srinivasa Sanjivi had his early education in P.S. High School and Presidency College, Madras. He took his MBBS degree from Madras Medical College in 1927 and qualified for his M.D. in general medicine in 1932. He had a distinguished career in the Madras Medical Service in Madanapalle, Madurai, and Madras, specialising in chest diseases. The positions he held included Director of Tuberculosis, Professor of Medicine in Stanley Medical College, Professor of Medicine in Madras Medical College, and First Physician in the Government General Hospital. His diagnostic skills and teaching abilities were legendary.

With the ideas he developed over the years, the Voluntary Health Services (VHS), a non-profit charitable organisation catering to the medical needs of the poor and middle-income groups of the community, was founded in 1958 by Dr. Sanjivi. He had prematurely retired from the medical service as he had been overlooked, on extraneous grounds, from the post of Director of Medical Services despite his impeccable professional record. While he was naturally disappointed at this denial of his rightful due, he did not become dispirited or bitter. Nor did he accept the offer of the prestigious position of Professor of Medicine at the then fledgling All-India Institute of Medical Sciences at Delhi, or turn to devoting his time to the rich potential of private medical practice. Instead, he immediately plunged into the creation of VHS.

As a respected teacher and public personality, Dr. Sanjivi could get his colleagues and students, who were eminent doctors themselves, as well as prominent citizens of Madras (like K. Srinivasan of The Hindu, the legal luminary T.R. Venkatarama Sastriar, the Congress leader M. Bhaktavatsalam, and the industrialist M.A. Chidambaram, among others) to help him put his ideas into practice. The Voluntary Health Services was registered as a Society in July 1958. The cornerstone for the first block of buildings was laid in October 1961 by Pandit Jawaharlal Nehru, Prime Minister of India. By July 1963, the Medical Centre was fully equipped and staffed, when the first in-patient was admitted. Today, the VHS Medical Centre is a tertiary teaching 405-bed hospital with almost all the specialities — ranging from general surgery and medicine to neurology and nephrology. About 70 per cent of the patients (those with a monthly income below a certain limit) are treated free of cost, which includes free diet and medicines.

The VHS is managed by a Board of Trustees, a Central Committee, and other functional Committees that have on them eminent public personalities, community leaders, social workers, and philanthropists. Over 100 doctors, many of them well-known specialists, serve VHS in an honorary capacity.

Dr. Sanjivi may be rightly considered to be the father of the primary health care movement in India. He evolved a model of mini health centres to serve a population of 5,000 to 10,000, staffed by men and women multipurpose health workers, in turn assisted by a lay first-aider for every 1,000-population. Instead of bringing in highly trained but insufficiently motivated staff, there would be greater reliance on a local resident trained in elementary health care. This model found early recognition and acclaim as far back as 1969 by UNICEF, ICMR, ICSSR, and others and has served as an archetype at the national level. At present, 14 mini health centres (in semi-urban and rural areas), functioning under the wing of VHS and its M.A. Chidambaram Institute of Community Health, offer a gamut of health care as well as community interventions to the rural poor. They cover a population of around 100,000, serving the rural community of the eastern parts of Kancheepuram district. Quality medical care is provided along with other health care activities like immunisation, ante-natal and post-natal care, family welfare, environmental sanitation, conducted deliveries, school health examination, and maintenance of birth and death records. The VHS offers a unique Medical Aid Plan that was evolved as an insurance scheme to be utilised by the middle and lower income groups. The family is taken into account as the unit of health care and the head of the family is enrolled as a member, on payment of an annual membership fee which is income based, and his family members are included as his dependants and the medical services are availed by them.

Several of the medical departments of VHS have become centres of excellence in Chennai. The departments of Neurology, Neurosurgery, Diabetology and General Surgery are renowned for their performance. The Department of Obstetrics & Gynaecology very successfully deals with all types of deliveries with ante-natal and post-natal care, along with 24-hour neonatology care. The VHS from its inception has had a good Blood Bank with only voluntary blood donors. This Blood Bank, originally named after Dr. K.S. Ranganathan, has now been expanded and fully equipped by a grant from Rotary International and is called the Rotary Central-TTK-VHS Blood Bank. It is one of the best in Chennai, with 800 to 900 units of blood on an average being collected and issued to the needy patients of VHS and also other hospitals. The Haemophilia Care Centre provides comprehensive care to haemophiliacs, free of cost.

The scourge of HIV/AIDS began to sweep the world during the later years of Dr. Sanjivi's life. And keeping to his philosophy of working for the community's health, VHS has been in the forefront over the last decade in the country's efforts to prevent and control AIDS. VHS was selected in 1995 by the United States Agency for International Development (USAID) as the nodal agency for implementation of the AIDS Prevention and Control (APAC) project through NGOs in Tamil Nadu. The main objectives of the programme are education for prevention of AIDS, behavioural change communication, enhancement of STD care services, condom promotion, and research. The work of APAC has been much appreciated and, as a consequence, the Bill and Melinda Gates Foundation has very recently awarded a substantial grant to VHS (the only Indian NGO in the list) to continue work in the AIDS field.

The VHS-YRG Care Centre, with a 24-bed ward and a day care centre, treats AIDS patients. The VHS has strong research and teaching programmes in its clinical departments and is recognised by both the Ministry of Science and Technology and the National Board of Examinations.

The paramedical courses offered to non-medical graduates are innovative concepts visualised by Dr. Sanjivi, as he felt that doctors' time should not be wasted in doing non-professional work.

The Government of India, recognising the yeomen services of Dr. Sanjivi to the community, conferred on him the prestigious awards of Padma Shri and Padma Bhushan.

We have been commemorating Dr. Sanjivi's birth centenary with a year-long calendar of events. Symposiums on subjects — like tuberculosis, community health, health security — that were dear to his heart as well as one on HIV/AIDS were organised, with the participation of eminent experts. The thirteenth K.S. Sanjivi Endowment Lecture was marked as a special event in this birth centenary year. Ms. Aruna Roy, winner of the 2000 Ramon Magsaysay Award for Community Leadership, talked on Towards a Healthy Democracy: Issues of Transparency and Accountability in Public Health.

It was Dr. Sanjivi's dream that voluntary agencies, the most encouraging aspect of the health scene in India, should reach a size and standing where they can help achieve the hope of Health for All. We, at the VHS, dedicate ourselves anew to making this a reality.

During his birth centenary, I feel greatly privileged and honoured to write about him.

(Dr. N.S. Murali is Honorary Secretary of the Voluntary Health Services.)

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