At the break of independence, Chennai was served largely by the Government General Hospital which had as its adjunct the Madras Medical College; and the Stanley Hospital with the Stanley Medical College attached to it. Both these institutions earned fame for their evolution contributed by hundreds of dedicated doctors and administrators. They also catered to the needs of the entire Madras presidency, attracting patients for special treatment from the sprawling presidency that extended in the north up to the southern parts of Orissa.
The railway hospital at Perambur catered to the requirements of the staff of Indian railway and earned a similar reputation.

When government hospitals attracted the best of talent...
These hospitals and colleges attracted the best of medical talent for some three decades well into 1980s. These had the reputation of offering quality medical treatment administered by renowned medical practitioners. The famous like Rajaji and EVR and the poor got admitted into the GH confident of availing the best medical treatment.
In the early years of independence, one could also witness practitioners of ayurveda, siddha and unani streams of medicines. There were special ayurveda centres like Jeevamirtham in G.N. Chetty Road, T.Nagar and Kesari Kuteeram near the Clock Tower, Royapettah. There were private practitioners with LMP (licensed medical practitioner) diplomas and others with the MBBS degrees. There were a few nursing homes set up as proprietary or partnership concerns. There were also few specialists like ophthalmologists, ENT surgeons, dentists and, of course, several maternity homes. Several legends also surfaced from time to time like Muthulakshmi Reddy, E V Kalyani, S Rangachari and Guruswamy Mudaliar who became celebrities due to their skills and humane approach.
Of course healthcare availability was limited and diagnostic facilities were confined, by and large, to blood tests. X-ray was yet to mark its presence. Infant mortality rate was very high as also maternal mortality rate, pre-or post-natal. Malaria and small pox, diarrhea… took a heavy toll and life expectancy at birth was low at less than 30 in 1947.

Dramactic increase in life expectancy...
In independent India administered by democratic governments, there has been increasing focus on education and public health. The control of epidemics and communicable diseases, better hygiene with focus on sanitation and safe drinking water, availability of food to the masses, spreading consciousness on nutrition and spectacular improvements in diagnostics, preventive and curative treatment methods have contributed to handsome increases in longevity. Today life expectancy at birth is estimated around 63 (for 2001-05). Death rates, particularly infant mortality rates, have fallen dramatically.

The advent of the corporate hospital...
The exposure of Indian medical professionals to living and working conditions in the west, particularly in the UK and USA, kindled the desire on their part to set up modern medical facilities in India as well. There have also been spectacular improvements in diagnostic tools and methods. These changes are dynamic; large manufacturers of such equipment like GE, Philips, Siemens… focused continuously on R&D and incorporated emerging and evolving technologies, notably in electronics, both hardware and software. Indian doctors, who have migrated to Europe and the US, attained proficiency, skills and expertise in effectively using these diagnostic tools and made quantum progress in success rates in invasive surgeries.
I visited the Texas Medical Centre, Houston in the 1990s. In a radius of 5 km, there were over a dozen super speciality hospitals – one of the richest concentrations of medicare facilities in the world. Dr. Denton Cooley working here, specialised in cardio- thorasic surgery. I know of a number of cases of Indians getting by-pass surgeries done at the hands of Cooley and regaining a fresh lease of life for a couple of decades and more. Dr Cooley was humane and liberally reduced the fees charged.
Four decades ago, in 1967, Christiaan Barnard successfully transplanted a human heart in South Africa. Medical research flourished in American and European universities, medical institutions and pharma companies, liberally supported by governments and philanthropists. The rapid evolution of IT software was also intelligently married to healthcare. More effective use of medical data, taking liberal recourse to IT, was a big help.

P.C. Reddy, the pioneer...
By the late 1970s several specialist doctors who had worked in Europe and the US and returned to India, were dreaming of setting up comparable facilities. I remember the dream outlined by the well-known cardiologist, Prathap C. Reddy, to a handful of journalists ( including this author) at a star hotel, of setting up a corporate hospital. The concept was bold and unconventional: till then healthcare was considered an act of service rendered by the government, philanthropic institutions and dedicated individuals. To make profits out of healthcare was considered a sin (I remember the violent reaction of Charan Singh, who served as deputy prime minister in the Janata government and succeeded Morarji Desai as prime minister for a few months, when the concept of a for-profit corporate hospital was mooted to him).

Facile tie-up of finances...
Luck was by the side of Reddy: the Charan Singh government was short- lived and Indira Gandhi returned to power in 1980; Reddy succeeded in convincing Delhi on the need for the corporate hospital. The outlay of around Rs.10 crore (large in those times) was mobilised by Reddy and a few of his prosperous friends – fellow medical practitioners in the US, who took care of the promoters’ share, a term loan from the Swiss Banking Corporation and through a public issue. The Apollo Hospitals Enterprise, the first corporate hospital of India, took shape in the next three years and commenced operations in 1983. Reddy took care to install state-of-the-art diagnostic equipment and also attracted specialists from far and wide. The reverse brain - drain of medical professionals started.

He expanded awareness on modern diagnostic equipment...
The Chennai population had the opportunity to gain familiarity with autoclaves for accurate and fast culture and analysis of blood samples and a vast range of x-ray and ECG machines, dopplers and scanners. With the acute sense of business and human psychology, Reddy introduced several innovative ideas: he induced prospects to opt for a simple registration system: for a fee of Rs.150 per annum, Apollo offered a 90 per cent concession on all diagnostic tests. Equipment, which were idling for want of custom, had been put to full use! In just a few months, knowledge on such diagnosis spread rapidly; Reddy promptly withdrew the concession at the end of the year!
Reddy had easy access to the portals of power. I remember the ease with which he would even work out of the offices of senior secretaries to the Government of India. In quick time he convinced the policymakers on the need to treat medicare as an industry eligible for term loans and other facilities from banks and development financial institutions. This cardiologist was bent on creating facilities similar to those in the US for heart surgeries that will eliminate the need for expensive treatment abroad. He focused on developing a strong nucleus for treating heart ailments. K P Mishra, M R Girinath, I Sathyamurthi and several others quickly established the reputation of Apollo for cardio thoracic surgery. Similar records have been set up by K M Cherian, S Thanikachalam, V V Bashi… Chennai has built a niche for treatment of heart ailments. Over 7000 heart surgeries are performed in Chennai every year with a success rate comparable to the best in the US!

Vijaya Gardens - the incubator and nursery for several large hospitals...
B Nagi Reddy, who made his fortune as a film producer, had invested extensively in land in Vadapalani. Thanks to the trigger of the urban land ceiling act, he turned his attention to healthcare. The Vijaya Medical and Educational Trust in Vadapalani emerged as one of the famous health care centres in the city. Reddy invested handsome amounts on building a rich infrastructure. Vijaya attracted specialists like P V Cherian, K M Cherian, P V A Mohandas, S S Badrinath... Vijaya Health Centre served as the base, incubator and nursery for several specialties. The Madras Institute of Orthopedics and Trauma Care, Sankara Netralaya, The Madras Heart Institute... later evolved as separate large hospitals on their own. The availability of acres of land with Nagi Reddy could have helped develop a massive medical complex like the Texas Medical Centre; but the attractions of real estate were far more formidable. With the demise of Nagi Reddy that dream vanished.

Super speciality hospitals ...
Chennai witnessed in quick succession the arrival of several super specialty hospitals. The young doctor couple S. Ramamurthy and Nithiya, set up the Malar Hospital, a much needed facility for the environs of Adyar. P V A Mohandas, the renowned orthopaedist, with his vast experience of working in the UK, Switzerland and Germany, set up the Miot Hospital, in Nandambakkam (I hope some day Miot and Fortis Healthcare, which has taken over Malar Hospital, both located on the banks of the Adayar river, would evince interest in cleaning up the river and make it navigable). Miot has today expanded to offer specialised treatment in several disciplines including cardiac care, nephrology...
The Madras Medical Mission in Mogappair continues to focus on cardiac care. K M Cherian, who headed the MMM, Ajit Mullasari and dozens of other specialists earned for this hospital, run by missionaries, a reputation for high quality treatment of heart ailments. Cherian moved out and set up the Frontier Lifeline Hospital and is currently busy with an ambitious medi village near Gummidipoondi (see separate article).

Welcome focus on research
Sri Ramachandra Hospital and University emerged in just a decade as a model institutions for university-driven healthcare. Promoted by businessman, N P V Ramasamy Udayar, this institution has emerged strong in medical education, research and training in healthcare. The education and training facilities focus not just on turning out quality doctors, but also a vast range of para-medics and medical technologists. Adapting state-of-the-art practices in medical translation from bench to bedside, the institute provides the promise of medical research, a field neglected in the last six decades, gaining importance. Udayar, who rose from humble beginnings, ensured that nearly half the patients were treated free; poor patients are provided medical treatment comparable to that offered for paying patients (see separate article).

Chennai has also emerged as the centre for several specialty hospitals that have gained rich reputation for their focus. Sankara Nethralaya is renowned for offering state-of-the-art research and treatment in ophthal-mology. With excellent recourse to IT, this hospital has introduced diagnostic and treatment systems to such efficiency that costs have been contained to a remarkable extent. The procedures have been so standardised and perfected that patients need to spend just a few hours at the hospital to undergo a cataract surgery! With strong focus on research, Badrinath and his colleagues have been able to attract rich talent to specialise and offer the best treatment to the ever-increasing number of patients who throng the hospital from far and wide.

Cancer care with a humane touch
Chennai is also a strong centre for the treatment of cancer. The Cancer Institute, Adayar set up by the first woman to qualify for MBBS in the South, Muthulakshmi Reddy, had been rendering yeoman service under the care of V Shantha and S Krishnamurthi.

Focus on diabetes...
At Royapuram in north Chennai, M. Viswanathan, spread awareness on diagnosis and treatment of diabetes, which, apart from heart diseases, is the most worrisome feature of the Indian health scene. His sons, Mohan and Vijay, are continuing with the pioneering work done by their illustrious mentor. Mohan and his wife Rema, through the M V Diabetes and Research Centre, have been focusing on the need for early diagnosis, the importance of exercise, frequent check up, diet and nutritious food that go a long way to control diabetes and to arrest deterioration of eye sight.

More hospitals...
The demand for healthcare is increasing in humungous proportions. The Tamil Nadu government has set up peripheral hospitals and specialty hospitals. More and more private hospitals have also been set up. Bilroth Hospitals that acquired the Kaliappa Hospital a few months ago, is expanding rapidly. T S Santhanam of the TVS family, with liberal contributions from his companies, set up the Sundaram Medical Foundation as a community hospital in Annanagar that offers quality medicare at modest cost. In the IT Corridor, new specialty hospitals like the Frontline Hospital and Chettinad Hospital have been set up. These have spent liberally on state-of-the-art equipment.

Some concerns...
Medical colleges and universities are also surfacing in good numbers. The SRM University has created a rich infrastructure for medical education and treatment in the southern part of the expanding metro.

Crowding of medical colleges...
While one is impressed by the interest on the part of businessmen to set up medical universities and colleges, one is also worried over their crowding the city with so many of these. Just think of this: the total number of seats offered by medical universities and colleges in Chennai Metro or the much smaller town of Puduchery is more than the number of seats offered by the whole of Bihar, the second largest state! When Sri Ramachandra Hopital and University has been providing quality healthcare in west Madras, four other medical colleges have been allowed to be set up in close proximity to this institution. It would be far better if the new licences are provided for setting up such colleges and universities in heavily under-served parts of the state like Dharmapuri.

Where the parallel economy flourishes...
Medical education has become a thriving business. There are estimates of capitation fees of Rs.25 lakh to Rs.50 lakh and more per seat demanded and got by medical colleges and these are mostly unaccounted. P Chidambaram, a grand son of Annamalai Chettiar, should be familiar with such capitation fees collected by private medical colleges in the state. In several institutions a portion of the faculty salaries are also paid in cash.
Admittedly, the facilities involve huge finances. Why not make bold and treat medical education as a business, legalise and permit the colleges to charge appropriate level of fees that would help them sustain and grow? In the last three decades one has witnessed the death of medicare as an act of philanthropy that would not entail profits; Prathap Reddy succeeded in setting up corporate hospitals with profit as the business motive. He is today as much concerned with the bottomline as Ambanis are and has succeeded in expanding the marketcap of Apollo manifold.

Increasing cost of medicare...
One should also be worried over the increasing cost of medicare. Reddy is never tired of explaining the high costs of diagnostic equipment and consumables, of equipment becoming obsolete in quick time and new generation equipment with better facilities costing much more as the reason. If a scan cost Rs.1000 when Apollo surfaced in the 1980s, it has snowballed to more than Rs.10,000 in the early 2000s; scans from very special equipment like the non-invasive cancer cost even more.

Hurry to amortise equipment costs quick...
There is the hurry to amortise the cost of diagnostic equipment in quick time and a plethora of tests are prescribed. Worse, there is no willingness to accept the test results of one leading hospital by another. And there is so much variance in treatment for the same ailment!
General physicians with expertise and capabilities to diagnose and prescribe proper treatment are fast becoming extinct. There is easy and frequent resort to the use of diagnostic tools. Medical insurance and fear of litigation play their own role for doctors adopting a costly, defensive attitude. Specialists again often do not adopt a holistic approach: in attempting to cure a particular ailment the hospital and the specialist tend to cause infections and damages in several other areas leading to a lot more of post- surgical complications. In most cases proper information to the patient or obtaining his consent is ignored. Sadly, there is no independent audit of these. Most specialists who perform 8 to 10 operations a day do not just have the time to attend to these essential functions. They succeed in increasing the longevity, but do they succeed equally in ensuring quality of life in the bonus years they get for their patients?

Sankara Netralaya: Chennai is surely the eyecare capital! more...

Frontier Lifeline Medivillage: India’s first healthcare SEZ.  more...

Tackling chronic kidney disease: Treatment of kidney-related diseases involve painful surgery, regular dialysis, trans- plant, lifelong medication.  more...

Interview: It will take time to provide health for all - Dr Shah Nawaz Khan more...

SRH & SRU are true mouments to the uncommon deeds of a common man. more...

Stanley Medical College & Hospital: The hospital that gave birth to such specialists! more...