footprints

Celebrating 40 years of Gods faithfulness

Bangalore Baptist Hospital 1973-2012

footprints
Celebrating 40 years of Gods faithfulness
Bangalore Baptist Hospital 1973-2012

Bangalore Baptist Hospital Footprints: Celebrating 40 Years of Gods Faithfulness: Bangalore Baptist Hospital 1973-2012 Copyright 2012 Bangalore Baptist Hospital All rights reserved. No part of this publication may be reproduced, stored in or introduced into a retrieval system or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book. Unless used autobiographically or with permission, all names and other personal identifiers in this book have been changed to protect privacy. Published by Bangalore Baptist Hospital Bellary Road, Hebbal, Bangalore 560024, Karnataka, India

9 Beginnings The early history of Baptist Hospital

37 Committed to excellence The accent on quality

ISBN: 978-93-5104-342-3 Ghostwriting and substantive editing: S. Sahu, Bangalore Design, layout and publishing consultant: George Korah, Primalogue Publishing Media Private Limited, Bangalore Printed and bound by Brilliant Printers Private Limited, Bangalore

69 Adding life to days The gentle touch of Palliative care

83 Out in the community Community outreach initiatives

113 Academic excellence Medical education and training

Contents

Foreword
It is a pleasure to write the foreword for this book, which traces the 40-year history of Bangalore Baptist Hospital. This book of pictures and vignettes enshrines what this institution is all about. As you read it, you will understand what God has been doing through the staff of this hospital in bringing hope and healing to all those who come to it. It will also give you a glimpse of the foundation and ethos of the institution. I have followed the development of this institution and have shared in its struggles and triumphs. I am impressed by the growth of the Hospital and that the institution has tried to remain faithful to its vision, Healing and wholeness in the spirit of Christ. Christian Medical College, Vellore considers it a privilege to contribute to the management of BBH and to be a partner in the BBH story. With this book in your possession, you will have connected with the BBH family. We wish that this connection will grow into a relationship that will be endearing and long-lasting. God bless you. Sunil Chandy, MD, DM Director Christian Medical College, Vellore

Preface
It is my privilege and honour to write this preface. This book is a vivid record of the first four decades in the life of BBH, right from its inception to the present day. For 34 of those years, I have witnessed, participated in and grown with this hospital. I joined it as an intern in my twenties, in 1979. I will soon be retiring from it. I am truly grateful to BBH for its influence on my life. It is a time to celebrate Gods faithfulness and blessing on this institution. From an outpatient clinic in a makeshift building, BBH has become a 300-bed multi-speciality facility. It is recognised nationally, holds its own in the private sector and has not compromised its principles and mission focus: remaining relevant to the poor and marginalised. This is a phenomenal achievement. To God be all the glory. I must mention those who have contributed to making this institution what it is today Dr Jasper McPhail, Dr John Wikman and Dr Richard Hellinger, of the International Mission Board (IMB), who helped set up this hospital; Dr Clyde Meador, Rev Jerry Rankin and other missionaries from IMB, who helped in the initial years; Dr Rebekah Naylor, who gave a lifetime of service to BBH; and Dr Stanley Macaden and Dr Santosh Benjamin, my predecessors at the Hospital. BBH owes them a debt of gratitude. Gratitude is also due to our governing boards and chairmen

for their support and guidance: the late Dr Benjamin Pulimood, architect of the tripartite relationship between CMC Vellore, IMB and BBH; Dr V.I. Mathan, Dr Joyce Ponnaiya, Dr George Chandy and Dr Suranjan Bhattarcharji; our present Chairman, Dr Sunil Chandy; and our committed staff. All of them have made BBH what it is today. As we move into the future, we look to Him, our Lord and our God, who makes it possible for us to remain true to our motto of bringing healing and wholeness in the spirit of Christ. Dr Alexander Thomas CEO

Acknowledgements
Celebrating 40 years of Gods faithfulness is a refrain from the heart as we recall how good and faithful God has been to the Hospital. Our praise and thanks to God. Capturing the 40-year history of an organisation in a little over 125 pages is a challenge. So I gratefully acknowledge the Editorial Committees hard work and support, especially that of Dr Asha Thomas, Dr Anita Thomas and Mrs Hannah Sinclair. To Dr Alexander Thomas for his wise counsel and for keeping us on our toes, and to the Administrative Committee, we owe heartfelt thanks. Appreciation is due to all contributors who sent in material and willingly responded to our queries. To Dr Rebekah Naylor and Dr John Wikman, we express sincere thanks for their consistent promptness. To those who contributed articles that failed to appear in Footprints, I apologise: we deeply appreciate your effort but could not print everything you sent due to space constraints. I thank S. Sahu for his conceptualisation of the book and the meticulous writing, rewriting and editing of the text, which are reflected in the quality of Footprints. To George Korah, I owe sincere thanks and gratitude for design, layout and assistance in printing. More appreciation is due to Elsa, his wife, who not only threw open their home for us to work from but provided us timely meals as we worked into the wee hours. I also wish to thank Mr Uday Daniel Mr Karunakaren for their tireless effforts in photography. Last but not the least, I thank my colleagues for covering for my divisional responsibilities, while I worked on the book. Dr Gift Norman Chairperson, Editorial Committee Bangalore Baptist Hospital

Message excerpts from our former chairpersons

Dr Benjamin Pulimood One of Dr Pulimoods lasting concerns was the future of Christian hospitals in India. He reiterated that they needed long-range plans and doctors with long-term commitment. He grew very concerned when he learnt that BBH might close down. Shutting down a Hospital that had served the community would be a great loss. So he was very happy to help execute the Tripartite Agreement. He visited BBH even after retirement, thrilled to see the work of Christ it carried out and at the way the Hospital expanded. (From Dr Ramani Pulimood, wife of the late Dr Benjamin Pulimood) Dr Joyce Ponnaiya Congratulations to the past and present staff and students of BBH on reaching this landmark! After the Tripartite Relationship was established, the BBH board expanded to include leaders from the wider Christian community in India. This had its benefits. Watching BBH, CMC Vellore learnt of the challenges faced by a small mission hospital in a cosmopolitan city that also had many corporate and tertiary care hospitals. We were always impressed by the commitment of BBH to quality and Christian witness. I am happy that the partnership with CMC Vellore has strengthened BBH. Dr George M. Chandy The model for Christian medical mission used to be a church, a hospital and a school, with a community around them. Today, with rapid strides made by healthcare in infrastructure and technology, that model is questionable. But BBH, through innovation and change management, has taken a quantum leap forward. It now attracts and retains the best talent, has adopted incentivebased remuneration with a human face and has identified and is developing appropriate specialities. It welcomes overseas students for training. It has become a model for the healing ministry in India. Dr Suranjan Bhattacharji I offer congratulations to a community that has moved a long distance from its beginnings. BBH has widened its reach, increased its expertise and innovated to address challenges without letting go of its core values. As BBH looks to the next 40 years, the challenges will not only be external but also internal. My prayer is that BBH continues to grow in its willingness to serve the lowly and the lost through caring; ethical medical care; providing transforming education; and developing its ability for research. I pray that it will continue as a beacon of light and life.

Adding life to days

A birds-eye view

alliative care, as defined by the World Health Organization (WHO), is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual1.

The next major development came in the 1950s, when Dame Cicely Saunders, the pioneer of the modern hospice movement, developed many of the foundational principles of modern hospice care.2 Dame Saunders developed the concept of total pain and derived from it the emphasis on patient-centred care. In 1967, Saunders developed St Christophers Hospice in London. Around this time, also in the US, Swiss psychiatrist Elisabeth KblerRoss began to consider the social response to terminal illness. Her 1969 bestseller, On Death and Dying, was influential in understanding how the medical profession had responded to the terminally ill until then. Through these pioneers, the modern hospice movement spread to Canada, Europe, Australia and many other regions of the world.

As a specialisation that it is today understood to be, Palliative Care goes back about 130 years. In 1879, the Irish Religious Sisters of Charity, who are considered to have been influential in developing the model of the hospice, opened Our Ladys Hospice in Harolds Cross, Dublin, Ireland in 1879. In 1905, they opened St Josephs Hospice in London.

Paliative care 71

In 1992, WHO took up Palliative Care as an important but neglected area of care and began promoting it all over the world. In 1986, the first hospice in India, the Shanti Avedana Sadan, was established in Mumbai. In 1994 followed the Indian Association of Palliative Care. Most palliative care services are based in Kerala, including the two WHO Collaborating Centres for Palliative Care, which are located in Kozhikode and Thiruvananthapuram. However, the overall coverage of palliative care in India is only around 2%. Further,

despite being the highest producer of legal morphine in the world, India has not yet made the drug easily available to treat the severe pain that patients suffering from cancer experience. BBH did well to initiate, as long back as 1995, a fully integrated palliative care programme that used a unique hospice and home care approach and offered bereavement support services as well. The Hospital aimed to restore wholeness to people in the face of life-limiting illness. Dr Stanley Macaden Consultant, Geriatric Care, CSI Hospital, Bangalore
The relative of a Palliative Care patient being trained to give injections

A graduate of CMC Vellore, Dr Macaden began at BBH as a physician, in 1978, where he took over as Director in January 1990. He retired from the Hospital in 2008. As the Hospitals first Indian head, Dr Macaden led BBH while it was transitioning from the Southern Baptist Conventions

International Mission Board (IMB) management to that under the tripartite agreement between CMC Vellore, IMB and BBH. Dr Macaden was instrumental in formally initiating palliative care services at BBH.

Palliative care: a wholistic model

he integrated Palliative Care model followed at BBH is unique. It upholds the four cardinal principles of palliative care that apply in the context of respect for life and the acceptance of the ultimate inevitability of death. The model derives its strength and motivation from the Christian scriptures, in which Jesus tells a parable about how God rewards unselfconscious acts of compassion toward the destitute, the lonely and the sick (Matthew 25:36). Integrated healthcare is part of Baptist Hospitals motto. BBH therefore seeks to understand the needs of dying patients and their families and take meticulous steps towards providing wholistic patient-centred care. We respect the feelings such patients and their families experience acceptance or denial of the illness and its consequences and the refusal to access palliative care services. We cannot be condescending toward the patients and their families because we believe in developing a partnership with them, which is the cornerstone for any successful provision of healthcare and, especially, of palliative care. The BBH model is sensitive to patients changing priorities. Therefore, it provides a wide range of continuous services in inpatient, outpatient, respite or terminal-care contexts. Patients, together with their families, may choose to remain with the

Paliative care 73
primary treating department, move to Palliative Care or to free home-based services when the patients health necessitates that. We believe that patients should spend quality time with their loved ones and complete unfinished family, social or personal tasks, e.g. arranging a marriage in the family, writing a will and so on. After more than 5000 home visits we understand the practical, physical and emotional difficulties, which they go through. Some stay in the third floor with narrow staircase or where there is no medical / nursing help for more than 9 kilometres radius or no road facilities for kilometres or caretaker could be the only one person to earn and take care of the family. In these cases we believe that the home care is so essential and consults with different professionals at the appropriate time for a gentle transition. The Palliative Care team at the Hospital pays bereavement visits and provides care to the bereaved, once the patient has passed from this world. This allows BBH to give that much-needed, special touch providing moral, emotional and social support, psychiatrist consultations and other help, as needed which means much to the relatives left behind. This is unique to BBH and leads to its lasting relationship with families and the community. Dr Ravi Livingstone Medical Superintendent Kotagiri Medical Fellowship Trust Hospital, Kotagiri, Tamil Nadu

Dr Ravi Livingstone specialised in Palliative Medicine at CMC Vellore, during 2007-08 and, during April 2008-July 2012, was in charge of Palliative Care at BBH. He is on the faculty of the Indian Association of Palliative Care.

74 footprints: Celebrating 40 years of Gods faithfulness

When care prevails

anjunatha was eight years old when he was brought to the Bangalore Baptist Hospital (BBH) outpatient department by his parents, Shivappa, 42, and Gangamma, 29. The boy had a lump the size of a tennis ball on his right ear. Shivappa looked anxiously at the doctor on duty at BBH, while Gangamma wrapped her arms protectively around Manjunatha (Manju), their youngest child. The family hailed from the village of Sadahalli, 30 km (18 mi) from Bangalore. Manju had two older sisters, Jaya, 18, and Lakshmi, 15, who were unmarried. Shivappa, Gangamma and Jaya were farm hands. Together, they earned Rs 450 in a good season. Lakshmi kept house

and looked after Manju but, when he started school, she began work on the fields. Three months earlier, Manjus lump had been the size of a marble. But it had been ignored. When it grew to tennis-ball size, however, Jaya took Manju to the village barber, who doubled as the village doctor. The lump was sliced off, a herbal poultice applied. The wound healed. But the lump grew back rapidly and Manju was brought to BBH. He was posted for biopsy. The diagnosis was rhabdomyosarcoma arising from the right ear, for which the treatment costs alone were upwards of Rs 400,000 anywhere in India evidently unaffordable for Manjus family. However, the BBH oncologist asked the social

worker to assess the familys socio-economic situation, and Manjus treatment costs were fully waived. Radiological investigations showed that the disease had, unfortunately, spread to the liver. Manjus parents were counselled about this and the poor prognosis. They were broken on hearing the news but took courage after the Oncology and Palliative Care teams had spoken to them. Chemotherapy was started. During the treatment, he lost weight and all the hair on his head. Manju was then started on radiotherapy for almost a month. He came daily for treatment, which lasted 15-20 minutes each time. During radiation, Manju would bravely lie completely still, as required, all by himself in the radiotherapy room, with

a plastic mask over his face. Chemotherapy was continued for four more cycles. Manju developed jaundice. The Palliative Care team visited every two to three weeks and later weekly as Manjus condition worsened. The final day for Manju and his loved ones came as the doctors had estimated, early one morning. He had slipped away during the night. When the palliative care team reached Sadahalli, Shivappa rose to meet the doctor, and broke down. Gangamma was sobbing. Then the couple wiped off their tears and said to the BBH team: If you were not here, I dont know what we would have done. You have been like our family! BBH has provided similar care to over 1,800 families

The Indian scenario

The term life-limiting illness is used to describe illnesses where it is expected that death will be a direct consequence of the specified illness. Such illnesses include (but are not limited to) cancer, heart failure, chronic obstructive pulmonary disease, dementia, neurodegenerative disease, chronic liver disease, endstage renal disease and HIV/AIDS. Around 3 mn patients suffer from cancer at any given point in time, with 1 mn new cases being reported every year. As much as 70% of all cancer victims are beyond cure at the time of diagnosis. End-stage renal disease claims 94% of those it affects. The remaining 6% survive through kidney transplants, a precarious and often exorbitant route to an extended life. 3.5 mn Indians are infected by HIV/AIDS. Over 30,000 of them die from the syndrome every year. Antiretroviral therapy (ART) suppresses the progress of HIV/ AIDS and is used to prevent its transmission. However, only 6%10% of those infected have timely access to ART. The rapid rise in the population of aging Indians, from 7.7% in 2000 to an estimated 12.6% in 2025, forecasts that the highest number of patients in need of palliative care will increasingly be from the elderly terminally ill.

Vinayashree Palekar (L) at a Palliative Care home visit

Paliative care 77
since April 1998, when the Palliative Care department added home care services to its care model. Till date, in its outpatient department and wards, the Hospital has served more than 2,500 patients. Inaugurated in January 1995 by former BBH Director Dr Stanley Macaden, the Palliative Care department extends the Hospitals interpretation of wholistic healthcare to those with life-limiting illnesses. BBH recognises that, at the end of a persons life, relieving their suffering is all that is possible. Approximately 20% of all families in BBHs Palliative Care ambit are from Indias poor. The service is offered free, with payment for medicines and procedures done accepted from those who can afford the cost. BBHs palliative care aims are early identification of the terminal health status of a patient, adequate control over the symptoms and improvement in the patients quality of life through a multi-pronged approach that combines hospice-, homeand outpatient clinic-based care. Wherever needed, the Oncology, Urology, Medicine, HIV/AIDS and other departments collaborate on a given intervention. The accent is on providing comprehensive psychosocial care and creating a homely atmosphere for patients by enlisting the active support of family, relatives and the community at large. The BBH Palliative Care team is multidisciplinary, composed of one or more doctors, nurses, a pastoral counselor and, whenever needed, a social worker.

Home visits to patients and their families are carried out throughout the entire duration of home care, right up to the moment of death, with bereavement visits made subsequently. Up to seven home visits are made daily. Wherever patients and families grant permission, spiritual support and

counselling are also provided. A regional centre for the Indian Association of Palliative Care and a recognised centre for the National Fellowship in Palliative Medicine, BBH also conducts regular training programmes in the specialisation for volunteers and medical personnel.

126 footprints: Celebrating 40 years of Gods faithfulness

The Samaritan Medical Outreach Ministries

s an outcome of the Tripartite Agreement, Baptist Hospital assumed sole responsibility for its capital development. For some years, therefore, BBH struggled for funds. So, in 1991, several longtime US-based friends of the Hospital, some of whom had volunteered earlier as doctors at BBH, talked over how they could raise funds for the Hospital and its ministry. They incorporated a charitable organization, the Samaritan Medical Outreach Ministries, so as to receive tax-deductible donations for the Hospital. During the initial years, substantial sums of money

were raised through personal and church appeals. The major projects funded were the Outpatient Department wing, the School of Nursing and some staff quarters. Then, some Samaritan Ministries board members fell ill; others passed away; and the organization went through a period of hibernation. However, in 2010, a new board of directors was elected. Samaritan Ministries has become active again in fundraising and applying for grants on behalf of the Hospital. Dr Rebekah Naylor

The Samaritan Medical Outreach Ministries team with Dr Alexander Thomas (standing, 2nd from L)

References
1. Beginings
From half a world away

1. McPhail P. McPhail lives dream as surgeon, missionary. [Online]. 2009 [cited 2012 Dec 1]; Available from: URL:http://www. calhouncountyjournal.com/mcphaillives-dream-as-surgeon-missionary/ 2. Hornbeck CL. Rebekah Ann Taylor, M.D.: missionary surgeon in changing times. Garland, Texas: Hannibal Books; 2008. 2. Commited to excellence
Charitable hospitals in India

of charitable hospitals: reviewing options for sustainable partnership. [Online]. [2010?] [cited 2012 Dec]. Available from: URL: http://www. hosmacfoundation.org/ResearchPublications.php/] 3. Adding life to days
A birds-eye view

1. World Health Organization. WHO definition of Palliative Care. [Online]. 2012; Available from: http://www. who.int/cancer/palliative/definition/ en/ 2. Palliative care. en.wikipedia.org/wiki/ Palliative_care 4. Out in the community
Healthcare and poverty

Poverty Index Country Briefing series. [Online]. 2010; Available from: www. ophi.org.uk/policy/multidimensionalpoverty-index/mpi-country-briefings/; p2 3. World Health Organization. World Health Statistics. [Online]. 2012; Available from: http://www.who. int/gho/publications/world_health_ statistics/EN_WHS2012_Full.pdf 4. Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet 2011 Feb 5;377(9764):505-15
The alcohol problem

1. Shyamprasad KM. Health, education and development. In: Post-Modern Challenges to Christian Mission. Workshop during the Tranquebar Tercentenary Celebrations; 2006 Jul 3-9; Chennai, India. [Online]. [2006?] [cited 2007 Aug 17]. Available from: URL:http://www.nlhmb.in/images/ Mission and Church.doc/ 2. Shah U, Bhatt D. Study of status

1. World Bank. Poverty and Equity Data, India, The World Bank. [Online]. 2012; Available from: http:// povertydata.worldbank.org/poverty/ country/IND 2. Alkire, Sabina & Maria Emma Santos. 2010. India Country Briefing. Oxford Poverty & Human Development. Initiative (OPHI) Multidimensional

1. Ranganathan TT. Alcohol related harm in India a fact sheet. Indian Alcohol Policy Alliance. [Online]. Available from: www.addictionindia. org/.../alcohol-related-harm-in-indiaa-fact-sheet 2. Girish N, Kavita R, Gururaj G, Benegal V. Alcohol use and its implication for public health: Patterns of use in four communities. Indian J Community Med. 2010 Apr;35(2):238-44

Editorial Committee
Dr Gift Norman Head, Community Health Division Chairperson Col Deepak Bunyan (Retd) Head, Support Services Division Member Sr Mercy Christudas Assistant Nursing Supervisor Member Sr Leena Raj Principal, Rebekah Ann Naylor School of Nursing Member Dr Sindhulina Chandrasingh Head, Training Division Member

Dr Anita Thomas Assistant Chief of Medical Services Member

Sunny Kuruvilla Deputy Director Member

Dr Asha Thomas Head, Radiology Department Member

Hannah Sinclair Office Manager, Directorate Member

Bangalore Baptist Hospital is located in Bangalore, South India in a sprawling beautiful campus. The hospital exists to serve all people in the spirit of Christ, irrespective of caste, creed, religion and socio-economic status. Dynamic growth have been our hallmark, while remaining centred on our vision, mission and values.

Donation: 500 / US $ 30.00 ISBN 978-93-5104-342-3 Bangalore Baptist Hospital Bellary Road, Hebbal Bangalore 560024 Tel: + 91-80-22024700, 22024598 E-mail: bbh@bbh.org.in Web: www.bbh.org.in

9 789351 043423