Amrita Health Sciences Campus
Amrita Kripa Hospital, Kalpetta
This hospital, situated in the scenic environs of the Western Ghats in Northern Kerala, was born out of Amma’s compassion for the tribes of Wayanad. "Tribal patients from far away and from interior regions of Wayanad come to the Amrita Kripa, which they fondly address as Amma’s hospital," states Dr. Ajitha, one of the doctors in charge. Dr. Ajitha, along with her husband Dr. Sanjeev, were instrumental in setting up services at Amrita Kripa Charitable Hospital (AKCH) in Kalpetta, and in developing it to its present capacity. The doctors were joined by 12 staff members at the hospital and two staff from the VRC (Village Resources Center).
The number of patients receiving help has increased year by year. In 2009, the hospital admitted more than 50,000 patients in the OP, nearly four times more than in its first year of operation five years ago. In addition, 5,600 patients were seen through the various out-reach camps conducted by the hospital. Seventy-five percent of the patients are tribal and receive free services. Nominal charges are levied from patients belonging to other communities.
Between 150 and 200 patients visit the outpatient department every day. On the busiest days, more than 300 people may require health center services. A well-supplied pharmacy stocks required medicine for routine outpatient care. Basic laboratory services are also part of the hospital’s facilities.
Devotee doctors from Calicut offer monthly services in the specialties of Internal Medicine, Pediatrics, Surgery and Dermatology. Gynecologic and Psychiatric services are provided on a weekly basis. Every three months the Amrita Jeevanam project from the Endocrinology Department at AIMS offers services in Endocrinology, heavily attended by patients with diabetic and thyroid disorders. Additionally, the patients have access to services like the Tele-med van, which makes monthly visits to Kalpetta and the Tele-medicine link up with AIMS.
Most of the tribal patients suffer from severe malnutrition because of a poor diet. Most of the children and women are very malnourished. They suffer from a host of illnesses related to malnutrition, especially anemia and repeated infections. They also suffer from other ailments such as TB, anemia, menstrual problems, skin diseases, and gastric problems. Modern life has also brought modern diseases like hypertension, heart disease and diabetes to the tribals as well.
At the root of many of their problems is malnutrition and lack of knowledge of proper dietary habits. The majority of the tribals work as day laborers and on a day when there is no work, there will be no food in the house. At the hospital, the doctors routinely see many severely malnourished babies and young children. Malnourishment at this young age leads to lifelong diminished mental and physical capacity. The children who come both to the outreach medical camps and to the hospital are weighed, given supplemental medicine and the mothers are given simple and practical nutritional instruction. On repeat visits, the children will be checked to see if they are gaining weight and if the mother is following instructions. Many children have been given a better chance in life and older patients have had long- term illnesses cured. Some of the patients visited other free hospitals previously, but had no improvement.
The higher rate of cures at Amma’s hospital likely has to do with the fact that from the receptionist who registers them, to the nurse, doctors, and to the pharmacist who usually sees them last; all the staff treats the patients with the utmost concern and courtesy. Drs. Sanjeev and Ajitha look deeply into the patients’ eyes when they listen to their symptoms and advise treatment. It is clear that they make real human contact with each patient and that they are interested in each one as an individual. The tribal patients, who often look a little apprehensive when they enter the doctors’ offices, visibly relax and look relieved when they leave. Studies have shown that when the patients have faith in the doctor who treats them, the healing rate goes up.
Treating the tribal patients effectively requires sensitivity and knowledge of their culture and lifestyle. Their reality is quite different from that of the dominant society. They live in the present, without a strong sense of time. Most of them will only have a vague idea of their age and their general sense of chronology is not developed. They traditionally have not lived in a world full of facts, figures and linear information, and become confused by too many questions.
They are not a questioning people themselves. They do not think much about the future and do not have the habit of saving their money. On a day they do not get work and earn money, there may be no food in the house and they simply fast. However, they do not seem to fear the future or have the level of anxiety from which many people in modern society suffer. For the doctor, information about symptoms and duration of symptoms can be difficult to ascertain. They are a quiet and uncomplaining people with a naturally stoic nature. In some cases, it takes experience with them and intuition to come up with a diagnosis.
Many of the patients who come have no life threatening illnesses, but the result of even a small injury or bad case of parasites can cause serious consequences and ultimately become life threatening. For example, Naryanan, age 60, supports his wife and two children by working in the fields as a day laborer. His family has no money if he doesn’t work. His toe became septic while working in muddy fields. He went to the Government Hospital for one month, but his condition had not improved. Here the doctors removed part of the nail and treated the infection with antibiotics. He says that he feels better and is happy with his treatment at the hospital. Like most patients, he came by bus and by walking, even with his bad foot. The average patient undertakes a two hour journey to reach the hospital and some have even traveled four hours each way.
Outreach - Special Projects and Medical Camps
From May 2006 to September 2009, AKCH hosted the Rheumatic Fever and Heart Disease Registry Project. The project, funded by the Indian Council of Medical Research, conducted a survey of 10,000 school children. The doctors involved examined and treated the children referred, gave classes to inform the public of the dangers of rheumatic fever and educated health workers.
Rheumatic fever is a hidden killer. It masquerades as a regular cold, flu or fever and often goes untreated. When a child suffers from untreated rheumatic fever, all may seem well until adulthood. During the most productive years of life, a serious heart condition will often develop, requiring major surgery for the patient’s survival. With India’s vast population, providing such specialized and costly services to the many people requiring them is a very difficult proposition. Diagnosing and treating cases of rheumatic fever in childhood is the best way to save lives and reduce the number of people needing highly specialized, costly surgery, which is available in only a few locations in each state in India.
The case of Laya shows the importance of screening. A team of medical professionals from the project visited her school and found that she was a probable victim of rheumatic fever. Her father brought her to AKCH to be checked by Dr. Krishna Kumar, an eminent cardiologist from the Amrita Institute of Medical Sciences in Cochin. The girl was found to have rheumatic fever and medicine was given free of charge. With the medication and careful monitoring, her outcome should be positive. One can only speculate what would have happened to her if the medical team had not come to this remote area of Kerala.
Periodically, AKCH holds cardiology clinics. At one such recent clinic the doctor saw over 60 patients on the first day of his visit, and in the few hours he had left that Saturday morning, he saw forty more. After interviewing the patients, he checked their heart function with an echocardiogram to confirm his diagnosis. On that basis, he would prescribe treatment by medication or recommend surgery.
One patient named R.K., age 60, had been spotted during an earlier visit to AKCH and was asked to come to consult with the heart specialist on his next visit. During his check-up, the doctor discovered that, although the patient had a serious heart condition, the government hospital where he had gone previously had scheduled him for surgery 18 months in the future.
The man explained that both his son and son-in-law were dead and he was the support for the entire family. However, his heart condition had made it impossible for him to work. The doctor patted his arm and told him not to worry. He invited him to come to AIMS where surgery would be scheduled immediately free of cost. Furthermore, he told the man to come directly to him upon arrival at the hospital, as he might get lost in such a huge place. Dr. Kumar told him that he should be able to work again after the operation. The man could not hold back his tears. This is the kind of difference this project and this small hospital are making in people’s lives. R.K. regularly returns to Amrita Kripa for check-ups and medication.
Every three months the Amrita Jeevanam project from the Endocrinology Department at AIMS offers services in Endocrinology in a major project launched in December 2007, to survey and treat patients with diabetic and thyroid disorders. Soorya is an 8-year-old diabetic patient. She was diagnosed with Type 1 diabetes when she was age three. She was four years old when she first came to AKCH. The doctors from the Calicut Medical College had put her on insulin. However, her blood sugars were very erratic, as the family often did not have the money to buy the insulin. They also did not know how to give the insulin properly at home. That is when the doctors from the Endocrinology Department at AIMS. through the Amrita Jeevanam project, decided to intervene.
Soorya came the first time the doctors visited AKCH to find if there was a need for an endocrinology project. They decided to provide her with regular insulin and insulin syringes, as well as all the other patients like her who need the drug. They also taught her mother how to give the insulin. The specialists from AIMS say that her blood sugar levels are under reasonable control now, even as good as a child living in a big city with access to all services.
As a grown up eight-year- old, she now attends school regularly and has even learned to self-administer her insulin! The project also gave her a glucometer that her mother has learned to use. They now come with fasting blood sugar values to the hospital! Soorya’s case shows how interested and capable tribal people are in helping themselves, when they have means and support to do so.
The Amrita Jeevanam project has also helped hundreds of tribal patients with thyroid problems. The incidence of thyroid problems and goitre is very high amongst the tribes. Sheela was a young 23-year-old mother who had been living for years with a huge goitre (swelling of the thyroid gland) in the neck. When she first came to the hospital, she had her neck covered with a shawl to hide the swelling. She had approached various centers for a solution, but to no avail. Initial blood tests and a needle biopsy revealed a benign swelling. She was referred to AIMS for surgery and the gland was removed surgically free of cost. She now walks proudly, without the shawl around her neck!
Outreach medical camps organized by Amma’s local devotes. The devotees are the ones who find the place to hold the camp and inform the people. They organize so well that within minutes after arrival, the doctors and staff can set up a clinic and treat large numbers of people in a short time. Regular camps are conducted twice a week on Tuesdays and Wednesdays at Modakkara and Edaguni . Additional camps are organized in association with other NGO's involved in tribal work such as PEEP, Ekal Vidyalaya, Vanavasi Kalyan Ashram, etc., usually once a week on a Thursday.
Future Plans
- Construction is underway to expand the hospital to provide more services.
- Establish regular out-reach centers in various interior regions of Wynad, where doctors and paramedical staff from the hospital can make weekly visits.
- Expand lab services and make available X-Ray facilities.
- Undertake research activities in collaboration with the Amrita Institute of Medical Sciences in order to find out the health problems in the tribal population and suggest remedies.