Site Visit

 

Visit Report of James Killam - St. Gregorios Balagram - Yacharam

Yacharam is about a two hour drive from Hyderabad. The hospital is located outside the town in a rural area but on the main road. The hospital is quite large (perhaps 6000 square feet) having had an additional wing added at the back as a prerequisite to its participation in our project. It is a clean and pleasant building with a small inner open air courtyard containing flowers and plants.

The hospital is part of a much larger facility which includes a residence for children of lepers (105), a dairy farm to produce milk for the children, (which was financed by the Rotary Club in Calgary and CIDA), a chapel and assembly areas. It also has a small farm where rice, maize, wheat, onions, mustard, cassava, fruits and vegetables are grown. Water is scarce so rice must be purchased from the market for at least 6 months each year.

The children (who are called inmates) are aged from 4 to 22 years. To be eligible, at least one of their parents must be a leper but they must be free of the disease. The children are provided with shelter, food and schooling.

The hospital was built about five years ago. It started as a small general hospital but it was inefficiently operated and underutilized, with a doctor available only part time. It became a drain on the resources of the facility. As there is much blindness in the area, it was decided to change it to an eye hospital only. After a number of false starts, they became aware of our project through LVP and asked to be included.

By the time of my visit, most of the staff had already been trained through our project. They were very enthusiastic about their training and the prospects for the hospital. The community outreach program had just started. Under that program, vision technicians go to each village to screen potential patients. For now they will bring them to the hospital although later, refraction will be done at the villages. The radius for the outreach program is about 50km within which there is a population of 300,000 to 500,000.

The paying/non-paying system had also just been introduced but at the time of my visit only 25% of the surgical patients had been paying. The income generated was still short and only covered 55 - 60% of expenses. Father Phillip, the Director of Balagram who had traveled from Gujarat to see me, said that the area is very poor and the paying patients limited. It also takes time for villagers to overcome a number of barriers to access. These include lack of awareness, fear of surgery, knowledge of poor outcomes, lack of an escort and a fatalistic attitude. This problem is being addressed in the outreach program but it will take time before the hospital is accepted by the community. As it becomes more well known, and the quality of its services more widely recognized, it expects to attract paying patients from the suburbs of Hyderabad. The hospital can provide LVP quality at one half the price and in a more relaxed country atmosphere.

Two of the trainees under our project are former students of Balagram. The first, Mr. Karthic Isaac came to Balagram in 1985 at age 4 as one of the first students. He has completed his training at LVP and works in stores. The second is Mr. Mehaboob who came to Balagram in 1987 at age 6. He has been trained at LVP as a maintenance technician.
The hospital appears to be efficiently run and with much enthusiasm. The staff of the hospital are obviously committed. If the patient load can be increased, which should occur over time with the community outreach program, self sufficiency should be attainable.

Update:

As at the end of September, 2002, 3,370 patients have been seen at the hospital. 440 surgeries, primarily cataract, have been performed. Three villagers, who are incurably blind, have been referred to LVP for rehabilitation. In the past 3 months, 66% of the outpatients seen at the hospital have paid for their consultations. The ratio for surgical patients is much lower however, with only about 25% paying.

Visit Report of James Killam - Suryapet, February 9, 2002

I visited Suryapet hospital, the second hospital in our CIDA project, on February 9, 2002. We left Hyderabad at 7:00 am for the 140 km (3 hour) drive to Suryapet. About one half of the drive was spent in the oncoming lane of the State "highway", dodging oncoming traffic. The countryside is very arid with a few small villages and no development other than "Film City", a gaudy oasis in the middle of nowhere.

Suryapet is a noisy and dirty town with a population of about 100,000. The hospital, located in the centre of town, is a two storey building with what appears to be about 8,000 square feet of space. There is a partly finished building next to it that has been awaiting financing for a number of years. The hospital serves a rural population of between 500,000 and 700,000 within a 70 to 100 km radius.

The hospital was built in 1988 by the local Lions Club with most of the financial support coming from the owner of a company which manufactures PVC pipe at seven factories in the area. This is a substantial company with 700 employees and a market throughout India.
The hospital appeared run down and in a state of some disarray although it was not as bad as a government hospital. It had lost its ophthalmologist in December as he was resistant to the changes required by our project. Among other things, these required him to start surgeries early in the morning so that he would be available to examine patients later in the day. He was not prepared to change. After he left, four doctors from the surrounding area performed the hospital's surgeries at night after working on their own patients. They rotated to reduce the burden but would sometimes work until the early morning. They performed about 10 to 15 surgeries per day, 7 days a week. I suspect that this high volume was achieved through sacrificing quality.

At the time of my visit, none of the staff had completed their training under our project. The hospital was still using its voluntary "contribution system" for patients. Most paid nothing while a few made a "nominal contribution". I was told that in the month before my visit, the hospital's income was 50,720 rs while its expenses were 114, 240 rs.

Update:

Since my visit much progress has been made. A new Ophthalmologist has been hired and trained in IOL surgery at LVP. Many of the staff have completed their training under our project and the paying/non-paying system has been introduced. There have been some problems with staff and the manager of the hospital has been replaced. In the period July through September 2002, 6,360 patients were seen with about 40% paying. 307 surgeries were performed but with only 23% paying. It will be a while before self sufficiency is attained at this facility but it should be possible as there is a high demand for the hospital's services. As the quality of the services is observed, more paying patients should be attracted.