Rajiv Gandhi Medical College

Region: Maharashtra Country: India

History
Rajiv Gandhi Medical College medicine was introduced to India by the Europeans. With the foundation of the Grant Medical College in Bombay in 1845 the native citizens of the presidency were given an opportunity to study western medicine from some outstanding teachers. The college soon gained a world-wide reputation and its founder-principal, Dr Charles Morehead, was invited to help the University of London in formulating its programme for medical education.

Towards the end of the century the old order represented by Sir Robert Grant, Dr Charles Morehead and Sir Jamsetjee Jejeebhoy was replaced by officers of the Indian Medical Service (IMS) who, far from encouraging the best talent of the college, maintained their hold on the prestigious professorial posts. After much hesitation, a few non-clinical professorial posts were opened to non-IMS Indians and Dr Y. G. Nadgir was the first to be appointed to a chair (Anatomy).

The fact that an IMS officer would be professor ofmateria medica one year and teach obstetrics and gynaecology the next underlined the unwillingness of the authorities to give opportunities to capable Indians.

Nationalist Indians strove to correct this imbalance. Among them was Dr K. N. Bahadurji, the first Indian to obtain the coveted M.D. degree of the University of London. When he was denied the post of Professor of Medicine at the Grant Medical College (an IMS officer holding only the Licentiate of the Royal College of Physicians diploma (LRCP) being appointed instead) he advocated the establishment of a new medical college, staffed by Indians, that would break the monopoly of the IMS.

He placed the idea before Sir Pherozshah Mehta - the lion of Bombay - and other members of the Bombay Municipal Corporation. Dr Bahadurji died on 15 August 1898 before his plans could materialize.

GENESIS AND FOUNDATION
In 1907, under the Police Charges Act, the work of medical relief within the city of Bombay was entrusted to the Municipal Corporation. In 1909, an ad hoc committee of the corporation decided that 'the time had come for the Seth Gordhandas Sunderdas Medical College in 1925 Photo by Keshav M. Godhia to be associated with the proposed hospital. At the instance of Sir Pherozshah Mehta, the donors also insisted \ that the professors and teachers to be employed should I all be properly qualified independent Indian gentlemen I not in government service.

The Municipality approached the Bombay Medical Union for a detailed scheme for the organization of the medical college and hospital. Dr. Jivraj Mehta, just returned from London after obtaining an M.D.degree, was approached by the union. He suggested a radical departure from the traditional design of teaching hospitals in India where isolated blocks housed separate departments.

Dr. Mehta proposed that the entire medical college be housed in one large building and the hospital (including the out-patient block) in a separate building. This would facilitate co-ordination between the various departments. The two buildings were to be interconnected by covered corridors so that patients, students and staff could easily go from one building to another during heavy monsoon rains. (The Seth G.S.Medical College and K.E.M. Hospital were the first multistoreyed institutions of their kind. The K.E.M. Hospital was the first Indian hospital housing the out-patient department within the main hospital building).

The plans were submitted to W.A.Pite who had designed the Kings College Hospital in London and was then a leading authority on hospital construction. The local architect was G.Wittet. In those days it was thought that if an architect happened to be an Englishman, he was not only a fit person to draw up plans for a hospital but also to select its equipment. Wittet drew up a long list of equipment to be imported from England, including even ordinary beds for the wards, lockers and mobile screens.

The equipment committee (consisting of Dr Rustom Cooper, Dr P.T.Patel and Col.Hamilton) insisted on obtaining most items from Bombay. Wittet strongly expressed his resentment but was disregarded. When the hospital and the college were formally inaugurated on 22 January 1926, Wittet was presented a gold cigarette cas 5* by the Governor of Bombay, Sir Leslie Orme Wilson, in appreciation of his services. In the very first week, however, a large piece of the plastered ceiling of the operation theatre came down and within the first fortnight, the tiled floor cracked! The total cost of construction of the hospital was Rs.2,527,699 and that of the college Rs 1,364,574.

In making the first appointments to the staff, the Municipal Corporation was largely guided by Dr G. V. Deshmukha very active member of the corporation and also a big noise in the profession (Cooper). Dr Jivraj Mehta was elected Dean of the college and hospital. The first batch of teachers included Dr.M.D.D.Gilder, Dr P.C.Bharucha, Dr A.S.Erulkar, Dr P. T. Patel, Dr G. V. Deshmukh, Dr.R.N.Cooper, Dr V.L.Parmar, Dr.N.A. Purandare, DrV.R.Khanolkar and DrB.B.Yodh,who, according to Dr Jivraj Mehta, were individuals of the highest capability and deepest integrity. There was a great bond of striving towards a common aim - ensuring a brilliant success for these institutions.

Remember, these were the first medical institutions in the country staffed by Indians at the professorial and other levels and there was a great sense of pride in all of us.The list of members of the staff in 1926 shows their designations as Honorary surgeon and lecturer in surgery,Honorary physician and lecturer in medicine and so on. Dr Rustom Cooper explained

To ensure smooth working, some departures from accepted policies were instituted. It was the usual practice in hospitals to have surgeons in order of seniority. The senior surgeon became, ipsofacto, professor of surgery. The surgeons at the K.E.M. Hospital decided differently. It was resolved to drop the high sounding title of professor and call the surgeons just lecturers. It must be said to the credit of Drs G. V. Deshmukh and A. P.Bacha that, though they had a senior standing in the profession, they agreed to this arrangement. This plan was accepted by all the other departments and has been responsible for the great fellow - feeling that has always prevailed. Many heartaches and petty jealousies were thus averted.

Part of the success was also due to the extraordinary qualities of Dr.Jivraj Mehta. 1 would come over to the hospital in the middle of the night keep my car outside the hospital compound so that no one knew in advance of my presence and moved about the hospital, entering the wards through the servants' staircase to check for myself that no one on duty misused his time.

I preferred using the small, winding staircases near the toilet blocks so that I could check on the sanitary facilities. Call books were checked regularly and doctors not attending within a reasonable period were disciplined. I would taste the patient's food from time to time and walk into the student's hostel and resident's quarters at midnight to see how they lived and worked.

Development :
The Rajiv Gandhi Medical College, the twelfth medical college in the country, opened its doors on I June 1925 to 46 students, six of them women. The formal opening followed the next year and it was affiliated to the University of Bombay. The hospital, with 125 beds, started admitting patients on 15 January 1926. Both the medical College and the hospital quickly gained a reputation and patients were attracted in large numbers. The demand for more beds led to a progressive expansion of the hospital. Table I shows the growth of hospital services.

As most patients are poor, the Municipal Corporation tried to provide hospital services free of charge. But increases in costs over the past decades have made it necessary to recover some of the expenses from those who could afford to pay.

There has also been an increase in the number of students joining the medical college (Table II). The establishment of the school of nursing in 1927, the first school of occupational therapy in India (by Mrs Kamala V. Nimbkar in 1950) and that of physiotherapy in 1953 made it possible for students to get training in these paramedica)disciplines. The E.C.I. Institute of electro-physiology was added to the school of physiotherapy in 1974.

Anatomy, physiology, pathology, pharmacology, preventive and social medicine were taught by full-time teachers. Whereas medicine, surgery, obstetrics, gynaecology and other clinical subjects were taught by individuals who worked part-time for the institutions on an honorarium (and were, hence, termed 'honoraries'). The 'honoraries', being outstanding clinicians, earned their living from their private practice. They spent most of their working hours in the college and hospital. The "honorary" system worked very well at that time as the number of students and patients were small.

Dr Jivraj Mehta sought to stimulate research as soon as the institutions started working smoothly. Besides obtaining funds for research from external agencies, Dr Mehta approached the 'honoraries' who had lucrative practices. He received generous contributions from Drs P.C. Bharucha, M.D.D.Gilder, N. A.Purandare and Rustom Cooper. (Dr.Mehta's account of the attitude of IMS officers towards applications for grants from Indian doctors is revealing. It was necessary to approach Sir Walter Fletcher, adviser to the Government of India on medical research, to improve the situation. Incidentally, it was Dr Jivraj Mehta who insisted that the All India Institute of Medical Sciences should be located in New Delhi instead of DehraDun as advised by the Fletcher Committee.)

As the number of patients and students progressively increased it became difficult for honoraries' to devote sufficient time to their wards, teaching and research. The situation was worsened by competition in private practice. Barring a few exceptions, the''honoraries" found themselves unable to do justice to their three responsibilities.

Achievements
The achievements of the institutions that hit the national headlines or won awards such as the Lasker or Padma Bhushan, include the contribution on Rauwolfia serpentina by Dr Rustom Jal Vakil, the first heart transplant in India by Dr P.K.Sen and the first documented Indian test-tube baby by Dr Indira Hinduja.

The major contribution was made towards the development of a good system of undergraduate and postgraduate education, the creation of a system where the poor can obtain good and free medical care and the creation of an ethos of service.

Problems
With limited financial resources it is becoming difficult to meet everyday requirements and it has not been financially possible to acquire modern equipment such as a computerized tomographic scanner. The staff feel discriminated against in the allotment of fellowships, equipment gifted by foreign governments and grants from international health organizations.

Moreover, because of commercialism there is a danger of our work ethos being eroded. The harmony among members of the staff is under strain resulting in the neglect of patient care, student education and research.

PLANS FOR THE FUTURE
The struggle to remain in the forefront of Indian medicine however continues. A recently constructed twelve-storeyed building houses new departments and has allowed some old ones to expand. The present orthopaedics centre is to be converted into a convalescent centre. A facility for producing blood products that will meet our most complex needs is being evolved. An intensive care unit for patients with serious neurological diseases is being planned. Preventive and Social Medicine are also being applied to new areas.

Epilogue
In their sixty-second year, these institutions continue to play important roles in medical education and patient care. Students can register for training in every branch of medical science. The teachers are qualified and recognized as guides for all diplomas and degrees offered by the University of Bombay and other academic licensing bodies. Patients from all over India are attended to by residents and consultants in departments ranging from dermatology to psychiatry and neurosurgery to proctology. Several departments have gained national renown. We hope the enviable past of these institutes will flow into a promising future.

The KEM hospital and the G.S. Medical College are big enough and famous enough in Mumbai (Bombay) for any one in the public transport system to know how to take you there. You can sit in a taxi anywhere in Mumbai and tell the driver to take you to "KEM" and almost certainly you will have to give no further address or instructions.

KEM is located in central Mumbai in an area called "Parel". This locality is home to the middle and lower middle class citizens of Mumbai. It also has many medical centers in a area of a square kilometer. These include, besides the KEM and GS Medical College, the Wadia Maternity Hospital, the Wadia Children's Hospital (both affiliated to the KEM); the Tata Memorial Hospital which is the largest cancer hospital in Asia , the Institute for Research in Reproduction and the Haffkine Institute, the latter being a premier "basic medical research" institute in the city.

Hospital
Founded in 1926, the Rajiv Gandhi Medical College and Hospital are amongst the foremost teaching and medical care providing institutions in India. The medical college (school) provides training to about 2000 students in undergraduate, postgraduate and superspeciality medical courses; in undergraduate and postgraduate physical and occupational therapy; Masters and PhD courses in various allied specialties. A nursing school is also maintained by these institutions.

With about 390 staff physicians and 550 resident doctors, the 1800 bedded hospital treats about 1.8 million out-patients and 85,000 in-patients annually and provides both basic care and advanced treatment facilities in all fields of medicine and surgery. Housed on the ground floor of the main hospital building, it is located where the old casualty, medical and surgical OPDs, minor surgery and Wards 20 and 20A were located.

This approximately 15,000 square ft area, houses all emergency facilities. There are separate medical (adult and pediatric) and surgical (surgery and orthopedics) areas to cater to all emergencies.

Each area is provided with all necessary monitoring and life support systems. The five fully equipped operating rooms are capable of handling all types of emergency surgeries including urologic, and vascular or thoracic surgery.Fully functional biochemistry, pathology and microbiology laboratory facilities are housed within this area itself. Plain radiography and ultrasonography are also available within this area.

A CT scan specifically for emergencies will be commissioned shortly.Established at a cost of approximately Rs.30,000,000 , this service has been made possible with a generous donation of Rs. 17,500,000 from the "Jasoda Narottam Public Charity Trust" and was inaugurated by the Chief Minister of Maharashtra, Shri Vilasrao Deshmukh.

A unique feature of this service is that all areas of this emergency care facility are computerised and are linked up through a Local Area Network, for both clinical and administrative needs. Dedicated software has been developed for the same. In time, this data will be exploited for evaluating and defining emergency management and treatment protocols in a typical urban Indian setting and could be used to develop and set standards for emergency medical practice in India.