Down the memory lane

My five year tenure as Secretary ( Health &Family Welfare) and then as Principal Secretary during 2001-2005 was varied , interesting and most challenging. It was an assignment that gave me immense satisfaction and enabled me to learn alot about health related issues and make rich contributions for the health sector of the state.

From the beginning of my stint, I started taking regular review meetings with Heads of Departments, Programme officers and my staff in the Department. In certain cases, I used join the Heads of Departments when they were taking monthly review meetings.It enabled me to have first hand knowledge as to what was happening in the field and what remained to be taken up on a priority basis. It enabled me to initiate advance action against monsoon - related and seasonal out -breaks of communicable diseases, ensure preparedness of the Departments concerned for any major casualty. It also enabled me to identify the missing crucial links in the system.

Dengue Outbreak & Control

In August 2005, the state was realing under a Dengue outbreak and deaths were mounting. Every death, even ordinary death was attributed to Dengue. We immediately called a meeting of the the Head of the Department of Community Medicine of the Trivandrum Medical College to understand the gravity of the situation and worked out a strategy to address the problem squarely. We launched an awareness campaign by giving talks over the television, Radio, Press and launched door to door campaign. We used the school choldren to carry home the messages relating to " Dos" and "Donts". All the hospitals were asked stack test kits and emergency medicines. The Medical Colleges were asked to adopt the most affected villages by this out- break. We requested all the local bodies to focus on cleaning up their clogged drains,waste dumps, backwaters- the source of dengue larvae breeding. These efforts and the commitment shown by the doctors and paramedics enabled us to bring the outbreak under control.

Facility Survey

In order to fill up the critical gaps in any instituion, a "Facility Study" ( of infrastructure,man power, equipment, drugs,beds & furniture,water,drainage etc) is essential. With this in mind, facility surveys were conducted on a war footing against a blue print prepared by experts.This was published as a book titled "Instituion Analysis".

Essential Drug Lists & Drug Procurement Policy

When I joined the Department, almost all Malayalam dailies flashed news repeatedly that there were no essential drugs and even dressing materials. I went into the issue and realised that the Directorate of Health Services had not settled biils for the supply of drugs supplied during the last two years and that amount had mounted to Rs.35 crore. On top of it , the DHS required allocation to the extent of Rs.65 crores for every year. I took it up as a priority item and moved the Finance Department, which released funds in 3 instalments. Once, we got over the pending bills, we thought of ensuring availabilty of Essential Drugs in all the hospitals, for which we had to come out with Essential Drug Lists for Primary, Secondary and Tertiary Hospitals. An expert committee was constituted and Essential Drug lists were prepared and after getting Cabinet approval circulated to all the instituions.

PHOTO OF ESSENTIAL DRUGS

In order to ensure transparency and quality in the procurement of drugs, a Procurement Policy was prepared and Cabinet approval was obtained. This became handy for the DHS officials concerned with procurement of drugs and supplies to ward off complaints.

Rural Service & abolition of Liquidity Damages

Kerala is known for 100% literacy but was poor in public health facilities for want of adequate resources and lack of technical manpower. Most of the doctors and paramedics, who gained their degrees/diplomas at the cost of exchequer flew out of India for better pasture and as a result there were many vacancies across the state. There was a ban on recruitment as well. It affected health delivery. There were only two options before us - one, to deny leave for taking up jobs outside the state and two, to make rural service compulsory for those,who pass out of the Colleges with an MBBS degree. This move resulted in a lot of furore amongst the staff; but we put our foot down and said no. Moreover, the question of "Liquidity Damages" was done away with.

Private participation in Medical Education

At the time of assuming office as Secretary ,Health, there were only 5 Govt Medical Colleges, two Dental Colleges and few Nursing Colleges in the State. The number of MBBS seats totalled upto 900 and there was heavy competiton amongst students to get into anyone of the Medical Colleges in the state. Kerala parents would not mind selling their properties to educate their children. When their wards could not make it into the local Medical Colleges , they admitted them in the colleges in the neighbouring states paying hefty capitation fee. During one of my trips to the Ministry of Health , I discussed with Mr.Rao, Director in charge of Mediccal Education and asked him the way to go about to set up Medical Colleges in the private sector in Kerala. Of course, Kerala politicians would detest anything that is private . Of course, there have been lot private management run colleges of Arts & Sciences. On return from Delhi, I initiated a put up a note to the Chief Minister for orders. The initial response was "No". However, my logic was appreciated when I circulated the second note. We, therefore, issued a press release calling for applications for setting up Medical Colleges in the state.We got about 42 applications and on scrutiny with reference to the Medical Council Regulations, it was found that only 7 of them had the where withall to start a medical college the same year ie 2002.


When the issue came up before the Cabinet for consideratuion, I was called in to explain the logic and I did to the satisfaction of the Cabinet. It gave its not for consideration of all the 42 applications and issue Essentially certificate. I though it was a wrong move. Only subsequently, I realised that the Cabinet, in its collective wisdom took a practical decision. They knew pretty well that if only few were given and the others were denied, the decision of Govt. would be stalled by filing Writ Petitions. The same year, Amrita Institute of Medical Sciences,Kochi opened the first ever Medical Ciollege in the private sector. Now, few batches MBBS students have come out of this institution and it has also started offering P.G Courses. In the next few years , another 8 colleges sprang up making available 800 seats.This has provided lot of relief to the parents of chidren,who are intelligent but could not go out of the state for education .Of course, commercialisation by all these instituitions belied our hope and instructions. The plus points of this opening up of Medical ducation for private participation are that specialty care is available to all those who could afford, lot of infrastructure came up besides commercial establishments . It also provided for lot of employment opportunities for both skilled and semi skilled labour.

Setting up of Paramedical Council


The services of Paramedical Staff is inevitable for health care delivery. But, unfortunately, the instituions that impart paramedical courses are not regulated and the personnel who come out of sizeable number of instituions are poorly trained and they play havoc with the lives of patients. Kerala was the first state to set up the Paramedical Council in India. I provided leadership in setting up this council to regulate paramedical instituion.

Telemedicine & CArdiac Emergency Hospital at Pmapa

Sabarimala is a pilgrim centre in Pathanamthitta district of Kerala. Located amidst forests, it has no medical facility worth mentioning for the lakhs of pilgrims, who throng the hills for darshan of Lord Ayyappa. I had the fortune of serving as Special Officer,Pmpa during my Adoor Sub Collector days. As Secretary, Dept.of Health & Family Welfare, I arranged for first aid posts, a Govt. run Hospital at Pampa and presssed into service lot of doctors and paramedics. In addition, I approached the Director of ISRO Dr.Madhavan Nair and appealed to him to station a telemedicine unit at Pampa so as to get tele consultation with specialists from Super Specialty hospitals in other parts of the state. He readily obliged. I also approached Amrita Institute of Medical Sciences,Kochi and also the Apollo Group of Hospitals, Chennai for their support. Amrita Institute of Medical Sciences responded the same year by establishing a 10 bedded cardiac emergency hospital and Apollo Group followed their steps next year. Since then, bith these institutions run cardiac emergency hospitals at Pampa, which are beneficial for the devotees.

Tsunami and the relief Operations

ON 25 December,2004 Tsunami struck the coastal belt of Tamil Nadu Kerala. The coastal belt from Trivandrum to Alleppy was the worst hit. We set up a round the clock Control Room and monitored the situation. I had instructed the DHS And the DME to press into service their doctors and paramedics and render relief on a war footing. The Medical Colleges were asked to send teams of specialists and paramedical staff to the affected areas well within their district. District Medical Officers and the Principals of Medical College were asked to draw medicine from their stores and buy from the open market in case of need. The local private hospitals were requested to offer medical services to those who were affected and Govt. undertook to settle the bills. Ambulances carrying doctors, paramedics and emergency medicines and equipment were asked to patrol the area and render services. The Secretary of the State Mental Health Authoriyu was asked to send Psychiatrists to the relief camps and asked to offer counselling. As suggested by me the Cabinet despatched senior Secretaries, who had workedd in those disricts to oversee relief operations and take on the spot decisions and help the District Collectors in carrying out effective relief operations.


A Fight Against Stigma

The Govt in general and the Health department in particular was shocked, when the news broke out that Benson and Bency , HIV-infected siblings of Chathannoor Village had been thrown out of the local Kaithakuzhy Lower Primary School and were forced to confine themselves to their home because of their HIV status . The efforts of the state machinary consisting of the Secretary , School Education, Director, Kerala AIDS Control Society and the District Collector,Quilon to allay the fears of the parents of the children studying in the school and the local panchayat did not yield results. These two children were virtually ostracized by the entire village community which also trampled upon their fundamental right to education.

Parents did not to want their children to share the classroom with Benson And Bency and the Parent Teachers Association voiced exaggerated fears of a risk of HIV transmission from these siblings. Exposing the deep-seated stigma that hounds HIV-infected victims, belligerent parents threatened to withdraw their children from the school if Benson and Bency were in.Eventually, the school gates slamed shut on the children.

Deprived of their fundamental right to education, the orphans, who are under the care of their grandparents, were forced to remain at home. Having found that my colleagues could not succeed in their attempt,I entered into the frey even though AIDS Control was the subject handled by Secretary ( Family Welfare). I made it a point to spend weekends with the children, invariably taking them for a stroll on the streets. My efforts to erase the stigma that surrounded them paid dividends. The following unpublished article written " Walking With +Vesby me would throw some light on my efforts to fight the stigma.

WALKING WITH +ves




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