A walk through Vaatsalya, new levels of healthcare for rural and semi-urban India

28th Aug 2013
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A new name for children in rural and semi-urban India is on the rise. In certain areas of AP and Karnataka, parents are beginning to choose the name Vaatsalya (Sanskrit word for affection) for their children. These namesakes are living marks of gratitude for the level of care given by the hospitals in which they were born – hospitals managed by Vaatsalya Healthcare, a social enterprise founded by Dr. Ashwin Naik and Dr. Veerendra Hiremath.

Since 2005 Vaatsalya has been working to account for the imbalance of healthcare in underserved parts of India by bringing quality health services at affordable costs to Tier II and Tier III Indian towns. They have established 17 hospitals in rural and semi-urban areas of Andhra Pradesh and Karnataka, providing community members with a level of care and accessibility never before experienced.

Vaatsalya hosted the SocialStory team for a tour of the Mandya hospital, in Mandya, Karnataka. We were greeted outside the hospital by Balasubramany, the hospital administrator, who ushered us into a crowded waiting room where patients bustled in and out of the office of Dr. B.N. Prabhavati, the hospital MD. A gynecologist by specialty, Dr. Prabhavati has worked in the building since it was a nursing home, before it was taken over by Vaatsalya and transformed into a hospital.

On the right side of the room, Balasubramany opened a door to a large closet containing stacked shelves full of folders of patient records, packed tightly, but neatly ordered.

Leaving the waiting room we passed the seven-bed pre-maternity ward and the maternity ward, complete with ultrasound equipment, a labour room, and an neonatal intensive care unit (NICU) – the only NICU in Mandya other than the government hospital. “We’ve had two or three babies delivered that have been named after Vaatsalya,” noted Mr. Balasubramany.

Continuing up the staircase to the second floor, we came to the first of the in-patient rooms in the hospital. Vaatsalya Mandya has a total of 66 beds, with permission for 75. They maintain an average occupancy of around 60%, and an average length of stay of 2.7 days, according to Balasumbramany. Beyond the in-patient rooms we came to the Pediatric Ward and the Surgical Suite, which consisted of an ICU, a post-operation ward, a gynecology room, and a radiology center. “We aren’t a high tech hospital,” explained Balasubramany, “but we are affordable and appropriate. We run on a no profit, no loss model.”

 

On the third floor, we walked through a second inpatient wing, a general ward housing both male and female patients at a lower cost than the Special and Deluxe rooms on the second floor. At the top of the back staircase was the Yashaswini Ward, a government subsidized inpatient ward for patients that cannot afford the prices offered by the hospital.

There are about 38 hospitals in the Mandya district, including specialty centers and the district’s government hospital. According to Balasubramany, Vaatsalya is both the most affordable and the most professional of the hospitals in the area.

“The heath care here is better than at government hospitals. The hygiene and cleaning is much better as well. This is one of the best house-kept hospitals in Mandya. All of our trash is segregated into human waste and hazardous waste. The hazardous waste is disposed of by contractors, and the nurses are all trained how to separate it.”

Nursing is Vaatsalya Mandya’s top priority, with nurses receiving training up to five days a week from Vaatsalya staff. “Our Head of Nursing is working very hard to change the ‘unofficial practices’ that have been adopted and to make things more standardized,” said Balasubramany. With Vaatsalya as with many other health care providers across the developing world, a well-trained nursing staff reduces the often intense pressure that comes with a lack of qualified doctors available to a particular region.

Vaatsalya

Indeed, despite the above-average level of professionalism to which Vaatsalya Mandya holds itself, it fares no better than other rural health institutions in attracting full-time doctors. “We have the facilities to treat everyone for just about anything, but not the doctors,” said Balasubramany. “It is difficult to get to rural towns, and even more difficult to attract high qualified doctors to come live here to work. So doctors come on a call-by-call basis. They will come from nearby areas on call, and we then pay them based on the treatment.”

Unfortunately, the demographics of doctors practicing in India are unlikely to change without creative and enforceable government policy. The bright side, however, is that India’s private sector has a particularly promising opportunity to at least partially circumvent challenges posed by a shortage of doctors in rural areas. By providing training in allopathic care to the hundreds of thousands of nurses and practitioners of alternative medicine, healthcare enterprises are in a position to fill an important gap that would reduce the overall burden of finding a doctor to treat patients at more advanced stages of illness.

Vaatsalya’s business model lends itself to this opportunity by taking over pre-established nursing homes. Facilities are re-branded and adapted to meet Vaatsalya’s standards, but the core staff remains the same. The transition allows Vaatsalya to access a group of health professionals familiar with the community and to provide them with the additional training necessary to meet the needs of the hospital and the patients it serves.

As we descended the hospital stairs at the end of the tour, Balasubramany stopped in the maternity ward where a man was sitting on a bed, apparently visiting his wife who recently gave birth. Some words in Kannada were exchanged between the two men, and Balasubramany emerged, frustrated, back into the hallway where we waited.

“That man was visiting his wife, but he was not supposed to be in there. Men are not allowed in the maternity ward,” Balasubramany explained as we continued to descend. “On of our biggest challenges is controlling the people that come into the hospital. We cannot turn people away, and we do not have the systems to monitor them. Rural people do not understand that they cannot just walk in and walk around.”

The problem, it seems, stems from a simple lack of familiarity with formal medical institutions. This should come as no surprise in areas where an individual’s earliest exposure to medicine is often with an untrained, unlicensed local provider. In many ways the challenge at Vaatsalya Mandya is representative of the state of Indian healthcare as a whole. Yet it also points to a movement in the right direction, to a day when, even in remote rural communities, individuals will be so accustomed to formal medical care that they naturally assimilate into hospital culture. With the concentrated efforts of Vaatsalya and similar enterprises in establishing standardized medical institutions in rural and semi-urban areas, it is only a matter of time before administrators like Balasubramany no longer have to worry about unauthorized visitors wandering the halls of their hospitals.

Website : Vaatsalya

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