The Southern Railway Hospital, Perambur

It is a usual weekday morning for patients. Boards on the wall highlight the salient features of the Railway Health Services, assuring "Total patient satisfaction through humane approach and shared commitment of every single doctor and paramedic to provide quality health care using modern and cost effective techniques and technologies." While the Southern Railway Headquarters Hospital (usually referred to as the Perambur Railway Hospital – PRH) and its sylvan surroundings, a 15-acre property, soothe the milling crowds who throng this premier institution, not many among them are aware or of its remarkable transformation – from a nondescript 40-bedded hospital of the 1920s to an institution of national repute in the 21st Century! Nor are they aware of how many stalwarts have contributed to its reputation of offering quality medicare, of its first link to fame being its state-of-the-art cardiology unit which, besides being a pace-setter for the nation, is known for producing some of the country's finest cardiologists and cardiac surgeons!

It was in 1925 that the need "for medical facilities in the preventive, curative and promotive aspects to the Railway population" was felt by the then Chief Medical Officer of the Madras and Southern Mahratta (MSM) Railway, Maj. G.J. Cruikshank. Thus it was in 1928 that a 40-bedded hospital was established for the MSM Railway staff in Perambur with a Senior Surgeon, four Assistants and twelve Nurses. Initially it served the needs of residents of the railway colony in the area and those of employees in the workshops, besides providing routine medical examination for employees.

"Surrounded as it was by dense woods, it looked more like a forest bungalow than a medical centre. The nearest semblance of modernity was Hotel Dasaprakash!" recalls Dr. J.S.N. Murthy, currently Head of Cardiology, Sri Ramachandra Medical College, who grew up on the verdant campus of the Hospital in Perambur. Trained and qualified in Cardiology from PRH, he also worked there between 1977 and 1994. His father, J. Sriraman, had served at PRH between 1955 and 1982 as its first anaesthesiologist.

By 1930, the bed strength had increased to 50 and an Operation Theatre, X Ray Centre, Lab and Out Patient Services Department had been added. By 1957, the number of beds had increased to 120 and the following year an X-Ray Block was opened. In 1959, a Maternity Ward with 12 beds was added and a Hand Clinic started. That year, the 24-bed TB Sanatorium at Pattabiram was shifted to the PRH as its TB Annexe. By 1960, the bed strength had increased to 220.

The tenure of the late Dr. T.J. Cherian (TJC) at PRH was a catalytical point in the hospital's momentous onward journey. Taking over as its DMO in the early 1960s, he spared no effort towards making it a premier cardiology centre. Until then, only the All-India Institute of Medical Sciences in New Delhi, Christian Medical College in Vellore and a few hospitals in Mumbai performed cardiothoracic surgeries in India. Under TJC's stewardship, the PRH soon progressed beyond its role as a primary health provider for the Southern Railway staff.

"After TJC's advent, doctors had to report for duty at 7.30 a.m. His enthusiasm for the profession was infectious and his team was willing to undergo any hardships and make the best of meager resources. The PRH had a dogs' lab, where experimental heart surgeries were performed on canines. During expansion, the lab was converted into a canteen for doctors!" Dr. Murthy recalls.

Doctors at the Perambur Railway Hospital were encouraged by Dr. TJC to think out of the box. Dr. Murthy remembers being on night duty sometime in 1977 when a patient with an aneurysm of the aorta – operated upon by the famous German doctor Meisner – was bleeding profusely. Those days, the need for blood could not be met easily, even if urgent. Through a relative who worked at Doordarshan, the television channel was requested to issue a plea for blood. It was issued immediately after the Oliyum Oliyum programme and also just before the news bulletin. Volunteers answered the SOS call by the dozen, minutes after the announcement. After that, hospitals started using DD to -request for blood. Indeed, the Perambur Railway Hospital has many firsts to its name!

Dr. TJC never let the hard hand of bureaucracy slow down the hospital's growth. Instead of relying on funding for purchase of sophisticated gadgets, he often innovated with available resources. A diathermy unit made at the Integral Coach Factory workshop was later refined for greater efficiency. A hypothermia unit (used in open heart surgeries on children under profound hypothermia to protect the brain and other vital organs) was made by harnessing the skills of the workers at ICF's airconditioning unit! A firm believer that developing people was the first step to building great organisations, Dr. TJC always led by example.

Veteran Dr. Muthiah Sankaran (at the PRH from 1966-77) has had the distinction of being part of this speciality for close to half a century. "Graduating in 1961, I was inspired by Dr.TJC's selfless humanitarian service and dedicated patient care. I tried to follow in his footsteps, even to remaining a bachelor (this I gave up in my mid-thirties!), and spent the rest of my life in cardiothoracic surgery. It was in 1962-1963, while working with the legendary cardiothoracic surgeon Dr. C.S. Sadasivam, that I joined Southern Railway as an Assistant Medical Officer. Our open heart surgery programme was initiated by Dr.Valiathan, who was trained in the USA and served in the Railways in the early 1970s. From 1963 to 1975 we were doing all types of lung surgeries (for TB, Cancer, some birth anomalies etc.) and some heart surgeries (which did not need to open the heart). Soon after, the two stalwarts in cardiac surgery, Dr. K.M. Cherian and Dr. M.R. Girinath, joined our team!

"I had the privilege of assisting Dr. KMC at the very first successful coronary bypass surgery in India! In the mid-1970s we did a lot of paediatric cardiac surgeries ranging from total correction of birth defects in blue babies to repair of various other congenital cardiac defects including valve replacements – many of them were done on newborns and infants for the first time in India. Since Madras had the only cardiac surgery speciality hospital in the Indian Railways, railway employees and their families from all over India came to Madras for their cardiac care, especially for adult and paediatric cardiac surgeries, as they got the benefit of subsidisation. "In those days, we did not have today's gas sterilisation units and used only boiling water to sterilise the surgical instruments. For open heart surgeries in the early 1970s, we used disc oxygenators, with the metal discs hand-cleaned by us and then sterilised with ethylene oxide. The initial open heart surgeries were all done with a metal oxygenator and the very first open heart surgery done in Indian Railways at the beginning of 1970s was by Dr.Valiathan who later became Director, Chithra Thirunal Institute of Medical Sciences and the Vice-Chancellor of the Manipal Institute of Higher Education (MAHE)," recalls Dr. Sankaran.

Dr. I.S. Naidu, currently Chief Anaesthesiologist, Apollo Hospitals, recalls, "I joined the PRH as Anaesthetist at the end of 1970, and was there till June 1984. The work culture there was remarkable. All of us were part of a team and enjoyed our work, even the round-the-clock bedside duties. We were at the Theatre Entrance by 7 a.m., because TJC would probably be there by 6 a.m. I remember that, post-surgery, the anaesthetist and surgical assistant had to spend the whole night sitting on chairs (as an incentive, we were provided dinner by the Railway Canteen!). We generally had about 10 minutes for lunch. Sister Savithri, who came from CMC Vellore, played a major role in instituting standards in nursing care and theatre culture."

Dr. T. Radhakrishnan, currently Chief Physician, Apollo Hospitals, joined the Railway Hospital when he was 27 years old, working there till he retired in 1984. He laughs as he remembers, "With only one building, one DMO and 150 beds totally, it was jokingly called the 'Die Soon' Hospital, punning on the name of a medical officer in charge, Dr. Dyson! I also remember introducing the Clinical Society meetings at the hospital and trying hard to collect a fee of Re.1 from each of the around 30 members, to be able to provide biscuits and tea. In the early 1960s, TJC entered the Hospital and began a revolution! He was the one who initially brought new technologies to Perambur. He also brought on board cardiac surgeons like Dr. K.M. Cherian and Dr. Girinath. By 1978, we were being sought out by people from all over the country. Most doctors stayed near the campus and, so, in an emergency like a railway accident, 20 to 30 doctors could be mobilised in a matter of minutes. Our workload was rather high. I had plenty of night calls, at least five times a week! But we were all like one big family… I remember TJC trying to reduce my load by offering to share the night duty when called, and my retorting 'What's the big deal. No one is going to call you anyway'!"

By 1973, a new medical ward with 80 beds and an ICU were started. 1974 saw the construction of the New Block and OP clinics like Eye, Dental, ENT, etc. shifted there. In 1975, the first Cath Lab at PRH was started by the late Dr. L.R. Parthasarathy, the radiologist. "Those days, cath labs were few in the country. Facilities were primitive, with only one mirror giving the image, and the contrast injected through an injector using a carbon dioxide cylinder, with a loud noise!" Dr. Murthy (he and Dr. K.N. Reddy were trained by the veteran radiologist) recalls. It was after his retirement in 1985 that Dr. Parthasarathy went on to start the Cath Lab in Apollo Hospitals.

(Continued next fortnight)

A 1966 picture of the Perambur Railway Hospital doctors. Standing: Top left to Right: 1. Dr. L.R. Parthasarathy,3. Dr. J. Sriraman, 5. Dr. T.J. Cherian. Seated: Left to Right: 2. Dr. P.R. Balakrishnan, 3. Dr. A. Ramdas, 4. Dr. P.A. Menon. Regrettably, many of them could not be identified by the author's sources.

The Railway Medical Department

Approximately 10 million people, one per cent of the population of India, travel by train every day. The railway network of hospitals is manned by more than 2500 qualified doctors who look after the needs of the entire railway community/passengers.

The railway hospital system has a network of hospitals distributed along the railway networks, with approximately one health unit every 80 km. Health units with OP facility are manned by regular doctors. The next higher centre is a sub-divisional hospital with facilities for inpatients/general routine cases. The next higher centre, the Divisional Hospital, is located in a major divisional headquarter.

The biggest zonal hospital is called a Headquarters Hospital (there are about 20 Headquarters Hospitals in the country in major centres like Chennai, Mumbai, Kolkata and Delhi). They are fullfledged multispeciality hospitals each with more than 500 beds. They have the best equipment, and highly trained and motivated doctors, nurses and technical staff. Besides full-time specialists, they also empanel visiting honorary consultants for various super-specialities to help the railway patients, and also teaching postgraduate trainees (like DNB, FRCS, etc).

The medical officers for Indian Railways are selected by the UPSC (Union Public Service Commission) and are sent for one month of administrative training at the Railway Staff College, Vadodara. Here they are taught about the Indian Railway Rules, Accident and Workmen's Compensation Acts, etc. apart from their privileges. The railway colonies and railway stations, including their hygiene and sanitation, also come under the purview of the Medical Department. The food stalls in the railway station and safety of drinking water and sanitation are also part of railway medical work.

One of the major responsibilities of the Medical Department is handling railway accidents. During train accidents, Railways' Control will alert the Medical Department, and the Railways Accident Relief Medical Coach, a mini hospital located at all major railway stations, will move to the site of the accident within a short time. It is a self-contained coach with all facilities including an operation theatre. It is the responsibility of medical, engineering and traffic departments to periodically check its readiness.

The other responsibility of the Railway Medical Department is mass transport of pilgrims during Kumbhamela/Pushkaras etc. when lakhs of devotees use railway facilities. It is the duty of the Medical Department to take care of hygiene, sanitation and supply of safe drinking water apart from vaccination. The railway medical service also covers passengers who become sick during travel. If coach attendants are alerted, medical help will reach the passenger for a nominal cost.

– SM