Dr. E.S. Krishnamurthy, a leading neurologist, who completed 50 years at the Voluntary Health Services in Adyar, recalls, “Dr. K.S. Sanjivi requested me to join the VHS in 1958, when I’d just returned after training in Canada and the UK. I was 32 when I began volunteering at VHS in 1965, on Pongal Day. First, only the poor and middle class came; later, due to its popularity across all cross-sections, the wealthier came. There was only one building on a 25-acre, absolutely desolate, snake-infested, flooded campus, with kutcha roads. What began on a verandah corridor with a single doctor, table and chair and exam kit has grown into a multidisciplinary institution with an international reputation and worldwide links! That’s been quite a journey.”

Dr. S. Srinivasan, who was Registrar of the VHS in the 1980s, noted at the time, “At 7 am daily, one corner of VHS springs into action, with patients gathering in orderly fashion in front of the medical records section to collect their case notes that have been earlier documented and preserved in a file. Upon production of their identity cards that have been issued for a nominal fee, the head of the family is assured of his family members’ health­care.”

Dr. J. Balasubramaniam, currently Director, VHS Blood Bank, says, “Dr. Sanjivi instituted the concept of the Family Card that recorded histories of the entire family, so that connected aspects could be dealt with early in a preventive manner. He insisted on a mini X-ray and sputum check for every patient who complained of cough, in order not to miss TB.

The beginnings of all this were at a meeting in 1957 of doctors, led by Dr . K.S. Sanjivi, a well-known specialist in General Medicine, and others, including the then Editor of The Hindu, Kasturi Srinivasan, legal luminary T.R. Venkatrama Sastriar, Congress leader M. Bhaktha­vatsalam and industrialist M.A. Chidambaram, where the lacunae in the healthcare system as it existed was discussed.

The focus subjects were:

1. Emphasis on prevention of disease.

2. The family as a unit for medicare (with every family to be attached to a combined public health and curative centre and to learn about prevention from the same social worker, health visitor or public health nurse attached to the centre).

3. Community participation in preventive health and sharing costs of medical care.

4. Shramdaan by the medical fraternity to give time, know­ledge and expertise for the poor.

Dr. Sanjivi was known for his expertise in many fields of medicine, but it was Community Healthcare supported by shram­daan that he was most focussed on. Out of this thinking was born the Voluntary Health Services (VHS), which was registered as a society on July 14, 1958. Its first President was K. Srinivasan; R. Balakrishnan, Accountant General (Rtd.) was its first Secretary. At the first AGM in 1959, Dr. Sanjivi took over as Secretary (he had retired from government service by then). Under the Land Acquisition Act, 25.3 acres were acquired in Adyar in 1960. The Government of Madras promised Rs. 9.35 lakh for building and equipment. M.A. Chidam­baram, then President of the Madras Race Club, had the Club donate Rs. 5 lakh and the proceeds of a day’s racing. On October 8, 1961, the corner­stone of the VHS’s Medical Centre was laid by Pandit Jawaharlal Nehru “who was brought with great difficulty through the only access, via Pallipattu, and midst heavy rains,” an old-timer remembers.

Outpatient (OP) facilities and lab and X-ray services were started even as the first block was under construction. The first patient was admitted in July 1963. One by one, other departments were started.

Dr. Sanjivi’s voluntary health plan was based on subscriptions assessed on a sliding scale in relation to income. This plan entitled subscribers to preventive and curative care at VHS. As a pre-paid medical aid plan for the whole family, providing preventive and curative care under one scheme, this was a landmark step, long before medical insurance was thought of. VHS encouraged families to enrol as subscribers, paying an annual fee to get free or subsidised treatment. Those who could afford full cost of treatment were asked to pay for it. Several health check-up programmes – master health, pre-employment medical check, food handler’s medical check, school health check-up – were offered, prevention being the ­focus. Dr. Sanjivi’s constant preoccupation was approaching ­donors for this cause, persuading wealthy patrons to divert money from temple hundis into medical relief!

In a pioneering move, the idea of a non-commercial blood bank run purely on voluntary blood donations was conceived by VHS in 1962 and started in 1963. This developed in 1997 into the Rotary Central-TTK-VHS Blood Bank, and is considered one of the best in Chennai. All blood samples are screened for HIV, Hepatitis and VDRL. The VHS’s YRG Care Medical Centre is one of the few private hospitals to take care of AIDS patients. VHS was selected in 1995 by the United States Agency for International Development (USAID) as a nodal agency for implementation of the AIDS Prevention and Control (APAC) project through NGOs in Tamil Nadu. The Bill and Melinda Gates Foundation also awarded a substantial grant to VHS for implementation of its Tamil Nadu AIDS Initiative Project.

A recurring grant from Government was given in 1964, the grant increasing in later years with rising costs everywhere. Top medical specialists and young doctors held Dr. Sanjivi in such esteem that they readily agreed to offer their services. Malini Balakrishnan, who recently completed 41 years in VHS to retire as Head, Hospital Administration, remembers that “many doctors volunteered services for a ‘carburettor water allowance’ of Rs 160 a month!”

Naomi Mitchison, wrote in the Glasgow Herald in 1968 that it was clear to her that Prof. Sanjivi could have asked his team for any amount of work and they would have responsed positively in an instant.

During the Silver Jubilee celebrations in 1983 the then President of VHS, C. Subramaniam, pointed out that “more than 75 doctors are participating, many of them specialists in various disciplines. Membership was nearly 90,000.” And Indira Gandhi, then the Prime Minister, said, “Madras has had a long and great record in voluntary social service, whether in education, in cooperation or social work. Here is yet another example of pioneering work which can be emulated by other parts of the country.” However, the then Secretary, Dr. N.S. Murali, noted, “For several years it was possible to show that such an innovative programme could be executed by a voluntary agency with minimum cost through dedicated efforts by selfless individuals. But things are changing... attitudes of people are also changing. The philosophy of shramdaan is fast disappearing!”

Donations helped in the building of space for one facility or another. They included the OP Block (1964), the Dr. A. Lakshmipathi Unit for Research in Indian Medicine (1965), the ENT Block (1966), the V Rama­natha Iyer Administration Block (1970), the Eye Block (1974), the Neurosurgery and Geriatric Block (1978), the Diabetes Centre (1984), the Day Care Centre (1986), and the Nephrology Block (1987).

Dr. B.S. Ramakrishnan notes in a record, “As the hospital started growing, operation theatre facilities were created under the guidance of Prof C. Ragha­vachari, the ‘grand old man of surgery’. Working with one operation suite and twin operating tables, surgical consultants and assistants spared time in the afternoons to do surgery at VHS. Many came at 1 pm and would leave only at 8 pm!”

Dr. C.V. Krishnaswamy, Chief, Diabetes Department, who associated with VHS for over 45 years, says, “The VHS Diabetes Department, started in 1965 with a modest table and chair and bench for patients, has reached the status of a premier institution for research and treatment that assures comprehensive lifetime free medicare for juvenile insulin-dependent diabetes patients.”

The statue of Dr. K.S. Sanjivi at the VHS.

With the VHS Medical Centre well established, Dr. Sanjivi in the 1970s turned his attention to another of his pet concerns, the unsatisfactory health services prevalent in rural areas. With the Public Health Centre (PHC) as its nodal delivery point for 60,000 to 100,000 people in each developmental block in the country, effective access to health was minimal. He advocated in place of the PHC the concept of the Mini Health Centre (MHC) that would look after a settlement of 5000-10,000 population in a rural area. There would be greater reliance on elementary healthcare and more local residents would be trained. The M.A. Chidambaram Institute of Community Health came into being within the VHS to oversee the MHC programme, with 14 units set up around Madras between 1968 and 1970. The Institute undertakes education, research, training and service activities connected with MHCs. The MHC concept was a unique contribution to the health scene in India.

Each Mini Health Centre was to have a part-time medical officer, full-time female and male para-medical workers and First Aiders trained in elementary health care in charge of Health Posts in peripheral villages, each serving 1000 persons. The model found recognition as far back as 1969 by UNICEF, ICMR, ICSSR, and others. Commended by the World Bank and the  Planning Commission, it earned  worldwide appreciation. It was recommended by VHS and accepted by the Tamil Nadu Government in 1977 as a model for voluntary agencies and has served as a model at the national level. Dr. N.S. Murali, Head of the Department of General Surgery, VHS, from 1964 took over as Medical Superintendent in 1972, and in March 1985 he became the Honorary Secretary of the VHS. He continued to manage VHS affairs, with Dr. Sanjivi’s active support till 1994, when the doyen passed away, and thereafter too (till he himself passed away in May 2009).

During that period, in 1980, the M.A. Chidambaram College of Nursing, was established. M.A. Chidambaram was the Managing Trustee at the time. A new surgical complex was also established with four operation theatres and the latest equipment.

By 2008, the VHS was a 405-bed tertiary teaching hospital, with a wide range of speciality departments. This included a De-addiction Ward and a separate ward to treat AIDS ­patients.

Today, 15 MHCs covering a population of 10,000 serve rural communities in the eastern part of Kancheepuram District. The VHS also runs a Senior Citizens Centre and a Palliative Care Ward. It has research units in General Surgery, Nuerosurgery, Neurology, Diabetology, Obstetrics and Gynaecology, Psychiatry, Community Health, Leprosy and Tuberculosis. The Dr. A.L. Research Centre focusses on Ayurveda.

In 1983, the Medical Aid Plans were:

Plan I – a lump payment of Rs 12,000 for a man and Rs. 10,000 each for his wife and any other dependent throughout life.

Plan II – Subscription varying from Rs. 12 per annum to Rs. 300 per annum for entire family. With benefits including maintenance of health records and several concessions for treatment at the Centre.

Plan III – Medical check up and records maintenance for a person.

The 2012-2013 Annual ­Report records 465 beds across different departments. Of the 60,451 out-patients treated, 32,995 were treated free. Of the 6,115 in-patients treated, 4, 129 were treated free.

As of March 31, 2013, subscribers numbered:

About 70 per cent of the patients (those with a monthly income below a certain limit) are  treated free of cost. Dr. S. Suresh, the current Secretary says, “This hospital, a remarkable example of the exemplary role of voluntary non-government organisations in assuring quality health services for the common man, and, even more remarkably, an example of community effort, continues to be managed by a Board of Trustees, a Central Committee and other functional Committees with eminent public personalities, community leaders, social workers, and philanthropists. It will forever be a standing monument to one stalwart’s dedication and ability.”

*The VHS has kept growing year by year – but without ever losing sight of what the founder had envisaged.

(To be concluded)