Neurology Services at VHS

Our Series on Prof. Krishnamoorthy Srinivas, his Life and his Work – IV.

Organisation and Delivery of Neurology Services

The early effort to run a department and establish himself by Srinivas seems to have been drawn from Reminiscences: On Running, a Small Department by Prof. Robert Currier which Srinivas read much later. It appealed to him as he reminisced that he had managed to muster those very enduring attributes required for the pioneering effort!

Skin of a rhinoceros – not be disturbed by criticism or opposition.

The patience of an ant colony – initially growth at snail’s pace, but with proper planning and a realistic approach, success comes one’s way.

The optimism of Pollyanna – characterized by irrepressible optimism and a tendency to find good in everything.

The balance of a Wallenda – Flying Wallendas being the name of a circus act by daredevil stunt performers, most known for performing high wire acts without a safety net.

The dutifulness of vestal virgins – who were keen on upholding their responsibility as women priestesses in ancient Rome, to the Goddess of Health, Vesta. They were appointed to keep Vesta’s fire alive.

The willingness of Hercules – to achieve the near impossible.

Self-deprecating humour of Rodney Dangerfield – an American stand-up comedian (as no one can hope for respect or praise at the outset).

Robert Currier goes on to say, “You have to convince yourself that it is fun. Your spouse has to be comfortable living at a lower level than the town men who are pulling in the bucks and the fellow faculty members who are making it with the gadgets”.

Srinivas first step in the planning was to set a list of priorities, starting with the most immediate requirement. He held tight to the purse strings of the department. Though each department was autonomous, he learnt to go slow and establish only what was required immediately for basic smooth running of the neurological services. He was quite willing to single handedly stretch himself to fulfil the expert human resource requirement, ensuring continuity of care and adequate documentation of medical records. It was important to ensure that the VHS pharmacy had regular supply of essential drugs, and long term administration drugs like anticonvulsants and movement disorder medication.

Left to right: Prof. Tandon, Prof. Krishnamoorthy Srinivas, Prof. Baldev Singh and Prof. B. Ramamurthi.

The next step was to work toward the sanction of more space to fit in a few examination rooms in the OP and a few beds for neurology patients in the general wards. Subsequently, rooms adjoining the initial room allotted for neurology service at VHS were “purchased” by enhancing the central VHS funds through transfer from the department funds. With further expansion of the space, an EEG/EMG laboratory was attached to the OP department. Srinivas did the EMGs himself, for a long time, while there was a technologist to conduct the EEGs. Prior to the purchase of the department EMG machine, he would do free EMGs and NCVs by appointment, for his deserving patients from the two community hospitals, who required these investigations, at his private clinic, where he had set up his machine.

Then came space for the books, which were initially stacked in one room till the floor to roof wooden shelves all round the room with front glass pane were ready to take the books. Even before this formal move, the department had journals on its subscription list, namely, ‘Neurology’ (The green journal) the official journal of American Academy of Neurology, New England Journal of Medicine, Journal of Neurology, Neurosurgery and Psychiatry, Journal of the Association of Physicians of India, and Neurology India. Other cupboards were bought to lodge the overflow of books in neurology, other specialities and General Medicine. Over all it formed an excellent library with select books. Of these cupboards, two antique rose wood cupboard with glass front were donated by Dr. Kamala, a paediatrician who trained with Prof. Srinivas for DM Neurology.

The professor started grappling with the problem of how to expand the healthcare service to the patient of stroke, degenerative disorders and developmental disability, in an acceptable form. Affordability, be it acute stroke or traumatic brain injury or chronic neurological disease, had to be considered realistically. He was sensitive to the direct cost of treatment, which was subsidised at a bare minimum for the poorer patient. Indirect costs due to loss of employment of the adult patient and loss of a day’s wage for the relative accompanying the patient to the OP had to be considered. Income lost by the family members who became caregivers could add considerably to the financial burden. Many of the patients at VHS belong to the unorganized sector.

Srinivas put together his first multidisciplinary team in the 1970s. Photographs in the department (part of his large collection) show the the team of doctors, physical and occupational therapists, psychologists and social workers making presentations to visiting dignitaries like Professors John Walton and Jack Foster from Newcastle-upon-Tyne in this period. Srinivas recognised that it was important to recruit doctors and qualified allied health professionals with the right aptitude towards patient care and ensuring their skills at basic level and taking it forward. The multidisciplinary team focused on motor, sensory and cognitive deficits and extended it to cover psychosocial rehabilitation and effective utilisation of community resources.

In view of the large burden of neurological disorders, a public health approach to provide primary healthcare at the community level was essential. Spreading awareness and public education about neurological disorders with specific emphasis on preventive aspects, initially with reference to stroke, epilepsy and dementia, seemed to show some response.

The development of patient care and clinical research at the Public Health Centre in West Mambalam, ran parallel to that in VHS with the generous support from the T.S. Srinivasan family and the construction of the dedicated Anantharamakrishnan facility block donated by Mr. Sivasailam of the Amalgamations group. These developments contributed to palpable progress in healthcare. Prof. Srinivas hardly went on leave, except to attend professional meetings, and so there was no loss of continuity in his patient care. When Lord Walton came to Chennai to deliver the T.S. Srinivasan Oration in February 1983, and visited the PHC and the T.S. Srinivasan Department of Clinical Neurology and Research there, he remarked, “A most impressive development, the combination of high quality specialist care with dedicated community service represented in this centre is surely a model for other centres to follow. I wish the Public Health Centre every continuing success in the future”.

With many philanthropists and business leaders coming forward to support Dr. Srinivas and his mission in community neurology over time the department evolved. With University affiliations for both Masters and PhD programs and formal Corporate Social Responsibility support in 2004, TINS-VHS as a fully fledged institute was born.

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