It began 100 years ago out of one woman’s kindness. V Shoba chronicles the evolution of the Christian Medical College in Vellore into a unique institution that combines charity, teaching and medical service
V Shoba | 10 Jan, 2018
IT IS A HALF hour from Vellore to the village of Nanjukondapuram. Tailing a white van with a red cross, past velvet carpets of paddy glistening in the sun and villages watched over by brightly-coloured guardian deities, we come to a stop at a ficus tree. A chattering crowd springs to attention. We are here with a mobile clinic that continues with a tradition started over a hundred-and-ten years ago by two American women, Dr Ida Scudder and Dr Louisa Hart, who set out on lurching weekly journeys to Gudiyattam, first on carriage and later on a one-cylinder Peugeot, to treat the untreated. Today, Peter M, the driver of the medical van—a definite improvement over Dr Scudder’s ride, it has a bed, a noisy little fan, and some basic equipment— doubles as a dispenser of medical and lifestyle advice to patients in his booming basso while he checks their blood pressure. “Do not waste egg shells. Powder them, mix the powder in a glass of water and drink up,” he tells a septuagenarian with joint pain. Peter has set up a table and a couple of chairs in the shade of the tree where an intern from the Christian Medical College Hospital in Vellore examines patients and writes prescriptions. Pregnant women go straight to the van—a donation by CMC alumni from Sweden— where Dr Jackwin Sam Paul, 27, a community medicine specialist, and two healthcare workers examine them, make an entry in their maternity charts, and advise them to come to the hospital in Vellore in case of any complications. “We may have to take one or two of them back with us. They won’t come otherwise,” says the doctor. “If the patient won’t come to the hospital, the hospital must come to them. We try to convince seriously ill patients to come to Vellore.”
Dr Ida Scudder, the medical missionary who founded the Christian Medical College and Hospital to help women give birth safely, started the practice in these parts of ‘roadside’ clinics—often likened to the adventurous medical aeroplane services in the Australian bush—accompanied by her trusted nurse, Gnanambal. CMC’s Community Health and Development Unit (CHAD) now conducts weekly clinics in 88 villages in the Kaniyambadi block, besides an outreach programme for the tribes of the Javadi hills. In the year ending March 2017, CHAD attended to over 100,000 patients and delivered 3,000-plus babies. “My mother’s three children and her mother’s five were all delivered by CMC doctors,” says 22-year-old S Lavanya, heavily pregnant in a white sari, her hair crested with fresh jasmine. Though Lavanya will break tradition by giving birth at a government hospital to avail Rs 12,000 in state maternity aid, she depends on the weekly rounds by a CMC nurse and the monthly doctor’s visit for regular check- ups. Married to an auto driver in Arcot, she has spent the past five months at her village to take advantage of the free health check. Her mother C Ananda, 40, says she wouldn’t have it any other way.
The young women we meet at the rural clinic, though more educated than the men, are reticent stay-at-home moms. “Women have never had it easy here,” says Dhanabagyam, 80, who delivered her only child in a dark hut with a midwife’s help. It was a complicated pregnancy and she could not have any more children. “We warmed to Western medicine thanks to CMC,” she says. CMC’s community healthcare workers and nurses have recorded every death and major illness in the area over the past few decades, even roping in traditional healers to spread awareness about health. “Now, all deliveries happen in hospitals,” says Dhanabagyam. Snatches of children reciting multiplication tables in a government school across the road make her smile. “Perhaps some of these children will even become doctors.” It is what Dr Ida Scudder would have wanted.
THIS YEAR, CMC, one of India’s premier medical colleges admitting just 100 students each year, will mark a hundred years. The only institution in south India to start a medical course exclusively for women in the early 20th century, it was one woman’s life’s work, a woman variously described by those who knew her as saint, pragmatist, aunt and impetuous thinker. It took a “cataclysmic event” for a young American who did not see herself following in her family’s destiny as missionaries to become a woman of substance, says Dr BJ Prashantham, director, Christian Counselling Centre, Vellore. The Centre operates out of Dr Scudder’s first residence in town, a historic 250-year- old bungalow that served as an indigo warehouse for the British before it was sold to the Reformed Church of America. Several members of her family, including her parents Dr John Scudder Jr and Sophia Scudder, were missionaries in India, and to them, this rambling bungalow became home. It was also where Ida Scudder began her medical practice, witnessing for the first time as a freshly minted doctor primal scenes of birth and death. It was here that she learned to defy not only disease but also superstition and ignorance. A room with two louvred windows served as her clinic, reverberating with the cries of those beyond any sort of ministration, and of babies with their faces crumpled against the world as though aware that one in four of them would die within the year. Pictures of Ida Scudder and about her epiphanies now hang from the walls of the 8-by-12 foot room with wood beams on the ceiling. “The Counselling Centre hosts 12 to 20 resident patients at a time. Patients dealing with various psychological stresses spend about two-to-three months here. There can hardly be a more inspiring place in all of Vellore,” says Prashantham.
The story of Ida Scudder’s ‘awakening’ at the age of 20 is a thing of legend in Vellore. Born in Ranipet in 1870, where her parents were stationed she was sent to the US at the age of eight, and returned only in 1890 to tend to her sick mother. They lived at the mission bungalow in Tindivanam. In the course of one portentous night, there were three knocks on their door—by a Brahmin, a Muslim and a high-caste Hindu. Their wives were in labour and needed immediate medical attention. However, they refused the services of her father, a doctor, and instead asked for a woman’s help because of the social stigma around strange men touching one’s wife. Ida felt like an impotent witness to three separate tragedies that could well have been averted. She had found her calling. She returned to America to graduate from Cornell Medical College in New York in 1899 as part of the first class at the school to accept women students. The next year, she was back in India to set up her first clinic with a lone bed from the mission house in Vellore.
This is where the good doctor would see 5,000 patients over the next two years as she waited for a 40-bedded hospital to come up two km away, thanks to a $10,000 grant from a banker in Manhattan who wanted to dedicate it to his late wife Mary Taber Schell. A determined fund-raiser, Dr Scudder had set out to raise $50,000, but her ambition was met with disapproval from the church. And so, she started small. The walls of the one-bedded clinic, to which two more beds were added in a neighbouring room, were often stained red with paan, a habit Muslim women found hard to give up even during pregnancy. By 1902, Dr Scudder could move to the roomy Mary Taber Schell Memorial Hospital, a brick building with vast verandahs, iron beds and two wards—one for the poor and another for those who could pay—that was unlike anything the town had seen. Young doctors linger in these verandahs today, discussing case histories. The campus now houses the CMC Eye Hospital and its Low Cost Effective Care Unit (LCECU), a department where the urban poor of Vellore get ready access to quality low-cost healthcare.
“Aunt Ida, as we called her, believed that a teaching hospital had to be compulsorily residential both for students and faculty” Dr P Zachariah, Former head of Physiology Department, CMC
Practising intimate family medicine and working at the intersection of clinical practice, public health and community development, Dr Sunil Abraham, head of the LCECU, reflects some of Ida Scudder’s passion and philosophy. “We want to reach the most disadvantaged patients living in the slums of Vellore. They find it daunting to walk up to the main hospital. They do not know if they can afford it,” Dr Abraham says. The LCECU asks patients to pay what they can—sometimes nothing at all—for tests, and prescribes generic medicines procured from a non-profit pharma company. There is no consultation fee; only a Rs 30 fee to register on the patient database, accessible across CMC departments. The unit treated 70,000 patients in the past year, not a small number for the Vellore Metropolitan Region, with a total population of over 500,000. “Our patients have access to all investigations. We have complete freedom to give them concessions, all it takes is a note to the main hospital, and sometimes, a health worker’s visit to the home of the beneficiary to gauge his or her financial position,” Dr Abraham says. For other townsfolk who don’t want to see specialists at the main hospital, there is a smaller one across the road. The Shalom Family Medicine Centre is not subsidised.
In the year ended March 2017, CMC spent Rs 171.22 crore towards healthcare subsidy, funded by income from the main hospital and the Shalom centre. “At the LCECU, we have turned the focus to preventive care, conducting weekly clinics in slums and scanning for red flags like diabetes and hypertension. We are trying to foster a culture of following up with patients who visited us, to ensure they are doing okay,” Dr Abraham says. He is a second-generation doctor from CMC Vellore who had not imagined he would one day follow in his parents’ footsteps.
“It is common to find three generations of doctors who studied at and came back to work in CMC. Quite often, fellow-doctors marry within the CMC community and a lot of people in CMC become part of your extended family,” says Anna Joseph, web content editor at CMC who came to Vellore 16 years ago after marrying a doctor. We meet several threads of this crocheted family tree, and find among them shared values of distributive justice and community living. Both were philosophies Dr Scudder instilled, says Dr JV Peter, director, CMC. There is a certain quality to a doctor educated at CMC, he says. “We get over 40,000 applications for 100 seats. We look at academic excellence, but also assess if candidates have a service orientation and other qualities. We charge a heavily subsided annual fee of Rs 3,000, and expect that our doctors do their part for society.” This year, for the first time in its history, the college has not taken in a fresh batch of students. Under NEET, colleges have no say in selection, which goes against the grain of how CMC handpicks candidates. Governed by a society of over 50 churches who sponsor a majority of students—up to 84 out of 100 for the MBBS course— on the condition that they serve for at least two years in a mission hospital, CMC retains much of its original character a century after it was founded. Doctors who return to serve in the hot, dusty town without malls or luxury brands cannot expect astronomical salaries, but healthcare is free for all employees and their dependents, and they are put up in staff quarters in the campus, a green haven to shut out the sounds of a modern, bulging town.
The MT Schell Hospital in Vellore had come up just in time for the plague, which until the turn of the century had spared the town. By the end of 1903, however, it had claimed over 300 lives in Vellore with renewed ferocity. Even after the crisis abated, Dr Scudder found the hospital woefully inadequate for the masses who rather preferred this flaxen-haired woman of science to the shamans they had earlier sought out. By 1922, the hospital was treating 40,000 patients a year—four times the number 20 years ago. ‘Thus it was that Dr Ida was driven to a courageous resolve, the only solution of a formidable problem. Let Indian women themselves be trained to undertake the task of serving India in her sorrow and suffering,’ wrote Pauline Jeffrey in her 1939 biography of Ida Scudder. After a visit by Lucy Peabody, an American representative of the International Missionary Council, to explore the possibility of a college for women in Vellore, Dr Scudder’s dreams soared as she envisioned a 200-acre campus sprawled on College Hill, symbolic of a woman’s readiness to move mountains for a greater good. Having set out on this path of accelerated wisdom and ambition, raising money at a time when there were few women in medicine was not easy. “The decision to start a medical school for women was perhaps the most revolutionary step Ida Scudder ever took,” says Dr Reena George, institutional archivist and head of palliative care at CMC. We meet early in the morning, before Dr George sets out on her OPD rounds. “There was no full-fledged MBBS in the beginning, only a diploma-like course in apothecary called the Licenciate Medical Practitioners’ (LMP) course,” she says. The girls attended classes in science at the Voorhees College and trained in medicine in rented buildings. Of the 17 girls selected for the first batch from over 150 applicants, one or two dropped out but the others passed and went on to serve in mission hospitals. In an address to the first graduating class, Dr Scudder lauded them for their toil and told them that “the practice of medicine affords scope for the exercise of the best faculties of mind and heart”.
“We have turned the focus to preventive care, conducting weekly clinics in slums and scanning for red flags like diabetes” Dr Sunil Abraham, Head of CMC’s Low Cost Effective Care Unit
The coming years saw the CMC’s facilities expand at breakneck pace. A hospital campus with general and private wards and operating rooms, with a total of 268 beds, was inaugurated in 1928. The women students moved to their new home on College Hill in 1933. A radium and X-ray block was put up in 1937. Buildings came up like shadows of the Vellore fort, thickening in the twilight. The next step up, however, presented a bigger challenge, and it came without warning. In the late 1930s, the LMP course was abolished in one fell swoop, and unless the CMC upgraded its curriculum to one suitable for an MBBS degree, it could take no students. This meant adding new clinical material for students, introducing a research wing, and doubling the number of hospital beds. World War II had broken out, and endowments were dwindling. And yet, in 1942, CMC introduced an MBBS course with affiliation to Madras University. “It was becoming increasingly clear that CMC could not sustain on funds raised from women-oriented missions alone. Dr Ida Scudder proposed going co-ed,” says Dr George. “It was a moment of introspection—whether to betray what you originally set out to do, or adapt to the situation?” She lost many friends, including Mrs Peabody, who is now a footnote in the history of medicine in Vellore.
“Aunt Ida, as we called her, was a pragmatist, an opportunist in the positive sense of the word,” says Dr P Zachariah, 86, a retired head of physiology who is among the doyens to have helped shape the course of the hospital. “To get fresh dollars as much as to expand the faculty pool at CMC, she saw potential in going co-ed.” The year India became independent, CMC, too, broke free of its shackles. It opened its doors to men, admitting, in addition to 24 women, 11 men students. The same year, the college also admitted 24 Hindu and Sikh refugee students upon the request of the government. “CMC was now in a position to attract talented doctors. With the coming of Dr Reeve Hawkins Betts, India’s first cardiothoracic surgeon, and Dr Jacob Chandy, India’s first neurosurgeon, the hospital entered an era of specialty work,” says Dr Zachariah. In 1949, Dr Chandy started the Department of Neurology and Neurosurgery, the first of its kind in India. Dr Betts put CMC at the forefront of cardiovascular and thoracic surgery. “The administration then was more focused on primary care and was not ready for these strides but the surgeons continued from ad-hoc theatres set up on the verandahs of surgical rooms,” Dr Zachariah says. “That is the thing about CMC; if you want to pursue excellence, no one will stop you.” In time, CMC started raising its own funds. By the 1970s, 20 per cent of rooms were private wards. With liberalisation came money, and a solution to the conundrum of primary health or high-tech excellence presented itself in a sustainable model. Patient fee now contributes 98.7 per cent of CMC’s income and it manages to pay its 9,218 employees besides subsidising healthcare for the poor and making capital investments in new campuses in Chittoor and Kanigapuram.
Dr Zachariah lives in a modern home in a serene retirement community that a handful of doctors from CMC designed for themselves. Awash with greenery and housing homes built from eco-friendly bricks, it faces a hill that seems to defy heaven to strike it down. “Aunt Ida insisted on community lunches where she would strike up conversations with students. She believed a teaching hospital had to be compulsorily residential both for students and faculty,” he says. Most of the doctors’ children attend schools run by CMC. Even with 1,718 doctors working at the hospital, it is essentially a big village where you look out for each other, she adds.
“AUNT IDA HAD no patience,” says Sunny George, 87, her driver for five years from 1955 till her death. “She liked to go fast in her Plymouth. And she would lose her cool if someone made her wait five minutes, no matter how important that person was. ‘Is he dead?’ she would ask.” George and his family were caretakers of her summer home in Kodaikanal, to which she retired from March to July each year. “When we drove in Vellore—and she wanted to drive for at least an hour every evening— people would wave at her everywhere. When we stopped, someone would come running, bearing bunches of bananas and other gifts. The local people were touched by her service,” George remembers. One of his sons is a radiologist who trained at CMC, another is a male nurse. “CMC has impacted the lives of thousands of employees, and some of us became better people because of it.”
At the cemetery in town where the Scudders are buried, there are always fresh flowers on Aunt Ida’s grave. (When her niece, also named Dr Ida Scudder, joined the hospital, the older one came to be known as ‘Aunt’, though she is known to have taken offence to ‘Granny’.) “She is almost a deity now. She wouldn’t have approved of it,” says Dr Jacob John, retired head of virology who famously led a CMC team in the first bid to identify HIV infection in India in the 1980s. Dr John also worked on the polio eradication programme and is known for arguing that the oral vaccine, which may result in cases of vaccine-induced polio, should make way for a safer, injectable vaccine. The institution founded by Dr Scudder would go on to create medical virtuosos like Dr John, Dr Mary Varghese the wheelchair surgeon who pioneered physical medicine in India, Dr Abraham Verghese who introduced a novel programme of family participation in residential mental healthcare.
The hospital today is a gabbling mass of people, over 8,800 outpatients and 2,100 inpatients a day. For the financially indisposed, CMC naturally bobs up on the healthcare horizon, trumping government hospitals whose reputation precedes them, and private hospitals where they would spend more in a day than they would in an entire week on subsidised critical care at CMC—and that is including the room rent at the lodges lining Ida Scudder Road. “We came here as a last resort, but the doctors have given us hope,” says Bishan Das, a 48-year-old taxi driver from Haldia in West Bengal whose 66-year-old mother is recovering from a session of chemotherapy that cost the family a few hundred rupees. Before CMC, the family had foresworn all medical treatment, afraid of sinking into debt. “You have to be lucky in life to find the right doctor and the right hospital,” he says. “I don’t know anything about Dr Ida Scudder, but I think, for many people before me, she must have come at the right time.”