BETHESDA HOSPITAL, AMBUR, PINCODE. 635 802TAMIL NADU, SOUTH INDIA

HISTORY OF BETHESDA HOSPITAL,  AMBUR,  PINCODE. 635 802 TAMIL NADU, SOUTH INDIA 

               Bethesda Hospital was started in the year 1921 by American Missionaries as a roadside clinic. It gradually developed into a 200-bedded secondary care multi-specialty charitable Mission hospital providing secondary level health care to majority of poor and middle class society in and around Ambur without discrimination of caste, creed and religion.

               Bethesda Hospital is situated in Ambur Town, with a population of more than one lakh and is surrounded by approximately 60 villages and hamlets. The hospital with a campus area of 35 acres serves the health needs of very large segment of the rural populations. Patients come from the nearby larger towns such as Vaniyambadi, Pernambut, Gudiyattam, Jolarpet, Natrampalle and Tirupattur but specially also from Districts like Salem, Dharmapuri and Kuppam.   Also we serve through our Community Health Programmes at  Nayakkaneri and kattu kollai, hill stations.

               Bethesda is a Hebrew word meaning “House of Mercy”. In Jewish belief,  it was the name given to a pool, that when stirred by an angel produced healing to those who first entered it thereafter. Miss. Angela Rehwinkle an American missionary nurse and Dr.Doderlein, who founded the hospital initially as a 16-bedded hospital, chose the name Bethesda to signify the healing that would take place here. During the early year, Miss. Angela Rehwinkle managed the hospital single handedly. Subsequently dedicated doctors such as Mr.J.C. Williams, Mr. Kalyan, Mr. Eapen Benjamin and Mr.Nallathambi joined the institution. In 1950 Dr.W.F. Bulle a dynamic and surgeon, through his devoted services enlisted the support of the Wheatridge Foundation to sponsor a tuberculosis control project within the municipal limits of Ambur. The Ambur municipality, pleased with the hospital’s service rendered to its community, donated one-lakh rupees towards a tuberculosis project.

               In 1956, in order to provide inpatient treatment the present day Medical ward was opened, as the TB unit. This ward was able to accommodate 75 patients (50 men and 25 women). As the patient numbers increased a need for more buildings was felt. The construction of the outpatients department took place. This also housed the laboratory and pharmacy.

               After an eventful period of 10 years, Dr. Bulle had to leave the country and Dr. Johannes Pueschel joined the institution as Medical superintendent. Dr. Charlotte Manoharan’s arrival as Pediatrician at this point, necessitated the construction of a pediatric ward, as the hospital was now in a position to offer specialized care to children.

               A leprosy programme was started in the outskirts of Ambur catering to an area up to Pallikonda. This with started with 4 paramedical workers and financial support from the German Leprosy Relief Association with its head quarters in Chennai.

               After the departure of Dr. Pueshel and Dr. Charlotte Manoharan took over as the medical superintendent in 1972. She helped the hospital provide health services to a much larger area within a short period of 10 years.

               The hospital gradually became famous, as numerous people from the surrounding villages entered its portals for the quality and dedicated health care given. It became known as the “American Hospital” and stood second only to the famed CMCH to innumerable job to local residents.

               Dr. Fenn, a renowned surgeon, together with a dedicated team of workers among who was Dr. Malathi Jadhav, an eminent pediatrician, transformed the traditional mission hospital into multispeciality health care center offering quality services and modern amenities. It soon became a model for various other mission hospitals.

               After the demise of the Dr. Fenn and Dr. Joel Nesaraj having been instrumental in the revival of the hospital and with an experience spanning several decades was appointed as director. Since then, the hospital has been marching towards the development in all aspects considerably.

BETHESDA AS MULTI-SPECIALITY HOSPITAL :

               The hospital is at present a 200-bedded multi specialty secondary care center and is a referral point for many doctors within the Vaniyambadi Taluk and neighboring towns. It has the following departments.

• Medicine
• Pediatrics
• Surgery
• Obstetrics & Gynaecology
• Orthopedic Surgery
• Pediatric Surgery
• Neurosurgery
• Anesthesia
• Otolaryngology
• Ophthalmology
• Radiology
• Dentistry
• Physiotherapy
• Dietary
• Emergency services
• Laboratory services-biochemistry, microbiology and clinical pathology

·        Medical Records

·        Dialysis unit

·        HIV/AIDS care and support programmes

·        Trauma care unit

·        Mortuary mobile van service

      Urban community people’s health:

 

Every country has urban community and the status of population is lower than worst level. These people will be belonging to different social caste and religious groups. Almost all of them are living under the poverty line and are they all will be daily wages earners.   Most of the families in such slum areas have limited the number of children just from two to three only. But they are facing very tough situation for caring them in a well to do manner.

They are usually facing almost all the problems in each and every aspect. Housing is one of their biggest problem and most of the families live in a single roomed houses or hutches only. In slum areas, especially the old aged people are a neglected group and their children do not take care of them ever. Hence all aged people especially in these areas will be facing so many unavoidable problems and they will not be guided or cared by any one and no one will be in a position to look after the needs of another. 

Usually in such slum areas, there is no chance for regular nominal standard of life is possible. Only on rare occasions like some sudden outbreaks violence, especially during the elections and festival occasions, they will feel peace of mind and peace of living with especial new edibles and clothes etc in any sense and otherwise they will be leading a poverty condition only.   Their literacy rate also very poor or even nil usually.   But probably they all will be having some sort of traditional knowledge.

Also their literacy knowledge or traditional knowledge will not be varied significantly between males and females. Most of the families in these slums are belonging to the lower income group.  Many of the males in these slum areas will be earning their income working as daily wage earners or doing some odd jobs.  Many of the women and men will be involved in making local form cigarettes that will be widely used especially by the lower income group of population. Most of the young girls are working as a daily wage earner instead of going for studies. 

Many of the women and young girls are preferred these kinds of jobs for their livelihood.  There are other women will try to all possible things to earn an income for the family. Some women sell vegetables and some of them  sell fruits or doing some cleaning works etc.,  The main negative aspect such slum areas is the negative aspect of health and hygienic. Many women in these areas will be suffering with their ill economic condition and from general malnutrition. Among them considerable women and youngster will be suffering from general iron deficiency anemia.

For example if a woman is pregnant in these areas, she will be advised by the elderly women in the family not to eat more food.  Also she will be advised not to ear protein rich foods.  Usually certain foods should be avoided during pregnancy.  So she will be asked not to eat fruits if they are in some specific color lest she will deliver a blue baby etc.,   It is a common belief that if a girl eats more food during pregnancy, the child will be large and as such delivery will become quite difficult. But as contemporary thoughts, physicians and health workers will advise the girl to ear more food for ensuring proper growth of the child.  By these types of different ideas and suggestions, the poor girl will become so confused.   The general tendency is that the girl follows the advices of the elderly women in families confiding trust in their words and to avoid incurring their displeasure. As the same above, there are two more areas where the pregnant women in slum areas are put in dilemma and confusion.  

Usually medical people advise a pregnant girl to take adequate rest especially after having lunch and the elders in family’s advice and insist them not to take rest or even to sleep at all during day time. In addition, she is also advised to do all sorts of heavy work so that she could have easy delivery.  This is contrary to the advice a given by the health worker or any physician who asks the girl to avoid heavy work like carrying heavy load. Hence maternity and morbidity however have been brought under control with the government health care workers making definite efforts right from the day they come to know about the pregnancy status of women.

Tetanus toxic injection should be  given to all pregnant women and iron and folic acid tablets are also should be  given to all pregnant women.  But not all of them could be claimed to be eating the tablets for want of education. Unwanted pregnancies are prevalent in all kinds of slum areas.  Unwanted pregnancies are terminated through illegal abortions also.  People do not like to go to medical termination of pregnancy.  Since they are all unqualified mostly, some of the elder unqualified people will take care to abort them in an uncivilized manner.

Reproductive track infection and sexually transmitted disease are common in men and women in these slum areas.  At the same time, if a man who contract the infection will meet some practitioner in the worn and will get relief, woman very rarely do this.   It they have become completely sick severely, and then only these people will go for proper further treatments. Suppose if they are taking treatment, they won’t receive the full course of treatment.  As a result, they will become acutely sick and they will continuously suffer by the severe infection all the time. 

Lack of knowledge about reproduction and related matters finally will result in unregulated fertility.  Their children mostly will suffer from many preventable illnesses.  Diarrheas and dysenteries are common and they will report to be a regular feature in these slums.  For cure of diarrhea or for some other simple disease, they will go for traditional wild treatments. Due to such useless treatments children will face dehydration and their disease will become more severe and finally it will become more difficult even for the qualified physicians to save the child.  

In general people are not satisfied with the treatment given there. People are sore about the type of communication used by the staffs in the government hospital. It is a common fact that almost all children have to be immunized against the killer diseases in their childhood compulsory.  But, children are not immunized against Hepatitis – B or Haemophilus B meningitis, as they involve a payment. Adolescent boys and girls in schools have the opportunity to learn about the human reproductive system, as there is a lesson in the middle standard education. There is also a topic on HIV/AIDS in in their middle term studies.  But, these subjects are safely left out and are not discussed in open by the teachers, as they don’t feel comfortable discussing this topic with their students.

When this is the case with the girls who go to schools one could imagine what knowledge girls and women who don’t go to schools can have about this subject. Interactions with representatives of adolescent boys in the community have revealed that the young ones have pertinent doubts and questions regarding sex. In the schools, they are not told anything about sexual matters. When they don’t receive scientific answers to their question, they are not going to remain complacent. They would try to get clarifications from their senior friends. But, the answers may not be right. It is against the above-mentioned health background, all of the slum communities should be proposed to take up a project that would include service, training and education components in order to effect improvements in the health conditions of people for the entire bright future.

If we want to give a great relief for theses people permanently, we have to frame out some objectives.  As a first we have to institute a low cost health care delivery system that is affordable to the low income group people. We have to identify and train minimum two health care volunteers such as one male and one female in each of the three slum communities to create human resources with sufficient knowledge and skills in giving health education messages on relevant health topics. We have to establish a referral system to secondary and tertiary care institutions to organize intensive health education programs on relevant health subjects using the services of the health care volunteers and students of nursing. 

We have to develop a field practice area in which we have to arrange for proper medical training to the nursing students in the principles and practice of urban community health. A perfect health team should be formed to look after the health care needs of the three slum communities with three professionals like a medical officer, a public health nurse and a driver for vehicle maintenance.  For more activities, in addition they have to be supported with some of the health care volunteers who will be on part time service and will become an essential part of the health team.   The health team should organize once in a week clinic in every three slum communities.  The clinics should be organized in a more traffic area that is accessible to all people in the area.   Whereas all people needing some health care would be seen by the team, special emphasis would be paid to the needs of mothers and children. In other words, the health care facility would be a mother and child friendly facility.

One of the main roles of the health care volunteers would be to encourage people from the low-income group to attend the clinic as soon as some problem develops and without wasting any time. Apart from the day of the clinics, the Public Health Nurse would pay visits to the project slums to make home visits of pregnant women, delivered mothers, families of under-five-years children, patients with chronic problems etc. Such visits are meant for giving interpersonal health education to motivate families to undertake desired health actions. During these visits, the health volunteers would accompany the Public Health Nurses.

Wide publicity in the three slum communities would be given to make people to know about the availability of such service in their midst. As far as payment for drugs dispensed in the clinic is concerned, it would be necessary to subsidize the cost of the drugs, as the establishment of the system is for the purpose of helping the poorer people to care for their health at low cost. Assessing the financial status of the patient is a difficult task for the health team. Home visits by the Public Health Nurse and the impressions of the health care volunteers could serve making judgments in this regard.

Stress among the nursing students in general is increasing now days.  Nearly nine in every ten enrolled nurses are experiencing an increase in workload and pressure. According to the surveys taken from 90% of all staff nurses, ward sisters and Charge nurses the enhancement of mental pressure and stress has become confirmed. Most of them say that morale had worsened and their work hours frequently conflict with their domestic arrangements.  Nursing students are always under more stress than medical practitioners due to the demands of studies and placements combined with financial hardship and the need to work.   Nursing students always has to be dealt with working nights, different shifts, and excessive hours when combined with course obligations. Maintaining domestic responsibilities, geography travel time and cost to lectures and placements, distant accommodation, financial difficulties are some of the troubles they are facing always.