Rotary Hospital in Vapi offers paediatric heart surgery

The 200-bed Haria Rotary Hospital in Vapi is the biggest hospital between Surat and Mumbai and prides itself in having, apart from other specialties such as joint replacement and other major surgeries, children’s open-heart surgery. And its Cardiac Surgeon, Dr Kalpesh Malik, who joined here seven months ago to do paediatric heart surgery — the cardiac unit here was established 18 months ago — is gung-ho about the hospital’s capacity to do much more.

He has so far operated at this hospital on 30 children, though in his 20-odd year experience as a cardiac surgeon he has operated on over 3,500 children out of a total of 8,400 heart operations he has done. “I had actually trained as a paediatric surgeon, but do all heart surgeries; paediatric heart surgery is so complex that once you can operate on children’s hearts, you can easily do a bypass surgery,” he smiles.

The practice of bending the knees such as in the namaaz position or doing Vajrasan or Padmasan is not good for your knees, particularly after a certain age. It puts too much pressure on them.
— Dr Kapil Pawar, Orthopaedic Surgeon

We are seated in the room of PRIP Kalyan Banerjee, Chairman of the Rotary Charitable Trust in Vapi which runs this hospital. “We started this hospital in the early 1980s; what began as a dispensary 40 years ago by the Rotarians of Rotary Club of Vapi, RID 3060, grew into a 24-bed hospital within a few years. In 1982, the Haria industrial group gave us ₹7.5 lakh which in those days was a lot of money. And we agreed to name the hospital as Haria Rotary Hospital. Today of course ₹7.5 lakh is nothing and our monthly turnover is now around ₹3 crore,” says Banerjee.

Chief Physician and Medical Superintendent of the Hospital Dr S S Singh says that over 40 years this hospital has been strictly following “one simple rule — not to turn away any patient who knocks on our doors for treatment, whether it is an accident or a medico-legal case or a patient with no capacity to pay.”

The hospital has 60 full-time doctors and 60 visiting specialists. “Our surgical department is very strong and well-equipped. We have a full-time neurosurgeon; Vapi is 160 km from Mumbai and 120 km from Surat, and there is no full-time neurosurgeon between Surat and Mumbai. This hospital has grown thanks to Rotarians of course, and also because of the goodwill and patronage of the local community,” says Dr Singh.

The Rotary Hospital serves a radius of around 150 sq km. Vapi being an industrial belt and located on the arterial road between Mumbai and Surat, there are many industrial accidents in the factories and trauma cases brought from road accidents. As there is no government hospital in Vapi and other private hospitals are reluctant to take medico-legal cases “we admit these patients, irrespective of who brings them — the relatives, police or passersby — and give them immediate treatment. Also, no hospital in Vapi has a full-fledged cardiac surgery department as we do; they have only visiting cardiologists and surgeons. As for open heart surgery we are the only hospital between Surat and Mumbai offering this facility,” says Dr Singh.

He adds that when it comes to neonatal and paediatric surgery, even some of the bigger hospitals in ­Mumbai do not offer these facilities except for the Kokilaben Dhirubhai Ambani Hospital. “So you have to go to the South — Chennai or Bengaluru — or Delhi, for these operations.”

The charge for an open-heart surgery for a fully paying patient in a general ward at this hospital is ₹1.25 lakh. But as most of the patients ­coming here are really poor, the funds are got from government schemes such as the Ayushman Bharat, Chief Minister’s Fund, ESIC, Railway Employees’ Insurance, etc. “Getting money from the government takes some time but we go ahead with the treatment and don’t keep any patient waiting,” says Dr Singh.

By and large this hospital pays for itself. As several hospitals have come up in recent times, we did face a challenge, but have tightened our belts, made a few changes, saved money and have started to break even.
— PRIP Kalyan Banerjee

An important feature of this Rotary Hospital, set up on a spacious 8-acre campus, is the excellent quality of critical care. “The intensive care in Vapi and surrounding areas is not much but we have a full-fledged ICU with 40 beds, 10 machines for dialysis, which we offer totally free. Earlier we were charging ₹300 but from 2011, we have done away with this,” he adds.

Every month 400-odd dialysis procedures are done. What is more, since such patients, who are mostly breadwinners, lose their jobs, the hospital also gives the family a monthly ration kit with rice, wheat, dhal, oil, etc.

The orthopaedic department is well-equipped and well-manned, and does joint replacement and spine surgeries in good numbers, at a ­reasonable cost of ₹99,000. ­Orthopaedic ­Surgeon Dr Kapil Pawar says that he does more knee replacement operations compared to hip replacements. Knee problems in Indians are not only due to our lifestyle such as sitting or squatting on the floor but also because of genetics. “We get more knee arthritis compared to westerners. It’s in our genes to get bent knees, whereas in the US or UK, hip arthritis is much more common.”

He says the practice of bending the knee too often, “such as in the namaaz position or doing Vajrasan or Padmasan is not good for your knees, particularly after a certain age. It puts too much pressure on them; the more you bend them, the more the wear and tear.” In women, they mostly see back problems. “Women don’t have fixed time exercise schedules; they think housework is exercise, which is a wrong assumption because the back muscles get strengthened only when you do back-strengthening exercise and not household work.”

Dr Malik says in children he operates both for valve defects and hole in the heart. The youngest patient he has operated on is 19-month-old Nidhi, who had a hole in the heart. The ­hospital gets its cases from the surrounding areas either through camps or its social workers bringing the patients. More than 80 per cent of its cardiac patients get treatment financed by government insurance. “Our challenge is that unless this hospital establishes a name for cardiac surgery, the fully paying patients will not come here, because Mumbai is 2–3 hours away.”

Intervenes Banerjee, “The industrialists from here prefer to go to ­Mumbai because they can afford it.”

To which Dr Malik quips sarcastically: “And of course everyone in Mumbai lives up to 300–400 years!”

He says his team puts patients “on the fast track and we send them home on the third or fourth day after surgery”.

Is it because they don’t have enough beds? “No, it’s because we have a better team,” he rallies.

What is the most challenging or complex surgery he has done till now, I ask Dr Malik.

“It was on a four-year-old boy named Shyamal Mishra. The heart has four chambers, but this child was born only with two, and was a blue baby right from birth. The child was from a village in Madhya Pradesh and his father was working in Mumbai. The parents took the child to AIIMS Delhi where they said they have a waiting period of five years. A private hospital in Delhi said the surgery would cost ₹4.5 lakh.”

For four years the parents kept getting shunted around, till they came to the Rotary Hospital in Vapi. “Luckily he had survived till then. We operated on him free of cost, and on the third day the child was smiling. And he suddenly became fair; from blue to pink,” says Dr Malik, adding, with a straight face, “so you see, we also do cardiac cosmetology here! We turn blue babies into pink!”

He adds that paediatric heart surgery is being sponsored by Rotarians in a private hospital in Mumbai. “We have additional capacity here; if they can divert some of the cases to our hospital, we can do the surgery at one-third the price. Luckily, there hasn’t been a single mortality in the children we have operated on here.”

Dr Singh adds that the hospital sees 500 OPDs a day and admits about 1,000 patients every month. The premises are spanking clean; when I say so, he smiles and says, “This despite most of our patients being from the lower strata! Initially Mr Banerjee used to personally check the toilets! We have about 60 people cleaning the place daily.”

Pointing to a few parents holding their children Dr Singh says they do cleft lip and palate surgery under the SMILE project. Whether it is 2-year-old Lucky or 3-year-old Vaidehi, the children are now able to talk properly after the correction surgery. Till now we have done over 650 cleft and lip surgeries, all of them totally free.

In the cardiac ICU, 22-month-old Riddhi and 11-year-old Dhaneshwari have had their holes in the hearts repaired by Dr Malik’s team and the mothers are all smiles.

On sustainability of the hospital, Banerjee says, “By and large it does pay for itself. As several hospitals have come up in recent times, we had been losing money because our charges are much lower. But we have tightened our belts, made a few changes, saved money and have started to break even. Earlier we used to make some profits which always went into expansion of our facilities.

In the adjoining Sandra Shroff Nursing College, Nursing degrees are offered — both BSc and MSc. Its Principal, Maj Gen T K ­Bhutia, who has retired from the Indian Army, proudly takes me around the spacious campus, and says most of the students are from the tribal belts in the region. This college was started in 2003 and till now some 300 nurses have graduated from here.

So do they get employed easily? “Employed? They are all grabbed by the Kokilaben Ambani Hospital in Mumbai,” says past president of RC Vapi Prafull Dewani, a Trustee of RCT. Their starting salary is ₹20,000 a month, “which we can’t afford to pay as we are a charitable hospital,” says Bhutia.

She adds that almost 80 to 90 per cent of her students — the total strength is 169 — cannot speak a word of English when they come in. “But by the time they are in their fourth year, they can speak English rather fluently.” I interact with the students, including some male ones, who are mostly children of farmers, labourers or white-collar workers from industries. The smiles they adorn and the confidence they display say a lot about the quality of training they get here.

This was the first private/self-financing Nursing college in ­Gujarat, and its yearly fee, including in the management quota, is only ₹85,000. “Most of our students stay in the hostel and are sponsored by the government which gives a stipend for the ST students.”