A Free Medical Camp At Cheyyar

The Idea for a Medical Camp
My paternal grandmother, Jayalakshmi, passed away a few years after my grandfather Ranganathan did. All their children together created the non-profit Jayalakshmi Ranganathan Trust (JR Trust) and contributed money to it.

Last year, in a meeting of the trustees when discussing ways to spend the money, they came up with the idea of holding a medical camp. They chose Cheyyar in Thiruvannamali district because that’s where my grandfather hails from. The school that my grandfather had studied in – the Government Boys School – is still going strong (my father also studied there) and that was the chosen venue.

The trustees were emboldened by the fact that Dr. Chandrashekar, a close family friend had successfully organized a medical camp before. A whole slew of arrangements and preplanning is needed to hold such a camp. Permission from the government is needed to see patients and to dispense medicines; the premises have to readied; and doctors, equipment, staff helpers, nurses and volunteers are needed.

Greasing the skids – Meeting the District Collector
My uncle, Mr. Santhanam requested that Rupal and I go and personally meet the collector of Thiruvannamalai, tell him about the medical camp and ask for some specific help in terms of getting permission to hold the camp and in getting the local hospital to assist us. We went, though we didn’t quite understand why we had to make the 200 km trip when everything could be accomplished by phone and email.

In retrospect, this turned out to be a very important move. By showing respect to the authorities and by inviting the district collector in person, we ended up reaping rich rewards. This camp would not have been possible without the immense manpower and resources that were subsequently placed at our disposal.

Publicity
It is not enough to decide and plan the logistics for a medical camp. We have to let as many people as possible know about it. For this camp, 100's of thin-paper flyers were printed (in English and Tamil) and distributed to the people of Cheyyar. A couple of digital banners were created with all the information (in Tamil) and these were displayed in two key intersections. We also asked the local administration (Taluk office, hospital) to help us with the publicity. Finally, a few days before the camp day, an auto-rickshaw was fitted with loudspeakers and daily, a person sat in the back of the rickshaw hollering about the medical camp while the auto drove up and down the town.

Uncertainty – How many will come?
This was the tough part. The expectation was that 600-700 people would show up. The medicines had been purchased for that many. Two days before the camp, someone in Cheyyar felt that well over a 1000 people would show up. Mr. Santhanam got worried. We had neither the doctor's availability, nor the medicine and the resources to handle a very large crowd. He had to take a decision based on whatever information he had. He decided to stop the auto-rickshaw announcements for the last two days. No one wanted the publicity to become too successful. As a precaution, some more of the very common medicines were purchased assuming that there would be a big crowd of patients.

But the night before the camp, we were all worried. We didn't want too many patients, nor too few to show up. The number had to be just right.

It Takes an Army
It was dark when we reached Cheyyar on the night before the camp day. A host of very deferential people were hanging around the guest house. They were afraid that the dinner from the local Cheyyar restaurant would not be good enough for us "city people." (It was perfectly fine.)

But my uncle, Mr. Santhanam was more interested in monitoring the arrangements. He called for an immediate visit to the school premises, even though it was past 8pm. And so we got into the car and we drove to the school. Local administration officials accompanied us. Dr. Karthi, of the Cheyyar hospital was summoned.

There had been a huge amount of pre-work that had gone on. Clearly, Dr. Karthi had conducted camps before and he knew what he was doing. There was a registration area with a shamiana. There were signs directing people to the various rooms depending on their ailment. Sixteen different rooms had been set – one each for General Physicians, Orthopedia, Eye diseases, Vision, Ear, Dental, Ob-Gyn, Ultrasound and many more. Each room had been arranged to suit its purpose with temporary bed sheets serving as curtains for doctor-patient privacy.

The medicine dispensing room looked like a full-fledged pharmacy. Boxes of medicines had been arranged by local pharmacists so that it would be easy to fulfill the prescriptions that would come flooding in the next day. Mr. Santhanam approved the purchase of a few more medicines which the experts felt we might run short of.

It was humbling to watch the amount of effort that had been put in.

We had one more task before going to bed that night. We had to be sure that none of the medicines that would be handed out the next day were expired. (Many of them had been given by the drug companies to the doctors as samples, who had in turn donated them to the camp.) So we went through the cartons of syrups and tablets and made sure that were all current.

The Day of the Camp
On the day of the camp, Santhanam uncle woke us up at dawn and right away we headed off to the camp site for a last minute look around. There was no one else there, and so we returned to get showered and ready for the day. There was still a lot of uncertainty about how things would turn out.

On our second visit, which was around 7.30am, we were surprised to see that a few patients had already showed up and were patiently waiting for everything to get set up. They knew that the camp would start only at 8.30am, but they were so keen on availing the free medical treatment. This meant that lots more patients would be turning up soon.

By 8.30am, the whole place was buzzing with activity. The doctors were getting set up in the rooms allotted to them. The patients were scattered all around the school, and we had to keep trying to herd them into something resembling a queue. The registration desk was being manned by local nurses from the nearby Government hospital. Several school boys showed up in uniform (it was a Sunday) and were assigned two to a room to manage the flow of traffic. There were even policemen assigned to keep things in order. Somehow, everything fell in place and the statement "It takes an army of volunteers" was never truer.

Even before the camp registration began, we counted nearly 200 patients. Most came walking and it was heartening to see them coming in hordes, old men and women and younger people who brought their children along to get them treated as well.

Every patient (after registration) had to go to a general consultation room. That was where the bottle neck was. Given this crowd, we had to keep trying out different queue flow arrangements to make things flow. We also had to keep everyone out of the harsh sun. Many times, the rush was such that the facilities couldn’t handle it, and so the registration had to be intermittently stopped to allow the existing patients to get beyond general consultation first, before more could be sent in.

And then Dr. Karthi came up with a solution that saved the day. Dr. Karthi's idea was to create two general consultation rooms, one for men and one for women. That split made all the difference.

A vanload of our relatives from Chennai showed up. With the extra manpower and the small adjustments that were made, things got a lot smoother. Rupal, who doesn’t speak Tamil was communicating with patients in a mixture of Hindi and English. She was helping with the flow of traffic, and also taking lots of photos to document the camp – all the accompanying photos are taken by her.

Once a system is in place, everyone follows it. I talked to patients just to gauge their responses. They were happy with the experience. Many of them told me that they had learned of the camp from the auto-rickshaw loudspeaker announcement. And people who got done were telling their friends to show up. (As an aside, I found it interesting that how satisfied a patient was depended on how many medicines and tablets they had been given. More medicines made them happier!)

Kazhiyur Relatives
A half a dozen of our grandfather Ranganathan's Kazhiyur relatives showed up for the camp. No one had compelled them to attend. They had simply heard that a camp was being held, and they had cleared their calendars and showed up.

A number of Jayalakshmi and Ranganathan's direct descendants could not attend the camp. This is not surprising, given that they are all geographically spread out, not all are in good health and that everyone leads hectic lives.

In light of all this, I was very heartened by the presence of the Kazhiyur relatives. These people loved thatha, and if there was a medical camp in his name, why, they simply had to show up. It was a genuine show of affection where nothing was expected in return.

Overall
In all, the camp handled just over a thousand patients. There were around 20 doctors who showed up from outside Cheyyar (from Chennai and Kancheepuram) and around 25 staff volunteers. The direct expenses (not including a lot of the time and materials that came as donations) came to between Rs. 75,000 and Rs. 1 lakh.

Doctors Hall of Fame
Dr. Chandrashekar is the one person who was instrumental in making the medical camp a reality. He worked tirelessly for days on end, and the JR Trust was particularly lucky in having some like the good doctor to partner with.

Dr. Karthi was the local Cheyyar hero. Of all the patients who showed up, more than 50% seemed to know him. It seemed that more than half of the patients came up to him to say hello to the doctor. He is a true people's person, so he had an encouraging word for each one. Also, his experience in holding medical camps and his practical view in handling all situations were immensely helpful. (I ran into Dr. Karthi's proud father who happens to be that school's retired Tamil master, and I told him how crucial his son's role had been that day.)

Dr Ramakrishnan is the CGHS specialist who treats my father, so I know him a little. Right after lunch, he disappeared. While going from room to room to collect patient logs and sundry articles I saw a crowd of people in one of the rooms. In a very unassuming manner, Dr. Ramakrishnan was continuing to treat patients long after his "official duty" had ended, instead of opting to head home on a Sunday afternoon.

Dr. Sukumar, the dentist from Kancheepuram, is a nephew (brother's son) of my late grandmother, Jayalakshmi. What I liked about him is how independently he operated. He brought along his daughter (also a dentist) and his own assistant. He also brought his own supplies, and medicines. He had even hired a van himself and carted a dentist's chair and some heavy equipment, all on his own initiative, right from his hometown of Kancheepuram. (He handed out small tubes of Colgate paste to his patients for free, and this made him immensely popular!) His whole team went back to work even after lunch. Word gets around fast and patients lined up to have their teeth checked even after the camp officially closed. In fact, Dr. Sukumar was among the last of the doctors to leave the school premises.

We all know of dedicated doctors, and all these doctors belong squarely in that category. But the one person who went well beyond anything that the Hippocratic oath demanded of her was Dr. Bhama, the wife of Dr. Chandrashekar. The camp was held on a Sunday. Just the previous day, on Saturday morning, Dr. Bhama's ailing mother passed away. They held the cremation on Saturday morning. That same morning, Dr. Bhama made up her mind – that the medical camp should go on as planned. Not only that, she was going to show up and play her part.

I don’t know Dr. Bhama personally, but she is that rare blend of pragmatism and dedication. Rather than sit at home immersed in the sorrow at the loss of her mother, she decided that the best way to honor her mother was to come to Cheyyar, put her expertise in ultrasound to good use and treat as many women as she could. (When my uncle, Mr. Santhanam, in his address to the crowd of patients and organizers, mentioned the death of Dr. Bhama's mother the previous day, there was an audible gasp and many eyes welled up.)

Lessons Learned
It was a wonderful camp. Everyone deserves a pat on the back for a job well done. However, here are a few critical suggestions. Please note that I offer these in the spirit of continuous improvement, and each one has a suggestion for how things could be done better.

Single Focus Camps
Right as the camp was winding down, we were reflecting on the day with Dr. Karthi, asking him what he'd do differently. He gave what seemed to be the best suggestion for improvement. He suggested that we could have held a single discipline camp – that is a medical camp focused on just one type of treatment or ailment. He said it could be just an Ob-Gyn camp. (Consequently, Cheyyar would have a bunch of healthy children being born.) Or it could be an Eye Care camp, or a Vision camp, or a Diabetes camp.

The idea is to specialize which makes the logistics a lot simpler. Fewer types of medicines, less equipment and fewer doctors are required. If the JR Trust holds more camps, my vote is to hold these specialized camps.

Fixed Costs versus Incremental Costs
This medical camp comes with a very large fixed cost. It takes considerable money and effort to plan and organize one.

However, the incremental cost for extending it is very low. If you are taking the trouble to hold a camp anyway, you can run it for a little longer at very little extra cost. (On the day of the camp, several people who had heard from their friends and came hurrying. to the site after 1pm and had to be turned back disappointed.)

The whole camp lasted for 4.5 hours – from 8.30am to 1pm. Given this high setup cost + low incremental cost combination, in hindsight, we should have let it run longer. Let it be a full day affair. Or better yet, make it a full weekend (two-day) camp, with a set of replacement doctors if the same ones cannot stay for both days. This also has the advantage of spreading out the crowds over the longer period.

Get More People Involved
Over 90% of the oversight for the medical camp was done by Mr. Santhanam and Dr. Chandrashekar. This is highly commendable and the JR Trust is very fortunate to have able men like these two working for it.

However, from a management point of view, this is not necessarily a good thing for the Trust. There was a whole vanload of our relatives, willing and eager to help, but the work hadn't been divided up and each person given a responsibility.

There is only one Mr. Santhanam, and he can only do so much. But there is so much more that the Trust could still be doing. That can only happen if more and more people are roped in. And others will participate only when they are given important tasks and made fully responsible for executing them.

I had a boss who used to keep reminding me that "work gravitates to those who are capable of accomplishing it." But it also means that these capable people should work extra hard at delegating things.

If there is another edition of the medical camp, or for any future activity, it would be good to see more of my cousins, uncles and aunts included and given concrete tasks. That is the only way that the JR Trust can live on, instead of relying on the time and efforts of a few very dedicated people.

Keep The Food Simple
The breakfast that morning, as well as the post-camp lunch were elaborate affairs, and therefore had to be limited to a small group. A simple and filling low-cost breakfast and boxed executive lunches would have sufficed. I don’t think anyone would have complained.

Multiple Medicine booths
The crowds at the medicine booth were like those at a crowded ration shop. Every single person who came to the camp had to wait at the medicine booth and it became a huge bottleneck. If we had anticipated this, we could have had two booths. Or better yet, had one booth but with two different counters on opposite sides of the same room to manage the crowds better by splitting the queues.

So was it worth it?
The question of effort versus results (ROI) is always a valid one. A 1000 people were treated. This means that it came to ~Rs 75-100 per patient. You have to ask yourself, if the Trust had given this money to a local hospital (instead of organizing the camp) could the hospital not have done a similar or better job? The answer is most likely Yes. But that's an accountant's way of thinking, focusing on the short-term ROI.

There is a different way to think about this camp. The idea is to propagate it, to let others know that organizing things like this is possible. The idea is to plant the seed in other minds so that they could be organizing such camps too. Two of my close friends wanted to know how our family managed to organize this.

If this medical camp leads to a few other similar ones being organized, that would arguably be its biggest success.

Ram Prasad
April 2010

5 Photos of the Medical Camp held on 14th February 2010. Click on Forward to view next photo


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