REJUVENATION OF THE MLDT MALAD CENTRE THROUGH COMMUNITY NETWORKING:
A HEART-WARMING EXPERIENCE

Kamlesh C. Jain, BHMS, DHA, MBA

Medical Superintendent, Dr. M. L. Dhawale Memorial Trust’s (MLDT) Malad Centre

*Address of correspondence: Dr Kamlesh Jain  Email: complan_1985@rediffmail.com

How to cite this article:
Jain KC. Rejuvenation of the MLDT Malad centre through community networking: a heart-warming experience. Journal of Integrated Standardized Homoeopathy (JISH) 2018; 01(02):

 

Introduction

Launched in 1991, Dr. M. L. Dhawale Trust’s Mahavir Maternity and General Hospital, Malad, is the first hospital of the MLD Trust. Dr. M. B. Jain, the father of one of our ICR students and the previous owner of the hospital, made this golden opportunity available to the Trust and it was taken up eagerly. What earlier was a Maternity Hospital was gradually converted to a small 20-bedded Multi-Specialty Hospital with various departments like Homeopathy, Gynecology and Obstetrics, Medicine, Ophthalmology, Surgery, Pathology, orthopedic, etc., with both IPD and OPD Services.

I joined the Hospital as an Assistant Superintendent in Jan 2012 and had the privilege of working under Dr. Gandhali Kothare for 3.5 years. This was the time when we were renovating the Hospital after the Trust had acquired it. There was considerable disruption of services, due to which patient attendance plummeted. Soon after, we had to face the untimely and tragic demise of Dr. Gandhali; subsequently, I was asked to take over the running of the hospital in June 2015.

 

What did I learn in my brief stint as Dr Gandhali’s assistant?

1. Granting freedom to the subordinate in functioning: My development as a Clinician, Homeopath, Manager, Individual is largely due to her advice regarding patients: “tuje kya lagta hai…de de… result nahi aaya toh bolna” (Give the remedy that you feel appropriate and give results. If any difficulty, revert). These words were the most important ones which have been helping me in my private practice too.
2. Buffer: Between senior and junior – how to protect the junior and convey their difficulties to seniors in an easy way thereby maintaining equilibrium.
3. How to create goodwill in the community and within the Hospital.
4. Her qualities of friendliness and cheerfulness and making people at ease.
5. She was not only my boss, but a friend, mentor, & a mother figure to me.

This article discusses the concerted attempts made for the development of this Centre and how a community-based solution was gradually arrived at leading to positive results.

 

Problem definition

The ICR has taught us that the problem resolution needs to be preceded by Problem definition.

• As discussed above, the prolonged renovation activity had reduced patient flow.
• The Centre continued to be known as just a Delivery Centre in the community and not as a multi-specialty centre. As a result, it was under-utilized and failed to serve the multiple health needs of the community. The bed occupancy was only around 40-50% and the daily OPD attendance was 60-70 pts, while its capacity was much more.
• The centre was known only as Mahavir Hospital (its old name), the MLD Trust remaining largely unknown to the people leading to difficulties in identification of the ownership as well as branding.
• The financial pressure was also considerable. We were given the entire Centre by a single donor. Therefore, we did not have to spend anything from our pocket to provide the facilities. It was imperative that the services be multiplied and reach out to a majority of the needy people in the community. At the same time, we were obliged to the staff who had to be compensated according to the statutory rules (minimum wages, gratuity, etc.) The Centre had to make enough money to defray the expenses and have enough to provide for upgradation of services. (It was not possible to request the donor for funds repeatedly!)

After identifying the above mentioned problems, we were in search of solutions. I reflected on my own academic training, which was in marketing, and concluded that we should be able to market our services more effectively. In fact, my project

• work was on those lines. Hence the question was – ‘How could one do that?’
• Coincidentally, Dr. M. B. Jain again became our Guide here. In the Diwali of 2015, the above issues were discussed with him, and he opined that medical care in India should begin from the root, which is at an Aanganwadi center. He recalled that he was the one who brought the first Aanganwadi to Malad way back in 1980 and that image was still in the memory of senior Aanganwadi workers. It was an eye-opener! When we searched, we discovered that indeed Aanganwadis were not a rural phenomenon as we had thought. We discovered that there is a huge network of Anganwadis in Mumbai, so efforts to reach this community needed to be initiated. The goodwill of M.B. Jain sir thus became the 1st step in our journey of rejuvenating our set up.
• Then we looked around in other centres of MLDT. I had seen the functioning of the MSW department at Dahisar and the work done by them. I was impressed by the efforts that Miss Vidya Patil took to connect with the different sections of the community; we thought to try similar activities at the Malad centre as well. The motto should be that along with services, awareness about our hospital and image should be built.

Problem Resolution

Not surprisingly, the definition led to a comprehensive resolution. The objectives were

1. Taking a holistic view of health, we had to reach out to the community to identify their problems and help them to help themselves
2. To introduce the name of the MLD Trust as a provider of affordable health services to the community through various activities.
3. To change the mindset of the community about the hospital from a single specialty to a multi-specialty unit
4. To establish a medical social work department at the Malad Centre who will be primarily responsible for carrying out the above tasks.Appointment of MSW was a big challenge considering the financial constraints of the Malad Centre. I had considered appointing a young girl and my offering would be raw experience, which she would be able to utilize to build her experience, and through that the Centre, rather than any person who would function only for a salary.

Unfolding of the Action learning plan

This was presented in the form of the health care efforts, the efforts through the community networking, and association with the MNCs

A. Health care Efforts:

1. Appointment of a dedicated MSW and planning the community work in the area within 3-5 km proved to be a real turning point. It was important to decide the zone of working in the initial days; the idea was taken from the Dominos brand. A radius of 3-5 Km was determined as one that was possible to cover.
2. Meetings were organized with school principals to persuade them to seek our services for the students. School principals were initially uninterested in meeting us. In one school, we obtained permission as one of the Trustees was Dr. Nikunj’s father’s friend. The Principal himself called and asked us to plan the camp. We realized that we need to approach in the right way through the right source.
3. The Director of a special children school (Shashimangal School, Goregaon) had approached us earlier requesting for starting homoeopathic services for her children with CP and MR. Unfortunately, we lacked the required staff at that time. Now we had Dr Rupali Kate, a Psychiatry postgraduate from MLDMHI, as our MO. We revived this connection and with the help of the Dahisar senior MO, Dr Navita Tambolkar, we launched this project. Today we are offering homoeopathic and physiotherapy treatment to 100-120 students with CP and MR, as well as the staff and parents.
4. Patients needing operative services like surgery for renal stones, CABG, joint transplants, etc. were connected to other likeminded organizations through the Rajiv Gandhi scheme; one of them was connected through our Palghar Hospital. This added to our image and we could develop good interpersonal relationships in the community.
5. Tie-ups were established with MRI/CT/PET/Angiography/Operation centers for concessions to patients. The way we built our image was interesting. The people from these centres came to offer sharing on a ‘% basis’. We requested them to pass this % to patients indicating to the patients that the 20% to 50% concession was because they were coming from MLDT Centre. This ensured that the patients benefitted and the image of the MLDT became entrenched in the mind of the community. I was able to take this step as my ICR Training had instilled a sound and ethical value system.
6. Association was established with like-minded NGOs – I) SATTHI-for free HIV treatment and delivery of pregnant mothers to prevent transmission to her child and II) PARTH (BMC) for free treatment of TB (Inclusion of medicines and investigations + Gene Expert for both 1^st 2^nd line and help for MDR TB)

The practice of exploring and sincerely attending BMC meetings gave this opportunity and we fully utilized it, with approval of the trustees. This helped us to build a name and contacts, both in the community and BMC. We were one of the top 5 hospitals in the P/N ward for providing free TB treatment.

B. Multi-Pronged Approach for Community Work–

a: Social Work groups

1. Posting of Social work students from SNDT and Nirmala Niketan Colleges for community work (MSW course). This was an initiative from a former Social worker, Ms Swati, who got her SNDT institute interested in our work. Nirmala Niketan also started sending their students. This helped in two ways- the students got first-hand experience about the community and we got a helping hand from them as well as the benefit of a different perspective. The work of the department was to establish linkages with the Aanganwadis, the schools, and other community outfits. Gathering information regarding the health care needs of the community, building awareness of different aspects of health and nutrition in community meetings, guiding them to the centres where holistic health care was provided, organizing and conducting health check-up camps, were the various activities assigned. Thus, building a health aware community was the first step. Guiding it to seek holistic health intervention was the next.

b: Association with officials /MNCs:

1. 

   Health Talks with Aanganwadi sevikas

   Meetings with ICDS officer and seeking permission for the work. Initially, the Aanganwadi sevikas were not responding to our visits. We thought it might be a security issue, because Aanganwadis are closed for a significant portion of the day. We searched on the internet and found the contact details of the ICSD officer who happened to be from the same village as our MSW. He readily gave us permission to network with the sevikas.

2. Approaching the key opinion leaders from the community. This was difficult, but sustained follow-up and constant updating broke the ice and developed the relationship.
3. Association with all political leaders within the community within a radius of 3-5 Km. This helped goodwill development and patient referrals as well as donations of essential items such as seating benches and large dustbins for the hospital
4. With the help of Ms Sayli Walke, we celebrated ‘Daan Utsav’ in October 2017 and 2018. In this Joy of Giving festival, we collected donations in the form of clothes, utensils, stationary, and toys through our established network. We have been performing this since 2 yrs and the response received from community is overwhelming. This has once again helped us to build our brand as a ‘giving organization’

C:  Association with MNCs

1. 

   Volunteers from Morgan Stanley

   We were approached by Morgan and Stanley exploring if their volunteers could be useful for us. We organized a skill development for children and involved them in paper bag making, quilling, and chocolate making. The programme was quite successful; this helped us to establish our credentials regarding our first MNC tie-up. We can now look forward to a prolonged association with this and other MNCs.

2. Similarly, we could get help from the TATA Proengage initiative for providing computer training to our hospital staff. Again, this is a start and we hope that more such help would be forthcoming.

 

 

 

Outcomes

a. Community: Networks established till date

Aanganwadi sevikas	Schools	Community areas	MNCs	Health Posts	NGOs
63+	15	20	2	2	2

 

b. Health Talks: conducted by the Hospital in different areas of communities with a number of camps and beneficiaries.

Aanganwadi			Community			In house			School			Camps
Activity	Camps	Beneficiaries	Activity	Camps	Beneficiaries	Activity	Camps	Beneficiaries	Activity	Camps	Beneficiaries	Activity	Camps	Beneficiaries
Orientation of Adolescent girls	21	350	Breast and Cervical Cancer Awareness	2	46	ANC & PNC Talk	284	593	Teacher orientation of emotional and Behavioral issues	1	25	Dental	9	1114
Good and bad touch	21	380	Menstrual Hygiene	5	50	Talk On Anemia	1	7	Monsoon illnesses	2	250	Diabetes	2	95
ANC & PNC	69	562	Health in monsoon and summer	3	250	Diet in ANC & PNC	1	35	Dental issues in school children	2	917	BMD	4	275
Diet in new born	1	26	Homoeopathic awareness	11	240	Exercise in ANC & PNC	16	59	Health and hygiene	1	250	Hemoglobin	17	1029
Women’s health	3	34	Family planning	1	14				Importance of brushing and its techniques	1	300	Homoeopathic	6	240
												General health check up	5	298
												Problems  of females as per epochs of life	5	250
												BMI	1	26

 

c. Expanded Services offered by the Hospital as a result of demand from the community

HOMOEOPATHIC SERVICES	ALLOPATHIC SERVICES	INVESTIGATION FACILITIES	INDOOR FACILITIES	SUPPORTIVE SERVICES
General Homoeopathic OPD & IPD Paediatrics Psychiatry Gynecology & Obstetrics Infertility Pulmonology Rheumatology Dermatology Diabetes Endocrinology	Medicine Gynecology & Obstetrics Pediatric Neonatal Surgery & Pediatric urologist General Dentistry & Ortho-dentistry Orthopedics Paediatrics Surgery Laparoscopic Surgery Ophthalmology	Computerized Pathology Sonography ECG Health check-up	IPD- 20 beds Wards – Male, Female, Labour, Paediatric, Special Room Operation Theaters- Major OT, Minor OT and Labour Room NICU- 1 bed equipped with Phototherapy unit 24X7 Casualty Services	Physiotherapy Dietician Free TB Rx 1st and 2nd Line with Gene Expert

 

d. Results of the Image makeover from maternity to multispecialty

Year	APRIL 2012 TO MARCH 2015	APRIL 2015 TO SEP 2018
Homoeopathy	28408	31289
Deliveries	1294	1349
Medicine	2207	3252
Surgery	536	820
Pediatrics	4377	4129

 

e. Financial data

Year	Annual income	Annual expenditure
2012	82,85,815	83,99,384
2013	1,05,96,310	1,02,09,839
2014	1,14,91,595	1,17,05,682
2015	1,30,55,621	1,34,13,133
2016	1,54,95,538	1,64,92,732
2017	1,59,502,44	1,62,29,721

 

What have all these efforts yielded?

1. A vast reservoir of goodwill in the community has resulted in referrals from all the above-mentioned sources. People have developed faith in our integrity and genuine desire to help them in need.
2. We became a preferred choice in Malad east for cost-effective services and guidance about various health-related queries/difficulties of patients and their relatives.
3. Increased patient flow in the homeopathy department.
4. Strong relationships with political leaders, parties, hospitals, laboratories, and investigation centres around hospital which has helped in getting donations for the hospital.
5. Due to our constant good work at Shashi Mangalam school, the principal Ms. Jyoti Doshi arranged for the donation of a LED photo therapy unit for our newborns and a cold water dispenser for patients. She has also been instrumental in introducing us to new donors at several occasions as needed.
6. Our most valuable gain has been Team Building: MSW + Hospital staff + Referral resources.
7. We have been able to make our Centre financially sustainable due to the vastly increased turnover and have been able to provide for our employees.

 

What is the future that we see for ourselves?

The work done has infused us with the desire to do more. Some of our new initiatives are:

1. Helping patients who cannot afford even charitable charges by means of a financial service provider “AFFORD PLAN”. Afford plan helps poor patients to plan resources for medical procedures such as delivery in the form of monthly savings. They also offer 10% concession to the patient. It is a new model, still in the experimental phase, but has gained a good reputation as a great help for needy patients. In a short span of 3 months, almost 60 patients have availed the benefit of this scheme.
2. Creating a large donor pool for generating resources.
3. Brand Make over from Mahavir to Dhawale Trust.
4. Creating an online portal/app so that the patient can get a second opinion
5. Introducing medical services to persons from the interiors of Maharashtra for affordable health care in surgical cases.
6. Creating a new segment for people who wish to obtain treatment from a private hospital but can afford only govt/BMC hospital”. Dhawale hospital is the option available.

We hope that the spark ignited by our team at Malad will soon spread throughout the state and will become a benchmark in raising community departments and functional operations.

Acknowledgements

• M. B. Jain Sir: Without whose guidance it was nearly impossible to develop a dedicated Community department at Malad.
• Swati Takle: Our first MSW who built the department from scratch as well as made a road map for our future engagements. It was her zealous attitude of transferring the inputs into action that was helpful.
• Priti Tarakar: Senior-most Aanganwadi sevika who had an acquaintance of Dr. M. B. Jain sir, without whom it would have been very difficult to understand the huge network of aanganwadis. She worked in and around the hospital with us like our family.
• Nathuram kaka and Mrs Phansekar Madam (Saibai School) helped us built school network.
• Mahananda Sister: An ideal nurse who helped us build a health post network at Appa Pada and worked day-night for our patients.
• Ritu Arya: Our current MSW and the ‘Karta’ of the department without whom it would not have been possible to walk down the path laid by our first MSW and helped in meeting the set goals in time.
• Malad Hosp Staff: Everyone believed and trusted in our project of developing the community department and helped us in achieving the same.
• Jyotiben Doshi, Director of Shashimangal school became our Mentor and Donor and helped us get enough donations and taught us the art of ‘asking for more’!
• Trustees and LMC of MLDT: Without their support and freedom to work, it was not possible to get things working.

Received on: October 24, 2018

Accepted for Publication: December 10, 2018