The hospital provides free medical care for some of the poorest people in Kerala, many of whom are farm laborers living in very remote areas. Most patients belong to tribal communities whose villages have few amenities. As many as 200 people a day, visit the outpatient clinic.
The hospital has a telemedicine link with AIMS Hospital, bringing state-of-the-art care to this poor region. AIMS doctors regularly make trips to visit the remotest tribal hamlets by jeep or on foot. They are not only concerned with the people's medical problems, but also with helping them attain a better quality of life.
The Amrita Kripa Charitable Hospital in Kalpetta (AKCHK) is a model of how to provide the maximum treatment with the minimum capital, for those who have the least and need the most. Since its inception on October 1st, 2005 through March 31st, 2012, this small outpatient hospital has:
This hospital, situated in the scenic environs of the Western Ghats in Northern Kerala, was born out of Amma’s compassion for the tribes of Wayanad. "Tribal patients from far away and from interior regions of Wayanad come to the Amrita Kripa, which they fondly address as Amma’s hospital," states Dr. Ajitha, one of the doctors in charge. Dr. Ajitha, along with her husband Dr. Sanjeev, were instrumental in setting up services at Amrita Kripa Charitable Hospital (AKCH) in Kalpetta, and in developing it to its present capacity. The doctors were joined by 12 staff members at the hospital and two staff from the VRC (Village Resources Center).
The number of patients receiving help has increased year by year. In 2009, the hospital admitted more than 50,000 patients in the OP, nearly four times more than in its first year of operation five years ago. In addition, 5,600 patients were seen through the various out-reach camps conducted by the hospital. Seventy-five percent of the patients are tribal and receive free services. Nominal charges are levied from patients belonging to other communities
Between 150 and 200 patients visit the outpatient department every day. On the busiest days, more than 300 people may require health center services. A well-supplied pharmacy stocks required medicine for routine outpatient care. Basic laboratory services are also part of the hospital’s facilities.
Devotee doctors from Calicut offer monthly services in the specialties of Internal Medicine, Pediatrics, Surgery and Dermatology. Gynecologic and Psychiatric services are provided on a weekly basis. Every three months the Amrita Jeevanam project from the Endocrinology Department at AIMS offers services in Endocrinology, heavily attended by patients with diabetic and thyroid disorders. Additionally, the patients have access to services like the Tele-med van, which makes monthly visits to Kalpetta and the Tele-medicine link up with AIMS.
Most of the tribal patients suffer from severe malnutrition because of a poor diet. Most of the children and women are very malnourished. They suffer from a host of illnesses related to malnutrition, especially anemia and repeated infections. They also suffer from other ailments such as TB, anemia, menstrual problems, skin diseases, and gastric problems. Modern life has also brought modern diseases like hypertension, heart disease and diabetes to the tribals as well.
At the root of many of their problems is malnutrition and lack of knowledge of proper dietary habits. The majority of the tribals work as day laborers and on a day when there is no work, there will be no food in the house. At the hospital, the doctors routinely see many severely malnourished babies and young children. Malnourishment at this young age leads to lifelong diminished mental and physical capacity. The children who come both to the outreach medical camps and to the hospital are weighed, given supplemental medicine and the mothers are given simple and practical nutritional instruction. On repeat visits, the children will be checked to see if they are gaining weight and if the mother is following instructions. Many children have been given a better chance in life and older patients have had long- term illnesses cured. Some of the patients visited other free hospitals previously, but had no improvement.
The higher rate of cures at Amma’s hospital likely has to do with the fact that from the receptionist who registers them, to the nurse, doctors, and to the pharmacist who usually sees them last; all the staff treats the patients with the utmost concern and courtesy. Drs. Sanjeev and Ajitha look deeply into the patients’ eyes when they listen to their symptoms and advise treatment. It is clear that they make real human contact with each patient and that they are interested in each one as an individual. The tribal patients, who often look a little apprehensive when they enter the doctors’ offices, visibly relax and look relieved when they leave. Studies have shown that when the patients have faith in the doctor who treats them, the healing rate goes up.
Treating the tribal patients effectively requires sensitivity and knowledge of their culture and lifestyle. Their reality is quite different from that of the dominant society. They live in the present, without a strong sense of time. Most of them will only have a vague idea of their age and their general sense of chronology is not developed. They traditionally have not lived in a world full of facts, figures and linear information, and become confused by too many questions.
They are not a questioning people themselves. They do not think much about the future and do not have the habit of saving their money. On a day they do not get work and earn money, there may be no food in the house and they simply fast. However, they do not seem to fear the future or have the level of anxiety from which many people in modern society suffer. For the doctor, information about symptoms and duration of symptoms can be difficult to ascertain. They are a quiet and uncomplaining people with a naturally stoic nature. In some cases, it takes experience with them and intuition to come up with a diagnosis.
Many of the patients who come have no life threatening illnesses, but the result of even a small injury or bad case of parasites can cause serious consequences and ultimately become life threatening. For example, Naryanan, age 60, supports his wife and two children by working in the fields as a day laborer. His family has no money if he doesn’t work. His toe became septic while working in muddy fields. He went to the Government Hospital for one month, but his condition had not improved. Here the doctors removed part of the nail and treated the infection with antibiotics. He says that he feels better and is happy with his treatment at the hospital. Like most patients, he came by bus and by walking, even with his bad foot. The average patient undertakes a two hour journey to reach the hospital and some have even traveled four hours each way.
Outreach - Special Projects and Medical Camps
From May 2006 to September 2009, AKCH hosted the Rheumatic Fever and Heart Disease Registry Project. The project, funded by the Indian Council of Medical Research, conducted a survey of 10,000 school children. The doctors involved examined and treated the children referred, gave classes to inform the public of the dangers of rheumatic fever and educated health workers.
Rheumatic fever is a hidden killer. It masquerades as a regular cold, flu or fever and often goes untreated. When a child suffers from untreated rheumatic fever, all may seem well until adulthood. During the most productive years of life, a serious heart condition will often develop, requiring major surgery for the patient’s survival. With India’s vast population, providing such specialized and costly services to the many people requiring them is a very difficult proposition. Diagnosing and treating cases of rheumatic fever in childhood is the best way to save lives and reduce the number of people needing highly specialized, costly surgery, which is available in only a few locations in each state in India.
The case of Laya shows the importance of screening. A team of medical professionals from the project visited her school and found that she was a probable victim of rheumatic fever. Her father brought her to AKCH to be checked by Dr. Krishna Kumar, an eminent cardiologist from the Amrita Institute of Medical Sciences in Cochin. The girl was found to have rheumatic fever and medicine was given free of charge. With the medication and careful monitoring, her outcome should be positive. One can only speculate what would have happened to her if the medical team had not come to this remote area of Kerala.
Periodically, AKCH holds cardiology clinics. At one such recent clinic the doctor saw over 60 patients on the first day of his visit, and in the few hours he had left that Saturday morning, he saw forty more. After interviewing the patients, he checked their heart function with an echocardiogram to confirm his diagnosis. On that basis, he would prescribe treatment by medication or recommend surgery.
One patient named R.K., age 60, had been spotted during an earlier visit to AKCH and was asked to come to consult with the heart specialist on his next visit. During his check-up, the doctor discovered that, although the patient had a serious heart condition, the government hospital where he had gone previously had scheduled him for surgery 18 months in the future.
The man explained that both his son and son-in-law were dead and he was the support for the entire family. However, his heart condition had made it impossible for him to work. The doctor patted his arm and told him not to worry. He invited him to come to AIMS where surgery would be scheduled immediately free of cost. Furthermore, he told the man to come directly to him upon arrival at the hospital, as he might get lost in such a huge place. Dr. Kumar told him that he should be able to work again after the operation. The man could not hold back his tears. This is the kind of difference this project and this small hospital are making in people’s lives. R.K. regularly returns to Amrita Kripa for check-ups and medication.
Every three months the Amrita Jeevanam project from the Endocrinology Department at AIMS offers services in Endocrinology in a major project launched in December 2007, to survey and treat patients with diabetic and thyroid disorders. Soorya is an 8-year-old diabetic patient. She was diagnosed with Type 1 diabetes when she was age three. She was four years old when she first came to AKCH. The doctors from the Calicut Medical College had put her on insulin. However, her blood sugars were very erratic, as the family often did not have the money to buy the insulin. They also did not know how to give the insulin properly at home. That is when the doctors from the Endocrinology Department at AIMS. through the Amrita Jeevanam project, decided to intervene.
Soorya came the first time the doctors visited AKCH to find if there was a need for an endocrinology project. They decided to provide her with regular insulin and insulin syringes, as well as all the other patients like her who need the drug. They also taught her mother how to give the insulin. The specialists from AIMS say that her blood sugar levels are under reasonable control now, even as good as a child living in a big city with access to all services.
As a grown up eight-year- old, she now attends school regularly and has even learned to self-administer her insulin! The project also gave her a glucometer that her mother has learned to use. They now come with fasting blood sugar values to the hospital! Soorya’s case shows how interested and capable tribal people are in helping themselves, when they have means and support to do so.
The Amrita Jeevanam project has also helped hundreds of tribal patients with thyroid problems. The incidence of thyroid problems and goitre is very high amongst the tribes. Sheela was a young 23-year-old mother who had been living for years with a huge goitre (swelling of the thyroid gland) in the neck. When she first came to the hospital, she had her neck covered with a shawl to hide the swelling. She had approached various centers for a solution, but to no avail. Initial blood tests and a needle biopsy revealed a benign swelling. She was referred to AIMS for surgery and the gland was removed surgically free of cost. She now walks proudly, without the shawl around her neck!
Outreach medical camps organized by Amma’s local devotes. The devotees are the ones who find the place to hold the camp and inform the people. They organize so well that within minutes after arrival, the doctors and staff can set up a clinic and treat large numbers of people in a short time. Regular camps are conducted twice a week on Tuesdays and Wednesdays at Modakkara and Edaguni . Additional camps are organized in association with other NGO's involved in tribal work such as PEEP, Ekal Vidyalaya, Vanavasi Kalyan Ashram, etc., usually once a week on a Thursday.
It’s eight in the morning. A light rain falls and there is a chill in the air. The mountains of the Wayanad are covered with mist. The hospital won’t open for over an hour, but already a number of patients have gathered. Most of them are Adivasis, some are wearing traditional tribal dress. There are old people and toddlers, patiently leaning against the walls and squatting on the veranda. The doctors arrive first and then the vivacious staff members walk up the drive from the nearby bus stand, smiling and chatting. It looks to be another busy day at the Amrita Kripa Charitable Hospital in Kalpetta. The Kalpetta Amrita Kripa Charitable Hospital (KAKCH),now entering its 7th year of operation, continues to make a big difference to many people in the region. Despite its small size, the hospital has been able to offer a wide variety of services using outreach camps, periodic specialty clinics, telemedicine and regular visits by consulting physicians. The hospital offers general consultation, and specialty clinics like endocrinology and psychiatry. It has added gynecology and infertility treatment. Visiting doctors come from Calicut to offer dermatology, general surgery and pediatric surgery. The hospital is a model in how to serve many people in need with a limited staff and simple infrastructure. The majority of the patients who come are of Adivasi origin. What began as a trickle of patients in 2004 has become a steady stream, as word of mouth recommendations spread through the community. Treatment and medicine here is free for tribals and available at a modest fee for others. But what seems to attract people here the most is the respectful and kind treatment they are given by everyone here. The infrastructure is currently expanding with the addition of second floor to the hospital. The new floor will provide much needed space for offices, storerooms, guest room and dormitory. The hospital is also considering working intensively with a tribal colony to initiate a wholistic approach to the health problems of these exploited people.
Although medical house calls are rare in modern times, Dr. Ajitha visited, Kembi, an elderly patient living in a nearby tribal colony who was no longer able to come on her own. Kembi was the very first patient to come to the hospital on its opening day in 2004. She recently had a stroke and after treatment at a nearby hospital had come back to her home. Dr. Ajitha and Nurse Sheila wanted to check on her condition and care. They brought medicine and a sheet and nightdresses as well. The team had to leave the jeep on the roadside and hike up a narrow path to a small hamlet picturesquely located amid paddy fields and coconut palms. On the edge of the hamlet, backed up against a huge boulder, they found the patient’s house. They discovered that Kembi was in pain from a recent fall when she had tried to move around her house. They cleaned her wounds and gave her painkillers. During their visit and local health care worker arrived and a discussion ensued about returning her to the hospital. However, no bystander was available or willing to go with her. (A bystander helps care for the patient in the hospital and fulfils many of the functions of a nurse). It was decided that if the doctors could look in on her occasionally and the family members could give her food, medicine and keep her clean, that she could stay a home. Everyone seemed happy with this decision and the team hiked back down the narrow path to the road, having lessoned the suffering of one more human being.
Mr. Balakrishnan, age 58, travelled 25 km to come here from Sulthan Battery. He is a diabetic and needs to come here every 20 days to monitor his condition and receive medication. He has been coming for the past 5 years and says that his condition is under control and he is able to work. He proudly told us that he is a Paniyar tribal farmer. His chief crops are rice and coffee. He mentioned that farming has become more difficult due to the lack of rain at the right time. He has three children, with the two girls being married and the son, a graduate of Polytech in electrical engineering, working on construction projects. He was diagnosed at a hospital in his town, but was not satisfied with the treatment there. He heard about this hospital and began coming here as he felt he had a better rapport with doctors and staff. He feels that this small hospital is much better than the other larger ones that he has tried and is very satisfied with the treatment. He hopes that the hospital will be able to add IP facilities soon.
Mr. Prabkaran, age 67, comes monthly by bus from Abalavayal which is 40 km. away. The journey takes about 1 hour and thirty minutes each way. He has been coming here for the last 5 to 6 years. He comes monthly to monitor his heart condition and diabetes and receives medicine worth 500 rupees on each trip. He has been to other hospitals, but settled on this one for his treatment as he feels that he gets better treatment here. He appreciates the good attitude of the staff and doctors and is very happy with his treatment. Prabakaran is a Paniya, Panchayat member and a social activist. He spoke about the problems of the tribals, saying that they have three main problems: lack of land, very low standard of living and low earnings when they can find jobs. He added that the tribals suffer from many health issues, including malnutrition. In the past, the tribes got food from hunting animals, but now government restrictions prevent hunting. They formerly hunted small animals like pigs, rabbits, and wild birds, using bow and arrows and traps. This sincere man has fought for the rights of tribal groups and been beaten and jailed in the struggle to obtain them. He feels the best way for tribes to better their condition is to come together and work as a unified group to assert pressure for their rights.
Chinchu, a 17 year old girl, walked here from her mountain top house in Muttil. She had to walk along the road for 3 km and then had to hike up and down 3-4 km to reach her house. There is no transport and access is only by foot. She came with a married older relative. She comes from a family of six children and her parents are day labourers in agriculture. Chinchu discovered that she was a diabetic when in a boarding school for tribal children in Trivandrum. She was in 5th Standard then. She continued her schooling until 9th Standard, but dropped out at that time. The main reason she gave for dropping out was the difficulty of obtaining and managing her medicine in boarding school. The local day school was too far away for her to attend. She has applied to Akshaya to learning stitching or handicrafts and is waiting and hoping to be accepted. She has been coming to this hospital for the last three years. She needs to come every two weeks to have her blood checked and receive medicine. She prefers this hospital to others that she tried as she says that the facilities are good. She can get her blood tested and have the results without delay and her treatment is carefully monitored. She likes the concern and caring attitude that she gets from the doctors and the staff and feels that there is more care personal attention given to her treatment. The medicine is free and if there is no money for transport , she can walk all the way to the hospital.
Sita, age 21, is a Panyar from the Muttil area. The day we met her she was on her way to a new job at AIMS. Her five year old son clung to her, aware that something was happening. He would stay with his aunt, while his courageous mother went to work at a large hospital several hours away where she knows no one. This situation was brought about by one of the greatest problems in tribal life- alcohol addiction. Her husband is an alcoholic and her home situation has become impossible. To add to her woes, her modest dwelling collapsed in this year’s severe monsoon, leaving her with no place to live. She has already faced many difficulties in her young life. She was forced to stop school in 7th Standard due to family problems. Both her parents became ill and she had to go to work to help support the family. Her son was also born with health problems and had to have an operation for urinary problems at AIMS at two months old. Sita has been coming to the hospital for various acute health problems for several years. When she was lacking clothes for herself and her children, she also received help. (The hospital receives clothing donations and distributes them to deserving people.) When her house collapsed and her marriage became untenable, the doctors suggested the ASK program at AIMS. She is grateful to the doctors for helping her and happy to be going to earn money. Her dream is to build a small house for herself and her son.
Madavan is a heart patient, but he does not want surgery. He is managing his condition with medication. He also has diabetes and hypertension. Madavan works as day labor on a plantation. His daughter is married and his son is studying. He introduced himself as a fearless man. He said that he does not fear death. He is ready to die anytime and has already set aside money for his funeral rites. He plans to donate his body to the medical college. He showed us many wounds on his body from injuries sustained at work. He told us that once a coconut landed squarely on his head and he was taken to the hospital unconscious and was given up for dead. However, he somehow survived. He seems to be a lucky man as well as a fearless one! Madavan works on some days and takes his cows into forest on others. says he has encountered many wild animals in the forest, but he is not afraid. He said that he is more afraid of human beings than wild beasts. Madavan says that he comes to the hospital because of the good behavior of the doctors and staff. He would like the hospital to have inpatient facility.
Devu is a 56 year old childless widow who has been coming to KAKCH since 2004. Initially, she lived close to the hospital, but after the death of her husband she had to move in with her sister, 30 km away. Devu is a diabetic and also has high blood pressure. She needs to come monthly to the hospital to monitor her condition and collect her free medicine. Devu earns her livelihood working as a day laborer in a tea estate collecting tea leaves. She gets work about two days a week. A few tears fell from her eyes when she explained that she was all alone and gets no help from her relatives. She says that she feels comfortable here and is getting better from the good and free treatments and medicines.
Parvati S., a young mother of two, knows well the value of preventive medicine and timely treatment of ailments. She has been coming to KAKCH since its beginning in 2004 for all family ailments. This time she was concerned because her new baby had conjunctivitis along with fever and a cold. She immediately brought the baby for treatment along with her niece who also had conjunctivitis. When asked why she came to this hospital for treatment she said that she understands the value of the treatment that she is receiving. She said that she has a good opinion of the hospital because of the good behavior of the doctors and the staff here. She would like the hospital to have IP facilities and wishes the hospital and staff well in their future endeavours.
Radha, age 45, lives in Meenangadi, 15 km. from the hospital. She has been coming to the hospital since 2005. Radha had a huge goiter and two years ago the doctors referred her to the Amrita Jeevan project. She was given a free operation at AIMS to remove the goiter which has made a big difference in her life. She needs to be on thyroid medicine the rest of her life which is being supplied free of charge. Previously she had visited other hospitals but found that that her medical treatments were more effective here. In addition, the treatments and medicines here are free. She said that she appreciates the good behavior and good character of the doctor and staff. She is very happy with the hospital and her treatment.
Sunanda, a young mother of 23, and her husband, along with their two children ages 4 1/2 and 1 ½ have been coming to KAKCH since 2007. They live in Kampalakad, about 8 km away. A neighbor recommended the hospital to them telling them they would get good and free treatment. On a recent visit, they came because the toddler had fever and diarrhea. They said that previously they had gone to the government hospital but they had to buy the medicine from outside medical shops which was difficult on the limited wages of the husband. They said that they are happy with their treatment and feel that they are getting better. They would like to see an IP facility in the future at the hospital.
Ravi is an 18 year old diabetic Plus One student. He travels 22 km by bus to the hospital. He was referred to the hospital by his uncle. (The majority of the patients coming to the hospital are referred by friends, family members or neighbors.) He is feeling better with his medicines and hopes to go on to higher studies in science. Getting free medicine was crucial for him. He says that he feels quite fine with his treatment. He said that he likes the character (swabhavam) of the doctors and their good behavior toward him.
Kelu, age 43, is a rheumatic heart fever patient, living in Kambalakady, Pulikkalkunnu Colony, 8 km. away from the hospital. He has been coming here since 2004. He has two children in 5th and 9th Stds and works as a day laborer earning around 200 rupees a day when there is work. Although he had gone to many private hospitals, his heart problem was not diagnosed until he came to KAKCH. After an initial diagnosis he was referred to the special cardiology camp, held periodically at the hospital An echocardiogram and examination confirmed the initial diagnosis. He was sent to AIMS for further consultation, where he received heart care and medicines free of charge. He also had free surgery for a hernia at AIMS. He said he is very pleased with his treatment at KAKCH. Not only did they diagnosis his problem correctly, they treated him with respect. He commended the good behavior of the doctors and staff explaining that they would say please and request patients to do things, not shout or demand. He appreciated the soft approach and said that less important to him than medicine was the kindness he receives here. The main thing he would like to see here is IP facility. He began talking of the problems of the tribals and pointed out that Amma, who he met at Mananthavady, is helping them and can do a lot to help them. He began spontaneously listing problems of the tribals. On his list, the number one problems are alcoholism and lack of money management. He said that 90 per cent drink. When asked why they drink, he said that the landlords of the plantations offer it to them as an enticement to work for them. Once they start drinking, they become addicted. Additionally, they don’t know how to manage their money and spend it as fast as they make it, alcohol being one of their major expenditures. Literacy is also a problem due to lack of good primary education. They lack education in hygiene and have an irregular food habits. They don’t eat at any fixed time, but just when they feel hungry. Heart trouble and cancer are beginning to be big issues for the formerly healthy tribal population. Kelu was happy that day as his niece had started working for KAKCH.
Dr.Sanjeev Vasudevan / Dr.Ajithakumari
Amrita Kripa Charitable Hospital
Phone : 04936 203395