By V. Srinivas, IAS in a thoroughly researched piece, delves deep into the past 60 years of this august institution and presents the different milestones it achieved during this period in a gripping way
A BRIEF HISTORY
9th May 1956: Rajya Sabha had concluded the marathon 4 day debate on the AIIMS Bill 1956. Rajkumari Amrit Kaur in her reply to the debate spoke thus – “I want this Institute to be a unique Institute, and to be able to give our people – the young men and women doctors – the opportunities for study for post graduate education that they have not uptil now been able to have in their country.
Not only that, it will, I hope draw students from the whole of the South East Asia zone and even from abroad. I want this to be something wonderful, of which India can be proud, and I want India to be proud of it.” The Deputy Chairman Rajya Sabha posed the Question “that the Bill be passed”.
The motion was adopted, and AIIMS was born.Rajkumari Amrit Kaur became the First President of AIIMS at the age of 67, a position she held from 1957 till her demise in 1964. Her contribution to the governance and institution building at AIIMS are legendary. The Princess of Kapurthala had her early education at Oxford University. She was awarded the Doctor of Laws by Princeton University in 1956. She joined the Mahatma’s Ashram in 1934 and served as his Secretary for 16 years. She spent 3 years in prison for participating in the Quit India movement. She became the first woman to hold a Cabinet rank in Nehru’s Cabinet and the President of the World Health Assembly in 1950. Prof V.Ramalingaswamicommitted his entire lifetime to the service of the Nation, and as the longest serving Director AIIMS wasa unique individual whose story continues to inspire – “he acquired an iconic status in his lifetime. Endowed with a brilliant mind, highly cultivated communication skills, a passion for teaching and research along with deep commitment to public welfare he chartered an uncompromising course to achieve excellence in whatever field he chose to follow.”
The Government of India conferred him with the Shanti Swaroop Bhatnagar Award, the Padma Shri, the Padma Bhushan and the Padma Vibhushan. The AIIMSONIANS are extra-ordinary men and women who undergo their education at the Institute and serve till retirement at 65.
It is a very long journey in public service marked by seriousness of purpose, a deep sense of commitment, willingness to work in complex areas of medical education, patient care and research. The Senior Faculty of AIIMS have, by their mercurial brilliance earned high respect for the Institute and individually attained a leadership role as flag-bearers of excellence both in India and abroad.
AIIMS ACT 1956 – THE PARLIAMENT DEBATE
The AIIMS Act 1956 provided for the establishment of the All India Institute of Medical Sciences. It was enacted by Parliament as Act no 25 of 1956 and has a mere 29 Sections. The Business Advisory Committee of Lok Sabha had allocated only 60 minutes for discussion and passage of the Legislation.
The Bill aroused tremendous enthusiasm amongst Members of Parliament and was debated for 3 days from 18th to 21st February 1956 in the Lok Sabha and 4 days from 3rd May to 9th May 1956 in the Rajya Sabha. The Parliamentary records of the debate run into over 800 pages.
18th February 1956, the Minister of Health Rajkumari Amrit Kaur rose in Lok Sabhato move the Bill to provide for the establishment of an All India Institute of Medical Sciences be taken into consideration. It was a 60 minute debate as was decided by the Business Advisory Committee. She did not have aprepared text of her speech.
She spoke from notes that she carried and from her heart. The words were quite magical. “It has been one of my cherished dreams that for post graduate study and for the maintenance of highstandards of medical education in our country, we should have an institute of this nature which would enable our young men and women to have their post graduate education in their own country. It will provide under graduate study to only a very very limited few. The major emphasis will be on post graduate study and specialization.”
The two special features of the Institute, which is the first of its kind in India and the first of its kind in Asia, are prohibition of private practice of every form and to pay the doctors reasonably high salaries to compensate them for the loss of private practice.
The Government wanted the doctors of AIIMS to devote their whole time not only to teaching, not only to serving the patients who come to the hospital but also to research. All the staff and students will be housed in the campus of the Institute in the best traditions of the Guru-Sishya ideal to stay in close touch with each other.
In her speech in Rajya Sabha on 3rd May 1956, the Health Minister explained why the Institute is called the All India Institute of Medical Sciences. The Institute includes all that modern medicine embraces within its wide orbit covering physical and biological sciences which make a vital contribution to medicine, including clinical medicine, radiology, nursing, non-clinical sciences biochemistry, biophysics, dentistry and nursing.
Hence it would not be right to call it just an Institute of Medical Science but the All India Institute of Medical Sciences. The Health Minister said that teaching institutions must specialize because an enormous amount of specialization is taking place and India cannot stay away from the progress and development that is taking place in other parts of the world.
The Health Minister further said that Dr. B.B.Dixit has been appointed as the first Director of the Institute given his research experience at the Haffkine Institute and the administrative experience as Surgeon-General of Bombay. She further reiterated that she will not allow the doctors of the Institute to have private practice and doctors at the Institute will be paid enough to ensure that they are quite contented to devote their whole time to teaching, serving patients and undertaking research.
The Institute was to be given the powers of a University to make revolutionary changes in curriculum and modes of teaching and the degrees given by the Institute shall be recognized by incorporating an amendment in the Indian Medical Council Act on the lines of the Royal College of Surgeons and Royal College of Physicians.
The Health Minister maintained that “Subject to such minimum control as the Government of India may exercise through its rule making power, the Institute will enjoy a very large measure of autonomy to fulfill its objectives.”
The Members of Parliament across party lines in the Lok Sabha overwhelmingly supported the revolutionary changes in medical education envisaged by the AIIMS Bill 1956. They said that it meets the long cherished desires of the Nation. Commencing the debate Dr. Rama Rao Member of Parliament from Kakinada, said the Institute should have more under-graduate seats, given that very limited opportunities were available in India.
The objects of the Institute provide for running one or more medical colleges. The Institute could develop the Irwin Medical College Hospital for graduate courses in addition to the Institute already developing for post-graduate courses.
T.S.A.Chettiar Member of Parliament from Tiruppursaid that the composition of the Institute should provide that the majority of the members should be non-officials. The Member also asked if the location of the Institute in Delhi could have a variety of affiliated institutions like the nursing college, dental college and rural and urban health organizations outside Delhi.
In addition to accounts being submitted to Parliament, T.S.A.Chettiar said that the Institute should lay an annual report of its activities in both the Houses of Parliament. This proposal of T.S.A.Chettiar was incorporated in the AIIMS Act by an amendment which says that “The Institute shall prepare for every year a report of its activities during that year and submit the report to the Central Government in such form and on or before such date as may be prescribed by rules and a copy of this report shall be laid before both Houses of Parliament within one month of its receipt.”
T.S.A.Chettiar further said that practical training for doctors in rural and urban areas cannot be provided on the campus of the Institute and the Institute should have a hospital where practical training can be provided. This is reflected in the Community Health Centre at Ballabhgarh which is administered by the Institute where undergraduate doctors are sent for practical training.
Shrimati JayashriMember of Parliament from Bombay Suburbansaid that the nursing college at the Institute is a welcome initiative and the nursing college of AIIMS should be a path bearer for the other nursing colleges of the Nation.Shri Narayan DasMember of Parliament from Darbhanga Central said that the Government must provide adequate finances to the Institute which should be reflected in the financial memorandum. Mohanlal Saksena,Member of Parliament from Lucknow District said that the Bill contained several important provisions.
The most important was the provision that said “It is hereby declared that the Institute shall be an Institution of national importance.” The other important provision said that “The President of this Institute will be exempted from disqualification of holding an office of profit for becoming a Member of Parliament.”
The third was that the Bill gave powers to the Institute to give degrees and diplomas by an amendment in the Medical Council Act. He further added that AIIMS is going to be an autonomous body and we will not have much control over it.
He along with several members felt that the bill should be referred to a select committee and not directly taken up in Lok Sabha, as the financial estimates for recurring and non-recurring expenditure remained suppressed. Several members also raised the need to incorporate Ayurveda, Homeopathy and other indigenous systems of medicine into the AIIMS.
In her reply to the debate in Lok Sabha, the Health Minister, clarified that the bill was introduced in the Lok Sabha on 21.9.1955 and that the members had plenty of time for studying the bill and giving their motions. As such Government did not agree for a reference to a Select Committee of Lok Sabha.
She said she was sorry that such an enormous amount of heat has been engendered over a bill which is a very straightforward and simple measure. She rejected calls for post-graduate studies in Ayurveda or Homeopathy to be introduced at AIIMS maintaining that the Institute will provide for undergraduate and post-graduate in the science of modern medicine and other allied sciences, including physical and biological sciences. She maintained that the majority of the Governing body would comprise of a majority of non-officials. She maintained that the name All India Institute of Medical Sciences was all inclusive and apt.
Even as the Bill was put to clause by clause voting, Joachim AlvaMember of Parliament from Kanara sought further clarifications on Clause 2 of the Bill. He expressed concerns that the Director who is to be appointed by the Government could perhaps be a retired politician – “a Khushamat” who has not had any teaching or operative work or anything of that sort for nearly 2 decades.
Joachim Alva said that the Institute must be filled up with young men of 50 and 45 whose contributions have been internationally acknowledged and whose articles have found place in the world research journals. The Standing Selection Committee may not be the appropriate body to recruit doctors to AIIMS. The Health Minister found many of the points made by Joachim Alva as quite irrelevant to the Bill and irrelevant to the issues at hand.
She said that the selection of Professors by a Standing Selection Committee has been agreed to by UPSC. She further clarified thatRules will be made by Government and Regulations dealing with a wide variety of subjects pertaining to administration will be formulated by the Institute.
All the clauses of the Bill except clause 9 were voted on 20th February 1956. The Lok Sabha took up Clause 9 of the Bill for discussion on 21st February 1956. The clause dealt with the nomination of 2 Members of Lok Sabha and 1 Member of Rajya Sabha on the Institute Body.
Clause 9 of the Bill was felt necessary lest the Members of Parliament could be held to be holding offices of profit by their nomination on the Institute Body and Governing Body. The AIIMS Bill was thus passed by Lok Sabha with a single amendment that AIIMS shall lay an annual report through Central Government in both Houses of Parliament.
The Rajya Sabha debated the AIIMS Bill for 4 days an incredibly long duration for a Bill with a mere 30 clauses, running into 540 pages of the record of discussions whichare available in the Parliament Library Debates Section. The debate commenced on 3rd May 1956 with Rajkumari Amrit Kaur saying thus “The future of the Institute will lie in the hands of the Director, of the Professors and other Members of the teaching staff and students. I believe that it will be their devotion to duty, their desire to promote their work and their spirit of altruism that will actuate them to subordinate their personal considerations as I believe the noble profession of medicine should do to the fulfillment of the objectives in view, that will eventually create and maintain an atmosphere which is necessary for an Institute like this.
I do therefore, hope that in presenting the Bill for acceptance by the Rajya Sabha today, the legal structure that is crafted may facilitate the progressive realization of improved methods of medical education in this Institute and through its influencethe standards of different courses of professional training in the field of health throughout this country will be raised.”
Thus began the 4 day marathon debate. The Members of the Rajya Sabha were overwhelmingly in support of the Bill, implementing one of the major recommendations of the Bhor Committee Report, for establishing an All India Institute of Medical Sciences facilitating for higher instruction in modern medicine.
Yet many felt that the legislation lacked clarity and envisaged excessive delegation to executive authority in the Rules. Members said that out of 30 clauses in the Bill as many as 25 clauses contained the provision, “prescribed by Rules” and 11 clauses contained the provision “prescribed by regulations”.
While delegated legislation comes with every Act, the AIIMS Bill sought extraordinary delegation to executive authority. The powers of the Medical Council to grant degrees and diplomas and the powers of the UPSC to conduct selections were delegated to the Institute.
Commencing the debate P.N.Sapru Member of Parliament from Uttar Pradeshsaid that “We cannot agree to the suggestion that the shaping of the Institute in its technical aspect should be entrusted to the Director and the Professors of the Institute acting as a medical faculty.
There is danger under a constitution of this character, of the academic faculty of the Institute developing into a closed corporation of mutual admiration. There must be representation of an expert character – representation of an outside expert character – provided in the constitution itself.”
Participating in the debate, Dr Radha Kumud Mookerji, nominated Member of Parliament, sought clarifications on Clause 5 of the Bill which says that AIIMS will be an Institute of “National Importance”.
There is a clause in the Constitution where it is stated that if a subject is a State subject, it might be centralized for treatment by the Union Government, if it is declared a subject of National Interest. He felt that the scope of National importance must be wide enough to cover all systems of medicine prevailing in the country – systems of medicine which have survived the onslaught of the ages.
Similar views were expressed by H.P.Saksena Member of Parliament from Uttar Pradeshon clause 5 which said that “It is hereby devclared that the Institute shall be an Institution of National Importance”. The Institute of National Importance should demonstrate a high standard of medical education to all other medical colleges and other allied institutions in India.
Dr. W.S.Barlingay Member of Parliament from Madhya Pradesh said that the Institute was really conceived in 1945 when Dr. Hill came to India for the Bhore Committee was meetings. A sub-committee of the Bhore Committee went to UK, USA and Canada to visit various Universities and study medical education system, which could best suit India’s needs.
Dr. Barlingay laid emphasis on the Objects of the Institute to Develop Patterns of Teaching in Medical Education as a critical component of the Institute’s focus areas. He felt that the Institute could be attached to Delhi University which could grant diplomas and degrees as also get grants from University Grants Commission.
Several members expressed concern at the total omission of references to indigenous systems of medicine in theBill and felt that the focus should ne pm Ayurveda and Unani systems also.
Biswanath Das Member of Parliament from Orissa said that the Health Minister who received inspiration from Mahatma Gandhi and served at his feet was making Ayurveda an untouchable system. Some Members also felt that the Dental College and Nursing College were not required at AIIMS and the focus should be on high-end research work.
In her reply to the debate, Health Minister Rajkumari Amrit Kaur provided answers to the concerns expressed by Members of Rajya Sabha. She argued that the Institute shall have the power to grant medical degrees, diplomas and other academic distinctions and titles under the Act of 1956. She maintained that Dentistry was has been a very neglected science in India and dentists have to go abroad to get first class qualifications. Hence a Dental College was attached to the Institute.
Similarly she said, Nursing was a most neglected limb of the medical profession though it was an important hub. She said she had consulted UPSC on the recruitment to faculty posts. UPSC was of the view that because AIIMS will be a statutory non-government institution, recruitment will be outside the purview of the Union Public Service Commission. With regard to excessive delegated legislation being taken by Executive authority, she said that Parliament should give as much autonomy as it can to this Institute which is going to be a pioneer venture.
“Let us have elasticity and let us have autonomy…after all you are going to have an extremely good Governing Body which will lay down the policies which will be followed by the Institute and the regulations must be left to the discretion of the Institute itself…the Government will be in very close touch with the Governing Body. Trust your Government, Trust your Scientific People…”.She promised to develop an All India Institute for Ayurveda at Jamnagar and al All India Institute for Homeopathy in future as also a chair for History of Medicine.
The Bill was put to vote on the 4th day of the debate on 9th May 1956. Clearly the Health Minister was exhausted by the 4th day of the debate. Even as the Bill was about to be passed Members continued to press for amendments in the clauses and the Health Minister seemed irate.
Dr. Seeta Parmanand Member of Parliament from Madhya Pradesh said “Sir, after all it is the right of this House, if at all they feel that something should be done by the Ministry, to criticize the Ministry. She called herself the Chief Servant of her Ministry. She is there to reply.” Despite these moments of acrimony, the Bill received support from all the Members of the House.
RAJ KUMARI AMRIT KAUR
Rajkumari Amrit Kaur chaired the first meeting of the Governing Body in 1957. In her eight-year tenure, she chaired 25 Governing Body Meetings. Dr Jivraj Mehta the Director General Health Services and Dr. B.B.Dixit Director AIIMS served with her for the entire period. She got an IAS officer as Deputy Director Administration a 12 year tenure to ensure stability in the process of Institution Building.
The 1st Governing Body meeting underscored the massive governance challenge before the AIIMS administration of establishing the Institute as an apex medical sciences University with tight budgets, lack of adequate personnel, absence of infrastructure and dependency on foreign funding.
It set the foundations for a governance structure where high level policy support and interventions for the Institute’s growth were available as the President AIIMS took upon herself the responsibility of coordination with the Health Ministers of State Governments, coordination with Union of India for additional budgetary allocations and for delegation of adequate administrative and financial powers to Director AIIMS.
The first Governing Body meeting of AIIMS was held in May1957. The Governing Body members who attended the meeting included Rajkumari Amrit Kaur in the chair, Dr. A.L.Mudaliar, Dr. Jivraj Mehta, Lt. Col Jaswant Singh Director General Health Services, Lt Col Amir Chand, Dr. R.M.Kasliwal and Dr B.B.Dixit Director AIIMS.
The Union Health Secretary was not a member of the Governing Body although the Joint Secretary Ministry of Finance was a member of the Governing Body.
The Budget for the year 1957-58 was Rs. 40 lacs and the entire 2ndFive Year Plan allocation for AIIMS was Rs. 11.11 crores. As the budget was not adequate for the construction of the hospital building upto the end of the 3rd Five Year Plan period, the Governing Body decided to approach the Government of India to transfer the Safdarjang hospital to the Institute.
The Institute also accepted donations from the Rockefeller Foundation for a grant of USD 200,000 for purchase of books and publications and scientific equipment. Amongst the important decisions of the Governing Body was to consider and adopt the Regulations of AIIMS.
In end 1957, the Governing Body decided that the Institute will award an M.Ch for Surgical subjects and DM for clinical subjects. It was in this meeting that Lt Col Amir Chand suggested that Dr. K.L.Wig Principal Medical College of Amritsar would be a suitable candidate for the post of Head of Department of Medicine.
The Governing Body agreed that Dr. K.L.Wig would be a suitable candidate for the post and the Chairman would persuade the Health Minister of Punjab to make available the services of Dr.K.L.Wig for appointment in the Institute. The appointments of Dr. Sujoy B.Roy as Professor of Cardiology, Dr. R.B Arora as Professor of Pharmacology were approved in 1957.
The decision not to construct a Hospital for AIIMS was taken in view of the lack of finances and increased cost on their buildings and equipment and was deferred till the 3rd Five Year Plan. Dr Jivraj Mehta as Director General Health Services offered 60 beds in Safdarjang Hospital for teaching purposes for the Departments of Medicine and Surgery as Professors had been appointed in these Departments.
That said, the Institute accepted the Pounds 1 million grant from New Zealand for construction of the Hospital at the Institute and construction was taken up in the 2nd Plan Period.
Rajkumari Amrit Kaur protected the autonomous nature of the Institute. She maintained that the Institute became autonomous from 15th November 1956 and all posts with a minimum pay of Rs. 600/- per month or more would be created with the approval of the Government, while no prior approval was necessary for posts carrying a minimum pay of less than Rs. 600/- per month.
It was based on this decision, that the Governing Body decided to fill 35 posts of Assistant Professors without prior approval of Government. The Governing Body ensured that the autonomous nature of the Institute was preserved. Rajkumari Amrit Kaur had created an international face for the Institute by collaborations with Rockefeller Foundation and the Government of New Zealand and encouraged further collaboration with the University of Pittsburgh. The AIIMS insignia was approved by the Governing Body in 1958 and slogan was decided in consultation with Vice President Dr. S. Radhakrishnan.
Rajkumari Amrit Kaur permitted Governing Body meetings to be chaired by Dr. Jivraj Mehta in her absence. Dr Jivraj Mehta led Governing Body decided to relax conditions of admission to candidates of Nepal under the technical cooperation scheme of the Colombo Plan as also students from Burma. The Institute permitted exchange of post graduate students by sending AIIMS senior students abroad and getting some students from abroad. The Nursing College at Delhi was shifted to the Institute and amalgamated with it in 1958.
The discussions in the Governing Body indicate the passion with which Rajkumari Amrit Kaur pursued institution building. By 1959, the Institute had 350 beds at the Institute and 84 teaching beds for medical and surgical cases at the Safdarjang Hospital in addition to the Nursing College. The Institute continued to make out a case for the transfer of the Safdarjang Hospital to the Institute in addition to the 650 beds that were planned for the Institute.
Rajkumari Amrit Kaur maintained that the AIIMS be mandated with the responsibility of developing teaching patterns in Under Graduate and Post Graduate Medical Education to all medical colleges and allied institutions of the country. It was for this reason that she said she chaired the Governing Body of the Institute and would run it as an autonomous institute through the Standing Committees namely Finance Committee and Selection Committee both chaired by Dr. Jivraj Mehta the Director General Health Services, the Academic Committee and the Building Committee.
The Membership of the Institute Body was pan-India representative, with medical faculties from Indian Universities, Members of Parliament, Distinguished Medical Educationists, members of the Indian Science Congress and representatives of Ministries of Education and Finance.
The close collaboration of AIIMS with the Indian Medical Council, the Indian Council of Medical Research were developed in pursuance of the objective of developing the apex Medical Sciences University of India.
Rajkumari Amrit Kaur’s vision envisaged selection of students for admission to the under-graduate MBBS course in AIIMS is made after an open advertisement, on the results of an open competitive test, strictly on merit with equal opportunities to students from any part of the country.
The advertisements calling for applications would be issued in all important newspapers of India. For Post Graduate Studies, candidates would be selected after calling for applications on an all India basis, and selections made by a selection committee. The AIIMS entrance examination was conducted in 5 cities in 1956, 1957 and 1958 namely Bombay, Calcutta, Madras, Nagpur and Delhi with 400 candidates appearing for 50 MBBS seats.
The performance of AIIMS by 1961 was noticed in international fora. The Massachusettes General Hospital on the occasion of its 150thcelebrations, placed AIIMS in the list of most distinguished hospitals of America, Canada and Europe and presented Rajkumari Amrit Kaur with a medallion and a ‘Book of Citation’.
Dr. B.B.Dixit in his letter to the Chairman, Board of Trustees Massachusetts General Hospital mentions how greatly AIIMS would cherish the citation – “This undertaking unites education and research in a courageous manner to meet the health needs of 400 million people” and AIIMs shall try its best to live upto these expectations.
Rajkumari Amrit Kaur chaired her last Governing Body meeting of AIIMs on 14th August 1963. The Governing Body accepted her gift of “Manorvile”, her residential building at summer hill Shimla to the Institute for rest and relaxation of doctors and nurses of AIIMS. A truly unparalleled gesture in the history of the Institute.
Dr. V. Ramalingaswami Rama applied for the post of Associate Professor in AIIMS in 1957, but was selected for the post of Research Professor in Pathology. He was only 36 years old when he was appointed a Professor in AIIMS in 1957.
Prof P.N.Wahi was selected as the Professor and Head of Department, and when Prof Wahi declined the post, Rama was formally made Head of Department of Pathology. Along with Dr. H.D.Tandon and Dr. Nabeen Nayak, Rama laid the foundation of one of the most outstanding Departments of Pathology in India.
In Rama’s own words “I joined AIIMS in 1957. During my stay at AIIMS from 1957 to 1979, I developed an intense interest in Medical Education. I introduced the case methods of teaching in pathology and the clinico-pathological conference as practiced at the Massachusetts General Hospital. I introduced student evaluation of teaching methods, as a corrective tool, at the end of every teaching session.
During the early part of this period, three men – Benjamin Castleman, Hans Popper and Hans Smetana – were great influences on my life and I learnt a lot from each of them.” Following 18-20 years of research work in the Kangra Valley, Rama confirmed that a very small dose of iodine or iodate could prevent endemic goiter, cretinism and deaf mutism. The information provided formed the basis of the National Goiter Control Program.
Rama’s contribution to research work in AIIMS covered the areas of nutritional pathology, thyroid goiter and iodine deficiency disorders, nutritional anemia, liver diseases and cardiovascular diseases. While there is significant documentation of Rama’s research contributions on nutritional pathology, malnutrition, goiter and iodine deficiency disorders as also his work as a teacher and medical educationist giving medical education a community orientation, his work as Director AIIMS does not seem to be adequately reflected.
The collected works of Dr. V.Ramalingaswami says that “as Director of the Institute, he relentlessly tried to expand the Institute’s activities in diverse disciplines. It was during his stewardship that several specialized centers – the Rotary Cancer Centre, the Cardio-thoracic Centre, the Neurosciences Centre, Centre for Community medicine – were established.
A number of new departments like departments of gastroenterology and human nutrition, endocrinology and metabolism, biomedical engineering, haematology, nephrology, paediatric surgery and biotechnology were created during his leadership. There were several others who had their capabilities and scope enhanced.”
During his long tenure as Director AIIMS, Rama worked with 5 Health Ministers namely K.K.Shah, Uma Shankar Dixit, K.K.Khadilkar, Karan Singh and Raj Narayan. His tenure covered 6 Health Secretaries namely B.P.Patel, K.K.Das, C.S.Ramachandran, Kartar Singh, Gian Prakash and Rajeshwar Prasad. Between January 13th 1970 and 20th September 1978, Rama as Member Secretary of the AIIMS Governing Body attended 28 meetings, the largest by any Director of AIIMS in the past 60 years.
AIIMS is a complex organization for governance, and Rama’s tenure was full of challenges. The frequently changing leadership at the top, scarcity of finances, sharp personal differences with Prof L.P.Agarwal Chief Dr. R.P.Center for Ophthalmic Studies and intra-faculty differences in several departments like Pharmacology coupled with the Junior Doctors strike in 1974 made it an extremely challenging tenure.
That said, the broader vision of Rama outlined the development of the Institute as a center of excellence, collaborating with International Institutes and Agencies, Training Quality Hospital Administration personnel, Improving Cleanliness and Upkeep of the Institute and formulating the Institute’s development plans to fit into the broad national health sector goals find resonance even to this day, 37 years since he demitted office.
The Collected works says that “During this period the overall academic and research activities of the Institute acquired a new dynamism. Distinguished medical scientists from within the country and abroad were invited to invigorate these activities. There was multiplication of symposia, seminars, workshop and CME programs virtually around the years. The Institute became a showpiece of what was the best in the bio-medical field in India.”
There is one standout incident for which Rama is still remembered – the 95 days strike of Junior Doctors from January 1, 1974 to April 4, 1974 in which AIIMS Junior Doctors also participated. Newspapers said the strike was caused by demands for suitable and acceptable grade pay, along with better working and living conditions.
As part of the post-strike negotiations, on May 28, 1974 AIIMS introduced the Residency Scheme in replacement of the system of House Surgeons, Post Graduate Students and Registrars in Central Institutions/ Hospitals. The scheme envisaged that the 4-year system consisting of one-year house job, followed by 3-year registration as post graduate student, be replaced by a 3-year junior residency scheme with separate selections at the first year, and second year of the Junior Residency.
The Senior Residents were considered on par with class II officers and their selection was to be conducted by the Standing Selection Committee. Uniform non-practicing allowances to Junior and Senior Residents were introduced and higher basic pay was approved. The AIIMS Residency Scheme was one of the significant policy changes of Rama’s tenure as Director AIIMS.
Dr. Ramalingaswami, the great visionary, conceptualized the development of major Centers of Excellence at AIIMS. The Dr. K.L.Wig Center for Medical Education and Research, the Dr. Rajendra Prasad Center for Ophthalmic Sciences, the Cardio-Neuro Sciences Center, the Rotary Cancer Center were all conceptualized and promoted with his untiring efforts.
The Development Plans of the Dr. Rajendra Prasad Center for Ophthalmic Sciences were taken up in 1970. The RP Center was envisaged to have 90 beds with separate budgets. The issues concerning the Institute – RP Center relationship created sharp divergence in views in the AIIMS governance model in the later years. The CN center was conceptualized subsequently.
The Institute’s collaboration with the World Health Organization resulted in the establishment of the Educational and Technology Institute at AIIMS with WHO funds. The Center was subsequently named as the Dr. K.L. Wig Center for Medical Education and Training. In 1972, the newly constructed library building of AIIMS was named as the Dr. B.B.Dixit Library.
One of big strengths of Rama was his capacity to develop international collaborations. AIIMS collaborations with World Health Organization in Human Reproduction was a huge milestone. Rama was also closely involved with the UNICEF, the Canadian International Development Agency and the National Institute of Health Bethesda, Maryland USA. He was also a visiting Professor of International Policy Harvard School of Public Health Boston. In 1973, AIIMS established the WHO Research and Training Center in Human Reproduction.
It was the Department of Reproductive Biology which identified some savings from this project to enable the construction of the world class AIIMS swimming pool. AIIMS entered into several bilateral collaborations too. Equipment procurement at the Institute was financed under the Indo-Danish and Indo-Swedish Technical Assistance Projects. The Institute pursued collaborations with the University of Basra, the Child Care Center Kabul in West Asia. The AIIMS-New Zealand collaboration was vigorously pursued.
The Institute accepted a donation of Rs. 5 lacs from Chauthmal Rajgarhia a donor from Bombay for construction of a suitable Dharamshala in the AIIMS campus in mid-1970. The Dharamshala was to be jointly utilized by AIIMS and Safdarjang hospital. The Estate Committee identified a suitable site in the AIIMS West Ansari Nagar campus and allocated it to the Chauthmal Rajgarhia Trust for construction of the Dharamshala. The Rajgarhia Vishram Sadan at AIIMS provides shelter for over 1100 inmates who are either patients or attendants of AIIMS.
There were some initiatives that were attempted but could not materialize. The Institute sought loans from State Bank of India, Life Insurance Corporation, Syndicate Bank, HUDCO for additions to the Hospital, Construction of Nursing Home and residential quarters. After preliminary discussions, the proposal was dropped as it was felt that it was neither possible nor practicable to raise loans from banks or other public sector financial institutions for the building residential quarters for the staff and a nursing home as these works are not financially remunerative.
There was a proposal called “Educating the Humanist Physician” which considered the role of humanities in the teaching of medical sciences. While the introduction of Humanities in teaching of medical sciences was considered, it wasn’t pursued. There were proposals like the reservation of seats for medical graduates from backward areas and for those who have served in rural areas, which were considered. The Institute could not implement area based reservations in its admission procedures.
The separation of the Dr. Rajendra Prasad Center for Ophthalmic Sciences from the Institute was a big challenge. Prof L.P.Agarwal the Chief of the Dr. Rajendra Prasad Center for Ophthalmic Sciences also served as the Dean of AIIMS. A separation of the Center from the Institute meant that the posts of Chief and Dean would be separated.
The 1977 Governing Body meetings record these extra-ordinary discussions between Dr. L.P.Agarwal and Dr. V.Ramalingaswami. The verbatim of the minutes said “Dr. L.P.Agarwal Chief Organizer Dr. Rajendra Prasad Center for Ophthalmic Sciences stated that he was opposed to the separation of the Dr. Rajendra Prasad Center for Ophthalmic Sciences from the Institute although he was pleading for it for a number of years.
He also did not think more autonomy was needed for the center. He added that he was working as Dean for the last few days and assured his fullest cooperation to the Director. The Health Secretary explained that with the expanding role of the Dr. Rajendra Prasad Center as an apex institution for the implementation of the National Program for Prevention of Blindness, and his additional duties as Advisor to the Ministry, the Chief Organizer had already had plenty of work on his hands.
The Health Secretary felt that it would not be advisable for the Chief Organizer to be given additional duties as Dean of Institute. Instead he may be given a suitable designation as Dean or Principal of the Dr. Rajendra Prasad Center.
Furthermore, the Health Secretary doubted from his past experience, if the present Director Prof Ramalingaswami and Prof L.P.Agarwal would be able to work together amicably. Prof V.Ramalingaswami said that as a disciplined person, he would carry out the decision of the President and the Governing Body and he had nothing personal against Prof L.P.Agarwal, but he was of the opinion that it would be in the best interests of the Institute if the first alternative suggested by the Health Secretary viz., more autonomy and separate Deanship for the Dr. Rajendra Prasad Center were accepted.”
The Governing Body continued to deliberate on the difficult relationship between the Institute and the Dr. Rajendra Prasad Center for Ophthalmic Sciences in pursuance of the report of Health Secretary and Director for separation of powers for almost 2 years. It was only in 1981 that the relationship was notified by the Institute, which stands to this day.
Prof Ramalingaswami catapulted AIIMS to the global stage as a leader in medical education and biomedical research. I wish to quote from the Collected Works of Dr. V.Ramalingaswami that he epitomized George Berna rd Shaw’s vision “I want to be thoroughly used up when I die, for the harder I work, the more I love. I rejoice in life for its own sake. Life is no brief candle for me, it is sort of a splendid torch which I have got a hold of, for the moment and I want to make it burn as brightly as possible before handing it on to future generations.” That’s what Rama was – an inspiration to one and all.
THE JOURNEYS OF AIIMSONIANS
The AIIMSONIANS are unique individuals because they have set out to do something significant, work on important problems, have the courage to pursue independent thoughts, are high achievers at a young age, have a tremendous drive, are willing to work longer hours than contemporaries with equal ability, have high emotional commitment to their profession and have the capacity to present their achievements to the world. I have often asked them if it was worth it? For they had an option to serve in many other Institutions of the country and abroad, and the common refrain has been that “It was worth it”.
The AIIMSONIANS journey usually begins as an MBBS student at the age of 17 or 18. They are young, intense, scholarly and represent the highest meritocracy. Prof Balram Airan Chief of the CN Center, and the man who was part of the team of cardiac surgeons that conducted India’s first heart transplant, joined the Institute in 1970 aged 18. Prof Vinod Paul the Head of Department of Pediatrics, the man credited with creating the neonatal resuscitation movement in India joined the Institute in 1972 aged 17.
Prof Nikhil Tandon the Head of Department of Endocrinology joined the Institute in 1981 aged 17. Prof Sandeep Agarwal Professor in the Department of Pediatric Surgery joined AIIMS in 1981 aged 18. They did their MBBS in 4 ½ years followed by a year of internship. This period is marked by an attachment with Community Health Center Ballabhgarh and PHC’s Dayalpur/ Chainnsa their first exposure to actual direct patient care after years of didactic and clinical teaching sessions.
They hold pleasant memories of the first phase of their lives where they graduated after being intensely competitive. Prof Balram remembers that the faculty-student relationship was open. Prof Paul remembered that students were the center of the Institute. The students had a local guardian from the faculty. For Prof Balram who was the youngest of 9 brothers and sisters, AIIMS represented a second home and his guardian Prof Subirmal Roy was a father figure.
The graduation is followed by admission to the MD or MS programs in medical or surgical disciplines and 3 years of work as Junior Residents. For some, there is an option of a 5 year MCH course. This is followed by selection of a professional discipline for the DM or MCH program.
It is only after 11 years of intensive study (5 years MBBS including 1 year internship, MD 3 years, DM/ MCH3 years afted MD/ MS) do the AIIMSONIANS reach the faculty appointment as Assistant Professor. Their choice of selection of disciplines at the M.Ch and MD stage and then at DM/ MCH stage are often based on their areas of interest. The reason why Prof Balram chose cardiac surgery although his first preferences were Pediatrics and Ophthalmology was the freedom and comfort levels which he felt with his Head of Department. Prof Paul chose Pediatrics for his love for public health and his fascination for Prof O.P.Ghai the Head of Department. Prof Sandeep chose Pediatric Surgery (M.CH) for his passion for pediatrics and surgery.
High recognition comes from taking huge responsibility. A family friend asked me if Prof Nikhil could consider her as his patient. Not only did she have enormous respect for Prof Nikhil, she also recognized that he would not accept common run of the mill subjects, but prefer to work on important problems that high meritocracy could choose from. Prof Paul’s seminal work on pediatric care made him the go-to man for formulation of WHO policies.
Prof Paul said to me, if AIIMS can invest Rs. 150 crores in a State of the Art research center and pursue international collaboration in a directed manner with constant follow-up, perhaps a Nobel Prize in Medicine could be 15 years away. The Institute has sanctioned a State of the Art Mother and Child Block which would take care of his passion for new born health, neonatology and translational research. Prof Paul’s dream Pediatrics Center would be fully operational by 2018. If its an important Medical Problem, one can be sure that there is an AIIMSONIAN working on it in AIIMS – such is their fierce motivation and emotional commitment to the societal cause. They are driven individuals, each one of them, and AIIMS provides them with the academic freedom for their creativity to blossom.
Prof Balram has been a pioneer in AIIMS whose passion for long work hours hasn’t come down even after 45 years. “If I am out of the Hospital for 30 minutes, the Hospital should realize someone is missing” is what he said. His work days commence at 8 am and goes on and on and on in Operation Theaters, as Chief of CN Center and in the Dean Office. Prof Paul, Prof Nikhil and Prof Sandeep are equally determined men who take great pride in their work. Prof Sandeep said that its his dream to fulfill India’s chronic shortages of pediatric surgical care. Prof Paul said translational including research keep him motivated.
The work hours that I have seen in AIIMS are far longer than what I have seen in most Government Institutions. In my years at the International Monetary Fund I did see economists who were equally driven but econometric analysis and monetary policy are far different from saving lives. AIIMS represents Indian society, its varying sections, each one of them coming for health care, and each one of them finding a panacea. There is no comparable representative institute in South Asia and perhaps in the World.
An AIIMS faculty attends a minimum of one international seminar outside South Asia and 4 seminars in South Asia. They get 40 days of conference travel to present their work in National and International Fora. AIIMS has a number of collaborations with major global institutes where frequent exchanges and joint research work is pursued. The AIIMSONIANS write papers by the hundreds, address global community in conferences, conduct workshops and head research teams.
Prof Paul has worked with WHO and UNICEF on an advocacy that brought neonatal health at the center of MDG4. He was also instrumental in the LANCET series publications, to create a neonatal health movement. Prof Sandeep has represented AIIMS at the World Congress of Pediatric Surgeons, at the American Congress of Pediatric Surgeons and the European Congress of Pediatric Surgery. Despite their presence at the global high table of medicine, they are simple men, sharing the empathy of India’s poorest of poor.
An AIIMSONIAN’s journey in AIIMS is roughly 45 years. From student years to retirement, the journey is one of high accomplishment, high visibility and high meritocracy. The traits described above makes them AIIMSONIANS. Their collective positive energy makes AIIMS, India’s apex Medical Sciences University.
Author is a senior civil servant, an IAS officer of 1989 batch, who served as Deputy Director Administration, AIIMS New Delhi.
The views expressed are personal and based on the research work done in the Debates Section of the Parliament Library, New Delhi, the Nehru Memorial Museum and Library, the General Section of AIIMS and interactions with AIIMS Faculty.