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Indian Medical CollegesTHE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 6, NO.3

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

s. R. NAIK

INTRODUCTIONThe All India Institute of Medical Sciences, New Delhiwas Independent India's first attempt at achieving highlevels of undergraduate and postgraduate training than werepossible in the state medical colleges of that time. Itssuccess was followed by another equally important effort, thePostgraduate Institute of Medical Education and Researchestablished at Chandigarh in the 1960s which was dedicatedpurely to postgraduate medical education. Both theseinstitutes have achieved high standards and produced com-petent teachers for the rest of the country. They have alsoset new standards in patient care and research. Although theGovernment of India received credit for conceiving andexecuting these projects, it was also criticized for havingshifted its focus from primary care and for having sunk a lotof public money into these 'white elephants'. Therefore,nearly two decades later when the Government of UttarPradesh decided to launch a similar venture, the by nowfamiliar debate was repeated. However, another importantquestion this time was whether the government shouldupgrade an existing state medical college or whether it shouldbuild an institute on an entirely new location. At thistime the health infrastructure of the state and the country aswell as the aspirations of the population had undergonemajor changes with the massive inputs of high technologymedicine. The new instruments were expensive and mostpublic institutions found themselves lagging behind thethriving private sector in acquiring them. This promptedthe Uttar Pradesh government to consider starting a post-graduate institution devoted to advanced tertiary healthcare delivery.

EARLY PLANNINGIn July 1980, the Government of Uttar Pradesh appointeda committee headed by Dr D. N. Sharma which submittedits report in December 1980 and the President of India,Shri N eelam Sanjeeva Reddy laid the foundation stone of theSanjay Gandhi Postgraduate Institute of Medical Sciences inthe campus of the King George's Medical College atLucknow. TheD. N. Sharma committee report was reviewedby another committee consisting of some secretaries to theGovernment of Uttar Pradesh and the Principal of the KingGeorge's Medical College. On the basis of this committee'srecommendations the state government decided to establishthis new institution to be an apex body in medical educationat the state level and which, as a deemed university, would

Department of Gastroenterology, Sanjay Gandhi PostgraduateInstitute of Medical Sciences, P.O. Box 375, Lucknow 226001, India

© The National Medical Journal of India 1993

award its own degrees. It was planned that in a phasedmanner all the other medical institutions in the state wouldform its constituent units. Another important decision takenwas. that the Institute would concentrate on postgraduateteaching and tertiary health care with its hospital being runas a purely referral centre. Subsequent to this decision, ateam of experts was sent to medical institutions in the USA,the UK and Sweden. Among the prominent institutionsvisited were the National Institutes of Health, Bethesda,USA; the Royal Postgraduate Medical School, London, UK;and the Karolinska Institute, Stockholm, Sweden. It waseventually decided that the Institute would be planned inthree phases. The first phase would include six super--specialties namely: (1) Cardiac sciences, (2) Neurosciences,(3) Gastroenterology, (4) Renal sciences, (5) Endocrinology,and (6) Genetics and Immunology. The first phase ofdevelopment would include establishment of a 600-beddedhospital, and provision of training for postgraduate medicalstudents at the DM, MCh and PhD levels. The Institutewould provide high quality tertiary health care, teaching anddo research. The same general policy would be followed forthe development of the next two phases ofthe Institute, eachof which would thus have 600 beds along with its own supportfacilities. The specialties to be developed in the subsequentphases would be decided later. '

INITIAL STEPSThe project report was submitted to the Government ofUttar Pradesh in January 1982 and it was decided to locatethe Institute in Lucknow because the city had a central loca-tion in the state, it had already established itself as a centre oflearning and had several good scientific research institutionssuch as the Central Drug Research Institute, Industrial

FIG 1. View of the hospital entrance

INDIAN MEDICAL COLLEGES

Toxicological Research Centre and the Central Institute ofMedicinal and Aromatic Plants. Five hundred and fifty acresof land were acquired on the Lucknow-Varanasi highwayabout 15 km away from the main city. The architectural andconstruction work was entrusted to the Uttar PradeshRajakiya Nirman Nigam, Lucknow. A budget of Rs 200crore was allotted and construction of the different buildingsbegun. Dr B. C. Joshi was appointed the Project Director.At this time, the Government of Japan offered the Institutean equipment grant of Rs 30 crores in two phases as part of apolicy of international cooperation. This gave the develop-ment of the Institute a timely boost. In 1985, Dr B. B. Sethi,the Principal of the King George's Medical College,Lucknow was appointed the first Director. A series oforganizational steps gradually established the Institute, vari-ous buildings came up and staff members were recruited.The initial difficulty in attracting faculty who were workingin other major institutions was partly overcome by offeringthem pay scales similar to those at the All India Institute ofMedical Sciences as well as other incentives like free housing,free membership of-scientific societies and financial supportto attend national and international scientific conferences.The first batch of about 25 faculty members joined theInstitute in and around June 1987; the faculty strength isnow over 90.

HOSPIT At SERVICES, TEACHING AND RESEARCHThe hospital activities started in phases-outpatient servicesin August 1987, inpatient services in January 1988 and opera-tion theatre services in January 1989. The first batch ofsenior residents was recruited in July 1988 after an all Indiaentrance test. Because the cost of tertiary care medicine isnow high, it was decided to levy subsidized charges for thevarious patient care facilities. At its full utilization capacity,the hospital is expected to generate enough funds to meet therecurring costs of maintaining its sophisticated equipment.

The postgraduate courses for the degrees of DM inGastroenterology and Immunology, MCh in Neurosurgeryand Urology and PhD were started in January 1989. DMcourses in other specialties such as Cardiology, Nephrology,Endocrinology, Neurology, Medical Genetics, and MCh inCardiovascular and Thoracic Surgery and GastrointestinalSurgery were also initiated in subsequent years as adequatefaculty staff, patient workload and other physical facilitieswere raised to the levels required for running such courses.In addition, MD courses were approved in Transfusion

FIG 2. Outpatient block. The lO-fioor ward block building isseen in the background

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Medicine, Nuclear Medicine and Radiology. A novel featureof all the Institute's courses was the introduction ofcompulsory basic background training in ancillary fieldssuch as statistics and computer science, molecular biology,medical ethics, scientific communication skills, electronicsand medical physics. It was considered that although know-ledge of these areas was essential for students of all thecourses, it was unlikely that any single department wouldbe able to run them. The Institute has since its inception,considered medical research to be an activity which wouldguide all its functions. The first step to promote this was toallocate a sum of Rs 30 lakhs annually for intramuralprojects. Publication of two research papers was made acompulsory requirement for all DM, MCh and MD degrees.

PRESENT STATUSThe Institute has only partially realized its aims. Of the firstphase buildings, the auditorium, lecture theatre complex,library, animal house and sports complex as well as hostelsand some of the residential buildings have yet to be built.However, the hospital services of all the first phase depart-ments have been established and are running well. In a statewhere superspecialty health care has so far been poorlydeveloped, all the departments of this new Institution havebecome popular and patient numbers have steadily increased.

The Centre of Renal Sciences runs one of the finest dialysisprogrammes in the country and offers live-related-donorbased renal transplantation. However, the programme wasstarted by using a cadaveric graft and our team has recentlydone two more such cadaveric transplants. The Institute iseagerly waiting for a change in the law so that brain death isrecognized and will then run a regular cadaver-transplantprogramme. The Renal Sciences Centre has also been thefirst in this country to provide comprehensive treatmentto patients with urolithiasis and offers percutaneous andendoscopic extraction of stones, shock wave lithotripsy andsurgery.

The Centre of Gastroenterological Sciences has modern. diagnostic facilities including endoscopic ultrasonography

and a manometry-cum-24 hour oesophageal pH monitoringfacility. It has a well equipped endoscopy theatre andperhaps leads the country in having the most organizedprogramme for treatment of gallstone disease using theendoscopic and percutaneous therapeutic methods, extra-corporeal shock wave lithotripsy and laparoscopic surgery.It has had considerable experience in treating patients

FIG 3. View of the administrative block

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with high bile duct strictures due to either benign or malignantdisease.

The Neurosciences Centre has an array of neurophysio-logical investigations including the ability to measure visualevoked potentials. It has well equipped neuro-otological andneuro-ophthalmological sections and a brain mappinglaboratory. The Cardiac Sciences Centre has laboratories forinvasive and non-invasive diagnosis and an impressive recordof open heart surgery for congenital and acquired heartdisorders. The Endocrine Disease Centre performs assaysfor most hormones and has an active programme for juvenileand adult diabetes, parathyroid disorders and endemicgoitres. The Institute has also established the first full-fledgedDepartment of Endocrine Surgery in this country. It has alsostarted the first full-fledged Centre for Immunology andMedical Genetics, which has an active programme for theinvestigation and treatment of rheumatological disorders,immune deficiency diseases, the thalassaemias and othergenetic disorders.

The Centre of Radiological Sciences uses all the modernimaging techniques including magnetic resonance andcomputerized radiographic imaging and performs manyinterventional procedures. It is also one of the few centresin the world where magnetic resonance spectroscopy is avail-able and is used to generate research data. The NuclearMedicine Department has gamma cameras, aSPECTscan and equipment to measure bone densitometry. TheDepartment of Radiotherapy is equipped to provide awide variety of therapeutic modalities and has a dual energylinear accelerator, simulator, high dose rate remote afterloading unit and a computerized treatment planning system.The Institute's Laboratory Sciences Centre has a fullyautomated clinical chemistry laboratory as well as histology,haematology and microbiology laboratories and a trans-fusion medicine department, which runs a voluntarydonor-based blood bank.

The referral character of the Institute is now known tomost doctors in Uttar Pradesh and other neighbouring states.Since this has been the first attempt in the country to estab-lish a referral network at the tertiary level, its success orfailure is likely to be watched with interest by health serviceplanners in other developing countries.

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL.6, NO.3

It is difficult at present to claim that the project has beensuccessful. To achieve this, the Institute has to further directits efforts to educate doctors at primary and secondary tiers:

1. regarding the value of a referral network2. that referred patients should carry better documentation

of their previous medical histories3. that the problem for which a specialist's help is sought

should be precisely stated4. that the continuing care of the patient is predominantly

the role of the referring doctors and not of the referralcentre.

The pioneers of this Institute have a unique opportunityof creating a new order in this country, since no existingmedical institution has addressed these problems.

There are many areas where the Institute has not been ableto fulfil the high expectations of the public. The hospitalhas not yet been able to activate more than 360 of the 600beds it was expected to have in use by now. The intensivecare and the day care beds have yet to be activated. Themodern 12-operation theatre block is yet to be completed.The departments now have the basic infrastructure andnecessary staff, but still have to move forward in the direc-tions of their projected thrust areas. The basic componentsof most clinical departments need strengthening. Animportant section of patients seeking superspecialty carebelongs to the neonatal and paediatric age group and thesehave not been adequately provided for.

EPILOGUEThe Sanjay Gandhi Postgraduate Institute of MedicalSciences is now established as the latest star among Indianmedical institutions. This was inevitable because of severalunique features that set it apart from others. It is still at avery early stage in its development and has a long way ahead.As a tertiary care institution, it remains isolated withoutadequate support at the secondary level. Thishas to developfrom either the existing medical institutions or be builtafresh. Lastly, although it has a constitution which guaran-tees it autonomy, it has not yet been able to free itself fromthe usual bureaucratic stranglehold that exists in India andthis has already interfered with its rate of progress.