THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 7, NO.2, 1994

Indian Medical Colleges

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Maharani Laxmi Bai Medical College and Hospital, Jhansi

B. L. VERMA, G. D. SHUKLA

HISTORYThe Maharani Laxmi Bai (M.L.B) medical college, Jhansihas just completed 25 years of its existence. It was createdin 1968 to cater to the needs of the Bundelkhand divisionwhich includes 5 districts of Uttar Pradesh-Banda, Jalaun,Jhansi, Hamirpur and Lalitpur. The institution stands as afitting tribute to three great women-Maharani Laxmi Bai,the legendary Rani of Jhansi , after whom it has been named;Dr Sushila Nayar, the Union Health Minister and a Memberof the Lok Sabha from Jhansi, who conceived, nurtured andexecuted the idea of opening a medical college in one of theleast developed regions of Uttar Pradesh and ultimately laidits foundation stone on 16 December 1965; and Mrs IndiraGandhi, the late Prime Minister, who formally inauguratedthe college and the associated hospitals on 14 April 1973.

Even as the construction of the college building was inprogress, the first batch of 50 MB,BS students was admittedto the Lala Lajpat Rai Medical College, Meerut in 1968. Itwas in 1970, when Dr S. K. Saxena joined as Professor ofAnatomy, to coordinate the activities of this nascent institu-tion, that regular admissions of students were started and thestudents in Meerut were transferred.

THE BUILDINGSThe college is spread over a walled area of 380 acres and isperhaps the biggest medical college campus in the country.The buildings are grouped into 4 blocks-the teaching block.the hospital block, the residential block and the maintenanceblock.

The teaching block consists of 3 interconnected wings. Thefront wing houses the main administration building, thecentral library, the department of microbiology and anauditorium with a capacity of 450. The middle and rear wingsaccommodate the departments of anatomy, physiology,biochemistry, social and preventive medicine (SPM),forensic medicine, pathology and pharmacology, 3 lecturetheatres and an examination hall. This block also includes apostmortem building, and an animal house and 'froggery'which are used for experimental research and teaching.

The hospital block consists of 2 main interconnectedwings. The front wing houses the general outpatient area, thecasualty ward, the hospital administration, the blood bank,

M. L. B. Medical College, Jhansi 284128, Uttar Pradesh, IndiaB. L. VERMA Biostatistics UnitG. D. SHUKLA Psychiatry Unit

Correspondence to B. L. VERMA

© The National Medical Journal of India 1994

the medical records section and various clinical departments.Close to it, there is a separate single-storeyed buildinghousing the department of obstetrics and gynaecologyand the postpartum programme. The four-storeyed rearwing houses \0 indoor wards, each with a 58-bed capacity,centrally controlled by the nursing staff, as well as a medicalofficer's duty room, acute room and a laboratory. Close tothis wing are located the hospital kitchen. four fully equippedoperation theatres and private wards. There is also aDharamsala (rest house), and a chemist's shop withinthe hospital premises.

The residential block includes bungalows for the Principal,the Chief Medical Superintendent and the Senior Matron;flats for the senior teaching faculty. resident doctors andnon-teaching staff. four hostels for boys, one for girls anda nurses' hostel.

The maintenance block includes the offices of the depart-ments of horticulture. electricity. water supply and sewerage.The installed water supply has a storage tank with a capacityof 46 lakh litres and an overhead tank (9 lakh litres). It isdependent on the Babina water works as well as on two tube-wells. There is an independent sewage disposal systemthrough a pumping station and two oxidation ponds situatedoutside the boundary wall. The separate maintenance build-ing houses a primary school, a branch of the State Bank ofIndia and a post office.

FIG 1. Maharani Laxmi Bai-the legendary Rani of Jhansi ,after whom the medical college and hospital is named

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THE ADMINISTRATIVE SET-UP

As in other medical colleges in the State. this college is underthe administrative control of the Government of UttarPradesh. The Secretary and the Director. Medical Educationand Training, Uttar Pradesh. regulate its functioning at theState level. Locally. the Principal is in charge. However.the day-to-day working of the hospital is controlled by thePrincipal Medical Superintendent who has some independentadministrative and financial powers.

Principals of the college

The development of any institution depends on thedynamism and stability of the head of the institution. Ourinstitution has been unfortunate because since its inception,there have been 19 Principals who have worked here forvarying times.

This instability has adversely affected the developmentand functioning of the institution in many ways. Thus strongadministrative control. concerted efforts to increase the staffand annual budgetary allotments. and adequate steps tostrengthen the teaching. research and curative serviceshave been lacking. During the temporary tenure of somePrincipals. only routine activities were pursued withoutany improvement in working conditions.

Staffing posuionThe staff of the college and the associated hospitals can begrouped into teaching (96 gazetted and ISO residents) andnon-teaching staff (20 gazetted and 775 non-gazetted).

ACADEMIC COURSES

The college's primary aim is to provide teaching and trainingto undergraduate (MB.BS) and postgraduate (MD. MS andDiploma) medical students. Admission to the MB ,BS courseis regulated by the State Government through a combinedpre-medical test. The admission capacity for the MB,BS

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FIG 2. Dr Sushila Navar. former Union Health Minister ofIndia, who played a key role in creating the medical collegeand laid its foundation stone on 16 December 1965

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 7. NO.2. I'N4

degree was 50 till 1972. it was increased to 100 in 1973.but in 1976 it was again reduced to 50. The total number ofundergraduate students in the college is now 437.

Postgraduate courses are conducted by the college inalmost all the departments (except in biochemistry. forensicmedicine. tuberculosis and chest diseases. psychiatry. skinand venereal diseases and dental surgery). Admissions tothese courses were regulated initially by the college andthereafter by the State Government till 1989. Since 1990.however. such admissions are made through an All IndiaPostgraduate Medical Entrance Examination. held everyyear. This college is also a centre for training nursing staff.laboratory technicians. ophthalmic assistants and dentalhygienists.

University affiliations

In 1971. the college was visited by experts from KanpurUniversity and on their recommendation the State Govern-ment declared it to be a constituent college of that Universityand it remained so till 1978. Later, with the establishment ofthe Bundelkhand University at Jhansi, the college becameaffiliated to it in April 1979. The Medical Council of Indiagave permanent recognition to the MB.BS degree in March1979 and granted permission for starting postgraduatecourses in different specialties in 1980. However. only twodcgrees-MD (medicine and anaesthesiology) have beenrecognized so far. In other specialties. inspections are eitherstill due or their outcomes not known. The University GrantsCommission recognized the College in 1985 and providesfinancial assistance.

Library facilities

The college library is spread over an 850 square metre areaand has a capacity for 100 readers. There are 8755 books.4780 volumes of journals and over 160 theses. Ninety-sixIndian and foreign journals are being subscribed to and thereis other literature from several international and national

FIG 3. Dr S. R. Kapoor, the Founder-Principal of the college

INDIAN MEDICAL COLLEGES

agencies. Facilities for microfilm reading and photocopyingare also available. The special services of the library includea Book Bank Scheme for students from the scheduled castesand tribes, a MEDLARS service from the National Informa-tics Centre and procurement of literature through theNational Medical Library, New Delhi and the World HealthOrganization. The Government has been providing anannual grant of just Rs 2 lakhs for journals and this budgetallotment is apparently being increased many times this year.

THE HOSPITAL SERVICES

The hospital provides comprehensive services to the peopleof the Bundelkhand Division of Uttar Pradesh and the fouradjoining districts of Madhya Pradesh. It has a total bedstrength of 664, including 20 beds in the casualty ward and10 paying beds in the private ward. There are 138 beds forgeneral medicine, 140 for general surgery, <)0 for obstetricsand gynaecology and 40 for paediatrics. Inpatient bedfacilities are also available for tuberculosis and chest diseases(26), psychiatry (20), skin and venereal disease (18), leprosy(20), otorhinolaryngology (26), orthopaedics (48), ophthal-mology (56) and dentistry (4). There are 4 sick rooms eachfor students and nurses.

The hospital has 4 air-conditioned and well-equippedoperation theatres with closed-circuit television facilities forstudents. Besides the major departments. the hospital hasspecialized units for dialysis, coronary care and neurology.The rural and urban health training centres of the collegeprovide curative. preventive and promotive health careservices to the populations in their field practice areas.Family welfare services arc provided by the departments ofgeneral surgery. obstetrics and gynaecology and the post-partum programme. The medical records section maintainsa manual information system, calculates outdoor and indoorhospital statistics and deals with the registration of births anddeaths. Mobile teams from the hospital provide familywelfare and eye care service through camps.

MAJOR ACADEMIC ACHIEVEMENTS

The academic contributions of the college have been diverse.Rooks. The books written or edited by the staff include

Clinical sangyaharan pravesika (Hindi). Anaesthetictechniques and Sangyaharan me takniki sahayata (Hindi)by B. C. Joshi; Dant samasya samadhan (Hindi) by R. P.Srivastava: Viva-voce and short-notes in biochemistry,Prayogatmak jeev rasayan vigyan (Hindi.). A textbook of

FIG 4. A view of the out patient block

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biochemistry and M CQ 's in biochemistry by S. P. Singh; Prin-ciples and practice of statistics in medicine and Biostatistics:Perspectives in health care research by R. N. Srivastava,B. L. Verma and G. D. Shukla; Medical jurisprudence andtoxicology by Bernard Knight and S. K. Bapat; and Cancer:Causes and cure and AIDS: Causes and prevention byT. B. L. Jaiswal.

Iournals. The college has been the headquarters of thefollowing medical journals: J Indian Assoc Commun Dis(\ lJ80-85). 1 Anat Sci (llJ86-88). and 1 Anat Soc India (sinceI<)<)()).

The book review section of the ISMS Newsletter-a publi-cation of the Indian Society for Medical Statistics, is editedhere.

Research. The institution has undertaken several projectswith funding assistance from national and internationalagencies such as the World Health Organization, the IndianCouncil of Medical Research. the Uttar Pradesh StateHealth Institute. the Central Council for Research inAyurveda and Siddha and the Government of India. How-ever, institutional funding for research is not available.Thus it is either dependent on external funding or on self-financed studies.

In spite of this we have produced a considerable amount of'quality' research. Reddy et al. I evaluated the quality of theresearch output of 128 medical institutions in the country inIlJ<)I, based on the number of times the papers publishedfrom the institution were cited and our college achieved therank of 37, with about 6 'quality' publications per year.Considering the constraints under which we work, it is nota bad performance.

Among the research projects completed or being carriedout are: (i) Health benefits of water supply in a rural areaof Uttar Pradesh. (ii) General morbidity and mortality in arural area of Jhansi , Uttar Pradesh, (iii) Toxicological studies011 indigenous drugs. (iv) Monitoring adverse drug reactions,(v) Survey of endemic goitre and cretinism in Jhansi, Lalitpurand Harnirpur , and (vi) Monitoring and evaluation of theNational Immunization Programme by involving governmentmedical colleges.

The research areas in which major contributions have beenmade include epidemiology. medical statistics. environmen-tal health. immunology, psychiatry, diarrhoeal diseases,nutrition. lipids. heart diseases and dentistry. Several of ourfaculty members have been actively involved with medicaljournals as editors. advisers. book review editors. members

FIG 5. The regional health and family welfare training centreattached to the medical college

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of the editorial board and referees. Some teachers have beentrained abroad under the WHO and the CommonwealthFellowship Programmes to undertake further research intheir subjects and some have been given awards for theircontributions.

Scientific meetings. The college regularly organizes inter-national, national and regional scientific meets.

Others. The college has made considerable efforts todevelop medical statistics on a national level. 2 These includethe organization of a national scientific meeting of bio-statisticians and doctors in 1983, establishing a nationalsociety, namely, The Indian Society for Medical Statistics.This institution has also served for 6 years (1983-88) as theheadquarters of the ISMS and regional headquarters for theSoutheast Asia branch of the International EpidemiologicalAssociation (1985-90).

CURRENT PROBLEMSIn these days of financial hardship, the state government,which is responsible for health expenditure, finds it difficultto make the required budgetary allocations. This has givenrise to several problems affecting medical education and thequality of medical care.

Our major problems are an inadequate teaching staffand managerial lapses. For example, the posts of thePrincipal, 9 Professors, 5 Associate Professors and 16 Assis-tant Professors or Lecturers have been lying vacant for 3 to7 years. The whole recruitment process has almost come to astandstill. Posts falling vacant owing to retirement or transferare not being filled. Several departments are being headedby Assistant or Associate Professors, and some have onlyone or two teachers. This has adversely affected teaching,research and patient care.

With the implementation of the 3-year residency schemein the state medical colleges, the strength of junior doctorshas been drastically reduced, so that there are many depart-ments with hardly any residents. Further, as postgraduateadmissions are now being regulated through an All-IndiaCompetitive Entrance Examination, the unpopular basicscience departments have few postgraduates.

Essential drugs are often not available and as themaintenance sector is inadequately funded, the upkeep ofthe roads, buildings, and the electrical and security systemsare neglected. Even common amenities such as computers,echocardiography and ultrasound machines, autoanalysers,emergency X-rays, CT scan as well as psychological testingand behavioural therapy are not provided. There is only oneworking telephone in the hospital which is locked after officehours. The transportation department is poorly equippedand there is no proper hospital information managementsystem.

Only a few months ago, the President of the IndianMedical Association (Jhansi Branch), in his address on the'Plight of public hospitals in Uttar Pradesh';' reviewed thepoor working conditions of medical colleges and othergovernment hospitals of the state and focused attention onthe facilities and the general condition of the hospital. Heenumerated some major problems regarding creation of new

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 7, NO.2, 1994

jobs, filling the vacant posts and providing grants tocontinue even the routine hospital facilities. He pointed outthat even after 25 years of its establishment there was noelectrocardiography technician. He mentioned severalreasons for this, including a lack of political will, the unevendistribution of government funds amongst medical collegesof the State and the faulty system of selection and promotionof the teaching faculty. Further, two recent incidents+" havehighlighted the prevalent indiscipline amongst students andserious law and order problems on the campus. This has beendue to the unsatisfactory teacher-student as well asdoctor-patient relationships. Several remedies have beensuggested, including performance evaluation on an annual ora 5-yearly basis.

CONCLUSIONOur government hospitals, which are not expected to raisetheir own resources, have to manage within the limitedannual public grants allocated to them. Thus, there is littleincentive to try to increase patients' attendance by improvingservices. Because of the medical college's policies and deficitfunding, its future is uncertain. The facilities for investigationand care are inadequate, while better facilities are beingdeveloped in the private sector. In Jhansi there are 5 privatediagnostic centres with facilities for ultrasonography andechocardiography. Even smaller local hospitals such asthe Bharat Heavy Electricals hospital with an indoor capacityof about 25 beds, the Railway Hospital, and St Jude'sHospital have these facilities." The medical college hospitalwith a bed strength of 664 docs not have these even after25 years of its creation. 3

If this state of affairs continues and effective steps arenot taken, our medical college will soon become a 'whiteelephant' where, due to the higher expectations of patients,the law and order problem might increase.

A positive change will require concerted efforts of both thecollege and the State Government. A strong Principal,whose tenure is for at least 5 years and who is given a biggerannual budget, must make decisions and improve the qualityof work in every sphere focusing attention on priority areas.Otherwise, the future of the medical college in Jhansi isbleak.

ACKNOWLEDGEMENTSDr S. R. Kapoor. former Professor of Physiology and Founder-Principal of this college helped us to prepare the article. We alsothank Dr V. K. Kulshrestha , Professor of Pharmacology and the presentPrincipal for his valuable suggestions and for reading the manuscript.

REFERENCESReddy KS. Sahni P. Pande GK. Nundy S. Research in Indian medical institutes.Natl Med J India 1991 ;4:9(1-2.

2 Verma BL. The development of medical statistics in the Indian sub-continent:A challenge to the Indian Society for Medical Statistics. Biometric Bull 1989;6:16--7.

3 Jain PK. Plight of public hospitals in Uttar Pradesh. IMA News (Jhansi Branchof 1MA) 1993;2:1-2.

4 Singh SP. Examination reforms for undergraduates and postgraduates: A needof the day. Indian J Medical Edu 1987;26:103-5.Singh SP. Health of medical campuses: A concern of Me!. Indian Med Gazette1992;76:233-4.