(World Health Forum 19,2 (1998), 196-200)
 

A.N. Safaya, Director
Sri Sathya Sai Institute of Higher Medical Sciences,
Prasanthigram 515 134,
Anantapur District
Andhra Pradesh, India
 

The Sri Sathya Sai Institute of Higher Medical Sciences in Andhra Pradesh can claim to have achieved the impossible --namely, the provision of high-tech medical services completely free of charge. Adherence to the five human values (truth, righteousness, peace, love and non-violence) and complete dedication to serve people without self-interest are the key elements for this success. This example may serve as a model for creating similar hospitals in the service of mankind.

The medical world is in a crisis owing to difficulties in keeping the costs down. In addition, controversies that challenge the ethics of modern medicine are bewildering both scientists and ordinary people in many countries. For example, euthanasia, organ transplants, artificial insemination, surrogate motherhood, abortions, prenatal sex determination, gene therapy and genetic engineering are some of the problem areas that are being discussed by specialists and governments, with no solutions in sight. The crisis is a reflection of a world in turmoil, with hardly any individual or country at peace. Values and relationships have changed greatly and there is conflict in human expectations because of uncontrolled temptation and greed for wealth and power. Any effort to build a more just and peaceful world must therefore be directed towards reforming and transforming the human character.

Spiritual concepts and religions, as practised today, are often divisive or too weak to hold together populations and protect the global society. More than ever before, there is now an urgent need for enlightened leadership and new directives to help solve the economic and other problems confronting mankind. To prepare new leaders, the Sri Sathya Sai Institute of Higher Learning was established some years ago by Sri Sathya Sai Baba, a renowned spiritual guide and teacher, for university and postgraduate education in the Arts, Sciences and Commerce. There are three campuses located in Prashantinilayam and Anantapur (in the Indian State of Andhra Pradesh) and in Brindavan (Whitefleld, near Bangalore). The most important feature of this education is the practice and propagation of five human values --truth, righteousness, peace, love and non-violence.

The need to apply these same values in health care led to a unique experiment to make modern high-technology medicine available, free of charge, to all who require it. This article describes briefly the concept and the achievements of the Sri Sathya Sai Institute of Higher Medical Sciences, often called the Super-Speciality Hospital, in the Anantapur District of Andhra Pradesh between 1990 and 1996.
 

Concept and development

The idea of providing the best diagnostic and therapeutic facilities of modern medicine to the underserved populations in a rural part of India, all free of charge and within the time-frame of a year, would be considered an impossible undertaking by any government or private organization. Yet, this is exactly what was proposed in November 1990 by Sri Sathya Sai Baba when he declared that, starting from scratch on a previously undeveloped site, a new building would be erected, staffed and equipped so that the first operations in open-heart surgery could be carried out one year later.

The story of how human effort was able to execute the "divine" will is a remarkable one. The impressive building, which rose miraculously within a six-month period, was designed by the British architect, Professor Keith Critchlow, and stands as a magnificent temple of healing, its inspiring architecture imparts an aura of divinity and peace to all who enter the hospital for investigation or treatment and to those who work there. As predicted by Sri Sathya Sai Baba, the first cardiothoracic operations were carried out successfully exactly a year after his declaration. The Super-Speciality Hospital was inaugurated by the Prime Minister of India on 22 November 1991.

This hospital is a monument to faith in the five human values mentioned above, and demonstrates compassionate loving care and selfless service in an age where high-cost specialized medicine is beyond the reach of the great majority of the world's population. A well-coordinated international effort has made it possible for every department of the hospital to have the most modern equipment and to be staffed by highly qualified and dedicated surgeons, physicians, nurses, other health care practitioners and technicians.

The hospital's development and expansion have continued since its inauguration. The departments of cardiology and cardiothoracic surgery, with all the necessary ancillary and support services, have been functioning since November 1991. A year later, in November 1992, the uronephrology department was commissioned and the unit for kidney transplantation was inaugurated a year after that. In November 1994, the department of ophthalmology was started and the Institute was accredited by the National Board of Examinations of India for the training of specialists in cardiology, cardiothoracic surgery, urology and nephrology. The Sri Sathya Sai Institute of Higher Medical Sciences is thus developing into a centre for postgraduate studies and research.

Plans for the future include the establishment of departments for neurology and neurosurgery, pulmonary medicine, oncology (cancer treatment) and ENT (ear, nose, and throat surgery). The Institute aims to cover all these areas, using modern medicine and, eventually with more than 300 beds and associated specialized clinics, will provide many essential diagnostic and curative services completely free of cost.
 

Organization and achievements

Patients are usually referred to the Institute by primary-level health promotion centres located in nearly 4000 centres of the Sathya Sai Seva Organization in all parts of India, but they are first examined and filtered through a secondary-level health centre located in the Sri Sathya Sai General Hospital, which is about 8 km away from the Institute. All patients are treated and referred back to their homes and the local Sathya Sai health promotion centre, which will provide for basic needs and follow-up.
 

Cardiology and cardiothoracic surgery

In the five-year period from November 1991 to November 1996, a total of 5345 heart operations were performed, 3052 of which were for open heart surgery (correction of congenital anomalies in children, valvular repairs, coronary artery surgery, removal of heart tumours, etc.). Some 4572 procedures were carried out in the cardiac catheterization laboratory, of which 733 were percutaneous transluminal coronary angioplasties, mitral or pulmonary valvuloplasties, and permanent pace-maker implantations. A total of 159361 outpatients were examined and treated, while over 8860 were admitted as in-patients for an average stay of 12 days. Those who had operations included 1509 students, 744 children and 1055 housewives. Mortality and infection rates have been below 2%, figures that are comparable to those in the best centres of cardiac surgery in the world. So that more patients can benefit with the available resources, the aim is to use plastic valves and other materials manufactured in India.

Three international cardiology symposia, which were organized by the Institute in February 1993, January 1994 and December 1995, were attended by leading cardiologists and heart surgeons from India and many other countries. Sri Sathya Sai Baba's addresses to the participants underlined the basic spiritual principles that should guide medical practice in the Super-Speciality Hospital and all hospitals everywhere. Leading personalities like the President of India and Ministers of Health also attended some of the proceedings.
 

Uro-nephrology and ophthalmology

In the past four years (1992-1996), a total of 47 396 outpatients were examined and investigated in the uro-nephrology department. Over 5652 surgical operations were performed, 4286 kidney dialyses, and 71 kidney transplants.

The ophthalmology department provides total eye care including vitreo-retinal surgery, laser treatment, photo-coagulation and cryosurgery. A sophisticated eye bank is being set up to serve the many cases of corneal blindness. In the two years since 1994, 28245 outpatients have been examined, investigated and treated; 2525 operations were carried out for eye trauma, corneal transplantation, and vitreous and retinal diseases.
 

Lessons

The Sri Sathya Sai Institute of Higher Medical Sciences shows how state-of-the-art diagnosis and treatment in medicine and surgery can be provided to patients completely free of charge. The whole project was funded by donations, went into a Trust that paid for the capital costs (buildings, equipment, etc.) of approximately US $75 million, and covers the running costs (drugs, staff salaries, etc.), which amounted to about $2 million for 1996. Income from a separate fund of approximately $30 million, which is managed by the the Trust, pays for the monthly running costs. Ideally, another fund, based on donations should be established for spares and replacement of costly equipment due depreciation. The hospital benefits from services volunteered by skilled professionals and others for periods of a few weeks or months; and the Trust continues to receive donations. The difference from other similar ventures lies in the basic spiritual concept that is the very foundation of this project --namely, adherence to the five human values of truth, righteousness, peace, love, and non-violence.

The Institute's message for shaping policies for health care delivery can= be summarized as follows:

• Globalization. Advice and treatment be freely available from any medical institution on a global basis as the birthright of every human being who falls ill.

• Decommercialization. The healing arts and treatment of all patients should not be marketable commodities for making profit. The cost of medical care should be absorbed by society and kept at an affordable level.

• Humanization. The human agents of health care delivery (health administrators, doctors, nurses, and technicians) should adhere to the five human values in their thoughts, words and deeds because it is not the building or equipment that makes a good or bad hospital, but the people who work there.

• Spiritualization. Modern medicine attempts to take care of the physical, mental and psychological health of individuals and populations, but to become holistic it must recognize the Spirit as the "driving force" behind every human being.

This article appeared in the World Health Forum 19, 2 (1998), published by the World Health Organization, Geneva, Switzerland. WHO Distribution and Sales, 1211 Geneva 27, Switzerland.  Fax: (41 22) 791 4857.

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