Bigger and healthier

The Tata Medical Center in Kolkata has expanded to better fulfil its mandate — providing inclusive and top-notch cancer care

It looks like a shiny corporate establishment, has a cadre of first-rate professionals dedicated to delivering high-quality care, and its services come swaddled in empathy and an acute understanding of the realities of India. The Tata Medical Center (TMC) in Kolkata is one of its kind, an institution where the care of cancer patients happens in a manner and in an environment far removed from the typical.

Set up in May 2011, TMC is clocking ever more miles in the quest to find its very own sweet spot in cancer care. What this means, essentially, is securing the resources to treat a greater number of patients who cannot bear on their own the bankrupting burden imposed by a disease that remains an ogre, relentless in character and dreadful to battle.

Viable and sustainable

To accomplish that while remaining viable today and sustainable in the days to come is the hard challenge TMC faces. The degree of difficulty is made steeper by the unyielding march of cancer in the region — east and northeastern India — that the Center serves.

The riptides have had an effect on the model of cancer care TMC swears by, but that has not dragged it into deep waters. TMC took in more than 18,500 new patients in 2018 and it currently handles in excess of 1,200 outpatients a day. The majority of these patients have had their treatment subsidised to some extent, and the Center has still managed to stay in safe, if not shiny, financial health (it expects to have a surplus of more than 100 million at the end of 2019-20).

Created by the Tata Trusts, with contributions coming in from Tata companies as well, TMC is in superior shape now to fulfil its mandate. A phase II renewal, completed in January 2019, has raised the Centre’s capacity to 437 beds, enabling it cope better with an unending rush of patients. The consequent need for further finances to continue helping the underprivileged among them is always an accompanying factor.

“The cost of treatment for most cancers is pretty high and unaffordable for the average Indian family,” explains VR Ramanan, the deputy director of the Center. “Most of our costs, including bed tariffs and medicines, are highly subsidised and we offer a lot of funds, which we receive from donors, to poor patients. But in spite of that our patients struggle for financial support.”

A second issue, adds Dr Ramanan, is getting the “right-minded doctors, nurses and other technical staff” for the cause. “The job can be demanding and we can never match the salaries offered by corporate, or even government, hospitals,” he adds. “Our attrition rates are a big bother.”

There is also the obligation for TMC to maintain its status and its standards as an academic and a research centre of the highest order. “This requires plenty of resource inputs and, given our present condition, it has brought us to stretching point,” says Dr Ramanan. There are inherent advantages that TMC can draw on, though, not least with the people in its ranks.

Doctor-centric as well

“We have a patient-centric approach, for sure, and a doctor-centric approach as well,” says Manas Roy, a surgeon who has been with TMC from before it became functional. “In contrast to corporate hospitals, the doctors here don’t have financial targets to meet. We don’t do any private practice and there is a trustworthy team to cushion the impact of work.”

Tough decisions are routine for Dr Roy and he has the personal experience to guide him. “Oncology is not like a buffet; we have to pick and choose and it’s complicated with the terminally ill. My dad had severe brain cancer and I chose to stop chemotherapy due to the side effects. I believe the experience made me a better doctor. I can relate to those in similar situations.”

Moses Arunsingh, a radiation oncologist with TMC for 18 months, sees the patient-doctor equation at the hospital through the lens of a training stint he had at the Leeds Cancer Centre in the United Kingdom. “We had about 15 patients a day there, 20 maximum; here I am responsible for 70-80 patients every day,” he says. “Also [since the British government’s health service covered it], I did not have to worry about affordability or expenses while prescribing treatment. In India, affordability is the key. Everybody is spending out of their own pocket.”

Nursing superintendent Piyali Bose points to the psychological strain of caring for cancer sufferers. This springs from the state that patients and their caregivers slip into. “People detected with cancer are severely stressed and so are their family members, and deaths are frequent,” she says. “Preventing the burnout of nurses is crucial, because being a nurse in a cancer hospital can be exhausting. Night shifts — the silent hours, as they call it — are particularly daunting.”

A few months back, Ms Bose had an even more daunting problem to deal with. This happened when TMC lost 175 nurses over three days after the whole lot left to take up state government jobs offering higher pay scales. “We extended the work timings of those who remained, we stayed back, we moved on,” says Ms Bose, who heads a team of 484 nurses, 83 of them men.

The exodus of nurses is likely to continue as West Bengal inducts more of them into its government hospitals setup, but TMC is determined to not get caught out the next time. “We broke down the job description of our nurses and we realised they were handling plenty of non-clinical work,” says senior medical administrator Aseem Mahajan. “We took that away from them and that has eased their load.”

Improvisation aside, the impulse to improve is not lost on TMC. “We certainly can get better, our doctors included,” says Dr Mahajan. “We need to train our doctors, nurses and other staff even more in customer care. Every cancer patient comes with a lot of anxiety; we have to handle them correctly. This also depends on the stress that our staffers undergo while at work. If we are overcrowded and handling too many patients, it doesn’t leave much time for good communication.”

The front office at the Center is always a crowded place

Bonding with patients

“We try to do our best but we are also human,” says Manideepa Ghosh, a nursing supervisor with TMC since 2013. “Patient care at a cancer centre is never easy, but what strikes me most about this place is the bonding between patients and staff; you don’t see that at many hospitals. As for the pressure here, it has become part of my life.”

The future for TMC looks promising, and just as challenging as what has passed. The expansion programme has brought a bunch of benefits beyond the desperately wanted enhanced capacity. The Center can now take in student doctors for speciality training programmes; equipment and technical know-how have been upgraded; and there’s a floor exclusively for children. A custom-built laundry, a modern kitchen and extra resources for sterilising operations and robotics surgery have been provided.

The facilities TMC already had in place have profited, too, from phase II. Premashraya, the cut-price residential facility for cancer patients and their families, has an improved paediatric wing and the Center has made dedicated space, at a site adjoining its 13-acre campus, for the Tata Translational Research Centre, where the objective is to improve research quality and output by bridging and blending clinical and laboratory research.

The end goal for TMC continues to be cast in stone: inclusive, exemplary and cost-effective cancer care, particularly for poor patients. And this can be an archetype for India. “I wish more hospitals are modelled along these lines; it would be a boon for the country,” says Dr Roy. “My frustration, as a doctor and as an Indian, is that there aren’t more such institutions.”

The daycare nursing station at the hospital