Mission hospital - towards developing a model

I have been an ardent proponent of the concept of "Mission hospital".I see the "mission" of the hospital as not only a conduit for a healthcare which provides justice , compassion and ethics, it should also be a birthplace of an alternate society with ideals and emotions which gives hope and healing to the society as a whole.The genesis of these hopes and ideals are not merely rooted in mere humanism but are the offspring of the divine seeds sowed in the minds of the individuals who take up the cause of these mission hospitals.The hospitals are seen as portals of transformation for those who enter it.

However the conceptual running of these hospital is wrought with various challenges.The government and civic bodies do not want these structures to flourish and see it as a challenge to its nationalistic ideals which are very self serving,intolerant and bigoted to say the least.The mission hospitals itself irrespective of the extraneous influences find themselves in rocky boats ,struggling to find a direction for the future.At this juncture some of the debates center around which kind of model is best suitable for the mission hospital.Some of the proposed models include

1. Community health and development /intervention - based model 
2. Primary health care model 
3. Institution based technocentric model - secondary and tertiary care
4. Hospitals as just a launch pad for propagating a particular religious / sectarian agenda /development in other spheres

I have been privy to witness the functioning of all these models in mission hospitals .Having heard the various debates about the pros and cons of each and every model the common consensus is that our country needs a robust primary health care / community based health care which would touch the roots of the problems in the community via healthcare and its the key solution for the ills of the nation.In fact the common rhetoric among the policy makers is to reclaim the health care from the so called "ivory towers" called the hospitals.A recent interesting article by Dr Soham captures this spirit beautifully.Though i agree to this concept on a broader scale i find some objections to its generalisation in a mission hospital setting.

Firstly , promotion of "Models of healthcare" is treated very rigidly with an absolute end in itself.Meaning once a model is designated or destined for a hospital its written on a rock with less room for flexibility and every individual is made to morph into the model irrespective of what they are made of.The model becomes greater than the individual.Instead of asking every individual to comply to a particular model of care is it possible to rephrase the question what is the best model for  this particular group of individuals and reposition the model for the sake of the individual thereby creating diverse models (even out of the box) with unified purpose.Every model of health care is conceived in an anticipation that all the stake holders will have a common interest in the model thereby ensuring participation and promotion of a particular model.Unfortunately truth is far different than what we would like it to be!This is true both within the government and also in mission hospitals.Most of the stakeholders(health and development professionals) in government and (sadly) in mission hospitals are happy to be just a fuel to the system irrespective of which direction the system goes!So the system decides to enforce a set of rules ( the compulsory rural govt postings,bond etc )to make the stakeholders as (fuel) in order for itself to sustain and run.So my argument is instead of trying to enforce law and make the stakeholders comply in bondage, make a system based upon the strength and uniqueness of the individuals and allow them to work in freedom  and encourage them to make appropriate choices for the welfare of the nation.This is where Dr Sohams suggestion that the generalists should be given utmost importance will fail in Indian setting.There is no system in India for a generalist to flourish unlike western countries .The medical student is not primed about the strength of a generalist and subsequently he makes a different choice of career when his time comes.In a system where is there is no scope and space  for a generalist where will he carve his niche?Only when a gated referral system as suggesetd by Dr Soham comes into vogue that a role of  a generalist will be meaningful in Indian health system.Going by the current mainstream thinking with the Indian healthcare force its a very very remote possibility to see a change in the health care system.

Practically it means in a govt setting ,a physician should not be posted in a place where there is no lab set up to back him up, or a obstetrician in rural set up where there is no blood bank or anesthetic back up, instead they should  be given a choice to choose their place of working (urban or rural)where they can exercise their skill sets to the maximum.This would create fulfillment in their job and government is also bound to ensure the quality of the work environment instead of just blaming the stake holders for not choosing rural areas.I am sure there would be many willing to  work in rural areas provided they are supported in their work monetarily and professionally.But the flipside is majority of the stakeholders in the govt are not bothered about the direction of the model in which they work.This will jeopardise the sustainability of the model in the long run

Secondly,there always exists a group in mission hospitals who refuse to be mere fuels in the system.They question the system and model in which they work and refuse to be just a cog in the wheel.They are anxious about who is driving it and worried about the direction of it .Mission hospital are not meant to be just another government scheme (a glorified rural govt hospital which functions well)rather an alternate force in the realms of the society in which they are a part of.So the major difference would be that the model in mission hospitals is tweaked for the individual and allowed to flourish at its fullest.This is in contrast to the rigid government model where every individual specialist or generalist is forced to comply to a certain standard of care and thereby promote resentment and rebellion against the system in the long run.

Practically it means in a mission hospital a generalist should be allowed to grow and flourish in his area of expertise and create an unique model himself which would inspire and teach a generation of medical people to follow .This ensures that the generalist is not forced to do something  beyond his capacity.He will make a voluntary choice to stay and improve the system rather than turning his back to it.Moreover this is true for all health care personnel in their varying spheres of influence.Dr Soham can then bat for this kind of model which is real and palpable even in Indian setting .Essentially the uniqueness and strength of the individual takes center stage over the primacy of the model in a mission hospital setting.A generalist should not be forced to be part of a secondary/ tertiary care model and vice versa.Each individual should be treated unique with a flexible and adaptable model.Mere debates and harping about the "best model" alone would not serve justice to the individuals who constitute the model.There is no model without the individual!

I believe only in this kind of environment will a mission hospital start to become what its supposed to be ( community of christian health care workers working to their full potential with freedom and choice rather than by coercion and force,mindful of its direction) giving food for thought to onlookers who wonder about the roots of this sustainable , thriving tiny island of people.Only these kind of individuals and  environment can begin to  create impact within itself and the community it serves which every mission hospital aims for.