Is there anyone today, especially in the context of the acute global health crisis that the Covid-19 pandemic is, who would consider the Sir Seewoosagur Ramgoolam National Hospital (SSRNH) as a ‘white elephant’? – which is defined as ‘something that costs a lot of money but has no useful purpose’. And yet when it was being planned, pursuant to the need for a hospital in the north of the island identified in a Report submitted to the Governor by Richard M. Titmuss and Brian Abel-Smith in 1960, ‘Social Policies and Population Growth in Mauritius’, this is the opinion that was expressed in a letter in the ‘Correspondence’ section of the Mauritian Medical Journal of October 1965, signed J. Singer, as shown in the accompanying picture.
It read as follows:
I would like the opinion of your readers on the question of the building of a big hospital in the North.
I personally feel that the money (estimated 24 million rupees, suspected 42 million rupees) would be much better spent in the development and extension of existing hospital facilities around our present centres – including our district hospitals. As this small island has a good system of trunk roads, linking all these centres with a fleet of decent ambulances would serve a more useful purpose than a white elephantoutpost in the North and ? others in the South, East and West. Although it is alleged that two-thirds of the funds would come from the Colonial Welfare Development Fund, I feel our one third could be more usefully spent on the above suggestion and the Colonial Welfare Development Fund money given to another new project’. (italics added)
So the North, South, East and West were considered as outposts not deserving of better medical services!
On the occasion of 50th anniversary of SSRN Hospital last year, a Souvenir Magazine was published. It was the laudable initiative of Dr D. Ramruttun, who had started his career there as Medical and Health Officer (MHO) before becoming Medical Superintendent at the hospital until his retirement recently. Besides the several articles covering the different departments of the hospital, there are a few others which give a historical account of the genesis and setting up of the hospital.
Today we take for granted the existence of our six Regional Hospitals (including the one in Rodrigues), the Specialized Hospitals, the Area and Community Health Centres, the Mediclinics, and the services that all these health delivery points provide. Neither in the public nor in the medical profession is there any great interest in knowing how all these developments took place, let alone understand or appreciate the fundamental concept that underpins the provision of the health and medical services in the island, namely Universal Health Coverage, right from the beginning. This is something that the country can be proud of, as many others that do not enjoy this privilege struggle to cope with the pandemic. It is because of this state-driven and centralized health system free at the point of service that we have been able to effectively bring the pandemic under control.
The rationale for constructing a new hospital was explained in the Titmuss Report in the chapter on ‘The Fundamental Problems of Medical Care’. The authors identified the main problems as being shortage of nurses and doctors, and of hospital beds. They noted that ‘The Government is fully aware that a growing population and other factors make necessary further extensions to the existing services. Among the projects which have been envisaged are a number of additions to the general hospital services…a new Central Hospital will be constructed to serve the North and to replace the services now provided by the inadequate small hospitals at Poudre d’Or and Montagne Longue; Rodrigues will be supplied with a new hospital.’
The government went ahead with the project. In 1962, the British firm of architects Messrs Fry, Drew and Partners were officially commissioned to design the ‘Central Hospital North’, and construction began in 1965. Finally, ‘in October 1968 the keys of the complete building were officially handed over to the Honourable Minister of Health. January 1969, therefore, saw the Government of Mauritius in possession of a very modern and fine hospital building with all the heavy equipment like boilers, X-Ray apparatus, etc. already installed’.
It needs to be highlighted that this was the first time in the history of Mauritius that there was proper planning for a hospital, which included its ancillary support services and collateral developments for its smooth running through provision of nursing training and quarters for medical staff. None of the existing hospitals had been purpose-built.
It was in August 1969 that the opening ceremony was held, and the hospital started running some specialist outpatient services, with specialists attending from the Civil and Victoria Hospitals. There was a delay in initiating inpatient services, that is, admitting and treating patients in the new wards. One of the reasons was that there were not enough nursing and medical staff. Nearly a hundred people sent to the UK were still undergoing nursing training. Besides, in the same vein as the correspondence in the Mauritian Medical Journal referred to above, there were others too who were critical – and that included government specialists who resided mainly in Plaines Wilhems and Port-Louis where they had their private practice too – and were therefore apprehensive about being posted to the North.
In November 1969 male and female medical wards were opened with a total of 52 beds, with patients transferred from Poudre d’Or Hospital, as well as 24-hour Accident & Emergency Services provided.
In December 1969, Dr J.C. Mohith was appointed the first Medical Superintendent of SSRH Hospital. He immediately began planning the expansion of services in phases, and in an integrated manner – that is, making provision for and accommodation of Public Health Offices and clinics for Health Education, malnutrition and anaemia, and scabies, which was in contrast to the uncoordinated and inefficient ‘vertical programmes’ approach that had till then prevailed.
Unfortunately, the nurses under training in the UK for nursing training in anticipation of the opening of the North Hospital decided to stay back, obtaining employment in the NHS which itself badly needed nurses and also offered better terms and conditions. Nevertheless, during the year 1970, commissioning progressed at a fairly rapid space as more and more staff became available, including several young specialists newly returned to the country, and the hospital gradually became fully operational by the time I joined as MHO in 1972.
What was unique about the SSRN Hospital were the innovative features that were brought in besides the integrated approach to healthcare delivery already mentioned. These concerned both infrastructure and functioning of the departments concerned, and related essentially to the non-medical activities, as follows: Medical Records; Central Sterile Supply Department (CSSD); Engineering: A Planned Preventive Maintenance Scheme; Catering, with the appointment of a Catering Officer and ten cooks trained in modern cooking methods and equipment; Domestic Services headed by a Domestic Supervisor; Regular meetings with department heads and with President and Secretary of the District Council of Pamplemousses Riviere du Rempart and Chairman of Village Councils to inform the public of facilities available and how to use them. These pioneering features were subsequently introduced in all hospitals.
What further characterized SSRN Hospital was that the newly-returned specialists were not only very dynamic, but acted as true mentors to the MHOs. Many of the senior Nursing Staff were equally ‘protective’ of junior doctors, especially the new recruits, and overall at least in the initial few years there was a very conducive and convivial atmosphere of ‘camaraderie’ that distinguished the hospital, and that led to several lifelong friendships among all levels of staff – and that persist to this day among those who are still around.
Further, there used to be weekly clinical meetings in the Conference Room which were well attended. Such were the exhilarating days of the SSRN Hospital, now a hub of medical activity – certainly not a ‘white elephant’!