The Living Giant- KEM Hospital Today

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Running KEM hospital is no easy task. The medical care given to patients only forms the proverbial tip of the iceberg. The housekeeping that is required to keep the hospital in shipshape is of Titanic proportions that have the potential to sink the whole show. Food, linen, laundry and supply of medicines and consumables are the major needs that have to be daily attended to.

Food For Thought

The trollers rumble along the corridors groaning under the weight of the lunch boxes they carry. Today, being Monday, there is ‘dahi kadi’ for the patients. The diet department had to place an extra order for milk on the previous Saturday, to make the ‘‘kadi’’. On a normal day, as many as 700 litres of milk are required to fulfil the needs of over 1500 inpatients. For Mr Temkar in the Diet Department, it is a ritual chore, which has to be unfailingly attended to. Each ward sends in its daily requirements. The total number of patients and their dietary requirements are all listed: most will be on a full diet while others will have special needs. The patients with diabetes and heart disorders are some of those who will require a specifically tailored diet. All the ward requirements are painstakingly added up to reach the grand total and the food prepared accordingly. The meals may be simple but the quantities are mind-boggling. Every day about 150 kilos of rice and 90 kilos of ‘’atta’’are consumed. The kitchens roll out as many as 1700 ‘’chappatis’’ a day. And that is the number of ‘’chappatis’’ required for a single meal. At night the patients are given bread, instead– a staggering 130 kilos being the daily requirement. The daily supply of 300 to 350 kilos of different vegetables and pulses too have to be ensured. And, of course, the children have their own special needs. All the tiny tots have to receive a banana, each day. It’s like organizing a wedding, twice a day, every day.

Washing Dirty Linen

The phone rings and senior administrators Dr Bhamare and Dr Salve sigh as they realize the source. It is Obstetric Operation Theatre once again reporting an acute shortage of theatre linen. Not surprising at all, since the two operation tables in this theatre see over 5000 operations each year. A small army of gynaecologists, neonatologists, anaesthetists, nurses and theatre attendants is needed to keep the theatre functioning each day. The magnitude of linen required by the hospital can be gauged by the fact that 5000 items of clothing(the equivalent of a loaded truck) are sent daily to the central municipal power laundry and an equal quantity of clean linen returned. But, it is a perpetual juggling act to ensure that sufficient linen reaches each ward and theatre. The monsoons too don’t help and there is a perennial cry for clean dry linen. Yesterday’s heavy rains have ensured that the van has played truant and it required a lot of verbal diplomacies and cajoling on the part of the administration, to convince the central laundry to release a truckload of linen later in the day. Everyone heaves a momentary sigh of relief. Tomorrow will be another day for the theatre staff. The administrators, however, are deep in thought as they think of ways to reach a solution. The only scheme they feel will work is to have a separate laundry facility just for theatre linen and they get down to the paperwork that will be needed to implement this plan.

Sweeping Times

Keeping the place clean sends a shiver down the spine of even the most efficient administrator. KEM hospital generates 1300 kilos of garbage every day. Moreover, every month 2100 kilos of potentially dangerous biomedical waste have to safely disposed-off. This means that besides the usual cleaning up process, the garbage has to be sorted at source. The general garbage is collected in black bags, which are to be disposed of at the dumping grounds at Deonar. On the other hand, the dangerous waste matter, which may be potentially infected is packed in colourful yellow plastic bags and sent off to the incinerator at the Sewri TB Hospital. Moreover, needles and other sharp instruments have to be collected in thick plastic jars and disinfected before they are sent for incineration. To ensure that the hospital is clean requires as many as 400 sweepers who man the campus each day in an effort to ensure cleanliness.

Let your Light Shine

The surgeon concentrates on the field of surgery, scalpel in hand, ready to make his next move. Suddenly, he is instantaneously blinded as the bank of theatre lights overhead shut off in response to a massive power failure all over Mumbai. But, before he can ponder upon his next step, the lights come on again. The emergency generators automatically take over and the theatre is flooded with light once more. The hospital receives its power supply through 15 main electrical cables with as many as 60 meters. The power supply to the various areas is then segregated into those that serve critical areas such as operation theatre and intensive care units as compared to the other areas. The cables to the essential areas are connected to an automatic mains failure panel, which is set to recognize any interruption in the power supply lasting 3 seconds. The diesel-fired generators are automatically triggered and generate sufficient power to supply all the critical areas of the hospital, within the next 15 seconds.

The responsibility of ensuring that all systems are kept going and machinery functioning properly lies in the hands of the Electrical Department. This department must also attend to the maintenance of the central suction pipes, which are essential in any hospital, and the supply of compressed air and medical gases such as oxygen and anaesthetic gases. Currently, besides their usual job of ensuring uninterrupted water and electrical supply and making certain all things electrical are humming smoothly, the department staff are immersed in attending to the high-tech ultra-modern “Emergency Medical Services”. It effectively means that they are trying to be in a dozen different places attending to a hundred different tasks all at the same time. Mr Chauker, the Assistant Electrical Engineer earnestly explains the electrical maintenance work as he simultaneously juggles with a telephone instrument needing repairs.

All the vital areas of the hospital, such as operation theatres and intensive care units, have to be centrally air-conditioned. The animal house also requires this facility. A total of 55 Air Handling Units(AHUs) handled by 5 AC plants ensure that these areas, and those within, remain cool. Additional package air-conditioning units have been installed in certain operation theatres and laboratories while 150 window units also service smaller areas. On the other hand, the blood bank, and the two mortuaries require even lower temperature and thus need separate refrigeration units. In effect, the quantities of energy are expanded to ensure an optimum temperature in the requisite areas.

There are 26 elevators all over the hospital. The enormity of maintaining their function can be gauged by the fact that each elevator has 6 limit switches at each floor level to ensure the safety of the lift. Thus, in the multi-storeyed building on the campus(with 14 storeys), each lift has 84 limit switches: which means there are 84 sites, which have the potential for getting jammed, triggering off the lift alarm.

The water of life

A hospital, which was originally started with only 125 beds, has now expanded to a mammoth 1800 bed leviathan. The water requirement of the hospital has taken a quantum leap over the years. Each expansion of the hospital saw an addition in the number of pump installations. Till a few years ago, there were 17 pump installations with 2 pumps per installation. Today, the water supply system has been largely centralized and an eight-inch diameter water pipeline encircles the entire campus with branches snaking off to various buildings and supplying 160 overhead tanks.

Ensuring that the hospital functions smoothly is indeed a gigantic task. It is only with the combined help of many hands that everything runs smoothly: well almost. It is a little-remembered fact that nearly 2 million patients come to these portals each year, in search of health and hope. These are people who are being treated almost free of cost and many of them have come because the treatment facility they seek is not available elsewhere. The medical care given is just a small fraction of the total work involved. It is indeed a living giant who tends to their needs.

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About the author

Dr Vinita Salvi is a renowned Gynaecologist in Mumbai and has had a long tenure as Professor and Head of Unit at the Seth G.S Medical College and King Edward Memorial Hospital. Dr Salvi has ample experience in the field of high-risk obstetrics. She is an Editorial Consultant for the Lancet.

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