The 115-year-old Hospital is gearing up to expand
its patient base and the facilities offered
Farrokh Jijina
"We are on a journey from survival to revival,” states Dr Vispi Jokhi, medical director of the 115-year-old, 270-bed Masina Hospital in Byculla. "We are laying down better standards for ourselves, keeping a close eye on our vision statement,” he avers, in his spacious office on the first floor of the much-photographed heritage building in the Hospital complex. The vision statement, pasted in three languages at several prominent places in the five buildings that house the medical facilities on the eight-acre property reads: "First choice in quality and value in health care.” The mission statement emphasizes holistic service in a safe and clean environment.
The heritage wing of Masina Hospital
Statue of the founder’s wife Jerbai Photo: Jasmine D. Driver
Elegance on the staircase: Sasoon family crest "Shine and persevere" in Latin
Photo: Jasmine D. Driver
Serenebai Banajee Nursing Home; Parsi Ward Photo: Jasmine D. Driver
First row Nursing School Photo: Jasmine D. Driver; patients in Parsi Ward; second row: Photos in Kharas Wing,
busts of Lady Pirojbai Bharucha Photo: Jasmine D. Driver; Ardaseer Mody, Merwanji Alpaiwala and
Dr F. N. A. Moos; alongside, clockwise: Kharas Centre, busts of Nariman Katgara and Noshir Irani, Dr Gool Kohiyar
Above, from left: Shapoor Mistry, Homi Katgara, Burjor Antia, Fali Sarkari; Dr Vispi Jokhi
From left: Drs Mahrukh Joshi, Jehanbux Chichgar, Yusuf Matcheswalla
The Hospital’s website lists over 15 specialties like dentistry, gastroenterology, nephrology, oncology and echo-cardiology. Their burns treatment facility is one of the largest in Bombay and "has a history of incredible survival rate — up to 70% of patients with 50% burns and over.” An intensive care unit and separate operation theater for burns victims function within the complex. Masina has a total of six operation theaters, four general wards (male, female, maternity and pediatrics) that are intended to be air conditioned soon, and semi-private and private rooms, notes Jokhi. The general wards are being geared for wi-fi connectivity. "We want to position ourselves as a good, no-frills hospital,” says the medical director, an orthopedic surgeon who joined the Hospital in August 2016 after three decades in the healthcare industry.
New services started include a diabetic foot clinic (with effect from June 24) and a pediatric neurology department inaugurated on March 28. The Nursing Home which occupies one of the buildings in the complex is being revived. Renovations have started, Jokhi points out. "We want to have the best care for diabetics to be available, along with a skin bank and an in-vitro fertilization (IVF) center there,” says the enthusiastic director. At Rs 1,50,000 (USD 2,331) and Rs 1,55,000 (USD 2,409) the Hospital provides amongst the cheapest knee and hip replacement surgeries in the city among private hospitals. "No other hidden costs at all,” emphasizes Jokhi.
"We are proud of being the only private hospital in the city to have a psychiatric ward,” says Jokhi. The Hospital runs a drug rehabilitation center sponsored by the Lions Club of Babulnath and a dedicated counseling center managed by psychiatrist Dr Yusuf Matcheswalla who heads the department. A 24x7 helpline was functional in April and May this year to provide emotional support to stressed students during the examination and results season.
Jokhi is planning an assisted living facility, with medical help available, within the complex for Parsis. "Co-morbidities (a medical condition that co-occurs with another medical condition) will be catered to,” he states, adding that it will be neither an old age home nor a hospital. "We want to provide all that it takes to live well,” he exults. The Parsi Ward of J. J. Hospital is generally full, Jokhi says, as is the (Lady Hirabai Jehangir) Gamadia Clinic. The F. S. Parukh Dharamshalla is for the mobile, he comments.
There is an old age home for Parsis run by the Dr Dossibai and Jehangir Ratanshaw Dadabhoy Charity Trust and a shelter for people with special needs which is run within the Hospital complex. The then trustees of Masina had, in the 1970s, provided land to the Dossibai Trust, "but that is a totally separate entity, run by that Trust,” emphasizes Jokhi.
Another facility that is on the cards is a palliative care unit to be set up under the supervision of oncologist Dr Boman Dhabhar and his team. About 5,000 sq ft of space is proposed to be made available for a day care center for cancer victims and for palliative care.
"Our infrastructure needs to be improved and better utilized,” asserts Jokhi. His foreword in the June 2017 issue of the newly introduced biannual newsletter of the Hospital echoes the sentiment: "While the need for change has been enormous, we have tried to balance this with the pace of work.” Medical superintendent Dr Satyendra Nath Mehra states in the newsletter that the World Health Organization’s surgical safety checklist is implemented "in almost 80% of the cases successfully,” and lists newly procured equipment: laparoscopic instruments, anesthesia machines, ultrasonic equipment for physiotherapy et al. Hospital Administrator Karuna Atilli highlights that medical records management is now a vital quality indicator for the Hospital. Doctors’ and nurses’ salaries have been rationalized and corrected, notes director, human resource, Suresh Mohite, while manager, administration and personnel Vinayak Kulkarni refers to the appointment of a heritage architect (Vikas Dilawari) to conserve the central heritage building. Digital prescriptions, discharge summaries and feedback monitoring are the highlights that Shubhi Kala, manager operations, quality and IT (information technology) exults over. Frequently asked questions and responses thereto about medical services and case studies are included, in language attuned to a lay reader.
What does Jokhi believe are Masina’s strengths? He names three: "If you want ‘affordable,’ come to us,” he says. General ward charges are Rs 1,300 (USD 17) per day whereas the semi-private and private rooms cost Rs 2,500 to Rs 4,000 (USD 39 to USD 62) per day. The per-bed daily cost of occupancy is Rs 4,000 on an average, says honorary medical advisor and senior physician at the Hospital, Dr Jehanbux Chichgar. "So you see, we are heavily subsidizing our patient-load,” he adds. Out-patient charges are a modest one time registration fee of Rs 200 (USD 3) valid for three months, for consultations. Pathology investigation charges have been significantly reduced, states Jokhi. The staff has come in for consistent praise for their care and concern. "I receive good feedback often,” Jokhi avers. "Add to that the sylvan surroundings,” he mentions, waving towards the greenery outside his large office windows.
"Patients need to go outside (to other medical facilities) only for Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET - studies of metabolic activity or body functions) scans,” adds the medical director. Whether equipment and facilities for PET will be feasible is being evaluated. The Hospital will not be going in for MRI facilities. "There are too many in the city; it will not be viable for us,” is Jokhi’s view on this.
Trustees speak
The Hospital "received a new lease of life recently thanks to a large donation from an overseas well-wisher … We were ‘hand-to-mouth’ till then,” states Homi Katgara, who has been a trustee since 2001 and managing trustee for the last five years. In an interview with Parsiana in the conference room of his office, Jeena and Company, he states that the last financial year was "one of the worst ever, but we nearly broke even this June… Staff salaries are always paid on time.” Well-wisher, Dr Gool Ardeshir Kohiyar, left Rs 10.86 crores (USD 1.68 million) in her will to be used for equipment and beds in the general wards at the Hospital, in memory of her father Dr Ardeshir Kohiyar, consultant physician at Masina for many years.
Property developer Shapoor Mistry of the Shapoorji Pallonji (SP) Group chairs the board of trustees. Katgara acknowledges that the SP Group has provided assistance to streamline accounting processes at the Hospital, and may even provide assistance in the construction phase of the proposed expansion. Mistry’s companies may also fund the setting up of solar energy and sewage treatment plants. "We are thankful to the SP Group for being supportive always,” says Katgara.
Explaining the high level of commitment to ethics displayed by the Hospital management, Katgara mentions that the fee structure for consulting doctors till recently was "a little rigid.” They now allow honorary doctors to selectively increase their fees in their private clinics at the Hospital, depending on the financial condition of the patients. Affiliation fees (what a medical professional has to return to the Hospital for practicing there) have been lowered, he states. "We haven’t been regularly upgrading our infrastructure… we use our equipment for up to 75% of its life and then consider upgrades or replacements,” states Katgara.
"Young Parsi doctors are difficult to come by… a few shy away for ‘image’ reasons and prefer to work at corporate hospitals,” says the managing trustee. Alluding to the roster of senior Parsi doctors who are empanelled with the Hospital, Katgara rues that "only a handful visit daily.” He personally visits the Hospital once a week to conduct review meetings with key staff members.
The managing trustee states that that they have had many rounds of discussions with a Madras based chain of hospitals. "We have lots of land… they can easily put up a 500-bed facility near the entrance to the complex.” The Hospital signed a memorandum of understanding with the hospital chain in 2011 and have now "opened discussions on a larger scale.” The new venture will specialize in heart disorders and oncology. The Masina trust will appoint two of their trustees on the managing committee of the new venture.
"It will be a 30-year contract for operations… The chain will equip the new facility… ownership will continue to remain with the Hospital trust…We will be able to do a lot more charity with the funds coming in,” asserts Katgara. "There will be periodic receipts from them, plus a share of their revenue,” he adds. He is sanguine that with the convenient and accessible location of the Hospital (Byculla is equidistant from the western and eastern coasts of the island city) and the proposed development of the eastern seaboard of the city, Masina will be the hospital of choice for many.
Is the market for healthcare saturated with the setting up of new corporate and stand alone hospitals in the city? Quoting a recent study by consulting firm KPMG, Katgara says, "There is a big gap in quality healthcare.” Corporate hospitals make large investments in their marketing efforts whereas charitable hospitals like Masina have not. What makes a charitable hospital tick? "It starts and ends with the doctors… They have to get comfortable with the facilities… a Hospital such as ours will have to be doctor-dependant rather than market driven,” he says.
The agreement with the unionized workers of the Hospital expired in March 2013, mentions Katgara. "Historically the union has been very strong… We are working with them to outsource certain activities like housekeeping and security,” he notes.
In addition to Katgara and Mistry, the two other trustees are chartered accountant and company executive Fali Sarkari and senior lawyer and previous Bombay Parsi Punchayet trustee Burjor Antia who has been a trustee at Masina since 1978, and also chairman of its board.
In his book-lined office in downtown Bombay, Antia recounts the various firsts in the history of Masina – Founder Dr Hormasji Masina was among the first three Indians to obtain a fellowship of the Royal College of Surgeons in 1898; the first ever X-ray unit in a city hospital was at Masina; as the first private hospital in the city, Masina predates The B. D. Petit Parsee General Hosptial by six years and Sir Hurkisondas Nurrotumdas Hospital, now Sir H. N. Reliance Foundation Hospital and Research Centre, by 16 years. He reiterates that the trust deed of the Hospital dating to 1907 allowed non-Parsis to be treated from the very beginning.
Flashback time
"Masina Hospital can have a great future,” avers ex-honorary pediatrician and neonatologist Dr Mahrukh Joshi who joined them in 1967 as a young professional. In an email to Parsiana from the USA, she recalls some milestones: the first cardiac surgery by Dr Bomi Billimoria ("sometime in the early 1950s”); the saving of prematurely born quadruplets delivered by gynecologist Dr Mehroo Hansotia after in-vitro fertilization. The Hospital "has one of the best plastic surgery departments,” she believes. The institution owes a lot to the services of the past trustees and director late Col P. M. R. Bharoacha, according to the doctor. Joshi narrates her experiences with setting up a new neonatal unit, the first such facility in a private hospital, under the leadership of Dr Jer Master: After receiving a "big donation we started with six incubators and devices to monitor and deliver oxygen to babies, tube feed them, and give them intravenous fluids with scalp vein needles, hardly used then in Bombay.” A fresh donation helped to start a neonatal intensive care unit. "We could save babies as small as one kg at birth, and one even smaller,” she recalls. The doctor was instrumental in getting "the Hospital recognized by the College of Physicians and Surgeons for diplomas in pediatrics and gynecology,” among other specialties.
Dr Shirin Mullan, head of the pediatrics team, who now leads a team of 20 doctors, having joined the Hospital in 1975, says, "We have had our ups and downs… Now there is a lot of improvement in all areas.” She singles out as recent highlights the restructuring of many departments, the additional training for the nursing staff, and the utilization of all available space. The focus has shifted from curing to preventing, in the area of pediatrics, she says, referring to the Well-baby Clinic and scheduled vaccination programs. "I would like to work here as long as I can,” ends Mullan.
The Parsi connection
Parsi names leap out at us from various plaques as Kala walks us around the complex, a luxury for space-starved South Bombay — the Noshirwan Muluk Irani Operation Theatres, Intensive Cardiac Care Unit and Diabetic Clinic; the Katgara Wing; the Alamai Shapoorji Mistry Ward; the Lady Broacha College of Nursing Building; the Kharas Memorial Centre; the Bai Serenebai M. Banajee Wing for the Nursing Home; Dr F. N. Moos Memorial Building; the N. M. Wadia Out Patient Department; donations from the Shirin and Jamshed Guzder Trust, the Godrej Foundation, the estate of Col P. M. R. Bharoacha and Dr Russi M. Bharoacha. The building that crowns the driveway of the Hospital was gifted to Dr Hormasji by the famous merchant family of the Sasoon baronets and the land was purchased for Rs 25,000, explains Jokhi.
Jokhi specially mentions various Wadia Trusts as benefactors. "Many community trusts give donations,” says Katgara, but "I wish I had a pipeline of donors that I could depend on,” he smiles. An effort to tap Muslim donors is on, given that a significant part of their patient load comes from that community.
Chichgar who has been associated with the Hospital since 1982 says, "(This was) my first attachment (after qualifying as a doctor)… It has made me what I am today.” His concern for the Hospital comes through: "We have to increase occupancy rates,” he states, thumping his table in his private clinic in down town Bombay. "We need to be at 180+ (number of beds occupied) to be profitable… the facilities on offer must be marketed more aggressively,” he notes.
"We have an illustrious history, now we have to make the most of our infrastructure,” says Jokhi, a sentiment echoed by Dr Behram Pardiwalla, honorary physician for internal medicine at the Hospital between 1980 and 2014. "A very homely atmosphere and its patient-friendliness… There was good junior staff in the early days,” he recalls. The hey-days of the Hospital were between 1975 and 1990, he reckons.
No other hospital provides facilities for the mentally handicapped on the scale Masina does, according to Katgara, adding that Bhatia Hospital has a few set aside for psychiatric cases. "We will continue to support the psychiatric ward,” says Katgara. "The Hospital runs on the psychiatry department,” quips Chichgar, adding that at any time, about 30% of the Hospital’s patients are treated in this Ward. "But things have to be tightened up in this Ward,” according to Pardiwalla.
"We face a perception problem about ourselves among the lay public,” laughs Jokhi. The Parsi Ward is not an old age home, he cautions, but is seen as such, the medical director rues. Community members are treated either free or at subsidized rates, depending on their financial condition. The Moos Memorial building, built in 1954 for the treatment of tuberculosis, now houses separate male and female wards and a hospice ward for Parsis. When Parsiana visited in late May this year, 15 of the 37 available beds in the ward were occupied. "We want us to be the health-care service provider of choice for our Parsi neighbors, among others,” he says, waving in the general direction of the nearby Jer and Rustom Baugs, and the not-so-distant Parsi Colony of Dadar. Katgara echoes Jokhi’s sentiment: "We want to give a major thrust to the Parsi Ward.”