THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 5, NO.6

Indian Medical Colleges299

lawaharlal Institute of Postgraduate Medical Education and Research,Pondicherry

S. CHANDRASEKAR

Presenting a panoramic view at the entrance to Pondicherryfrom Madras, a magnificent array of buildings extends awarm welcome to visitors. This is the Jawaharlal Institute ofPostgraduate Medical Education and Research, popularlyknown as 'JIPMER'. This Institute, named after our latePrime Minister, Pandit Jawaharlal Nehru, has achievednational fame and international recognition. JIPMER issituated on a large 190-acre site, forming an educationaland residential campus which includes the Institute building,an 850-bedded hospital, an outpatient block, an infectiousdiseases block, kitchen, laundry, workshop, a printing press,six hostels for students and about 400 staff quarters.JIPMER traces its origin to November 1956, when the Ecole

de Medecine de Pondicherry (one of the oldest schools oftropical medicine established in 1823 and maintained by theFrench Government) was taken over by the Government ofIndia in the wake of the de facto transfer of Pondicherry toIndia. The Government of India upgraded the medicalschool to be the Dhanvantari Medical College. By the endof 1958, a separate campus was acquired at Gorimedu,now renamed Dhanvantari Nagar, 5 km away from thecity of Pondicherry and construction of the college andhospital buildings began. On 13 July 1964, the new collegebuilding was opened by the then President of India,Dr S. Radhakrishnan. The Institute is administered bythe Central Government and is under the direct controlof the Ministry of Health and Family Welfare, through theDirectorate General ofHealth Services, New Delhi.

ACADEMIC COURSESAffiliated to the Pondicherry Central University, the Instituteoffers instruction in both undergraduate (MBBS) and post-graduate courses (diploma courses, MD and MS in variousdisciplines). A superspecialty course leading to the MCh inUrology has already been started and a course for the MChin Cardiothoracic Surgery is also likely to begin during thecurrent year. Besides these, JIPMER also offers the follow-ing programmes: (i) BSc (Medical Laboratory Technology),(ii) BMRSc (Bachelor of Medical Records Science) and(iii) MSc (Biochemistry) for non-medical science graduates.Research facilities leading to a PhD degree are available in

several disciplines. The Institute also conducts certificate,diploma and higher diploma courses in French.

J awaharlal Institute of Postgraduate Medical Education and Research,Pondicherry 605006, India

S. Cl:IANDRASEKAR Former Director

© The National Medical Journal of India 1992

The annual enrolment to the MBBS course is limited to75 students and is done on the basis of an all-India competi-tive examination, for which about 8000 applicants competeevery year. Admission to various postgraduate courses(about 65 in number) is also based on all-India competitiveexaminations.The World Health Organization has established the first

National Teachers Training Centre at JIPMERfor the wholeof India, to train teachers of health professionals. Thecentre has conducted 27 national courses and trained more

FIG1. The foundation stone of the present JlPMER complexbeing laid in March 1959 by His Excellency Count StanislasOstrorog, Ambassador of France

300 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 5, NO.6

FIG2. The original 'Ecole de Medecine' started by the French in 1823

FIG3. The Medical College started by the Government of India in 1956 after taking over the 'Ecole de Medecine'

INDIAN MEDICAL COLLEGES 301

FIG 4. The JIPMER complex

than 500 teachers from over 75 medical colleges in modernmethods of pedagogy. In addition, regular courses are heldto train postgraduate students in the educational sciences.JIPMER is also a recognized WHO collaborating centre

for training in disaster management.

HOSPITAL SERVICESThe Institute hospital provides a comprehensive medicalservice to the people of Pondicherry and the neighbouringrural areas. It emphasizes the preventive and promotionalaspects of community health, integrating family welfarewith the general package of health and nutritional services.The hospital has a total bed strength of 850, with 62 special

paying beds. The daily outpatient attendance is about 4000.Out of this more than 75% are from adjoining districts ofTamil Nadu and the rest are from Pondicherry.It has earned a reputation for cleanliness and a high quality

of patient care. The services in the general wards are freeand over 30 000 patients are admitted annually.There are separate blocks for patients with infectious

diseases and leprosy. The postpartum block houses a sterili-zation ward with 10 beds and an operation theatre.An anaesthesiology resuscitation ward and an intensive

care unit are centrally organized for the care of seriouslyill patients. The Department of Cardiology is the only centrein India doing free pacemaker implantations in poor patients(about 150 pacemakers have been implanted), thanks to thegenerous cooperation of the STIMUBANK, Nancy, France.Other features of the hospital include:

1. A central medical records department which maintainscomputerized inpatient and outpatient records forservice, teaching and research.

2. A mechanized laundry, central gas pipeline, centralpaging system, cloak room and patients library.

3. Three rest houses for relatives of patients, for those poor

patients who need short spells of treatment and for thosewho have to wait for admission to the hospital.

PERIPHERAL SERVICESThe Institute runs urban and rural health centres forproviding family centred healthcare and also for trainingmedical interns to deliver comprehensive healthcare topatients in the rural areas. The Jawaharlal Institute RuralHealth Centre at Ramanathapuram provides services to 12neighbouring villages with a total population of 14 680. It hasone subcentre at Sedarapet and a subsidiary health centre atCoodapakkam. The urban health centre was established in1959 and caters to a population of 8090 in the Kurichikuppam,Vazhakulam and Vaithikuppam areas of urban Pondicherry.In 1980 the Institute received three mobile hospitals (fully

equipped buses with facilities for minor operations) underthe Reorientation of Medical Education Scheme. Thesehave been used to organize a hundred medical camps in thevillages around Pondicherry.

RESEARCHResearch is an integral part of the Institute's academicactivities. Several programmes are being supported by grantsfrom the World Health Organization, the Indian Council ofMedical Research, the University Grants Commissionand the United States Public Health Fund. The JIPMERScientific Society meets every month and plays an effectiverole in promoting research. Academic meetings, symposia,seminars, workshops and conferences are organizedregularly in various subjects with the participation of nationaland international experts.The Central Library is housed in a separate building and

has about 30000 volumes and subscribes to 342 journals. Aseparate Book Bank with 1555 books caters to the needs ofstudents from the scheduled castes and tribes. Back volumesof medical journals since 1930 are available and now number

302 THE NATIONAL MEDICAL JOURNAL OF INDIA

about 19000. The Institute has an active Medical Illustrationand Photographic Division which contributes to its academicactivities. Foreign students or visiting fellows from countriessuch as Afghanistan, Bangladesh, France, Malaysia, theMaldives, Mauritius, Nigeria, Rhodesia, Singapore, SouthAfrica, Sri Lanka, Tanzania and Thailand have been spon-sored for training by various agencies including the WHO.The strength of this Institute is the high calibre of its

students. This is evidenced by their high success rates in all-India competitive examinations and in foreign entranceexaminations. Many of our alumni occupy importantacademic positions both in India and abroad.JlPMER has been providing medical care of a high quality

to the rural poor. 'However, the Institute has been laggingbehind in developing courses in the superspecial ties and agreat deficiency is the absence of a neurosurgical service.

Correspondence

VOL. 5, NO.6

Another missed opportunity has been the lack of collabo-ration with France. In the beginning there was provision fora close link but this was not followed up.I have been in this Institute for more than two decades and

have felt that sometimes our problems are not understood oracted upon in Delhi. If the people's representatives fromPondicherry had shown some interest in JlPMER, we wouldhave had a better deal. Even during the Nehru CentenaryYear nothing was done to improve the diagnostic capabilitiesof our Institute.Two decades ago when I was in the Johns Hopkins Medical

School in the USA, I had hesitated to join JlPMER. When Ireturned to India I found the JlPMER students as good asany I had taught in the United States and I have recently leftthis Institute with a great sense of fulfilment.

Reproduction in MentallyRetarded Females

Sir-A recent study in India has shownthat mentally handicapped teenagersaccounted for 2.1% (20) of all patientswho had abdominal hysterectomies over aperiod of five years.'The question of interfering or not inter-

fering with menstrual and reproductivefunction in women with mental retardationinvolves medical, psychosocial and legalissues. Situations may arise where deci-sions about reproductive function have tobe taken, not just by the individual, butby others as well, because a mentallyretarded woman lacks the ability to dis-charge parental duties.At present, ethical issues are inherent in

the sterilization of persons with mentalhandicap. The Committee of Bioethics ofthe American Academy of Pediatrics hasissued the following guidelines- (based ona statement by the American College ofObstetricians and Gynecologists):1. Prepubertal sterilization is not indicated,except under rare circumstances.

2. The indications for surgical steriliza-tion based on presumed or anticipatedhardships to others must be viewedwith great reservation. The judgementof hardship is very subjective and mustnot simply be a matter of inconvenienceor preference for the easier of the twoalternatives.

3. When sterilization or pharmacological

control of menses is chosen, one mustadvocate the least permanent andintrusive method consistent with thelowest risk to the patient.

4. Even if satisfactory informed consentcannot be given by the patient, effortsmust be made by the personnel knownto her or by persons trai.ned in com-municating with mentally handicappedpatients to estimate the patient's abilityto comprehend and participate in thedecision-making process.Mental handicap alone \~oes not, in

itself, justify either sterilizatio or its denialand before eliciting infor ed consentfrom such patients, certain precautionsare necessary. To ensure that the decisionis voluntary, multiple interviews may berequired, taking help from personstrained in communicating with mentallyhandicapped patients. If despite these, thecapacity to give informed consent remainsinconclusive, the matter should be referredto a court of law.Proxy consent for medical treatment

can be given by parents, immediate familymembers or legal guardians. However,reliance on proxy consent alone increasesthe risk of sterilization abuse, because acontlict of interest may exist. The physicianmust therefore evaluate whether the bestinterests of the patient will be served byconsultations with other professionalssuch as paediatricians, neurologists,psychiatrists, social workers and lawyers.Where appropriate, an alternative pro-

cedure, alone or together with surgicalsterilization, should be considered. Train-ing should be given in socialization, sexualabuse avoidance, menstrual hygiene,family counselling and sexual education.To protect the best interests of the

patient, the followingshould be considered:1. The mental incapacity should be apermanent condition.

2. The patient is likely to be fertile andmay experience sexual intercourseunless her social freedom is restricted.

3. Even if no health risks are associatedwith pregnancy, there may be an un-supportable burden on the patient as aresult of child bearing, parenting ormenstruation.A debate on the subject is urgently

needed in India.25 October 1992 G. R. Sridhar

G. NagamaniEndocrine and Diabetes Centreand Department of Obstetrics

and GynaecologyAndhra Medical College

Vishakhapatnam

REFERENCES

1 Sheriar NK, Bhathena RK, Walvekar VR.\Hysterectomy in mentally handicappedteenagers. J Obstet Gynecol India 1991;41:103-4.

2 Fost NC, Clayton EW, Grodin MA,Kohrman AF, Nolan K, Wagner VM.Sterilization of women who are mentallyhandicapped. Pediatrics 1991;2:580-3.