In this chapter I have mentioned about some points about the health and the society - some scenarios, establishing the centres where will be able to give most of the health care instead of writing reference letter frequently (even in villages - and it is possible with model village and model nation ...
In this chapter I have mentioned about some points about the health and the society - some scenarios, establishing the centres where will be able to give most of the health care instead of writing reference letter frequently (even in villages - and it is possible with model village and model nation concept), scenarios on the competition between the disease and the treatment and who is going to win for whom, necessity to setting up and maintaining the things and manpower to handle the emergencies, a new nomenclature system for the various brand medicines available in the market to remember them easily and to decrease the mistakes in dispensing and administration of drugs, a new concept in the hospital facility (Village Panchayath Hospital) in contrast to the present 'Primary health center', better hospital networking all across the nation and the world to access all the health activities from the time of birth of the person, at any time, at any place, to make the people to have positive health with longevity, youthfulness, energetic and happiness.
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Contents of section 9: Health.
Chapter 2-Health.
2.1-Health and society – some scenarios.
2.2-Better to open the centres which cares instead of telling go to higher centre.
2.3-Competition between the disease and the treatment, who wins?
2.4-VPH, to begin with.
2.5-VPH administration.
2.6-VPH – Creation of Infrastructure.
2.7-Beginning staff of the VPH.
2.8-Catering population of the VPH.
2.9-Introduction to the emergency trolley.
2.10-Advantages of Emergency Trolley.
2.11-Dimensions of emergency trolley.
2.12-Emergency trolley rack description.
2.13-Common features
2.14-Emergency drugs to be kept in Emergency trolley, System wise classification (A prototype).
2.15-Emergency drugs to be kept in E – trolley, Rack / Compartment wise classification.
2.16-‘Medicines’ in medical practice.
2.17-Let us decrease our confusion on drugs with present brand names, still retaining the brand.
2.18-Let us have clarity in the name of the drug from the time of study to practice.
2.19-Solutions to decrease the mistakes with different brands by different companies.
2.20-Reducing the number of hospital (PHC to VPH) will add quality to the health services and the
doctors can spend time for periodical updates.
2.21-Periodical inspection is the need to maintain the quality in service.
2.22-Quantity decides the quality in some areas.
2.23-Strict waste disposal protocols are the need to prevent many life threatening infections.
2.24-National health programmes and the private medical practise.
2.25-National health services and Village Panchayath Hospital.
2.26-VPH – NHS – Cellar and Ground floor.
2.27-VPH - Department of OBG.
2.28-VPH - Central sterilization station.
2.29-VPH - Department of Physiotherapy.
2.30-VPH - Department of Paediatrics.
2.31-VPH - Department of Medicine.
2.32-VPH - Department of Ophthalmology.
2.33-VPH – Hospital Stores.
2.34-VPH - Department of ENT.
2.35-VPH - Department of Surgery.
2.36-VPH - Department of Orthopaedics.
2.37-VPH - Department of Radiology.
2.38-VPH - Laboratory.
2.39-VPH - Department of Microbiology.
2.40-VPH - Department of Biochemistry.
2.41-VPH - Department of Pathology.
2.42-VPH - Department of Blood bank.
2.43-VPH - Department of Pharmacy.
2.44-VPH - OPD registration.
2.45-VPH - Minor OT.
2.46-VPH - IP registration.
2.47-VPH - Trauma care centre.
2.48-VPH - Reception.
2.49-VPH - RMO – CMO.
2.50-VPH - Casualty.
2.51-VPH - Ambulance.
2.52-VPH - Police.
2.53-VPH - Canteen.
2.54-VPH - Department of Dental science.
2.55-VPH - Department of Ayurvedha.
2.56-VPH - Department of Siddha, Homeopathy, Unani.
2.57-VPH - Department of Forensic medicine.
2.58-VPH - Stores – Furniture’s.
2.59-VPH - Department of Anaesthesia.
2.60-VPH - Nursing and housekeeping staff section.
2.61-VPH - General and special wards:
2.62-VPH - Medical superintendent:
2.63-VPH - Meeting rooms.
2.64-VPH - Hospital administration.
2.65-NHS – VPH - VP Preventive medicine.
2.66-NHS – VPH - VP Pollution control office.
2.67-NHS – VPH - Public health engineering.
2.68-NHS – VPH - Coordinator – National health programme.
2.69-NHS – VPH - Coordinator NHP1 – HIV / AIDS.
2.70-NHS – VPH - Coordinator NHP2 – Malaria.
2.71-NHS – VPH - Coordinator NHP 3 – Tuberculosis.
2.72-NHS – VPH - Coordinator NHP4 – Blindness control programme.
2.73-NHS – VPH - Coordinator NHP – Nutritional disease control programme.
2.74-NHS – VPH - Coordinator NHP6 – NRHM.
2.75-NHS – VPH - PIN registration record maintenance officer.
2.76-NHS – VPH - PIN registration office.
2.77-NHS – VPH - PIN health update record maintenance office.
2.78-NHS – VPH - PIN health updating officer.
2.79-NHS – VPH - Birth record maintenance officer.
2.80-NHS – VPH - Birth registration officer.
2.81-NHS – VPH - Death record maintenance officer.
2.82-NHS – VPH - Death registration officer.
2.83-NHS – VPH - Library and reading rooms.
2.84-NHS – VPH - Hospital networking.
Views to make this ‘World’ developed and this
‘Earth’ as the lovely place for every ‘Human’.
SECTION 9
HEALTH
Targeting for long life:
Why we need to target only for 100 to 150 years of
life, why not 200 to 300 years of healthy, active,
productive life as we read in our ancient epics.
Try to achieve the state where there is health for
everyone, everywhere, all the time.
Chapter 2: Health.
2.1. Health and society – some scenarios.
Health scenarios:
1. Obstetrician did an emergency LSCS, which was referred from the PHC / Village TBA / Urban slum
which is an un booked / un registered case. Obstetrician decided to do cesarean section, because the
fetal heart rate was very slow and there is not much dilatation of the cervix and she did the LSCS
immediately without waiting for the report to save the baby. Both the mother and the baby were
saved and later the report comes from the lab as the lady is positive for HIV / HBsAg.
Solution: With VPA – VPH - MV – MN, all the cases will be booked cases and adequate ANC checkups
can be done.
2. Sometimes we receive the patient in respiratory failure and we refer the patient in the same
respiratory failure due to the non availability of the ventilators. Leave about the PHC, even at the
taluk levels hospital, the same procedure is followed. The patient reaching the higher centre with
the respiratory failure will be decided by the god. Sometimes the ambulance that we send the
patient to the higher centre may not have the Oxygen cylinder in working condition in it.
Solution: With VPA – VPH - MV – MN, all the VPH will have adequate facilities to treat such cases and
the availability of life line ambulances.
3. A family from Chikmagalur migrated to USA on some job with their child who is seven year old.
US government is asking for immunization certificate. Parents lost the immunization card. BCG was
given at the government hospital, as it is not routinely given in the private set up. The baby received
few vaccines in the Holy cross hospital Chikmagalur, few vaccines were taken in Bangalore, and
different cards were given in different places. And the government card did not have the space for
all the vaccines other than UIP (Universal Immunization Programme).
Solution: With VPA – VPH - MV – MN, the entire event can be computerized for better
documentation and for follow-up.
4. A person had head injury, taken to government hospital, was then referred to other private
hospital, where surgeon was not present on that day, then he was referred to CT scan centre to rule
out intracranial injury, on the way the patient developed convulsions.
Solution: With VPA – VPH - MV – MN, such types of cases can be well managed.
5. Pregnant women with IUD (Intrauterine death) was made to deliver the child, went for DIC
(Disseminated Intravascular Coagulation), had PPH (Post partum hemorrhage – excessive bleeding
after delivery), platelet count dropped – requires immediate platelet concentrate to stop bleeding
and /or fresh blood, but the blood is not available in that hospital, the doctor shifted the patient to
higher centre taking risk, reaching the higher centre is left to the god.
Solution: With VPA – VPH - MV – MN, all the needed specialists to handle such cases, all the needed
instruments and the laboratory to diagnose and to prognosticate the event, and all the needed
things including the blood components can be made available and accessible to all the people.
6. Newborn – birth asphyxia – HIE – Neonatal seizures: Pediatrician thinks 100 times to give Inj.
Phenobarbitone, because he does not have the ventilator backup if the child goes for respiratory
failure with the drug. Attendees are not affordable to go to the higher center where the neonatal
ventilators are available. It was the case referred from the government taluk hospital, and the
district government hospital may not have the pediatric ventilator or all the ventilators are occupied.
Solution: With VPA – VPH - MV – MN, such types of cases can be well managed in the VPH.
7. A old man who is having seizures due to low sodium in blood (Hypo nitremia), which was
diagnosed after the hospital admission, was made to move from the hospital to hospital due to non
availability of the physician, in that Sunday with holidays in the previous two days. Different
physician have gone for different work to different place without knowing that everyone is out of
the station on the same day, because they were working at the different hospitals in the same city,
thus there is a possibility that all of them may leave the station in one day for their work or all of
them may stay back in one day, it is possible different Physician can go on different days of the
month so the services for the needy people will not suffer.
Solution: With VPA – VPH - MV – MN, it possible to coordinate among the doctors and they can take
leaves on different days to get their work done.
8. G2, P1, L1, routine scan were done but some congenital heart disease was not picked up in that
scan. LSCS was done for PROM and oligo hydromnia (less fluid). Baby looked well at birth, so
tubectomy was done. Later it was found to be having some murmur on day two and the baby died
after few days and they were arranging some money to go to higher centre for getting the
echocardiography to be done.
Solution: With VPA – VPH - MV – MN, better diagnostic tests can be made available even at the VPH
level.
9. Most of the patient with head injury needs to move many kilometers to rule out the possibility of
intracranial injury.
Solution: With VPA – VPH - MV – MN, such types of cases can be well managed in the VPH.
10.Most of the ambulances are just ordinary vehicles except for the siren on their head. The
situation may be better with the present 108 ambulance and some private ambulance service.
Solution: With VPA – VPH - MV – MN, all the ambulances can be made in to life line ambulance,
since an ordinary thinking emergency can turn in to mortality at any time.
11.An emergency call was made to the 108 ambulance, telling that a lady is in labor pain. Lady
delivered a female child in the ambulance itself, and the blood was spilled all over the floor of the
ambulance, later the mother and the child were shifted to the hospital and it was found that both
the mother and the baby are retroviral positive. Ambulance by that time has already shifted another
patient to some other hospital.
Solution: With VPA – VPH - MV – MN, all the patients will have regular checkups and thus the people
working in health services and the people coming in the way will not get such infections accidentally.
12.OPD: Regular staff for injection room especially in the immunization room. Otherwise there is a
possibility of administering the injection to the wrong site /route/so on or child may land up in some
of the complications of wrong technique of injection.
Solution: With VPA – VPH - MV – MN, it is possible to give good trainings in the fields they work and
thus we can minimize the unexpected complications due to wrong techniques.
13.Husband, wife and a child of 2 month old had come to one of their relative's house for a festival.
Child was having some cough, which the parents noticed during their journey to their relative's
house. They had the plan to show the child to their family doctor when they go back to their place
next day. From the late evening the child was not sucking well at the breast, but the parents tried
some Pallada feeds and thought 'why to give trouble to their relatives, let us go to our place and will
show to our family doctor'. But the child became worse by night, started having noisy breathing,
refused to take Pallada feeds, became lethargic, cry and activity became poor. Now the parents are
worried and wanted to show to some doctor and they told their wish to their relatives and their
relatives arranged some vehicle and took to one of the nearby hospital where no pediatrician was
available at that time. Later they have taken to another hospital where no oxygen was available and
they did not have the facility to monitor the oxygen saturation, so the baby was referred to another
hospital. In the third hospital they recorded the vitals and systemic examination was done. The
doctor recorded the heart rate of 180/min, respiratory rate of 80/min, oxygen saturation as it is
recorded by the pulse oxymeter was 60% in room air and 75% with 10 liters per minute of flowing
oxygen, baby had nasal flaring, chest retractions, cyanosis, grunting. Diagnosis of pneumonia in
respiratory failure was made, oxygen was continued, and the doctor explained to the attendees that
this baby requires ventilator support and that hospital did not had the ventilator to support that
baby (no neonatal and pediatric mode, the machine can support only the children above 12kg's), so
the doctor in that hospital told to take child to the hospital where the ventilator support to support
that child is available and also told that it is ideal to shift the child to that centre with oxygen support
at least. Then the baby's attendee asked the doctor 'how much is the ambulance charge' (since free
ambulance services like 108 ambulances will not shift the patient from hospital to hospital). Doctor
said it may cost 3000 to 5000 rupees. Then the attendees told 'we do not have so much money', but
their relatives told 'we will arrange the money' and the doctor told 'I will inform the administrator to
arrange the ambulance'. But the administrator told that the ambulance driver is on leave. So the
attendees planned to take the child in some private vehicle without the support of the oxygen.
What are the possibilities after this event?
a. The baby may die in another half an hour or so on the way to another hospital.
b. It may reach the hospital where ventilator facility is available but the ventilators are not free. In
this case they may have to take the baby another hospital or to another city to put the baby on
ventilator if at all if it is alive by the time it reaches another hospital.
c. The baby may die after few days of ventilator support because of delay in initiation of treatment
and by this time the baby had injury to the brain, kidney, heart, and so on because of hypoxia. But
the family has already sold some property to save the child to pay few lakhs of hospital bill.
d. The baby is saved but the baby is not normal, now the baby is diagnosed as cerebral palsy with
mental retardation and the family has to suffer throughout their life and the problems increases as
the parents becomes old, when they are not earning and when they are not in a position to look
after themselves.
e. The baby may die because of drowning during an attack of seizures and tubectomy was already
done during cesarean section and the parents will not have any one to look after them at their old
age.
Solution: creation of MV - MN - VPH - NHS will reduce the number of hospitals thus it reduces the
people running from hospital to hospital with many advises which they cannot understand easily and
it creates lot of confusion in their mind. VPH will have all the facilities to handle all type of cases and
thus no cases will be referred to another hospital unnecessarily thus the ambulance services will be
reduced to the maximum. If the patients are getting the treatment in their own village then they will
have more comfort and less personnel expense, thus the public transportation will be reduced, fuel
consumption will be reduced, pollution will be reduced to the maximum extent.
Since the treatments are initiated early with better round the clock monitoring there is better
recovery with less morbidity and mortality.
Solution: With VPA – VPH - MV – MN, such types of cases can be well managed in the VPH.
14.Chronic diseases: One day a 60 year old lady was going out from the casualty on the wheel chair,
as I was entering at 1AM. I enquired the doctor on duty, he said it is a case of CRF (Chronic Renal
failure), physician explained the need for dialysis, they are telling it is not possible to go to any other
place, if you give 100% guarantee, then we will try and spend the money, thus they are taking the
lady home.
Solution: All the terminally ill and chronic patients can be kept in the hospital till their death or till
they become better and they can be tried with all possible modalities of treatment possible, so that
it will help the next generate doctors in following the protocols formulated by their senior doctor.
The family will also feel free in managing the situation and they can visit the sick person whenever
they want. This is possible with the establishment of model village - model nation - village panchayat
hospital.
15.Babies delivered at house or at PHC, if they are term babies, will do well at house, if they are
preterm then they are recognized well and will be taken to the hospital for preterm care, but if they
are borderline term or IUGR then they will be taken to the hospital only if they stop feeding
completely, and after doing all the exercises like feeding the child with bottle, spoon, Pallada. Many
a times they may suffer from border line hypoglycemia and may recover with subclinical injury to
CNS, later they are the ones who are going to be the children with ADHD, poor school performer.
This type of injury can happen even at the hospitals, where round the clock monitoring and the
facilities to identify such type of problems are absent. Late admissions of such babies with many
problems like sepsis, hyperbilirubinaemia, hypocalcaemia, hypoglycemia, hyperglycemia, and so on,
will make the child to survive with morbidity or may lead to mortality.
Solution: creation of MV - MN - VPH - NHS will reduce the number of hospitals and make all the
deliveries as hospital deliveries. All the neonates will get better neonatal care and later they will
become the healthy citizens with sound mind and sound body.
2.2. Better to open the centers which cares instead of telling go to
higher centre.
The primary and higher primary health care should be available VPH in the MV.
It is better to have only few thousands of VPH which gives all the necessary services to the needy
people instead of lakhs of centers which say ‘we don’t have the facility to handle this problem, so go
to higher center at critical times when the already the patient had spend lot of time in reaching the
hospital and waited for the doctor to listen this sentence. That is what the situation exists in the
rural health care setup that can be solved with VPA - VPH – MV – MN.
2.3. Competition between the disease and the treatment, who
wins?
The beginning of the disease is like the beginning of the marathon. No one will recognize that there
is one unwanted participant (Disease) in the marathon in the beginning of the run. When we
recognize the thing like the disease is progressing in the marathon and it is reaching its target of
death, it may too late that the athlete - treatment has not started its run in the marathon. The
question is who is going to win the race the athlete of disease or the athlete of treatment.
2.4. VPH, to begin with.
To begin with, the VPH should have adequate beds with facilities to handle emergencies including
the facilities for intubation and IPPV, blood transfusion etc. It should have adequate doctors, nursing
staff, lab & x-ray technicians with ambulance facility.
Taluk Hospital should act like secondary health care center. District hospitals should be incorporated
with Medical college hospital.
The student studying in that college should be given seats as per the population distribution of the
nation. The entrance system is explained in the education section under the university education.
The principal/Director and the district health officer of the Medical College should post Interns and
postgraduates to various VP Hospitals.
Any accidents/emergencies happening in the VPA Area should be handled immediately by the VP
Hospital. If necessary help can be taken from the nearby VP Hospitals; Cases can be referred to
appropriate higher center according to the needs.
Regular health talks, screening camps for the people for hypertension, diabetes etc., awareness
about agricultural injuries, first aid for bites, stings, injuries etc. for the people should be provided
by the VPH.
It should have a regular contact with Medical collage hospitals; inform the higher center about
agricultural methods and its health impact, usage of fertilizers, insecticides, assessment of toxin
levels in the food grains etc. The help for all the activities is taken from the District medical college
hospital and from its university.
The medical university (Allopathic) of the state posts the graduates for the hospital. The Allopathic
medicine university will announce the job opportunities in its national magazine (see job counseling
section of the university education), and the candidates are selected through interview at the
university campus and posted in the VP Hospital and other hospitals.
2.5. VPH administration.
The Controlling System for the Hospital (Allopathic) is as follows:
↓1 The President of India.
↓2 Prime minister of India.
↓3 Central Health minister
↓4 Central Health Commissioner
↓5 Vice chancellor / Governor of national
Allopathic University.
↓6 Chief Minister at state.
↓7 Health minister at state.
↓8 State Health commissioner.
↓9 Vice chancellor of state allopathic
university.
↓10 Principal and district health officer.
↓11 Taluk Health officer.
↓12 VP Medical officer.
The transfer of the hospital staff and appointing other required staff is done by the allopathic
university. Interuniversity communication with other universities like university of Nursing service,
University of Nursing faculty, University of Pharmacy is also taken in appointing necessary staff.
Those staffs are appointed through their universities only. Allied specialties can have same university
campus for better administration and sharing the teachers.
The materials and equipment supply is done by the Allopathic University, the drugs are supplied by
the University of Pharmacy.
The doctors and the other staff of the hospital are given regular orientation by the District Medical
College Hospital and by the University. The doctors have to attend the conferences conducted by his
Allopathic University to upgrade their knowledge in a rapidly changing field of medicine.
2.6. VPH – Creation of Infrastructure.
National Health services: Department of health and medical science: Creation of Infrastructure.
The hospital building will be constructed as per the design planned by the MV – MN creating team.
The working team of the VPA will work in the construction work under the supervision of the
architects of MV – MN team. The materials will be supplied by the central team directly from the
factory, will be transported and stock will be maintained under the security of the army. The health
of the people of the MV will be maintained by the VPH under NHS.
2.7. Beginning staff of the VPH.
The staff pattern of the VPH to begin, with will be as follows:
Designation: No. Degree
1. Physician. 4 PGD in Medicine.
2. Surgeon. 4 PGD in surgery.
3. Obstetrician 4 PGD in OBG.
4. Ophthalmologist. 3 PGD in Ophthalmology
5. ENT surgeon. 3 PGD in ENT.
6. Biochemist. 2 PGD in Biochemistry.
7. Pathologist. 2 PGD in Pathology.
8. Microbiologist. 2 PGD in Microbiology.
9. Forensic specialist. 2 PGD in Forensic
medicine.
10. Community
medicine.
2 PGD in Community
medicine.
11. Anesthetist. 4 PGD in Anastasia.
12. Intensivist. 4 PGD in Intensive
medicine.
13. Pediatricians 4 PGD in Pediatrics
14. Radiologist. 3 PGD in Radiology.
15. Orthopedic
surgeon.
2 PGD in Orthopedics
Supporting staff:
16. Lab technician 6 Degree in lab
technology.
17. X ray and radio
imaging technician.
4 Degree in X ray
technology and radio
imaging.
18. OT technician. 6 Degree in OT
technology.
19. Physiotherapist. 6 Degree in
physiotherapy.
20. Nursing staff 300 Degree in nursing
services.
21. Housekeeping
staff
150 SSLC pass / PUC not
completed.
2.8. Catering population of the VPH.
Each VPH will be catering the people of 50000 to one lakh. No health camps, no home delivery by
TBA, no mobile vaccination, no field visits by the health worker are done with the complete
establishment of VPA – VPH – NHS – MV – MN.
The life line ambulance services are done inside the village from the home to the hospital by
designated electrical vans. The referrals are done only rarely when the treatment is not available at
the VPH for that disease with the staff of the VPH.
All the health events of the individuals are recorded in the patients PIN under the health file with the
details of the doctor treated at each visit both in outpatient and inpatient visits. So if we open the
health file we will get the details of the individual health from his birth to till date / death.
VPH focuses on curative / preventive / promotive health services. No clinic set up is allowed
anywhere. Individual practice can be done at the VPH itself if the person has appropriate degree
without any rent for the room and the doctor need to update the health details of the patient with
PIN. The doctors PIN will be attached with special codes for opening the health files of the patient.
PIN for every new born is issued on the day of discharge from the hospital by the obstetrician and
the pediatrician with their PIN and it will be added in the family tree of the newborn. Automatic
updates of the PIN is done at various places like at the entry of school / primary education /
secondary education / pre university education / university education / post graduation / job /
change of job / marriage / transfer / child birth / children marriage / death. The PIN will be
automatically will be added in the list of Voters at the entry of 18 years of age.
2.9. Introduction to the emergency trolley.
Introduction: Emergency Trolley is the common idea which already exists in the field of medicine.
Here we repeat the same with little modification make this available in all the hospital at all the time
to give better emergency service, to all the needy people, because the life is precious for the family
and sometimes for the nation. This project is to increase the quality of Emergency services. It is one
stem among the several steps of NHS.
It is created to get the emergency drugs and other materials required during emergency handling
without wasting the time.
Delay in each second in initiating the treatment due to any reason related to communication,
transport, roads, traffic, vehicle, vehicle fuel, shifting methods, splinting, doctor, supporting staff,
drugs, perenteral routes, equipments, tubes, connectors, loving mind from the people who delivers
the related services can significantly affect the mortality and morbidity of the person and will make
the dependent family and the nation to suffer for the rest of the period.
In India in the present economic status, it may not be practical to establish the emergency services in
public places and to train the public in the events related to emergency handling by giving related
education like in some of the developed countries, but at least in the hospitals which provides the
health services should be ready with all the necessary items in hand to decrease the time between
the onset of emergency and initiation of the treatment to decrease the mortality and morbidity.
Where we can keep these emergency trolleys?
These E trolleys can be maintained in the places like 1.ICU, 2. ICCU, 3.SICU, 4.OT, 5.LABOUR ROOM,
6.PICU, 7.NICU, 8.Emergency ward, 9. Casualty,10. Ambulance.
2.10. Advantages of Emergency Trolley.
What are the advantages of emergency trolley?
The advantages are,
Availability of all the necessary drugs, tubes, monitor, oxygen, defibrillator in one portable small
table measuring 24(Breadth), 42(length), 31(Height) inches;
The table can be shifted near the patient and thus it decreases the walking and searching time.
The empty compartment with designated name without any material inside will tell the staff to refill
the item which was utilized for the previous patient and thus we need not spend long time to look in
to all the items/ drugs to know what is absent and what is present.
When the administering staff (Doctor/Staff nurse) requests the assisting staff (Staff
nurse/Pharmacist) to load some drug and give, it is easy to search because, we will know which
row/box/compartment has that item and thus it decreases the searching time.
The money that we invest to maintain the trolley (towards used items) will decrease the mortality
and the morbidity as it is used in a needy time without writing the prescription to the hospital or
outside pharmacy through the patient attendee. [There may be a delay due to money (some body
may be bringing the money from home which may be a far place) or non availability (the pharmacy
might have closed/ stock might have got over)].
At present all the items may be present in the hospital/drug store in a scattered way and may not be
available at the needy time due to many reasons like pharmacy time got over, needs permission
from the higher officer for giving the stock, the person in charge may be on leave or the key may be
with him and he might have gone for food and thus it leads to the delay. The aim is to get all the
needy items in a composite way at all the time in one table in the places where we handle the
emergencies. If needed, the used items can be replaced by the patient attendee itself at a
convenient time.
Some time we may not be maintaining all the items at all the places, routinely, like Inj.Streptokinase
in NICU- E – Trolley, where we can put a label like no stock is maintained, but all the necessary drugs
should be replaced immediately.
Autoclaved surgical set can be kept on the table top, which contains needles, threads, artery forceps,
mosquito artery forceps, thumb forceps (toothed and smooth), needle holder, hole towel, gloves ect
for doing emergency bed side simple procedures like ICD insertion, tracheotomy, vene section and
others. A separate surgical trolley should also be maintained apart from the E trolley as it is running
today for the purpose of wound dressing and for minor suturing.
2.11. Dimensions of emergency trolley.
Dimensions of Emergency Trolley:
S
N
Dimension, Measurements,
1 Height( Excluding the table
top and the electrical panel
on the table)
31 inches
2 Length 42 inches
3 Breadth 24 inches
Height division,
S
N
Division, Measurements,
1 Row1 2 inches
2 Row2 2 inches
3 Row3 3 inches
4 Row4 3 inches
5 Row5 3 inches
6 Row6 3 inches
7 Row7 6 inches
8 Row8 6 inches
9 Wheel space height 3 inches
Total height excluding the
table top and the electrical
panel
31inches
Length division,
S
N
Division, Measurements,
1 Right wall space 0.5 inches
2 Right row length 20 inches
3 Central separator space 1 inches
4 Left row space 20 inches
5 Left wall space 0.5 inches
Total length 42 inches
Electrical panel measurement,
S
N
Dimension, Measurements,
1 Height 6 inches
2 Length 42 inches
3 Breadth at the base 6 inches
4 Breadth at the top 2 inches
1. Side walls – wooden/plywood/plastic laminated – Screwed: - The top, right and left side walls and
the back walls are made of wooden or play wood sheets (Non conductors) which are screwed and
fitted to the body.
2. Electrical panel: - Are created at the top of the trolley to fit the electrical sockets. And this panel is
divided in to two compartments, one for wiring purpose and another for placing the rolled wire. The
size of the panel is – height 6 inches, width at the base is 6 inches and at the top is 2 inches.
3. Electrical sockets: - are fitted at the electrical panel with the provision for four connections.
4. Wire holder: - the folded wires are kept in the wire socket in the electrical panel.
5. Side Para path walls for the trolley top: one inch height side walls are created to prevent fall of the
vials when it is kept at the top.
6. Handles can be fixed on either the sides of the table to push and pull the table.
7. Slid able and foldable drip stand and light source can be incorporated.
8. Oxygen cylinder: Provision can be made to fix the conventional size oxygen cylinder on either the
sides of the E – Trolley.
9. Pad holder can be created on either the sides of the trolley to keep the necessary files.
10. Open vial holder: - Used vial holder is fitted at the top to keep the used/opened vials on the top
with different diameters. The length of the open vial holder is fitted along the breadth of the trolley.
The floor plate of the holder has got depressions for holding the ampoule base at place
corresponding to the top placing holes. The first hole plate is fitted at one inch above the floor plate
and extends throughout the length of the floor plate and has all the seven rows of holes with 0.5
inch gradient with the biggest hole diameter being the 3.5 inches and the smallest being the 0.5
inches in diameter as shown in the picture. The second hole plate is fixed one inch above the first
plate and which extends only for the 10 inches of length and has got only three rows of holes with
the diameter of 3.5inches, 3.0inches, 2.5inches in diameter, two each in number.
Dimensions of the open vial holder:
S
N
Dimension Measuremen
t
1 Length 16 inches
2 Breadth 8 inches
3 Height- Back 10 inches 2 inches
4 Height – Front 6 inches 1 inches
Holes plate places,
S
N
Diameter of
the hole
Number
of rows
Number of the
holes places in
the row.
1 3.5inches one Two
2 3.0 inches one Two
3 2.5 inches one Two
4 2.0 inches one Three
5 1.5 inches one Four
6 1.0 inches one Six
7 0.5 inches one Eight
Total
number
of holes
27 (Twenty
seven)
Measurement description of rack 1, 2 & 3.
S
N
Dimension Measuremen
t
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
2 inches
Box description of rack 1, 2 & 3.
S
N
Dimension Measuremen
t
1 Number of boxes along the
Length
5
2 Number of boxes along the
Breadth
8
3 Total number of boxes 40
4 Length of each box 4 inches
5 Breadth of each box 3 inches
Rack4.
Measurement description of rack 4.
S
N
Dimension Measurement
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
2 inches
Box description of rack 4.
S
N
Dimension Measurement
1 Number of boxes along the
Length
5
2 Number of boxes along the
Breadth
4
3 Total number of boxes 20
4 Length of each box 4 inches
5 Breadth of each box 6 inches
Rack 5 & 6.
Measurement description of rack 5 & 6.
S
N
Dimension Measurement
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
3 inches
Box description of rack 5 & 6.
S
N
Dimension Measurement
1 Number of boxes along the
Length
5
2 Number of boxes along the
Breadth
4
3 Total number of boxes 20
4 Length of each box 4 inches
5 Breadth of each box 6 inches
Rack 7,8,9,10,11 & 12.
Measurement description of rack 7,8,9,10,11& 12.
S
N
Dimension Measurement
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
3 inches
Box description of rack 7,8,9,10,11& 12.
S
N
Dimension Measurement
1 Number of boxes along the
Length
7
2 Number of boxes along the
Breadth
1
3 Total number of boxes 27
4 Length of each box 2.75 inches
5 Breadth of each box 24 inches
Rack 13 & 14.
Measurement description of rack 13 & 14.
S
N
Dimension Measurement
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
6 inches
Box description of rack13 & 14.
S
N
Dimension Measurement
1 Number of boxes along the
Length
3
2 Number of boxes along the
Breadth
2
3 Total number of boxes 6
4 Length of each box 6.6 inches
5 Breadth of front row of
boxes
16 inches
Breadth of back row of
boxes
8 inches
Rack 15 & 16.
Measurement description of rack 15 & 16.
S
N
Dimension Measurement
1 Length 20 inches
2 Breadth 24 inches
3 Height including the
separation plate
6 inches
Box description of rack 15 & 16.
S
N
Dimension Measurement
1 Number of boxes along the
Length
5
2 Number of boxes along the
Breadth
2
3 Total number of boxes 10
4 Length of each box 4 inches
5 Breadth of each box 12 inches
2.13. Common Features
Descriptions.
The height of the rack mentioned in the picture includes the separation plate/ bar also.
One centimeter obdurate plate is fixed on either the sides of the rack to prevent the rack falling
when it is excessively pulled.
Sliding bar is fixed at the floor of the rack to prevent the damage to the floor and formation of the
holes and others by repeated use (Pull and push).
Number and name bar is inserted at the front part of the box row at a little depth to write the
number and name. It is fixed at a depth of 0.5 centimeters to prevent the erosion of letters written
over the bar while pulling and pushing.
A 0.25 centimeter back fold is made or a plate is bordered so that the area for writing the number
and names are placed 0.25 centimeters inside to prevent the erosion by body touch.
2.14. Emergency drugs to be kept in Emergency trolley, System wise
classification (A prototype).
Com
part
num
ber.
Name of the drug. Strength / Dose
CVS
4-18 CHEST LEAD PLASTERS
4-19 ELECTRICAL JELLY
4-20 SCALPEL BLADES
6-20 PULSE OXYMETER
SENSOR PROBES -
PEDIATRIC AND ADULT
13-1 CARDIAC MONITOR
WIRES
13-1 PULSE OXYMETER
WIRES
13-1 SPANNER, HAMMER,
AMPULE CUTTER,CELLS
FOR LARYNGOSCOPE.
TOP & SIDES
TOP PULSE OXYMETER
TOP CARDIAC MONITOR
WITH DEFIBRILLATOR
TOP OPEN VIAL HOLDER
TOP PLUG POINTS
SIDE OXYGEN CYLINDER
SIDE PAD HOLDER
SIDE LIGHT SOURCE
SIDE DRIP STAND
2.15. Emergency drugs to be kept in E – trolley, Rack /
Compartment wise classification.
RACK1:
Compartment measurements.
Length Breadth Height No. compartments
10 cms 7.5 cms 5 cms 40
Drugs-Injections.
Com
part
num
Name of the drug. Sto
ck.
Length
in cms/
RACK7:
Compartment measurements.
Length Breadth Height No.
compartments
7.5 cms 60 cms 7.5 cms 7
Drugs-Injections.
Compart
number.
Name of the drug. Stock.
7-1 1.Central line catheter-
Femoral- one each
1each
no
7-2 2.Central line catheter –
Jugular – one each
1each
no
7-3 3.Central line catheter –
Basilic/cephalic– one each
1each
no
7-4 DRIP SET – MACRO 20
7-5 DRIP SET – MICRO 20
7-6 DRIP SET – PEDIATRIC
WITH MEASURING
CHAMBER
10
7-7 ORAL SUCTION TRAP 10
RACK16:
Compartment measurements.
Length Breadth Height No.
compartments
10 cms 30 cms 15 cms 10
Drugs-Injections.
Comp
art
numb
er.
Name of the drug.
Strength/Dose
Sto
ck.
Length in
cms/
Diameter
in cms
16-1 6.IsolyteP.500ml 2 20.5/7
16-2 7.IsolyteM.500ml 2 20.5/7
16-3 8.DNS.500ml 2 20.5/7
16-4 9.0.45%DNS.500ml 2 19/7
16-5 10.NS.500ml 2 20.5/7
16-6 11.NS.100ml 4 10.5/4.5
16-7 12.3%Saline.100ml 2 10.5/4.5
16-8 13.0.45%NS.500ml 2 20.5/7
16-9
16-10
TOP & SIDE
TOP PULSE OXYMETER 1
TOP CARDIAC MONITOR WITH
DEFIBRILLATOR
1
TOP OPEN VIAL HOLDER 1
TOP PLUG POINTS 4
SIDE OXYGEN CYLINDER 2
SIDE PAD HOLDER 2
SIDE LIGHT SOURCE 2
SIDE DRIP STAND 2
2.16. ‘Medicines’ in medical practice.
The hand writing of the person depends on how much he write in the copy writing book in his school
days, the pen he uses, the paper he uses, and the support underneath the paper and so on. It also
depends on the grip, hold and the pressure we use with the pen on the paper. Most of the peoples
hand writing may be good in their school days and it may not be good after few years of intensive
practice in their profession.
Some of the professionals may have better hand writing as the day advances in their profession like
those who do clerical job. Those professions who use less pen for their work, but they use their
finger skills more for other works, may develop poor hand writing with ‘pen on the paper’. Those
professionals who frequent change the ‘grip and hold’ on pen and the pressure on the paper will not
have good hand writing. People like type writer, those who work with the computer may have better
typing skills with the type writer and the artist may have better drawing skills, but may not have
good hand writing. The doctors with busy practice may be examining the patients, will be doing
some procedure, and thus leaves and holds the pen frequently, writes fast on the paper, because of
this they lose ‘grip and hold’ on the pen frequently and thus the pressure on the paper, thus their
hand writing may go bad with passage of time. This may not hold good for those who are not too
busy in their profession and those who involve in wring for long hours for some reasons in between
their regular profession. Many times we hear from the common people telling like ‘the doctors
language will be known only by the people of the medical stores’. That means the common people
will not be able to understand the spellings of the medicines the doctor write (this will not apply to
all the doctors). The people of the medical shop know the routine drugs written by the doctor or in
case of doubts they may call the doctor and clarify the doubt. Mistakes can happen while giving the
medicine with this type of confusing hand writing.
One medical shop may be running by one pharmacist. The drug controller is there to control the
standards of the medical shop, and ‘he ensuring the presence of the pharmacist all the time in the
medical shop’ is of more theoretical. Pharmacist is also a human being, he may have to have food,
go for natural calls, may require some rest some days, and to go for other place for shopping and
other works. Because of this reason most of the medical shops will appoint some assistant, who are
educated enough to read the names of the drugs. And they will be working more than the real
pharmacist. Appointing another pharmacist in the place of the regular pharmacist in the times when
the regular pharmacist goes for buying medicines may not be feasible by the owner of the medical
shop or they may not be getting that type of replacing pharmacist. So at these times the assistant of
the pharmacist may be managing the medical shop and with the bad hand writing of the doctor he
may give the ‘wrong but similar looking drug’ which may lead to the problem.
The medical students will read the pharmacology in detail. All the words in the text book may look
new for them, even though they might have used some of them at home in their early life. For a
medical student the name ‘paracetamol’ may look like a new word, but if he sees the name ‘dolo’ he
may tell ‘I have used it when I was suffering from the fever in my younger days’. One drug and
thousands of brand names makes everyone confused, and no single doctor on this earth will be able
to remember all the brands and its contents. But, all the medical professionals will know the entire
drug molecules that are present in their pharmacology book; otherwise they will not be able to pass
the examination. If a patient bring some prescription written by some other doctor to other doctor
telling that ‘two months back we have used this medicines and the patient was better in between,
again he is having fever’. They may bring only the prescription but not the medicine. The doctor may
not have sufficient time to see the content of the brand by looking at the ‘drug books’, enquire how
much of drug is present in that bottle, think whether it is sufficient for that illness - for that patient,
and advise ‘that is sufficient, you can use the same, if it is not expired’. This may not happen and the
doctor will write new prescription for that illness and will start seeing another patient. Thus every
house will have miniature medical stores with half empty drug bottle and few tables with them.
After some days they will be thrown in to the dust bins with the general waste, thus it will add
burden on waste management, possibility of poisoning, apart from the economic burden by this type
of wastage over the family and on the nation.
The different brands for single molecule by different companies might have originated in the market
in order to give ‘competition to similar molecules with different brand’ and ‘to sustain in the market
with better quality with competitive price’. It is the science and it is the business through which we
need to lead the life. But, it should not be at the cost of the life of the patient. Mistakes can happen
at any stage, like giving different molecule with different trade name which looks similar, or
administration of different drugs with confusing brands, or the marketing people keeping similar
looking words to give competition for good running brand.
The doctors may be prescribing some brand because he feels that brand is good – gives better
results that mean that company which manufactures that drug is good, they might have done many
studies to see that the brand is working well.
So, let the doctors write which ever company they prefer, let the manufactures prepare the
medicines in the good standard possible by them, let the people who market the drug do their job in
the process of providing the medicines to all the nook and corner of the nation. All the people have
to lead the life, so let all of them take their share of income.
The only request by me in the present system of pharmacy is to decrease the confusion while writing
the prescription, while dispensing the medicine, while administering the medicine among the lacks
of brands, which we have with us in the present market. It is better to have a system where no one
is going to have confusion with the brand they use including the patient and thus prevent the
possible accidents by wrong administration.
2.17. Let us decrease our confusion on drugs with present brand
names, still retaining the brand.
We can see lot of brands with very minimal change in the letters but will have different molecules
with them, same brand name but different molecules, same brand name and the same molecule by
different pharmaceutical company and sometimes different cost and so on.
The examples are as follows: The following tables (e.g. 1to 20) are based on the references taken
from the ‘DRUG TODAY – 79, VOLUME 1 & 2, January to March 2013.’
Brands
which
look
similar
with
very
minimal
change
in
letter.
The different
molecules
that the
brand
contains.
Preparati
on
Pharmace
utical
company
name
e.g.1
Atorno Atorvastatin Tablet Gnova
biotech
Atorlo Losartan Tablet Olcard
e.g.2
ATS Artesunate Injection Vee
remedies
ATV Atorvastatin Tablet Zee lab
e.g.3
Axon Methyl
cobalamine,
ALA,
Tablet Bajaj
pharmace
thiamine
mono
nitrate,
pyridoxine,
folic acid
uticals
Axone Ceftriaxone
sodium
Injection Newgen
e.g.4
B - com B complex syrup Prism
pharma.
B - con Flucanazole Tablet Bio max
lab.
e.g. 5
Lenova Levofloxacin Tablet Genova
life care
Lenova Levofloxacin Tablet Gnova
biotech
Lenovo Levocetirizin
e
Tablet Innova
e.g. 6
Axytee Hydroxyl
progesterone
Injection Axygen
Axytef Clarithromyci
n
Tablet Axygen
Axytex Acetazolamid
e
Tablet Bionext
e.g.7
Azicare Azithromycin
e
Tablet Bindlysh
biotec
Azi-care
-200
Micronized
progesterone
Tablet Azillian H
- care
Same
trade
Different
molecule
Preparati
on
Different
pharmace
utical
name company
e.g. 8
Beta Atenolol Tablet Stad med
Beta Betamethaso
ne
Tablet Mefro
pharma
Beta Beclomethas
one
diproprionat
e
cream Micro
labs
e.g. 9
Levot Levofloxacin Tablet Genasia
Levo-t Levoceterizin
e
Tablet Genx
health
care
e. g. 10
Zanin Azithromycin
e
Tablet Glencare
life
sciences
Zanin Hydroxy
progesterone
caproate
Injection Zenlabs
India
e.g. 11
LCD Levodopa +
Carbidopa
Tablet Intas
LCD Levoceterizin
e
Tablet Mac
organics
e.g. 12
Azin Asenapine Tablet Intas
Azin Azithromycin
e
Tablet Oyster
labs
Azin azithromycin
e
Tablet sanshis
Same
trade
name
Same
molecule
Same
preparati
on?
Different
cost.
Different
pharmace
utical
company
e.g.13
Axicef Ceftrioxone Injection Numera
life
sciences.
Axicef Ceftrioxine Injection Axis
pharma.
e.g 14
Azicin Azithromycin Tablet Shalman
pharma
Azicin Azithromycin Tablet Nutron
e.g.15
Azinik Azithromycin Tablet Nick
pharma
Azinik Azithromycin Tablet Orange
biotech
Azinik Azithromycin Tablet Unik
health
care
e.g. 16
Azipro Azithromycin Tablet Cipla
Azipro Azithromycin Tablet Mepro
pharma
e.g.17
Azisil Azithromycin Tablet Basil
Azisil Azithromycin Tablet Silicon
pharma
e.g. 18
Balamin Methyl
cobalamine
Injection
(Rs 30)
Kapeetus
medicorp
Balamin Methyl
cobalamine
Injection
(Rs 250)
Avni H
care
e.g.1: Brands with minimal change in letters with different molecules:
Brand Molecules. Preparati
on
Company
e.g.1
Atorno Atorvastatin Tablet Gnova
biotech
Atorlo Losartan Tablet Olcard
Here the trade names Tab. Atorno and Tab. Atorlo may look similar if the doctor is not writing
prominatly looking ‘L’, and thus the pharmacist may give the molecule Atorvastatin instead of
Losartan potassium and the patient may land up in complications related to hypertension.
e.g.2: Brands with minimal change in letters with different molecules:
e.g.2
ATS Artesunate Injection Vee
remedies
ATV Atorvastatin Tablet Zee lab
The possibility of making errors may be less if the doctor write all the letters in capital, thus the ‘s’
and ‘v’ will be differentiated well between Injection. ATS and Tablet. ATV. An intelligent pharmacist
can make the differentiation by looking at the preparation since Injection is written before ATS
(artesunate). This will also be differentiated in the hospital before giving the injection. The attendees
of the patient may have to come to the pharmacy may be once more for the same reason if the
pharmacist makes the mistake or the nursing staff writes only the trade name but not the
preparation in the prescription, thus the pharmacist may give Tablet. Atorvastatin.
e.g.3: Similar looking brand with one extra letter with different molecules:
Axon Methyl
cobalamine,
ALA,
thiamine
mono
Tablet Bajaj
pharmace
uticals
nitrate,
pyridoxine,
folic acid
Axone Ceftriaxone
sodium
Injection Newgen
There is one letter ‘e’ is extra between Tab. Axon and Inj. Axone. If the pharmacist is intelligent then,
he will get the clue from the preparation even if the letter ‘e’ is not prominent.
e.g.4: Brands with minimal change in letters with different molecules:
e.g.4
B - com B complex syrup Prism
pharma.
B - con Flucanazole Tablet Bio max
lab.
The possibility of the pharmacist giving syrup B complex (B – com) instead of Tablet. Flucanazole (B –
con) telling that they do have the same brand tablet of B complex or they may replace with other
brand of B complex tablet. Thus the patient may land up in extensive fungal infection for which he
was not given the correct tablet in the pharmacy. If the patient goes to the same doctor and if the
doctor remembers him as his old patient or if the patient takes the old prescription with him telling
that he is not better, then this mistake may be corrected at the second visit. If the patient goes to
another doctor thinking that the doctor is not good because he is not better or if he loses the
prescription, and if another doctor writes the same brand then this cycle of mistake may repeat.
e.g.5: Brands with similar name and molecule and also similar looking brands with minimal change in
letters with different molecule.
e.g. 5
Lenova Levofloxacin Tablet Genova
life care
Lenova Levofloxacin Tablet Gnova
biotech
Lenovo Levocetirizin
e
Tablet Innova
In this example we can see the similar two brand names with the same molecule inside and by
different companies. The doctor may be aware of one company and its quality, but when it comes to
the pharmacy the pharmacist may give the drug which is available in his pharmacy. If the pharmacist
gives wrong drug like ‘tablet Lenovo’ in the place of ‘tablet Lenova’ then the infection in the patient
may progress and becomes fatal. The patient will also have the faith in the doctor and will wait for
the drug to act, thinking that it will take some time to have the cure without knowing the thing like
he is not consuming the same medicine as it is meant by the doctor.
e.g.6: Brands with minimal change in letters with different molecule:
e.g. 6
Axytee Hydroxyl
progesterone
Injection Axygen
Axytef Clarithromyci
n
Tablet Axygen
Axytex Acetazolamid
e
Tablet Bionext
The possibility of replacing, the medicine by the other brand names is present with such types of
brand names.
e.g.7: Brands which look similar with very minimal change in it with different molecule.
e.g.7
Azicare Azithromycin
e
Tablet Bindlysh
biotec
Azi-care
-200
Micronized
progesterone
Tablet Azillian H
- care
Possibility of dispensing ‘Tablet. Azithromycine’ in the place of ‘Tablet. Micronized progestrerone’ as
the second one may not be available with all the pharmacist and the cost of it may not be known by
the pharmacist. If the pharmacist reads the ‘doctors name and qualification’ and the ‘patient’s age
and sex’, then he may get the clue that it is some different drug. Most of the time the pharmacist
may not commit such type of mistakes, but his assistant in the absence of the pharmacist may make
such mistakes.
e.g.8: Brands with similar names but entirely different drugs.
e.g. 8
Beta Atenolol Tablet Stad med
Beta Betamethaso
ne
Tablet Mefro
pharma
Beta Beclomethas
one
diproprionat
e
cream Micro
labs
Different molecules like ‘Atenolol’ and ‘Betamethasone’ and both are in tablet form will lead to lot
of problem for the patient. If the pharmacist is intelligent, then he may identify it difference with the
dosage written along with the drug.
e.g.9: brands with similarity with different molecules:
e.g. 9
Levot Levofloxacin Tablet Genasia
Levo-t Levoceterizin
e
Tablet Genx
health
care
If the doctor writes it in small letter, then the small ‘-’ will be merged when the ‘o and t’ combines.
e.g.10: brands with same name with different molecule.
e. g. 10
Zanin Azithromycin
e
Tablet Glencare
life
sciences
Zanin Hydroxy
progesterone
caproate
Injection Zenlabs
India
These brands may look similar but the molecules are different and the pharmacist has to identify it
by its preparation.
e.g.11 & 12: Same brands with different molecules.
e.g. 11
LCD Levodopa + Tablet Intas
Carbidopa
LCD Levoceterizin
e
Tablet Mac
organics
e.g. 12
Azin Asenapine Tablet Intas
Azin Azithromycin
e
Tablet Oyster
labs
Azin azithromycin
e
Tablet sanshis
When many brands with same name and preparation are present in one pharmacy, then the
possibility of giving different molecules is the possibility like replacing ‘talbet levoceterizine’ for
‘tablet levodopa+carbidopa’, and replacing ‘tablet Azitromycine’ for ‘tablet Asenapine’.
e.g.13, 14, 15, 16, & 17: Brands with similar name and similar molecules but by different companies.
e.g.13
Axicef Ceftrioxone Injection Numera
life
sciences.
Axicef Ceftrioxine Injection Axis
pharma.
e.g 14
Azicin Azithromycin Tablet Shalman
pharma
Azicin Azithromycin Tablet Nutron
e.g.15
Azinik Azithromycin Tablet Nick
pharma
Azinik Azithromycin Tablet Orange
biotech
Azinik Azithromycin Tablet Unik
health
care
e.g. 16
Azipro Azithromycin Tablet Cipla
Azipro Azithromycin Tablet Mepro
pharma
e.g.17
Azisil Azithromycin Tablet Basil
Azisil Azithromycin Tablet Silicon
pharma
In such cases the patient may not get the same brand he wants as it is intended by his doctor. The
doctor may mean one company and the pharmacist may give different company’s drug with same
brand and molecules. The doctor may not be sure whether that company is producing quality drug,
whether has done lot of studies to prove the molecule of its company as potent drug on the patient.
One company may be spending crores of rupees to do lot of studies to make its products superior, to
bring objective evidences, where as the other company be spending lot of money on advisement,
gives good margin to the pharmacist and offers to the doctors, makes lot of difference in giving
better cure for the patient. It is very much essential to understand the efficacy of the drug, because
the same molecule with difference in preparation and the adjuvant they use as preservative makes
lot of difference in pharmaco kinetics and pharmaco dynamics of the drugs in the body of the
humans and thus on its targeted action.
Every brand will go under series of people and the drug controllers before it steps in to the market,
but still the same molecules with same brand is coming may be difference in the price is little
surprising. The possibilities are the drug controller might have forgotten that similar brand is existing
in the market, or that brand might be away from the market for some time in that new company
might have introduced the same brand and same molecule in to the market, or the same brand
name may be given in the period of different drug controller and so on.
e.g.18: Same brand name and same molecule but difference in price:
e.g. 18
Balamin Methyl
cobalamine
Injection
(Rs 30)
Kapeetus
medicorp
Balamin Methyl
cobalamine
Injection
(Rs 250)
Avni H
care
The companies may give many reasons for this type of difference in the cost of the medicines. The
company with the high cost will tell ‘we ensure quality in manufacturing at every step; the
bioavailability is more, good action on the targeted tissue with good tissue penetration’ with the
supportive clinical data for the same. On the other hand the company with low price may tell ‘we
also ensure quality in manufacturing at every step, the bioavailability is good even with our
molecule, we also have studies to prove the good action on the targeted tissue with good tissue
penetration, we are giving this for lower cost because our brand is moving well in the market in large
quantity, because of which we are able to give it for low cost’.
We cannot rule out the possibility of making money by any one of the company, they may be giving
good margins for the pharmacists, the quality may not be good even with high cost, if the mind of
the company concentrates only on money making.
e.g.19: Brands with different name but the molecule is the same.
Brands
with
different
name (It
is difficult
to
remembe
r all the
brands)
All the
brands
containing
the same
molecule.
Name of
the
pharmace
utical
company.
Suggeste
d brand
name for
the same
company
(it is easy
to
remembe
r all the
brands)
Acetamin
ophen
Paracetam
ol
Agrawal Paraceta
mol -
agrawal
Aceto Paracetam
ol
Ormed H
care
Paraceta
mol -
ormed
Achmol Paracetam
ol
meriodin Paraceta
mol -
meriodin
ACN500 Paracetam
ol
MLS
health
care
Paraceta
mol -mls
Activate Paracetam
ol
Divine
pharma
Paraceta
mol -
divine
Alpamol Paracetam
ol
Allpa Paraceta
mol -
allpa
Anamol Paracetam
ol
Elder Paraceta
mol -
elder
Arimol Paracetam
ol
Aries
drugs
Paraceta
mol-aries
Askapyrin Paracetam
ol
Asklepios
remedies
Paraceta
mol -
asklepios
Bacine Paracetam
ol
Baxil
pharma
Paraceta
mol-baxil
Bambiti Paracetam
ol
Deys Paraceta
mol -
dyes
Bepamol Paracetam
ol
Biological
E
Paraceta
mol -
biological
Calpol Paracetam
ol
Glaxo
smithklin
e
Paraceta
mol - gsk
Cemol Paracetam
ol
Inga
laboratori
al
Paraceta
mol - igna
Cincro Paracetam
ol
Welkind
pharma
Paraceta
mol-
welkind
Cofamol Paracetam
ol
CFL
pharma
Paraceta
mol - cfl
Crocin Paracetam
ol
Glaxo
smithklin
e
Paraceta
mol -
glaxo
Decetol Paracetam
ol
Deltoid
pharma
Paraceta
mol-
deltoid
Dispar Paracetam
ol
Rekvina Paraceta
mol -
rekvina
doliprane Paracetam
ol
Nicholas Paraceta
mol -
nicholas
Empar Paracetam
ol
Materkin
formulati
on
Paraceta
mol -
materkin
Ezee para Paracetam
ol
Nicholas
actis div.
Paraceta
mol –
Nicholas
actis
Fastpara Paracetam
ol
Santiago Paraceta
mol –
santiago
Febrex Paracetam
ol
Indoco Paraceta
mol-
indoco
Fee Paracetam
ol
Safetech Paraceta
mol-
safetech
Fepanil Paracetam
ol
Citadel Paraceta
mol-
citadel
Fe - stop Paracetam
ol
Hamax Paraceta
mol-
hamax
Fevago Paracetam
ol
Cipla Paraceta
mol-cipla
Zepara Paracetam
ol
Zee lab Paraceta
mol-zee
e.g.20: Brands with different name but the molecule is the same.
Brands
with
different
name (It is
difficult to
remember
all the
brands)
All the
brands
containing
the same
molecule.
Name of
the
pharmace
utical
company.
Suggested
brand
name for
the same
company
(it is easy
to
remember
all the
brands)
Ab - cef Cefixime Bestoche
m
Cefixime-
bestochem
Ab – fax Cefixime Ameriacan
biocare
Cefixime-
american
Abirec
200
Cefixime Gulsun
overseas
Cefixime-
gulsun
Abixim Cefixime Abia
pharma
Cefixime-
abia
Aelxim Cefixime Allenge
india
Cefixime-
allenge
Aknicef Cefixime Aknil
biotech
Cefixime-
aknil
Arcefim Cefixime Aryan
biological
Cefixime-
aryan
Askacef Cefixime Asklepios
remedies
Cefixime-
asklepios
Astecef Cefixime Aster
mediphar
ma
Cefixime -
aster
Audixim Cefixime Diya H
care
Cefixime-
diya
Bezofix Cefixime Zeal lab Cefixime-
zeal
Brexime Cefixime Brit health
care
Cefixime-
brit
CE Cefixime Care
pharma
Cefixime-
care
Delocef Cefixime Deltoid
pharma
Cefixime-
deltoid
Deltacef Cefixime Mecado H
care
Cefixime-
mecade
Ecefibard Cefixime B.M. Cefixime-
Medico bbm
Fexburg Cefixime Ginsburg
drugs
Cefixime-
ginsburg
Frix Cefixime Unichem Cefixime-
unichem
Rezix Cefixime Rezicure
pharma
Cefixime-
rezicure
Taxim - o Cefixime alkem Cefixime-
alkem
Zifi Cefixime FDC Cefixime-
fdc
With this we will add the company name with the molecular name to make the brand name. it may
look long at the beginning, but it will be like putting signature on the paper as the days passes, by
reflex we can write the drug fast and all the people can understand the medicine and also the
company. There will be less confusion with all the brand names.
The present prescription like ‘Tab. Bambiti, 500mg, one tid’ will be replaced by ‘Tab. Paracetamol -
dyes, 500mg, one tid’.
Similar types of brands can be made even for drugs having more than one molecule with it. But need
to consider some uniform protocols for making such nomenclature. The national university of
allopathic medicine in its pharmacy division can do all such things after discussing with the experts
and the drug inspectors working in this field.
2.18. Let us have clarity in the name of the drug from the time of
study to practice.
It is not good to practice short hand while prescribing the drug, because this short hand will not be
able to understand by all, even within the group of people who are writing this short hand (doctors)
and who are reading this short hand (pharmacist), we should be able to prevent even a single error
coming with such type of practice.
It is better to make all the marketing companies to sell the product under the banner of the
manufacturing company, so that the doctor and the people will easily recognize whether it is a good
company or not. If the manufacturing company is not possible to manage the marketing, then let it
give to the marketing company which the manufacturing company prefers and let them market it,
but the name should come to the manufacturing company, because it is the one which prepares the
molecule and the molecule is most important for the doctor and the patient, but not the people who
puts the label and sells. Putting label and selling is also important for making the drug available to all
the nooks and corners, but it is necessary to see that only quality brands with quality molecules
should reach the people and the doctor and the people should be able to recognize the same by
looking at the company by which that product is prepares as it is with the name of the molecules.
It is possible to remember all the names of the molecules that we use in our practice by the doctor
and by the pharmacist, which is very much essential. But it is not possible to remember all the
brands of the single molecules which are not essential, if we are not going to see the prescription of
the other doctors in our practice, but it is not possible because as medical practitioners we need to
take the ‘drug history’ of the patient. Let us make it possible to remember all the brands by simple
changes in the nomenclature of the brands, so there is less confusion by all the people. The doctors
and the pharmacist will be able to recognize all the products easily, without looking in to the drug
books. The medical and the pharmacy students will remember the names with ease. There are fewer
errors with the names of the brands as we see in today’s practice with lakhs of brands existing in the
market for one molecule. I am not telling any doctor to change the brand which they believe it as the
superior among all the brands available in the market. The medicine which is present inside the
bottle or the packing will not change; the person who is supplying the drug will not change, the
stockiest will not change, the people who are marketing the brand will not change and the
companies will not change and the only change I request is to make the names of brands by
combining the names of the molecule and the name of the pharmaceutical company as shown in the
example 19 and 20 of this section, so that there is less confusion at all the stages, like the children
and the common people will be seeing the same molecule in their routine life as and when they use
the medicines, thus they are familiar with the commonly used drugs, the students can easily
remember the molecules as they have already familiar with most of the common drugs used by the
people in the society, doctors will have less confusion in selecting the brand if they know that the
company they are writing is a good company, the people in the pharmacy can arrange all the drugs
with similar names (same molecules) at one rack in their pharmacy and they will never go wrong as
the molecule name is present with the brand the doctor wants, the common people can identify the
mistake, if they do not see the molecule on the drugs they buy, as it is present in the prescription of
the doctor and the corrections can be made at the pharmacy itself, because it is very clear and
transparent.
The one side of the cover or the packing which is enclosing each tablet should contain the minimum
information like brand name (molecule with company), dosage, the expiry date, and the batch
number. So that even with single tablet we will be able read the necessary things like what is that
drug and when is the expiry. The other side of the packing may contain the same information as of
today. With this we can avoid many tablets going waste, if it remains one or two in number.
I was listening to one of the lecture, in that, the speaker was telling that we do not know the potency
and side effects of the drugs produced by different companies, as one company product may contain
100% drugs, another company drug may contain 60% of the drugs, he was also telling ‘we do not
know, from where they import the molecules and what are base used to stabilize the primary
molecule’ and so on. He was also telling about the development of the drug resistance due to
inadequate dosage and duration, thus countries like India leading the top, in producing microbes,
resistant to most of the drugs. He was stressing that the doctors are the sole responsible people for
such cause.
With the present health system it is not possible to identify, which doctor is using which brand, why
he is using, what ‘dose’ he is using, how long he is using, why he is changing the drug, why patients
change the doctor - thus all the treatment regimen changes with the change in the doctor. Patients
simply go to the hospital with some complaint which they are suffering from, the doctor will listen to
the complaint and no record will be maintained for the same. The doctor may write the medicine for
three days and will ask the patient to come after two or three days to see the response, the patient
will lose the prescription once he gets the medicines in hand and most of the time, he will not get
the bill or he will not preserve the bill or the prescription. The patient may go to another doctor, if
he is not improved within, one or two days without having any records in his hand. Another doctor
will start, another antibiotic and this patient may develop resistance for the drug started by the first
doctor, thus this patient may spread the microbe to many people in his community, which is
resistant to many drugs and this is an endless problem in countries like India.
2.19. Solutions to decrease the mistakes with different brands by
different companies.
Let us think about the practically of issues related to the drugs – manufacturing company – drug
prescribing doctor – the patient who takes the medicine for his illness. There are many companies
which produces the same drug with different trade names. They will do some clinical study, will use
some method and will prove that their drug acts better both in vitro and in vivo. They may use the
better drug and they may maintain better quality till they get the approval from the drug controller,
but what is the guarantee, that they maintain the same quality as they market publicly. It is the
patient and the treating doctor who has to give feedback for using various drugs, after using the
same as per the recommended dose and duration. The clinician has to comment on why he used
that drug, why he chosen that brand, what is the clinical status of the patient before starting the
medicine, what was the diagnosis made, what was the course of the illness and the prognosis, what
are the side effects noticed and with what dose and duration the side effects appeared, whether the
drug or the brand stopped or changed and the reasons for the same. The doctor need not do, all
these exercises separately, if the doctor enters his day to day notes digitally then the drug controller
will come to know how many doctors are using that particular brand in that day and in that hour,
why the doctors prefer that brand, what are the side effects seen with that particular brand (from all
the places simultaneously sitting at one place) where it was used, the reasons for discontinuation,
whether the different brand with the same of molecules acted well as seen by the clinical
improvement and if that is the case which brand is not acted well and which brand acted well and
what are the reasons for the same. All these compilation inferences have to be worked by the drug
controller. We can generate the dedicated soft ware for the same purpose and this soft will grasp all
the details and will give the statistics like the molecule name, then the brand name, the name of the
doctor, the hospital which uses that brand and the clinical status of the patient like improved, same
status, died. Thus the drug controller can do vertical, horizontal and random analysis of the drugs
which comes under same status or died by collecting the drugs in the open market at different
places and can subject for analysis.
The patients can also enter their comments like, what was the medicine taken, for how long, and
how they feel after taking that medicine. We can create the soft ware with biometrics like, when he
comes to the hospital he swipe his finger at the counters dedicated for these comments - the PIN
based persons file opens - health file has to be opened - visit file can be opened and then the patient
can enter his feelings like, whether he is feeling better or no improvement in the box dedicated for
the same. Both the doctor at the time of follow up and the drug controller can assess the comments
and the effectiveness of that brand. Those drugs which are not working well can be removed from
the market. Thus the quality assessment can be done for every drug, used at all the nook and corner,
on day to day basis and thus the quality assessment will not end soon after giving the licence for that
brand by the drug controller. This is possible with the establishment of the MV - MN - VPH with the
establishment of inter VPA communication soft ware’s through net by the NHS. We can easily
compare all the brands, their efficacy, side effects, where all it is used and so on, by sitting at one
place, thus we can continue with better ones.
2.20. Reducing the number of hospital (PHC to VPH) will add quality
to the health services and the doctors can spend time for
periodical updates.
The doctors and the other professionals who work in small towns and in rural areas may not get
much time to update themselves in their field, because they are busy in their routine work, so, these
people may stick to their old concept. The newer technology and its advantage will not reach the
common people. For example a 150 bedded hospital in a rural area or in a taluk head quarter with
one physician, one gynecologist, one surgeon, one pediatrician and two duty doctors will work most
of the time in the hospital. They may have blood bank with a blood bank officer who is trained in
blood banking under some pathologist and will be running the blood bank. The physician, surgeon,
pediatrician, obstetrician will use the blood when there is an indication. Sometimes they will use
A1+ve donor blood for a A2+ve recipient patient. In the next transfusion the same patient will
develop transfusion related reaction because he has developed the antibodies for A1 and will land
up in complications, like this many problems like O negative (Bombay blood group) blood group
person developing reaction to O negative blood with H antigen, developing reactions with other
blood group antigens like kell, duffy and so on are all common. Many of the doctors will not be
aware of identifying such type of problems with the conventional old methods used in their lab for
many years, even if they come to know about the new technology, all the doctors in the hospital will
think having such type of technology is going to give financial burden to the patients because they
are not doing transfusions regularly. In the same way doctors present in the 100 small hospitals,
nursing homes and clinics present in that district distributed in 4 to 5 taluk head quarters and in 8 to
10 small towns will think and they will use their own ideas and will try to help the patients in their
own way to minimize the cost of treatment and in long term they will be creating harm to the
patients without their knowledge. Many units of blood may be transfused every day in different
hospitals at different times, but no one becomes responsible for complications that can occur at the
next transfusion. In the same way because of this type of haphazard services we will not be able to
adopt the newer techniques and thus it will never reach the common people.
Solution: creation of MV - MN with VPH under national health services will reduce the number of
hospitals and will make all the hospitals to have such type of facility when once the efficacy and
effectiveness is proved, since the turnover becomes large one place, managing the demand and the
stock according to the expiry becomes easy and if the turnover is better than the technology
becomes cost effective and all the segments of the people will be able to afford the services and we
can have less complications related to the treatment.
2.21. Periodical inspection is the need to maintain the quality in
service.
It is necessary to create the team which inspects all the emergency drugs, equipments, instruments
and the staff periodically, so that all the hospitals will update themselves and delay in initiating the
treatment due to no availability of drugs, equipments, staff will be corrected and many lives will be
saved due to timely initiation of treatment.
Solution: with the establishment of MV - MN - VPH, the number of villages are going to reduce,
number of hospitals are going to reduce, people come closer to the better services and all will be
aware of the available best treatment modalities and the inspection group for monitoring the
emergency drugs, equipments and the dedicated staff for this service can be maintained well and
will be monitored well by the team. The monitoring team with dedicated physician, pediatrician,
obstetrician, pharmacist, equipment engineer can do the rounds in all the hospital once in 15 days
and the physician will inspect the register of emergency patients treated, their case sheets, the
medicines used in the treatment of emergency cases, their correlation with the stock register, will
call for the mortality meeting and will assess the deficiency and will correct mistakes. Pediatrician
and the obstetricians will do the similar exercise in their department. The pharmacist will inspect the
drugs, stock, expiry and will write his remarks for the same. The equipment engineer will inspect all
the equipments used in the emergency treatment and if some are not working then he will write his
remarks then it is the duty of the concerned department of get it corrected as early as possible by
the hospital maintenance team. If the same remarks repeat at the next inspection at 15 day then the
actions will be taken to the concerned staff, technician or on the hospital by the inspection team. If
things still not corrected then the inspection team will raise the issue to VP member for health, VP
secretary for health, village panchayat president, DHO, MLA, DC, MP for needed action.
It is common to replace the drugs in the pharmacy like the pharmacist may give cough suppressant
in the place of expectorant/bronchodilator and the staff nurse will also not know about this
difference and will open the seal and may administer the dose. When the doctor comes for the
rounds and examines the chest he will hear rhonchus, fall in the oxygen saturations, increased
oxygen requirement by the patient, and increase in the respiratory rate. The doctor is worried and
he will check all the medicine and he will see the cough suppressant ABCD-D instead of ABCD-X, by
this time the patient might have already had an injury to his brain due to low oxygen.
2.22. Quantity decides the quality in some areas;
One of the lab in charge of one authorised blood bank was telling that, they get, only 4 to
5 bags of blood in a week for that they have to do Elisa test for HIV, HCV, HBsAg, and
sometimes, they have to do these tests once in 2 to 3 days, and its works out costly for
the hospital. The conventional Elisa try contains 96 wells, and at a time they can do
Elisa test for 92 patients with 2 positive controls and 2 negative controls. If the lab gets
more samples then it work out cheaper per investigation, the man power will be utilized
well, and the cost for the patient is going to decrease.
2.23. Strict waste disposal protocols are the need to prevent many
life threatening infections.
Is the ear buds selling at the roadside people are prepared with hospital waste cotton
used to clean blood and pus? May be possible, some of the microbiologists in pollution
control board may say yes for this statement.
Microbiologist tells, father dies in the family with HBsAg infection and the son also dies
with the same disease after one year. Later it was found that both died because of prick
by the HBsAg infected needle in the slipper used for walking, which was thrown out of a
clinic with the common waste and the dog displaced the needle to the walking path
which got pieced in to the slipper.
2.24. National health programmes and the private medical practise.
The people of the private medical practise will not be updated with the recent
developments in the national health programmes. There is a possibility that the private
medical practices may suffer with the national programmes as they lose their person
patients through the national programmes and also through the pharmaceutical
companies. A private medical practitioner may be very efficient in making the diagnosis
and may advise the remedy for the patient and guide the patient to get the medicines
through the national programme, but the patient may think the doctor is incapable of
treating my disease so he referred me to this centre and after taking the medicine from
this centre I became better and this is better than that doctor and will stop going to that
doctor, on the other hand a doctor who make the patient to buy the medicine in his
pharmacy and make him feel better will retain the patient to his hospital and also get
the income from his pharmacy. For the common people the person who cures the disease
becomes the god, but not the person who identifies the disease and makes him not to
suffer financially, for a ordinary person doctor and the health worker is not going to
differ and he calls both of them ‘doctor’. Sometimes the patient will not know who the
doctor who is treating him, someone old, some one big – he thinks he cured his disease
and this he will express when he comes for follow up through his body language. Many a
times the post graduate students will be given more respect than the head of the
department, because the post graduate student might have interacted better than the
head of the department and the patient may think the post graduate student has cured
his disease.
For a private practice, writing prescription is the matter of few seconds, but referring the same
person losing his income from his pharmacy is the job of many hours. He need to fill many forms,
need to contact many people through the phone and finally the patent will come bank without
getting any service for problem and the patient himself may think ‘why this doctor is sending me
there? Whether he gets any money for this type of referral? And if the same patient is sent to the
same place again and if his work is not done then that patient will never come back to this practice
nor. The patient who gets the letter from the small clinic or nursing home to get the service from the
big government hospital may find difficulty in identifying the place where he need to go and he may
spend some time in searching the same and if he is not getting the place he wants, then he will
identify some other doctor who writes prescription for his problem. There may be long quo for
getting this free service under national health programmes and patient who come from the far place
will be at the end of the quo and will get the service at the end and thus may not be able to return
back to their place so their personnel expense may be more than the free service they get it from
the government, so they prefer the doctor who writes and gives the medicine. The service provider
may not be available at the time of service seeking by the patient due to various reasons and thus
the patient may choose another doctor who writes the prescription and makes the patient to
purchase the drug in his dispensary and also advises how to take the medicines and thus the work
will complete within few minutes. Thus there is no accountability in terms of number of patients in
the nation and the number of patients who started with the treatment, who completed the
treatment, nothing like bacteriological cure and later he may become the resistant case and will be
spreading the resistant bacteria to the community thus he may land up in some higher hospital after
sometime or may die. Sometimes the lower level officers may not be accepting the letters from the
private practice nor thinking that their diagnosis is not correct and thus the initiation of treatment
may be delayed till the gross damage to the organ occurs thus even if the treatment started at the
later time there may be lot of morbidity or the patient may die after sometime. There may be many
objective evidences the government officials need to start the treatment for which the patient may
not cooperate. The possibility of initiating the treatment for false cases is also present. Some time
the government doctor may ask the patient to repeat the whole panel of investigation since the
report, the patient has is not from the standard laboratory to maintain the records in his file and to
show that to his higher officials that he has initiated the based on the reports he has with him. If
they initiate the treatment for some disease and if the patient has some other disease, then the
patient will have two problems like the disease which the patient has will worsen and the patient
may be getting the treatment for the disease which he do not have and thus gets the side effects of
the drugs.
2.25. National health services and Village Panchayath Hospital.
Refer the drawings of the MV in Model village section for positioning different areas.
All these areas / rooms are organized in such a way that any consultant can reach the
different units in one department within few minutes by climbing up or down or walking
front or back like from OPD to OT or ICU or to the wards or the seminar room, and so on,
still connecting all the blocks of the village through inter building bridges in a short way to
make all the people to reach the hospital in a closer distance.
2.26. VPH – NHS – Cellar and Ground floor:
Space for parking and prayer assembly.
Block F: VPH - NHS
VPH – Cellar / Under Ground floor:
1. Parking. (G) (16)
(G)
52
2. Prayer assembly. (G) (6) (G) (30)
(G)
2.27. VPH - Department of OBG.
1. Department of OBG: 931 staffs.
OBG – Ground floor. 253 staffs
Department of Pediatrics – First floor. 15 staffs.
Department of pediatrics – Retroviral wards –
First floor.
30 – R2 Pediatric
retroviral General wards
(PGD. In Pediatrics) (3)
(G)
(3) (G) (3)
(G)
15
29 – R2 Pediatric
retroviral General ward
(D. in Nursing) (6) (G)
Pediatrics.
General ward – Second floor. 243 staffs.
GW 3(PGD. in Pediatrics)
(9)(G)
(18)(G) (18)
(G)
243
GW 3(D. in Nursing) (36)
(G)
GW 4(PGD. In Pediatrics )
(9)(G)
(18)(G) (18)
(G)
GW 4(D. in Nursing) (36)
(G)
GW 15(PGD. in pediatrics)
(9) (G)
(18)(G) (18)
(G)
GW 15(D. in Nursing) (36)
(G)
Pediatrics.
Special ward – Third floor.246 staffs.
SW4(PGD. in Pediatrics)
(6) (G)
(18)
(G)
(18)
(G)
246
SW4(D. in Nursing) (40)
(G)
SW5(PGD. in Pediatrics)
(6) (G)
(18)
(G)
(18)
(G)
SW5(D. in Nursing) (40)
(G)
SW6(PGD. in Pediatrics)
(6) (G)
(18)
(G)
(18)
(G)
SW6(D. in Nursing) (40)
(G)
2.31. VPH - Department of Medicine.
5. Department of Medicine. 1032 staffs.
Department of Medicine – Ground floor.275
staffs.
6 – R2 Endoscopy / echo
cardiograph (PGD. In
(18)(G) (18) 275
Surgery ) (4) (G) (G)
6 – R2 Endoscopy / echo
cardiograph (PGD. In
Medicine) (3) (G)
29 – R4 Male retroviral
General wards (PGD. In
Medicine) (3) (G)
(6) (G) (6)
(G)
29 – R4 Male retroviral
General ward (D. in
Nursing) (24) (G)
Medicine.
General ward – Second floor. 324 staffs.
GW 5(PGD. in Medicine)
(9)(G)
(18)(G) (18)
(G)
324
GW 5(D. in Nursing) (36)
(G)
GW6 (PGD. In Medicine)
(9)(G)
(18)(G) (18)
(G)
GW 6(D. in Nursing) (36)
(G)
GW 7(PGD. In Medicine)
(9)(G)
(18)(G) (18)
(G)
GW 7(D. in Nursing) (36)
(G)
GW 14(PGD. In Medicine)
(9) (G)
(18)(G) (18)
(G)
GW 14(D. in Nursing) (36)
(G)
Medicine.
Special ward – Third floor. 328 staffs.
SW7(PGD. in Medicine)
(6) (G)
(18)
(G)
(18)
(G)
328
SW7(D. in Nursing) (40)
(G)
SW8(PGD. in Medicine)
(6) (G)
(18)
(G)
(18)
(G)
SW8(D. in Nursing) (40)
(G)
SW9(PGD. in Medicine)
(6) (G)
(18)
(G)
(18)
(G)
SW9(D. in Nursing) (40)
(G)
SW10(PGD. in Medicine)
(6) (G)
(18)
(G)
(18)
(G)
SW10(D. in Nursing) (40)
(G)
2.32. VPH - Department of Ophthalmology.
6. Department of Ophthalmology. 248
staffs.
Department of ophthalmology – Ground floor. 84
staffs
8 – R1 Ophthalmology
OPD (PGD. in
Ophthalmology) (4) (G)
(12)(G) (6)
(G)
84
8 – R1Visual acuity,
Refraction (D. in Nursing)
8 – R4 Ophthalmology
OT2 (D. in Anastasia) (2 )
(G)
8 – R4 Ophthalmology
OT2 (D. in Nursing) (24)
(G)
8 – R4 Ophthalmology
OT2 (D. in OT technology)
(12) (G)
2.33. VPH – Hospital Stores.
7. Stores: First floor. 153 staffs.
8 – R4 Drug stores (D. in
pharmacy) (8) (G)
(8) (G) (8)
(G)
153
8 – R4 Surgical stores(D.
in Pharmacy) (8) (G)
(8) (G) (8)
(G)
8 – R4 Electrical stores (D.
in Electrical engineering)
(8) (G)
(8) (G) (8)
(G)
8 – R4 Electronic stores
(D. in Electronic
engineering) (8) (G)
(8) (G) (8)
(G)
8 – R4 Computer stores
(D. in Computer science)
(8) (G) (8)
(6) (G) (G)
8 – R4 Store
superintendent (D. in
Administration) (3 ) (G)
(8) (G) (8)
(G)
8 – R4 Stationary stores
(G)
(12)
(G)
(4)
(G)
2.34. VPH - Department of ENT.
8. Department of ENT. 324 staffs.
Department of ENT – Ground floor. 122 staffs.
10 – R1 ENT OPD (PGD. In
ENT) (8) (G)
(12)
(G)
(6)
(G)
122
10 – R1 ENT OPD (D. in
Nursing) (4) (G)
10 – R2 ENT seminar
room(G)
(3) (G) (3)
(G)
10 – R3 ENT staff room
(G)
(3) (G) (3)
(G)
10 – R4 ENT – ICU (PGD.
In ENT) (16) (G)
(8) (G) (16)
(G)
10 – R4 ENT – ICU (D. in
Nursing) (40) (G)
ENT – First floor. 202 staffs.
9. ENT OT
9 – R2 Patient waiting
area(D. in Nursing) (6) (G)
(3) (G) (3)
(G)
202
9 – R3 Staff chambers (G) (3) (G) (3)
(G)
9 – R4 ENT OT (PGD. In
ENT) (8) (G)
(6) (G) (12)
(G)
9 – R4 ENT OT (PGD. In
Anastasia) (8) (G)
9 – R4 ENT OT (D. in
Nursing) (24) (G)
9 – R4 ENT OT (D. in OT
Technology) (12) (G)
ENT – First floor.
18 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
18 – R4 Post operative
ward Surgery (PGD. In
Surgery) (6) (G)
(24)
(G)
(24)
(G)
18 – R4 Post operative
ward ENT (PGD. In ENT)
(6) (G)
18 – R4 Post operative
ward (D. in Nursing) (48)
(G)
2.35. VPH - Department of Surgery.
9. Department of Surgery. 863 staffs.
Department of Surgery – Ground floor. 122 staffs.
11 – R1 Surgical OPD
(PGD. In Surgery) (8) (G)
(12)
(G)
(6)
(G)
122
11 – R1 Surgical OPD (D.
in Nursing) (4) (G)
Department of Surgery – First floor. 194 staffs.
5 – R2 Surgery OT1
Patient waiting area (D. in
Nursing) (6) (G)
(3) (G) (3)
(G)
194
5 – R3 Surgery OT1 staff
chambers (G)
(3) (G) (3)
(G)
5 – R4 Surgery OT1 (PGD.
In Surgery) (8) (G)
5 – R4 Surgery OT1 (PGD.
In Anastasia ) (8) (G)
5 – R4 Surgery OT1 (D. in
Nursing ) (24) (G)
5 – R4 Surgery OT1 (D. in
OT technology) (12) (G)
10.Surgery OT 2.
6 – R2 Surgery OT2
Patient waiting area (D. in
Nursing) (6) (G)
(3) (G) (3)
(G)
17 – R4 Post operative
ward Surgery (PGD. in
Surgery) (6) (G)
(12)
(G)
(12)
(G)
17 – R4 Post operative
ward (D. in Nursing) (24)
(G)
Additional OT;
Additional OT – First floor. 58 staffs.
11.Additional OT, e.g. Neurosurgery, Urology,
Pediatric surgery, vascular surgery, and so on.
They are the visiting surgeons from the district
hospital, preoperative diagnosis, investigations
will be discussed by the Surgeons working at the
VPH and the visiting consultant will come,
operate and will give post operative instruction
or the case will be referred to higher centre.
12 – R2 Patient waiting
area(D. in Nursing) (6) (G)
(3) (G) (3)
(G)
58
12 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
12 – R4 Additional OT
(PGD. In Anastasia) (4) (G)
(6) (G) (12)
(G)
12 – R4 Additional OT(D.
in Nursing) (12) (G)
12 – R4 Additional OT(D.
in OT technology) (6) (G)
Surgery.
General ward – Second floor. 243 staffs.
GW 8(PGD. in Surgery) (9)
(G)
(18)(G) (18)
(G)
243
GW 8(D. in Nursing) (36)
(G)
GW 9(PGD. in Surgery) (9)
(G)
(18)(G) (18)
(G)
GW 9(D. in Nursing) (36)
(G)
GW 13(PGD. In Surgery)
(9) (G)
(18)(G) (18)
(G)
GW 13(D. in Nursing) (36)
(G)
Surgery.
Special ward – Third floor. 246 staffs.
SW11(PGD. in Surgery)
(6) (G)
(18)
(G)
(18)
(G)
246
SW11(D. in Nursing) (40)
(G)
SW12(PGD. in Surgery)
(6) (G)
(18)
(G)
(18)
(G)
SW12(D. in Nursing) (40)
(G)
SW13(PGD. in Surgery)
(6) (G)
(18)
(G)
(18)
(G)
SW13(D. in Nursing) (40)
(G)
2.36. VPH - Department of Orthopedics.
10. Department of Orthopedics. 759 staffs.
Department of Orthopedics – Ground floor. 122
staffs.
12 – R1 Orthopedic
OPD(PGD. In
Orthopedics) (8) (G)
(12)
(G)
(6)
(G)
122
12 – R1 Orthopedic OPD
(D. in Nursing) (4) (G)
28 – R4 Homeopathy
procedures (D. in
Homeopathy) (6 ) (G)
28 – R4 Unani procedures
(D. in Unani) (6) (G)
28 – R4 Siddha/
Homeopathy / Unani (D.
in Nursing) (24) (G)
28 – R4 Siddha
preparation room (D. in
Siddha) (6 ) (G)
(6) (G) (6)
(G)
28 – R4 Homeopathy
preparation room (D. in
Homeopathy) (6 ) (G)
28 – R4 Unani
preparation room(D. in
Unani) (6) (G)
General ward – Unani, Homeopathy, Siddha, and
others – first floor. 60 staffs.
28 – R2 Female General
ward Unani (D. in Unani )
(1) (G)
(3) (G) (3)
(G)
60
28 – R2 Female General
ward Homeopathy (D. in
Homeopathy) (1) (G)
28 – R2 Female General
ward Siddha (D. in
Siddha) (1) (G)
28 – R2 Female General
ward (D. in Nursing) (6 )
(G)
28 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
28 – R4 Male General
ward Unani (D. in Unani)
(1) (G)
(6) (G) (6)
(G)
28 – R4 Male General
ward Homeopathy (D. in
Homeopathy) (1 ) (G)
28 – R4 Male General
ward Siddha (D. in
Siddha) (1) (G)
28 – R4 Male General
ward (D. in Nursing) (24)
(G)
2.57. VPH - Department of Forensic medicine.
31. Forensic medicine. 90 staffs.
Forensic medicine – Ground floor.90 staffs.
29 – R1 Forensic medicine
(PGD. In Forensic
medicine) (6) (G)
(12)
(G)
(12)
(G)
90
29 – R2 Forensic medicine
seminar room (G)
(3) (G) (3)
(G)
29 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
29 – R4 Post mortem
stations (PGD. In Forensic
(16)
(G)
(16)
(G)
medicine) (16) (G)
2.58. VPH - Stores – Furniture’s.
32. Non medical works. 150 staffs.
Store – plastic – wooden – iron furniture’s –
Ground floor. 96 staffs.
30 – R1 Store office (G) (12)
(G)
(6)
(G)
96
30 – R2 Plastic and
wooden furniture (G)
30 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
30 – R4 Iron furniture
stores (G)
30 – R4 Work shop
area(D. in Mechanical
engineering) (8) (G)
(8) (G) (16)
(G)
30 – R4 Carpentry (D. in
Carpentry) (8) (G)
(8) (G) (8)
(G)
Electrical works – First floor. 15 staffs.
22 – R4 Hospital electrical
department (D. in
Electrical engineering) (3)
(G)
(9) (G) (3)
(G)
15
Plumbing and civil works – First floor. 15 staffs.
23 – R4 Hospital
plumbing and Civil works
department (D. in Civil
engineering ) (3) (G)
(6) (G) (6)
(G)
15
Civil engineering works – First floor. 15 staffs.
24 – R4 Hospital civil (6) (G) (6) 15
engineering department
(D. in Civil engineering)
(3) (G)
(G)
Hospital garden works – first floor. 9 staffs.
25 – R4 Hospital Garden
in charge (D. in
Agriculture) (3 ) (G)
(3) (G) (3)
(G)
9
2.59. VPH - Department of Anesthesia.
33. Anesthesia. 225 staffs.
Department of Anesthesia – First floor. 225 staffs
13 – R2 (PGD. in
Anastasia) (3) (G)
(3) (G) (3)
(G)
225
13 – R2
Echocardiography, TMT,
ECG, (PGD. In Medicine )
(3) (G)
13 – R2 Fundus
examination (PGD. in
Ophthalmology) (3) (G)
13 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
13 – R4 USG and X Ray
(PGD. In Radiology) (3)
(G)
(6) (G) (6)
(G)
13 – R4 USG and X Ray (D.
in Radiology) (3) (G)
13 – R4 OT stores (D. in
Administration) (3) (G)
Department of Anesthesia:
14 – R2 Anastasia
seminar hall (G)
2.61. VPH - General and special wards:
Note: VPH – NHS – Second floor – General wards.
Block F: VPH - NHS
VPH – Second floor:
Row 1, 2, 3, & 4
1. General wards – 15 in numbers, 72 beds per
column, 6 nurses station per column, total beds
1080.
Note: VPH – NHS – Third floor - Special wards.
Block F: VPH - NHS
VPH – Third floor:
Row 1, 2, 3, & 4
2. Special wards – 15 in numbers, 30 rooms per
column × 15 columns, 6 nurses station per
column, total rooms 450.
2.62. VPH - Medical superintendent:
35. Medical superintendent office – first floor.20
staffs.
1. Medical superintendent office – First floor.
1 – R1 Medical
superintendent (PGD. in
Allopathic medicine) (1 )
(G)
(6) (G) (6)
(G)
20
1 – R1 Personnel
secretary to MS (D. in
Administration) (1) (G)
staffs.
4 – R1 Hospital
Administrator (D. in
Administration) (1 ) (G)
(6) (G) (6)
(G)
60
4 – R1 Personnel
secretary to
Administrator (D. in
Administration) (1) (G)
4 – R1 Hospital office (D.
in Administration) (16)
(G)
Complaints and suggestions.
10 – R1 Complaints and
suggestions: Related to
hospital(D. in
Administration) (1) (G)
(12)
(G)
(12)
(G)
10 – R1 Hospital office (D.
in Administration) (2) (G)
10 – R1 Complaints and
suggestions: Related to
Public health (D. in
Administration) (1) (G)
10 – R1 Public health
office (D. in
Administration) (2) (G)
2.65. NHS – VPH - VP Preventive medicine.
38.VP Preventive medicine – First floor. 26 staffs.
5 – R1 VPA preventive
medicine Head (PGD. in
Preventive and social
medicine) (1) (G)
(6) (G) (6)
(G)
26
5 – R1 Staff VPA
preventive medicine
(PGD. In Preventive and
Social medicine) (4) (G)
5 – R1 Preventive and
social medicine office (D.
in Administration) (3) (G)
Preventive medicine training centre.
7 – R1 Preventive and
Social medicine training
center (G)
(3) (G) (3)
(G)
2.66. NHS – VPH - VP Pollution control office.
39.VP Pollution control office – First floor. 32
staffs.
6 – R1 Lab 1 Water
quality assessment (PGD.
In Preventive and Social
medicine) (2) (G)
(12)
(G)
(12)
(G)
32
6 – R1 Lab 2 Air quality
assessment (PGD. In
Preventive and social
medicine) (2) (G)
6 – R1 Lab 3 Waste
disposal assessment
(PGD. In Preventive and
social medicine) (2) (G)
6 – R1 Reporting and
communication centre (D.
in Administration) (2) (G)
2.67. NHS – VPH - Public health engineering.
40.Public health engineering – First floor. 34
staffs.
9 – R1 Public health
engineering (PGD. in
Environmental
engineering) (1) (G)
(12)
(G)
(12)
(G)
34
9 – R1 Drawing room of
Public health engineering
(D. in Civil engineering)
(2) (G)
9 – R1 Lab public health
engineering (PGD. In
Environmental
engineering) (1) (G)
9 – R1 Office of the Public
health engineering (D. in
Administration) (6) (G)
2.68. NHS – VPH - Coordinator – National health programme.
41.Coordinator National Health programme–
First floor. 23 staffs
11 – R1 Coordinator NHP
(PGD. In Preventive and
social medicine) (1) (G)
(12)
(G)
(6)
(G)
23
11 – R1 Office of the NHP
coordinator (PGD. In
Preventive and social
medicine) (2) (G)
11 – R1 Reporting and
communication station
(D. in Administration) (2)
(G)
2.69. NHS – VPH - Coordinator NHP1 – HIV / AIDS.
42.Coordinator NHP1 – HIV / AIDS – First floor. 23
staffs.
12 – R1 Coordinator
NHP1 – HIV /AIDS (PGD.
In Medicine) (1 ) (G)
(12)
(G)
(6)
(G)
23
12 – R1 Office of the
Coordinator NHP1 – HIV /
AIDS (PGD. In Medicine)
(2) (G)
12 – R1 Reporting and
Communication (D. in
Administration) (2) (G)
14 – R1 Reporting and
Communication (D. in
Administration) (2) (G)
2.72. NHS – VPH - Coordinator NHP4 – Blindness control
programme.
45.Coordinator NHP4 – Blindness control
programme – First floor. 23 staffs.
15 – R1 Coordinator
NHP5 – Blindness control
programme (PGD. In
Medicine) (1 ) (G)
(12)
(G)
(6)
(G)
23
15 – R1 Office of the
Coordinator NHP5 –
Blindness control
programme (PGD. In
Medicine) (2) (G)
15 – R1 Reporting and
Communication (D. in
Administration) (2) (G)
2.73. NHS – VPH - Coordinator NHP – Nutritional disease control
programme.
46.Coordinator NHP5 – Nutritional disease
control programme – First floor. 25 staffs.
16 – R1 Coordinator
NHP5 – Nutritional
disease control
programme (PGD. In
Pediatrics) (1 ) (G)
(12)
(G)
(6)
(G)
25
16 – R1 Office of the
Coordinator NHP5 –
Nutritional disease
control programme (PGD.
In Pediatrics) (2) (G)
16 – R1 Office of the
Coordinator NHP5 –
Nutritional disease
control programme (D. In
Nutrition) (2) (G)
16 – R1 Reporting and
Communication (D. in
Administration) (2) (G)
2.74. NHS – VPH - Coordinator NHP6 – NRHM.
47.Coordinator NHP6 – NRHM – First floor. 23
staffs.
17 – R1 Coordinator
NHP6 – NRHM (PGD. In
Preventive and Social
medicine) (1 ) (G)
(12)
(G)
(6)
(G)
23
17 – R1 Office of the
Coordinator NHP6 –
NRHM (PGD. In
Preventive and Social
medicine) (2) (G)
17 – R1 Reporting and
Communication (D. in
Administration) (2) (G)
2.75. NHS – VPH - PIN registration record maintenance officer.
48.PIN Registration – Record maintenance officer
– First floor. 18 staffs.
18 – R1 PIN Registration
record maintenance
officer (PGD. In
Preventive and Social
medicine) (1) (G)
(6) (G) (6)
(G)
18
18 – R1 PIN Registration
record maintenance
office (D. in
Administration) (2) (G)
18 – R1 PIN Registration
record maintenance
computer station (D. in
Administration) (3) (G)
2.76. NHS – VPH - PIN registration office.
49.PIN Registration office – First floor. 37 staffs.
19 – R1 PIN registration
officer (PGD. In
Preventive and Social
medicine) (1 ) (G)
(12)
(G)
(6)
(G)
37
19 – R1 Newborn PIN
registration station (D. in
Administration) (6) (G)
19 – R1 Pediatric age
group PIN registration
station (D. in
Administration) (6) (G)
19 – R1 Adult age group
PIN registration station
(D. in Administration) (6)
(G)
2.77. NHS – VPH - PIN health update record maintenance office.
50.PIN health update record maintenance office
– First floor. 21 staffs.
20 – R1 PIN health
updates record
maintenance officer
office (PGD. In Preventive
and Social medicine) (1)
(G)
(6) (G) (6)
(G)
21
20 – R1 PIN health
updates record
maintenance officer
office (D. in
Administration) (2) (G)
20 – R1 PIN health
updates record
maintenance officer
office - Computer
station(D. in
Administration) (6) (G)
2.78. NHS – VPH - PIN health updating officer.
51.PIN health updating officer – First floor. 40
staffs.
21 – R1 PIN health
updating officer (PGD. in
Preventive and Social
medicine) (1) (G)
(12)
(G)
(6)
(G)
40
21 – R1 Newborn PIN
health update station
(PGD. In Neonatology) (3)
(G)
21 – R1 Pediatric age
group PIN health update
station (PGD. In
Pediatrics) (6) (G)
21 – R1 Pediatric age
group PIN health update
station (PGD. In Surgery)
(3) (G)
21 – R1 Adult PIN health
update station (PGD. In
Medicine) (6) (G)
21 – R1 Adult PIN health
update station (PGD. In
Surgery) (3) (G)
2.79. NHS – VPH - Birth record maintenance officer.
52.Birth record maintenance officer – First floor.
21 staffs.
22 – R1 Birth record
maintenance officer
(PGD. in Preventive and
Social medicine) (1) (G)
(6) (G) (6)
(G)
21
22 – R1 Birth record
maintenance officers
office (D. in
Administration) (2) (G)
22 – R1 Birth record
maintenance office
Computer station (D. in
Administration) (6) (G)
2.80. NHS – VPH - Birth registration officer.
53.Birth registration officer – First floor. 34 staffs.
23 – R1 Birth registration
officer (PGD. In
Preventive and social
medicine) (1) (G)
(12)
(G)
(6)
(G)
34
23 – R1 Birth registration
office (PGD. In
Neonatology) (3) (G)
23 – R1 Birth registration
station (D. in
Administration) (6) (G)
23 – R1 Birth registration
station Computer station
(D. in Administration) (6)
(G)
2.81. NHS – VPH - Death record maintenance officer.
54.Death record maintenance officer – First floor.
19 staffs.
24 – R1 Death record
maintenance officer
(PGD. in Preventive and
Social medicine) (1) (G)
(6) (G) (6)
(G)
19
24 – R1 Death record
maintenance office (D. in
Administration) (3) (G)
24 – R1 Death record
maintenance office –
Computer station(D. in
Administration) (3) (G)
2.82. NHS – VPH - Death registration officer.
55.Death registration officer – First floor. 28
staffs.
25 – R1 Death
registration officer (PGD.
In Preventive and Social
medicine) (1) (G)
(12)
(G)
(6)
(G)
28
25 – R1 Death
registration office (D. in
Administration) (3) (G)
25 – R1 Death
registration station (D. in
Administration) (3) (G)
25 – R1 Death
registration – computer
station (D. in
Administration) (3) (G)
2.83. NHS – VPH - Library and reading rooms.
56.Reading room – news paper, journals – First
floor. 48 staffs.
26 – R1 Reading room (G) (8) (G) (3)
(G)
11
E Library
27 – R1 E library (G) (8) (G) (3)
(G)
11
Medical library.
28 – R1 Medical library
(D. in Library science) (2)
(8) (G) (3) 13
(G) (G)
General Library.
29 – R1 General library
(D. in Library science) (2)
(G)
(8) (G) (3)
(G)
13
2.84. NHS – VPH - Hospital networking.
57.Hospital networking – First floor. 58 staffs.
30 – R1 Hospital net
working officer (PGD. In
Computer science) (1) (G)
(8) (G) (3)
(G)
16
30 – R1 Hospital
networking computer
station (D. in Computer
science) (4) (G)
National health programme networking,
computer station,
16 – R2 National health
programme networking
computer station (D. in
Computer science) (6) (G)
(6) (G) (3)
(G)
15
Central computer station for the hospital records
and the post operative wards of surgery and
orthopedics.
17 – R2 Central computer
station of the hospital for
hospital records (PGD. In
Computer station) (3) (G)
(3) (G) (3)
(G)
21
17 – R2 Central computer
station of the hospital for
hospital records (D. In
Computer station) (6) (G)
17 – R3 Staff chambers
(G)
(3) (G) (3)
(G)
Internet parlor – First floor.
19 – R4 Internet parlor
(G)
(3) (G) (3)
(G)
6
Note: For the details of the population distribution of the people working in the hospital and for the
skilled population (Doctors, specialists and other field specialist working with the VPH), please see
the section on ‘Education’.