Who were..

THE FIRST
NURSES?
PRE HISTORIC PERIOD
GOD,EVIL ,SIN CAUSE DISEASE
MAKING HOLES IN BODY TO WARD OFF
DISEASE
MIDDLE AGE
care was provided primarily by religious
orders , mainly by nun sisters


NURSING AS A PROFESSION
Emerged in late 19
th
century
Credit is given to Florence
Nightingale

IN INDIA
KING ASHOKA, CHARAKA,SUSRUTHA
ARE IMPORTANT PERSONS
EAST INDIA COMPANY INTRODUCED
NURSING
Military Nursing

Military nursing was the earliest type of
nursing. In 1664 the East India
Company started a hospital for soldiers in a
house at Fort St.George, Madras. The first
sisters were sent from St Thomas'
Hospital, London to this military hospital.

Maternity

In 1797 a Lying-in-Hospital (maternity) for the
poor of Madras was built with the help of
subscriptions by Dr.John Underwood. In 1854
the Government sanctioned a training school
for midwives in Madras.

Florence Nightingale

Florence Nightingale was the first woman to have great
influence over nursing in India and had a close knowledge
of Indian conditions, especially army. She was interested
in the nursing service for the civilian population, though
her first interest was the welfare of the army in India.
In 1865, Miss Florence Nightingale drew up some
detailed "Suggestions on a system of nursing for hospitals
in India". Graduates were sent out from the Nightingale
School of Nurses at St.Thomas Hospital, England to start
similar schools in our country. St Stephens Hospital at
Delhi was the first one to begin training the Indian girls as
nurses in 1867.

Training schools
In 1871, the first School of Nursing was started in
Government General Hospital, Madras with 6 months
Diploma Midwives program with four mid-wife
students.
Four lady Superintendents and four trained nurses from
England were posted to Madras. Between 1890 and
1900, many schools, under either missions or
government, were started in various parts of India. In
the yearly twentieth century, National Nursing
Associations were started.
In 1897, Dr. B. C. Roy did great work in raising the
standards of nursing and that of male and female nurses.

The 20th century
In 1908, the trained nurses association of India
was formed as it was felt necessary to uphold the
dignity and honor of the nursing profession.
In 1918, training schools were started for health
visitors and dais, at Delhi and Karachi. Two English
nurses Miss Griffin and Miss Graham were appointed
to give training to and to supervise the nurses.
In 1926, Madras State formed the first registration
council to provide basic standards in education and
training. The first four year basic Bachelor Degree
program were established in 1946 at the college of
nursing in Delhi and Vellore.

With the assistance from the Rockfeller Foundations,
seven health centers were set up between 1931 -
1939 in the cities of Delhi, Madras, Bangalore,
Lucknow, Trivandrum, Pune and Calcutta.
In 1947, after the independence, the community
development programme and the expansion of
hospital service created a large demand for nurses,
auxiliary nurse midwives, health visitors, midwives,
nursing tutors and nursing administrators.
The Indian Nursing Council was passed by our
ordinance on December 31, 1947. The council was
constituted in 1949.

In 1956, Miss Adrenwala was appointed as
the Nursing Advisor to Government of India.
The development of Nursing in India was
greatly influenced by the Christian
missionaries, World War, British rule and by
the International agencies such as W.H.O.
UNICEF, Red Cross etc.
The first masters degree course, a two-year
postgraduate program was begun in 1960 at
the College of Nursing, Delhi. In 1963, the
School of Nursing in Trivandrum, instituted
the first two years post certificate Bachelor
Degree program

The associations such as International
Council of Nurses, the nurses auxiliary of
the CMA of India, T.N.A.I. Indian Nursing
council and State level Registration Council
are closely connected with promotion and
the upliftment of the nursing profession.

TOP CAUSE OF DEATH IN INDIA
CAUSE DEATH/ 1OOO
IHD 15
LRTI 11
CEREBRO VASCULAR DISEASE 106
COPD 88
TUBERCULOSIS 36
DIARRHOEAL DISEASE 65
HIV/AIDS 46
W H O(2008)
DISEASE WISE POPULATION IN INDIA
DISEASE POPULATION
COPD & ASTHMA 4.6 MILLION
DIABETIC 3.5 MILLION
HIV POSITIVE 2-3 MILLION
EPILEPTIC 0.5 MILLION
CANCER 1 MILLION
CARDIO VASCULAR 3.3 MILLION
MENTAL HEALTH 7.5 MILLION
TUBERCULOSIS 1.8 MILLION
BLINDNESS 16 MILLION (11
TH
FIVE YEAR PLAN )

MEDI CAL AND NURSI NG STUDI ES
CONDUCTED I N I NDI A












(CLINICALTRIAL.GOV 2008)
NO OF
RESEAR
CH
STUDIES
CNS COPD CVD CANCER Tb DM HIV PSYCH
IATRY
591 51 10 149 166 14 115 40 46
HEALTHCARE INDIA
Beds = 0.7/1000 people
Extra Beds needed = 75000 beds / per year

Expected spend on = Rs.2000 billion by 2012
Healthcare
% of GDP =0.9% to grow
up to 8.5% of GDP
Govt. Spend expected = up 6% by 2010

GDP- sum of the income generated by production in the
country in a period

TECHNOLOGY - TRENDS(Healthcare will be the
largest user of technology and the largest Employer)`
Micro-processor based implantable in patients.
CPU-driven technology supported by artificial
intelligence.
Robotics in OTs
Robotics in Path-labs / Research.
Laser Technology in surgery
Instrumentation in medical and surgical practices.
Biotechnology, Genomics, Molecular Biology and Stem
cell research.

Video conferencing over very low
bandwidth: Video + audio + data
transmission at 28 Kbps

Equipment taking rural conditions
into account: completely battery
operated, reengineering of probes,
wireless connectivity with the PC

Breaking of the cost barrier while
maintaining the quality: entire
telemedicine solution at affordable
prices

No additional software or
hardware needed other than PC,
web cam, internet connectivity


ReMeDi Telemedicine solution
ReMeDi: Remote Medical Diagnostics
Medical equipment
12 channel ECG, Blood pressure,
Heart sounds, Pulse rate,
Temperature, Pulseoximeter, Image
capture,
Video and audio conferencing,
Data presentation and display,
Electronic patient records
accessible at any time, print facility
Tele-medicine cluster for villages
Healthcare can reach every village with Tele-medicine
SERVER at
Central
Location
Healthcare
Provider
(Consultation-
Pri/Sec; Delivery of
Medicines,)
Connectivity
Connectivity
Internet
Kiosk
Village A
Connectivity
Internet
Kiosk
Connectivity
Internet
Kiosk
Village B
Connectivity
Internet
Kiosk
Village C
Telemed
Solution
Telemed
Solution
Telemed
Solution
Telemed
Solution
Lok Satta
Limits to Modern Medicine
24
Spectacular
Advances
Low
Cost
Nutrition, Immunization,
Antibiotics, Aseptic
surgery, Maternal and
child care, Healthy life
styles
Grey Areas
High Cost

Degenerative diseases,
Autoimmune diseases,
Malignancies
Dark Areas

Idiopathic, Iatrogenic,
Hospital Infections,
Progressive, irreversible
disorders
Lok Satta
Hospitalization Financial Stress
Only 10% Indians have some form of health
insurance, mostly inadequate
Hospitalized Indians spend 58% of their total
annual expenditure on health care
Over 25% of hospitalized Indians fall below
poverty line because of hospital expenses
25
Lok Satta
Percent of Hospitalized Indians falling into
Poverty
26
Lok Satta
Differentials in Health Status (States)
27
Sector Populatio
n BPL (%)
IMR/ Per
1000 Livr
Births
(1999
SRS)
<5Mortality
per 1000
(NFHS II)
Weight For
Age - % of
Children
Under 3
years
(,2SD)
MMR /
Lakh
(Annual
Report
2000)
Leprosy
cases per
10000
population
Malaria
+ve
Cases in
year 2000
(in
thousand
s)
India 26.1 70 94.9 47 408 3.7 2200
Rural 27.09 75 103.7 49.6 - - -
Urban 23.62 44 63.1 38.4 - - -
Better Performing States
Kerala 12.72 14 18.8 27 87 0.9 5.1
Maharashtra 25.02 48 58.1 50 135 3.1 138
Tamil Nadu 21.12 52 63.3 37 79 4.1 56
Low Performing States
Orissa 47.15 97 104.4 54 498 7.05 483
Bihar 42.60 63 105.1 54 707 11.83 132
Rajasthan 15.28 81 114.9 51 607 0.8 53
UP 31.15 84 122.5 52 707 4.3 99
MP 37.43 90 137.6 55 498 3.83 528
Source: National Health Policy, 2002
Over the past years, we had set a bold aspiration
for health in India
India was a signatory to the Alma-Ata
declaration 1978, to attain the
global objective of
Health for All by year 2000
now
Health for all by the year 2020
Escorts Heart Institute & Research Centre Ltd, New Delhi, INDIA
But we are far from achieving that vision
Beds Physicians Nurses
Per 000 population,
2001*
Per 000 population,
2001*
Per 000 population,
2001*
1.5
1.5
4.3
7.4
India
Other low income
countries (e.g., sub-
Saharan Africa)
Middle income countries
(e.g., China, Brazil
Thailand, South Africa,
Korea)
High income countries
(e.g., US, Western
Europe, Japan)
1.8
1.8
1.0
1.2
0.5**
World average
3.3 1.5 3.3
0.9
1.6
1.9
7.5
Escorts Heart Institute & Research Centre Ltd, New Delhi, INDIA
NATIONAL SAMPLE SURVEY
Demographic Facts: Longevity
Life Expectancy (years)
Year AGE
1941-50 32.1
1951-60 41.2
1991-95 60.3
1996-2001 62.88
2001-2006 64.77
2006-2011 66.43

INDIAN HEALTHCARE CAPABILITY
Over 60,000 cardiac surgeries done
per year with out comes at par with
international standards

Multi organ transplants like Renal,
Liver, Heart, Bone Marrow
Transplants, are successfully
performed at one tenth the cost.

Patients from over 55 countries
treated at Indian Hospitals.

INDIAN HOSPITALS CAN OFFER MEDICAL SERVICES AT A
FRACTION OF THE US / EUROPEAN COST
PROCEDURE
COST (US$)
7,500
-------
-------
8,000
3,500
6,000
26,000
69,000
6,000
2,000
US UK
23,000
1,50,000
2,00,000
12,000
10,000
Heart Surgery
Bone Marrow Transplant
Liver Transplant
Knee Replacement
Cosmetic Surgery
40,000
2,50,000
3,00,000
20,000
20,000
INDIA THAILAND
India has the opportunity to provide the best of the
Western & Eastern healthcare systems
Escorts Heart Institute & Research Centre Ltd, New Delhi, INDIA
Ayurveda recognized as an
official healthcare system in
Hungary.

Doctors in the west are
increasingly prescribing Indian
Systems of Medicine

More than 70% of the American
population prefer a natural
approach to health

Americans are said to spend
around $ 25bn on non-
traditional medical therapies
and products *
Indias Gift to the World
Ayurveda

Yoga

Siddha
Source : Los Angeles Times
* Economic times dated 25
th
July 2003
The Gamma Knife isn't really a knife at all,
but radio surgery - a non-invasive neurosurgical
procedure that uses powerful doses of radiation to
target and treat diseased brain tissue while leaving
surrounding tissue intact.
Gamma Knife surgery represents one of the most
advanced means available to manage brain
tumours , arteriovenous malformations , pain or
movement disorders.
The procedure is unique because, with the
Gamma Knife, no surgical incision is performed to
expose the target.

Lok Satta
39
Challenges of the Future
Immunization coverage ( TB: 68%, Measles:
50%, DPT: 70%, overall : 33%)
Four major infectious diseases: Malaria, TB,
HIV/AIDS, RHD
Preventable blindness
Population control large northern state
Alternative systems integration
Mounting cost of hospital care
Health manpower training inadequacies


India needs at least 750,000 extra beds to meet the
demand for inpatient treatment by 2012- opportunity in
tertiary healthcare facilities.
India needs at least 1 million more qualified nurses and
500,000 more doctors by 2012 as compared to existing
number.- opportunity in medical education.

Government and international agencies will only be able
to gear up US$ 7 billion and the rest of investment has to
come from private sector.

Healthcare Infrastructure..
In Summation

Politics encircles us today like the coil of a
snake from which one cannot get out, no
matter how much one tries

- Mahatma Gandhi
41