Delhi, India: A letter from Dr. Zehra Husain, Consultant Neurosurgeon, Department of Neurosurgery, St. Stephen's Hospital, Delhi

St. Stephen's Hospital is Delhi’s oldest hospital. Established by a British missionary in 1875 to serve the health care needs of women in purdah, it has now grown into a 700-bedded multispecialty hospital, serving the needs of around 5 million people residing in the old walled city of Delhi. The majority of the Hospital's patients are low-income and are given full medical treatment at subsidised rates. For poor patients, the entire treatment is free of charge.

The neurosurgical department at St. Stephen's has two consultants, with room for a third. We have built up a comprehensive neurosurgery program, including craniospinal trauma, tumors, spinal surgery with instrumentation, neurovascular and pediatric neurosurgical work. Earlier, we had had two ICU beds with one ventilator and two pulse oximeters for critically ill patients. We have now a separate 6-bedded intensive care unit for neurosurgery. We are also trying to start a post graduate teaching program in Neurosurgery.

When I joined the department two years ago, all that we had by way of instruments was a craniotomy set with a Hudson Brace and perforators and burrs, a gigli saw guide and wire, a set of Penfield dissectors and some rongeurs and kerrison punches. We have added a Mayfield headrest, a Midas Rex Drill, a neuroendoscope system and essential microinstruments to our neurosurgical armamentarium. By way of a microscope, we share an old Zeiss ENT microscope (OPMI 1 series). It is as graceful as a dinosaur, a behemoth grossly unfit for microneurosurgery, a point I have been patiently trying to put through to the hospital authorities. It lacks a binocular eyepiece for the assistant making him preciously redundant in microneurosurgical procedures. As in the old Chinese saying, we do live in interesting times.

Medicine, and neurosurgery in India, are torn between two evils, the state run health services with their attendent organizational problems and poor utilization of resources and the corporate-run health organizations with their promise of quality medical care at a considerable price. Since there is no medical insurance, the common person does not have much of a choice. Moreover, neurosurgical facilities and services are available only in the larger cities and the vast majority in the countryside have no access to even the most basic neurosurgical care. I believe that St. Stephen's is uniquely placed in this system. While it offers quality medical care to its patients, at par with the best corporate sector hospitals, it is also committed to the welfare of the poor and needy.

I hope that the we can collaborate closely on areas of mutual interest. I am excited by the possibilities that the internet offers and the vistas it has opened up. A regular internet meeting would enable interaction between neurosurgeons with interests in different neurosurgical subspecialities.