LT Gen AS Narula Takes Over as New Commandant of Army Hospital (R&R)

LT Gen as Narula Takes Over as New Commandant of Army Hospital(R&R)
Lt. General AS Narula has taken over as the new Commandant of the prestigious Army Hospital(R&R), Delhi Cantt. A graduate from Stanley Medical College, Chennai, Gen Narula completed his MD (Medicine) from Armed Forces Medical College, Pune and DM(Nephrology) from the prestigious PGI Chandigarh.
An eminent Nephrologist of National and International repute, Gen Narula has had a very illustrious career. He has been the head of Medicine department at Command Hospital (Central Command),Lucknow and Armed Forces Medical College (AFMC), Pune. As an able administrator, GeneralNarula has successfully commanded Base Hospital Delhi and has served as Additional DG in the office of DGAFMS.
Prior to taking over as Commandant, Gen Narula was MG (Med) at Chennai. Gen Narula is also an eminent teacher par excellence with many national and international publications to his credit. DM/NN (Release ID :87318)
LT Gen as Narula Takes Over as New Commandant of Army Hospital(R&R)

IESM Serving its Members

Dear All,
Maj Gupta's medical condition is a matter of great concern for all of us. It is really laudable that Gen Satbir and other members of the Steering Committee took timely and prompt action to rush medical team with ambulance to provide necessary medical aid. I feel proud of their devotion to the ESM cause and convey my heartfelt compliments for the same. I also pray and wish speedy recovery of Maj Gupta. Kindly convey my best wishes to Maj Gupta and his family members. I also take this opportunity to cnagratulate you all for the action taken to deposit medals with the President.
With regards to all,
Maj Bhupal Singh, Veteran

Information
Major DC Gupta, who was part of the IESM team coming from Kanpur to deposit medals at Jantar Mantar, New Delhi, suffered a stroke while in the train.

The Kanpur team members in the train, informed Maj Gen Satbir Singh, Vice Chairman IESM, on mobile phone about Maj Gupta’s illness around 9.00 AM on 25 Oct 09. Gen Satbir took very prompt action and managed to rush an ambulance from Fortis Hospital to Ghaziabad railway station. Instead of first coming to Delhi, the medical team took charge of Maj DC Gupta at Ghaziabad railway station and rushed him to Noida Fortis Hospital. This saved very valuable time for the patient.

His three companions, Capt SNSharma, (Rank) CV Singh and Sgt K Kapur accompanied Maj Gupta in the ambulance to Noida.

All the ESM at Fortis Noida have been met by Gp Capt VK Gandhi, Secy Gen IESM and Col RP Chaturvedi, Member Steering Committee IESM and Coordinator ECHS Division of IESM. The necessary documents have been collected from Fortis Hospital to regularize and have an emergency referral made out tomorrow (26 Oct) at Noida polyclinic. That would take care of paper work.

Necessary contact numbers have been given to CV Singh. CV Singh is staying on while Capt Sharma and Sgt Kapur are returning to Kanpur late night. In the meantime, Maj Gupta's son is expected tonight. We wish veteran Maj DC Gupta a speedy recovery.

In Service of Indian Military Veterans
Chander Kamboj.

ECHS: News, Views and Updates

Additional Polyclinics
It is learnt that ECHS plans to have 197 additional Polyclinics as part of their next expansion plan. While the time frame for this is not known, a list of the Polyclinics planned is linked for your information-click me.
With Warm Regards,
Col RP Chaturvedi
Coordinator,
IESM ECHS Division,

IESM ECHS Division Feed Back to MD ECHS
The Feedback sent to MD ECHS is here- click me for your information please. This may please be read in conjunction with the following already published.

Road Map for the ECHS Cell.

ECHS Concept Paper
Our efforts at improving ECHS services is a Joint Venture between the ECHS and us Veterans. It is hoped that even as we expect a positive thrust from the ECHS hierarchy, we on our part will get on and see how best we can make our healthcare facilities.
RLC and PLC members are requested to now get actively involved in local issues in consultation with the ECHS representatives. Thanks.
With Warm Regards,
Col RP Chaturvedi,
IESM ECHS Division

ECHS: Teething problems being weaned

05 Jul 2009
A few steps that are being taken or have been taken by the ECHS to improve the service provided to Veterans need to be promulgated for the information of all.

The salary of all employees contracted in Polyclinics has been increased by up to 50 %. This includes OIC Polyclinic, Drs etc. This will result in employment of better personnel and should also reduce the incidence of employees leaving for greener pastures.

The earlier restriction on referring NCR veterans to empanelled hospitals in Delhi has been removed. Veterans in Noida for e.g. can now be referred to any other empanelled hospital within the NCR and vice versa. If this problem is being faced by veterans in other stations please do press the issue with the MD Echs through your Polyclinic or write directly to– HQ ECHS at– mdecshs at bol.net.in

The earlier proposal to shift the Noida polyclinic to Sec 52 has been shelved. The proposal now being actively considered is to shift the AWHO office and the MI Room for serving personnel to some other area, or to have a small section separately for serving personnel within the enlarged ECHS polyclinic. During my interaction with The Dy MD ECHS I had stated that shifting the MI room would not be fair to the serving personnel and should not be attempted. In fact I had stated that at no time should veterans ever be provided facilities at the expense of our colleagues in Service. Shifting the AWHO office was the obvious answer.

As earlier mentioned Veterans can now go to the following hospitals of repute in Delhi viz Gangaram, Apollo and Rajiv Gandhi Cancer Hospital Rohini AFTER TAKING PRIOR Sanction from the ECHS. They will have to clear the hospital bills of these hospitals at normal hospital rates directly and will only be reimbursed ECHS rates.

A major problem being faced by Veterans in nearly all stations is of issue of medicines for three months in case of chronic ailments. The MD ECHS had very sensibly directed all polyclinics to issue three months medicine in such cases to cut out the unnecessary inconvenience of monthly visits specially where polyclinics are located at inconvenient distances. The DGMS Army has however overruled this decision resulting in utter confusion at most stations. He basically has two reasons. Firstly, problem of bulk procurement and secondly on the ground of medical ethics wherein he feels that a patients condition needs to be reviewed every month before the treatment is continued. On both counts he is wrong. There will be no need for bulk procurement since it is unimaginable that 100 percent of the chronic patients will suddenly land up in hordes to draw their three months entitlement. Even in the normal course the three months drawl will be spread out to nearly three months. A simple statistical check or a queuing plan would illustrate this. Secondly, I can state from personal knowledge that my cardiologist at Escorts ALWAYS asks me to continue my treatment and report to him for a review after six months. FINALLY whenever I go to draw my monthly quota of medicines for my chronic ailments, which are HEART, BLOOD PRESSURE AND PROSTATE I get the prescription from a Gynaecologist, which is given to me thankfully without a review. WILL SOME MEDICO VETERAN WHO READS THIS PLEASE SPEAK TO THE MEDICAL TOP BRASS AND SUGGEST TO THEM THAT THEY WILL ALL BE JOINING OUR FRATERNITY IN THE NOT TOO DISTANT FUTURE.
Brig SC Kuthiala (Retd)

Army continues relief measures

Staff Reporter
KOLKATA: Even as the agencies concerned struggle to contain the outbreak of enteric diseases in areas affected by the cyclone Aila, the Army has sustained relief efforts and medical aid to North and South 24 Parganas, the districts of West Bengal worst affected by the cyclone.

Senior officers of Eastern Command, including Major General Ravi Dastane, VSM, GOC Bengal Area, visited the cyclone-affected villages in Gosaba on Tuesday.

Sixteen medical teams, each with one doctor and four medical assistants, have been deployed in the area since June 4 and have treated over 8,000 people for diarrhoea, dysentery as well as respiratory and skin infections. Diarrhoea has affected over 5,000 and has killed about 10 people, government officials said. The medical teams provide training to the locals in water sterilisation and first-aid.

Even as the waters recede, tube wells have submerged and saline water has mingled with the sweet water sources in the Sunderbans, causing a scarcity of drinking water and an outbreak of enteric diseases.
Army continues relief measures

Tailpiece: Do the state civil authorities have a disaster management drill in place? The Military is called out as a routine to manage disasters. In fact most of the civil authorities vanish from place of disaster to save their skin!

ECHS

ECHS is indeed a very welcome facility for us. A much needed requirement for all especially retired ex- servicemen. Hopefully the authorities are seriously considering the following 'human' failings which are negatively affecting the quality of the service.
ECHS polyclinics are getting more and more crowded with the patients. A sick person in pain can hardly wait endlessly and go around collecting queue coupons.
The Specialists, overcrowded with patients, do not give enough time to examine the patient properly. Medicines are prescribed without checking the root causes for them.
The prescribed medicines are sometimes not available. The person at the distribution counter summarily issues a substitute without clearly marking it as a substitute. Medicines issued have different brand names furthur confusing the patient
Majority of the patients are 60 years or older. Specialists trained in treating old persons ailments are required.

V K Ahuja
Brig (Retd)
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ECHS- A Failed Concept- A Point of View
"The illiterate of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn". Alvin Toffler

Ex-Serviceman Contributory Health Scheme (ECHS) was a noble concept to formulate a comprehensive health care scheme to cater to the needs of pensioners of the Armed Forces, and reduce the load on the service hospitals. However from the very inception I held a different view - While curtailing the teeth to tail ratio of the services we should not have curtailed in case of the AMC but in a phased manner increased the Doctors, staff and support services keeping in line with the increasing strength of our Ex-Servicemen (ESM). Few years back, before the ECHS was born I had gone to call on some officer. There I met a serving Maj Gen who was involved in the Study to introduce the concept of ECHS for the ESM. Having had few drinks the General officer started talking about his involvement in this yeoman project. I bluntly and frankly told the General "You will be doing greatest dis service to the ESM of the rural far-flung areas", I also told him about the problems and corruption likely to set in due course. The General did not appreciate my views. He said the concept must be tried out before such comments are made. I told him "this is the problem". We start certain projects because some one wants to implement a new idea without taking the views of a cross section of the environment. Truly playing to HMV (His Masters Voice). As I did not further want to be a spoilt sport for the evening as he was also to have dinner there. Some of the problems I had visualized prior to the ECHS having been established:

The ECHS would only help the creamy layer of the towns, especially the officers and not the ESM of remote areas. How do you replace the trust and faith our serving soldiers and the ESM have in the armed forces doctors. ESM will prefer to visit MHs rather than ECHS Polyclinics.

The salary offered to the doctors may not attract the best of the talent for the ECHS to be established in remote, rural areas especially when the aim of ECHS would be to extend Health Care arm to distant remote areas and not focus in metros, big cities and military stations.

I had also forecast certain malpractices, likely to set in based on experience with reimbursement of medical bills of serving/ retired personnel of other departments. Post ECHS concept having put in place, Over the period I have had extensive opportunity of interacting with a large number of ESM while serving in CI/ CT environment and also while I was on leave in my village. The feedback on ECHS is not encouraging. In the words of the DGAFMS Vice Admiral VK Singh "ECHS is a big failure". ECHS I believe was conceived to be run, somewhat on the lines of the CGHS. However ECHS in the present form is no where near the CGHS. Now without going into history I would like to bring to the notice of those who refuse to see the problems of ECHS:

The concept of ECHS as I view it, was primarily to extend the medicare arm to remote distant areas and secondly to decongest the existing service hospitals. I feel the focus has been reversed . The ESM of military station and metros are drawing maximum benefits and the ESM of remote areas are undergoing added harassment.

Station HQs with re- employed officers are not geared to meet the additional load of work involved in processing the ECHS membership. Becoming a member of the ECHS by an ESM from a remote area involves a minimum of 10 trips to become a member due to babugiri and related hassles at the station HQs. Problems are well known to all. Problems of conveyance of senior retired ESMs for repeated visits for getting the ECHS card. Who bears the burden? It may cost an ESM of remote areas upto Rs 2000/- just to get the card made not counting days wasted! OPD accommodation problems at empanelled hospitals if not admitted and the related financial burden on the ESM. ESM get themselves enrolled only on contacting serious diseases. ESM go to empanelled hospitals for a specific disease whereas these hospitals carry out investigations not only related to the disease, leading to highly inflated bills. This is sometimes done by ESM in connivance with these hospitals. ESM visit empanelled hospitals posing an emergency case and put up inflated bills thereafter.

The investigations be it laboratory or radiological investigations are ordered to suit the need of the hospital (monetary) rather than to suit the case. The normal investigation which we can get for Rs 50 will normally be available at Rs 100 or so just because it is not paid by the consumer but by the Government. The treatment given is also very expensive and do not corroborate with the disease per se, for e.g. the antibiotics prescribed are the costliest ones available in the market. Colossal amount of money has been spent in a great hurry on buying modern tech medical equipment without the support staff to handle. At certain ECHS co-located with MH and minimal load of ESM such equipment was not essential are presently lying idle! Why the government should pay to the private hospitals for the investigation and treatment which is available in service hospitals. Our armed forces are continuously modernizing its hospitals by continuously acquiring the latest medical and diagnostic equipments.

"ECHS is a big failure", Surg Vice Admiral VK Singh, DGAFMS & Sr Col Comdt AMC in his inaugural address for Continuing Rehabilitation Education (CRE) at ALC, Pune mentioned on 23rd Nov 2006.

To arrest the malpractices existing in the present ECHS concept and revert back to the old system a few suggestions :

ECHS in remote areas should be made responsible to look after the serving soldiers dependents and also the soldiers when on leave for optimum utility. ECHS doctors should also be empowered to refer such patients to specialists of the nearest service Hospitals. Stop further expansion of ECHS infrastructure and have a re- look.

Merge the existing ECHS infrastructure resources with the nearest service Hospitals and existing ECHS there by becomes an OPD outlets for the nearest Service Hospitals. Specialists visits these ECHS say once a month.

Enhance the existing facilities of Service Hospitals with Doctors and support staff.
Fd Ambulance concept needs to be revisited in view of the road infrastructure available upto the forward most posts. Future wars are likely to be intense and of short durations. The surplus Fd Ambulance staff need not be curtailed but merged into the nearest MH or of an ECHS of a military station. Fd Ambulance on need basis be only authorized to a offensive formation duly modified.

Compulsory membership by paying instalments of the membership fee through the PPOs/DSSAB/Banks. Details of parents be recorded in the service record book and in the discharge book to avoid the malpractices to get treatment for elderly relatives in the name of parents. The family dependents need to be clearly indicated with photographs in original documents from AHQ/ Record Offices, which should be tallied with documents made for ECHS. The dependents number should be curtailed. You cannot have a dozen dependents for a ESM.

The article needs to be read with an open positive mind by the authorities who matter and the issue be seriously deliberated and discussed in house before any remedial steps are considered to be taken to improve the existing system. Views of the cross section of the senior retired ESM especially from remote and rural areas be obtained to confirm to the feed back views of the writer to launch a Damage Control Mission if considered appropriate.

Col RC Patial, SM
11GR
12 Jan 2008

ECHS: What Veterans Say

Cmde BB Mistry writes...
1. Let us look at the ECHS issue from the basics. As I understand this scheme has been instituted to:
(a) provide medical care to ex servicemen both in quality and quantity at an area closest to their residence. This pre supposes that the care would be similar to that which he or she received whilst being on active duty.
(b) to unburden the existing medical institutes of the Armed Forces for care of those in service.
(c) to assist the GOI by providing contributory funds from the pensioners.
2. We observe from the various feed backs that the main objective has not ben fulfilled at all in the mofussil areas. The facilities in the urban areas has also been wanting. In Mumbai there are three centres viz INS Asvini (Colaba). Kanjur Marg Dockyard colony and one at New mumbai. For those of us who stay at suburbs on the western, central and the harbour lines such as Virar, Karjat, Thane etc the crowded connectivity makes it nearly impossible to avail of these centres. Further specialised medical services are provided only at Asvini, which is approx 60Km from Thane and 120 Km from Karjat.
I suppose a senior citizen retired serviceman would probably have to make his final halt at one of the chandanwadis on his way before reaching Colaba notwithstanding the number of stars he had been displaying in service. Even if he does make it he would be a mind boggling challenge for the medics at Asvini. The situation is thus no different from the days when the facilities were free. Please remember Death does not make any concessions to the king or the pauper. It is the one and only leveller. During my visit to the Raigad district the DSSAB officer told me that lack of ECHS facility has been an unfulfilled wish of the gentry in and around.
3. The solution lies in reviewing the system empathatically by those who are responsible for its implementation. We should endeavour to affliate more hospitals into the systems. Neighborhood physicians should be inducted for primary care. There are many doctors who charge a pittance (max Rs. 30 only) in Mumbai for consultations and also make residential visits. We should encourage these gentlehealers.
4. Some neighbourhood laboratories could also be recognised and affliated on recommendations of these doctors.
5. High- end hospitals must be kept as a last resort. Neighbourhood docs must be requested to conduct some sort of modified annual/ six monthly health check up, depending upon the age, to assess the condition of the body and mind.
6. Both the in sevice and Ex servicemen must be encouraged to take up alternative health upkeep excercise such as yoga. If this is institutionalised in active service then the same agencies could continue with the ex servicemen.This would make prevention the by word in health care. It would be economical too.
7. Finally the staff of the agencies at active end should be trained by expert counsellors to be sympathetic listners, respectful, polite and considerate to the ex servicemen without discriminating ranks and positions. It would be an excellent example if the starred retired personnel awaited their turn with patience and dignity. This would make us exemplary and different citizens.
There is more to write if the interest by concerned authorities is forthcoming.
With Best wishes.

BB Mistry
Cmde (Retd)
Vice President, War Veterans Party. A Party with a difference for the veterans from uniform and like minded civilians. Registered with the CEC.
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Cdr Iyer writes...
I visited the AFIDS (Dental Clinic) at Bangalore today for dome dental treatment. Dr Vidya Gupta,who takes care of ECHS patients said that I will have to be referred to a referral clinic. This cannot be done now as the revision is yet to be approved and asked me to report again after a month or TWO. It is obvious that unless we pressurise at some higher levels, some serious patient will land in trouble.

G V Iyer
Cdr (Retd)

ECHS- Constraints

Lt Gen Harbhajan Singh, PVSM (Retired), Former SO-in-C, met Maj Gen RK Kalra, the MD of ECHS, at the beginning of this month and informed him of certain problems being faced by retired Defence Personnel. In turn Gen Kalra explained what all is being done by HQ ECHS to improve the services. But being a Govt setup, the bureaucratic hassles have to be overcome by them (as we have faced in Delhi during our tenures).

Gen Harbhajan Singh further informed Gen Kalra about the 'Report My Signal - Blog' setup at website http://reportmysignal.blogspot.com/
In view of lack of a forum for proper interaction between retired Defence personnel and ECHS, Gen Harbhajan suggested to Gen Kalra that retired Defence personnel could put up their suggestions on the Blog, which Gen Kalra or one of his officers could periodically check and take necessary action where feasible. General Kalra agreed to the suggestion.

Therefore, it is suggested to members that as and when you wish to put up a suggestion regarding ECHS, please send your suggestion to -
'Report My Signal - Blog' setup at website http://reportmysignal.blogspot.com/

The link for sending your email to The Blog is given at the Blog itself, under Heading - "Sharing",

OR you can directly use the email ID - reportmysignalblogspot@gmail.com for sending your suggestion.

You would appreciate that it would depend on ECHS officers whether to visit the Blog and read your suggestions or not; and whether piecemeal suggestion can bring out the desired results? All the same let us make efforts and hope for the best.

CS Kamboj
Brig (Retd)

ECHS- Feedback

Dear friends,

Ex-Servicemen Contributory Health Scheme (ECHS) was launched with effect from 01 Apr 2003. The aim of the Scheme is to provide quality medicare to its members and their authorised dependents through 227 ECHS Polyclinics and a network of service and empanelled hospitals and diagnostic centres. The Scheme is fully financed by the Government.

There is a network of 227 polyclinics, ie, 106 Military and 121 Non Military Stations Polyclinics, based on density of ESM in various regions.

With the ECHS now functional for nearly five years, it is disheartening to hear criticism of the scheme.

There are numerous reasons for lack of popularity of the scheme. However instead of analyzing reasons, what is necessary, now, is to collect objective feedback and try to convince the authorities to carry out introspection with an open mind, and bring about improvements.

Having retired only in Dec 2006, I have very little experience of ECHS so far. However since some friends (coursemates in particular) have asked me to project a case, may I request you for your feedback. If you can collect feedback from your colleagues and forward it, you would contribute immensely to the cause.

Feedback is requested covering the aspects given below: -

Personal particulars .
Service No, Rank, Name.
Arm/Service/Regt/Branch.
Date of retirement/ leaving service.
ECHS Membership No.
Postal Address.
Email ID.
Phone/Mobile No.
Any other detail you wish to give.

Any comment regarding the org at the Army HQ (old name), Comd HQ, Stn levels.

Adequacy of staff vis a vis requirement. No of doctors and No of exservicemen dependent on the clinic. Is there a need to tailor the org of clinics based on requirements?

Competence and attitude of the staff.

Is there a need for more specialists, even on part time basis, once or twice a week?

Difficulties experienced in dealing with affiliated hospitals, and diagnostic centres.

Procedures followed by ECHS to prevent fraud or misuse. How justified and whether it is too bureaucratic. Any examples.

Any info on the finances of ECHS. Reasons for non clearance of bills of hosp, if known. Any avoidable expenditure in the clinics. Use of ECHS ambulances, if any (are they used for patients?).

Feedback systems in place. Attitude of different authorities.
Are you aware of any actions taken by any ex servicemen orgs or individuals, in this regard, so far? If anyone else is working on this please let me know.

Comment on the overall ambience. Is there place for patients to wait or do they wait in verandas and corridors? Parking space adequate? For how many vehs should it cater? This would depend on No of patients expected and time spent in clinics.

Your recommendations to make it an ideal org.

I intend using only authentic feedback with names and dates.

If some other issues arise on receipt of feedback I intend asking for more data to support such issues.

I will need data of as many stations as possible. I recommend special efforts to collect this data, to include interaction with pers in the clinics, and with the stn cdrs. Aim is to improve the system and not point out individual faults. The stn cdrs may be assured of the same, in case you interact.

May I take the liberty of reminding you that medical requirements will only increase with age. So efforts to collect feedback and attempts to bring about improvements are our investments for a better future. Feedback collected from senior colleagues will be most useful.

During visits to the ECHS or with your Regt affiliation could you please collect feedback from JCOs and OR, with their particulars.

Early action is requested. Comments should be sent on email ID echsfeedback@gmail.com

Even if our success is limited, we would have collected some data and made some progress which could be used in subsequent cases.

For those who do not know me, I would like to make it clear that I am no authority on the subject, and there are scores of senior offrs who would handle the case better. I harbour no grudge against any org nor do I have any axe to grind. Also I have no bitter experience of ECHS. I am doing this only because I hear a general crib and feel it is better to do something more positive.

Request excuse use of some commonly used abvns in my comns.

Regards.

Lt Gen KK Khanna, PVSM, AVSM** (Retired)