AIIMS Delhi has a fascinating history. Most of what follows is indebted to the PhD thesis of Anna Ruddock, formerly at King’s College London. The thesis is titled ‘Special Medicine: Producing Doctors at the All India Institute of Medical Sciences (AIIMS)’.
The genesis of the idea of AIIMS lies not in independent India, but in British colonial India and colonial reports. In 1943 one Professor A.V. Hill, Secretary of the Royal Society in London, was invited to India to advise on the future of scientific research in the country. These are some excerpts from that report, and it is astonishing how what was imagined then has indeed been translated almost word to word and largely persists to this day:
The most effective way of producing a change in all this would be to set out deliberately to create teachers and research workers of a new kind, people who would devote their lives to the single object of advancing in India the art, science and practice of medicine. For this purpose a great All-India Medical Centre should be established, an ‘Indian Johns Hopkins’ staffed in all departments by the ablest people available anywhere, employed full-time and adequately paid.
The intention of the All-India Medical Centre would be to produce the future leaders of Indian medicine and public health, the teachers and research workers. If the All-India Medical Centre is to play the national part it should in advancing medicine and public health, and to gain the international repute which will put Indian medicine ‘on the map’ and attract first-class teachers and research workers from any part of the world, then I think it must be given the national recognition and status which is possible only by its establishment at the Capital of India.
A few years later, the Bhore Committee Report also batted for such a national level institute. On independence, the new Indian government recorded its intention to establish the recommended institution in its first five-year plan (1951– 56), and the project was revived by the allocation of a $1.25 million grant by the Government of New Zealand under the auspices of the Colombo Plan. The foundation stone of the ‘All India Medical Institute’ was laid by New Zealand’s minister of industries and commerce in 1952. The institute opened its gates in 1956.
AIIMS was one of the pet projects of independent India’s early leaders, including Jawaharlal Nehru and Rajkumari Amrit Kaur (India’s first Health Minister). Kaur took a lot of personal interest in the institution. Here’s what a senior doctor said about her association with AIIMS in its early days:
After doing my house job, I was planning to go to England like everyone else, to do FRCS. Due to many reasons I could not go immediately…. My mother was a politician … I knew the ruling elite in those days very intimately. The All India Institute of Medical Sciences had already been planned. And Rajkumari Amrit Kaur was the President of the Institute. She told my mother that if our children go abroad to study, who will study here? So I was forced to explore the possibility of getting a job here.
And they did not have any clinical departments; they had just started basic sciences. Since I wanted to be a surgeon, I liked anatomy very much, I applied for a job in anatomy. And I was interviewed very informally on a Sunday, and I was selected for the post of what they called a tutor.
The institute was highlighted everywhere – it was going to be the best institute. I was told that a delegation went around the world, picking up and interviewing outstanding Indians in different medical colleges in England, in USA. And the professor that they had selected for anatomy was an outstanding professor, Professor NH Keswani, and he was also awarded Outstanding Achievement Award by Mayo Clinic. So the name of Mayo Clinic in those days, and hearing these very westernized people, young people, without much of that old culture of ‘yes-sir no-sir’ appealed to me very much.
In my early days the atmosphere in the Institute was very nice. It was like a family. And the students, you did not treat them as students, everybody knew everyone…I mean the first batch of students, they must have attended my wedding, they were all there you know! That’s why I started liking it and continued to work here. The place certainly was very congenial; it was not like any other place. [The administration asked for] feedback from the students about the teachers, and things, everything, very modern techniques.
The only thing is it was meant to be a referral centre, it was not meant to be a general hospital. When it started, it was meant to be a referral centre. And that character could not be kept due to reasons, probably, pressure of population, or patients or whatever. If it had remained as a referral centre, it would have been easier for people to work. I feel sorry for those clinicians who are seeing loads and loads of patients, you know. I mean it’s not fair to expect them to work under these conditions. Otherwise so far I think it’s holding on, it’s bursting at the seams, but it’s holding on.
While early leaders did their best to lay down strong foundations in nation-building, later leaders (and voters/citizens) haven’t exactly stepped in. We happily embraced AIIMS, but did not do our bit in later continuing to expand healthcare facilities through the country. This sorry state of affairs was not lost on the early leaders too. Only a few weeks before his death, in April 1964, Nehru delivered the convocation address at AIIMS:
One thing that troubles me is that in spite of such fine institutes as this one, yet there are vast areas in this country…where the benefits of modern medicine do not reach and sometimes we are rather overwhelmed by the problem. So many people are wanted there – qualified physicians, surgeons and properly equipped institutions – and we have so few. It is obvious that, however good an institute like this may be, that is essential of course; one can only be satisfied if it reaches down to the villages and if thousands, hundreds of thousands of villages feel the impact of it.
I do not know how we are going to train the people in such large numbers to go there; and I will suggest to you, those who are trained, have received the benefit of training at these special institutes, should always bear in mind the need of the people of India who live in the villages. And then how to deal with such vast numbers and how long it will take enough people to go there, is a difficult matter. Whether it is conceivable to have institutes at these villages, some kind of assistance to serve the community, bring up the real cases to experts or how to deal with it, I do not know. But something has to be done to bring modern medicine to the great majority of our people in the country.
All said, AIIMS was one of the dearest dreams, and remains one of the greatest achievements, of our early leaders, of our freedom fighters.