Tata Memorial Hospital: a Peerless Icon

Abstract

Few institutes last long and fewer maintain their pre-eminent position throughout their life. They are called temples of their silo. Tata Memorial Hospital and Centre (TMC) is one such temple of healing. The contribution of TMC in patient care, education and research is unique and reasons for its success are varied. It is probably the best  expression of Tata culture, Government’s commitment, dedication and autonomy of people who ran it. A glimpse into the journey with its changing vision towards a pointed mission of conquest of cancer in India is captured in words.

Sir Dorab and Meher Tata, two luminous souls lie side by side in eternal quietude, resonating devotion, love, and commitment, in a mausoleum at Brookwood Cemetery, London. On the lintel above the main door, engraved in regal splendor, is the family crest and motto from Zoroastrian scriptures—“Humata, Huxta, Huvarshata” (good thoughts, good words, good deeds) [1].

From this fountainhead of spiritual legacy sprang forth the genesis of Tata Memorial Hospital…

Creations of great medical institutions have often been exemplars of visionary acts inspired by deep compassion, missionary zeal, or personal tragedy. This holds true more specifically for cancer hospitals, where suffering and loss have motivated noble souls to translate their grief into actions for universal good. A star was born, which guided, helped, and healed many, casting forth rays of hope, courage, and inspiration. Dorab and Meher Tata created a commendable progeny for the world to behold as a peerless icon.

The noble mission statement of the Hospital, which has underlined its operations, aims, and goals ever since was documented as, “…To provide quality treatment to each patient who walks through its doors, irrespective of his or her ability to pay.” A selfless act to create a temple to conquer a scourge was whole-heartedly supported globally by Memorial Hospital, Rockefeller Institute and Yale School of Medicine in the USA, and Curie Institute in France [2]. Training and exchange of experts fructified with Memorial Hospital, Massachusetts General Hospital in the USA, Radcliff Infirmary in Oxford, Holt Radium Institute Manchester, and Curie Institute Paris to create systems that were sui generis.

The first 2 decades were witness to excellent documentation of disease patterns, leading to reliable research findings that unraveled a link between tobacco chewing and oral cancer. It has taken 60 years to effect a ban on tobacco sales (gutka, a popular form of tobacco) in spite of one of the first causal links between tobacco and cancer being established globally. This was published in Indian Journal of Medical Research in 1945 [3], 5 years ahead of the famous paper of Sir Richard Doll [4], linking lung cancer and smoking. The second causal link that was reported by epidemiological studies was lack of cervical and penile cancer in the Muslim community and its highest incidence in Hindus. After 50 years, it is common knowledge that HPV has a strong correlation with uterine cervical cancer and circumcision in Muslims prevents transmission of this virus. The hallmark of two decades was research in etiology of common cancers in India.

The following three decades could be termed as effectively adopting technology to be abreast with global developments and harness surgical skills to achieve the best in the world. This gave Tata Memorial Center a unique place in India for cancer treatment and education. Skills were mastered to disprove that body regions that were considered a Waterloo for surgeons were in fact quite safe, with the 30-day mortality for esophagus, lower rectum, and pancreas reduced to less than 5%. This gave recognition to the center as one of the best in performance of radical surgery, which was and continues to be the single most effective modality in treatment of solid tumors. I must confess that research took a little backstage during this time, but the seeds of curiosity were being sown.

The next 15 years marked complete dedication to the rigor of clinical research. Efficient infrastructure was created with the launching of the Clinical Research Secretariat (CRS), the formation of the Institutional Review Board (IRB), and the allocation of intra-mural funding for clinical research. This time span brought to fruition the cross-talks between physics and medicine with the launching of affordable NICE prosthesis leading to limb conservation surgery for bone tumors in adolescent patients. Collaboration between physics and engineering resulted in a low-cost radiation equipment Bhabhatron-II that could work uninterrupted in an environment where the power supply was unpredictable. Thirty such machines are functional in Rural India and one each in Vietnam, Sri Lanka, Mongolia, Namibia, Kenya, and Tanzania. Curiosity sown 2 decades ago was blossoming and bearing fruits. Studies in common cancers in India yielded results that put TMC on the global map. Breast, cervix, oral cancer, and other sites offered a large number of patients to run practice-changing trials, the results of which had the potential to save thousands of lives globally and the affordable interventions had the appeal of implementability across the developing world. These studies elevated TMH to plenary lectures in ASCO [5] and SABCS [6]. It was not a surprise then that the trials were published in New England Journal of Medicine [5], Lancet Oncology [7], BMJ [8], JCO [6], and Journal of National Cancer Institute [9].

The final decade that crossed 75 years in its middle marks the harnessing of technology to facilitate health care delivery, documentation, and tame genomics with well-thought-out hypotheses. TMC went paperless with electronic medical records and patients’ smart-card, and succeeded in evolving one of the cheapest procurement systems that could offer life-saving drugs at affordable rates to all patients. We now await some novel answers to some pointed questions using next-generation sequencing technology. Finally, cross talk is about to reach newer heights with new targeted molecules carrying a pay-load of alpha or beta emitting radio-isotopes to render a staggering if not fatal blow to receptive cancer while sparing normal tissues. The decade approaching 75 years also saw the expansion of our mandate to India for cancer control through the National Cancer grid and globally with Vishwam Cancer Care Connect, with incisive yet affordable insights into cancer biology. The dream that was pronounced at Tata Memorial Hospital’s inception by Sir Roger Lumley, governor of Bombay, described it as India’s first largest contribution to the international fight against cancer and waxed eloquent on its prominence, “What has impressed me the most was the greatness of the conception and the care and patience with which it has been worked out. There has been no tinkering with the problem. You are attacking it on three fronts—Treatment, Education, and Research—all three of them essential and interdependent… The hospital will spearhead the attack of cancer in the country. It will provide, not only a center where specialized treatment can be given but also one from which knowledge of new methods of treatment and diagnosis will go out to doctors and hospitals across the country.”² Sir Lumley’s optimistic prophecy mapped Tata Memorial Center’s destiny, and eighty glorious years later, unchallenged, it still maintains the position of a polestar.

Over these 80 years, what has evolved is a very effective, affordable, and implementable model of health care delivery. The model could serve the whole spectrum of society, offer evidence-based care, mentor future doctors, and run low-cost research endeavors that address common problems in society. A model that could run with meager support from government/charity as it could generate enough revenue for sustenance. It evolved public–private partnerships with individual medical faculty so that they not only flourished in the academic environment but also were rewarded for research outputs handsomely. The governance principles were strict control over non-sharable inputs/outputs and incentives for sharable outputs. The center has thus contributed not only to medical research to improve patient outcomes but also evolved an effective model for a sustainable health care delivery system globally. Hon Prime Minister, Shri Narendra Modi, described it as “A beacon of cancer care in India, an idea to replicate, not only across India but also in the emerging world” and Mr. Ratan Tata called TMC an inspirational chapter in the medical history of India that needs to be memorized and repeated often.

The journey is astounding, and the metamorphosis of the institute is dazzling. One wonders, was it the energy of the place, the determination of the individuals, or the writing on the sky, which delivered it to its goal—an unparalleled success story?

The answer probably lies in the expression that whenever one will commit oneself to live the highest ideal and ascribe to the noblest intentions known to humankind, the Gods do smile as destiny…!

Declarations

Conflict of Interest

The authors declare no competing interests.