Priest Revives Former TB Clinic for AIDS Patients

Father Tomy. i i

Health care professionals come from all over the world to see how Father Tomy Karyilakulam has transformed a rundown hospital into an advanced-care facility for AIDS and TB patients. Erica Frenkel hide caption

itoggle caption Erica Frenkel
Father Tomy.

Health care professionals come from all over the world to see how Father Tomy Karyilakulam has transformed a rundown hospital into an advanced-care facility for AIDS and TB patients.

Erica Frenkel

Bel-Air Rises from Ruins

At the beginning of the 20th century, the clear air and hygienic surroundings of Bel-Air were promoted as therapeutic and restorative for patients with tuberculosis. But by the 1980s, it had fallen into ruin, and businessmen from Mumbai sought to turn the health center into a resort.

  

Read about how Father Tomy Karyilakulam saved the center and gave it a new purpose.

HIV Infections Estimates

India released new HIV estimates for the country that equal about half that of prior UNAIDS numbers. Read about the estimates and how this and other estimates are calling into question the numbers put forth by UNAIDS.

A woman rests outside the gynecological ward at Bel-Air Hospital. i i

A woman rests outside the gynecological ward building at Bel-Air Hospital. Joe Neel, NPR hide caption

itoggle caption Joe Neel, NPR
A woman rests outside the gynecological ward at Bel-Air Hospital.

A woman rests outside the gynecological ward building at Bel-Air Hospital.

Joe Neel, NPR
A nurse hostel on the Bel-Air hospital grounds. i i

Many of the 60 nurses on staff stay at a hostel on the grounds of the Bel-Air hospital while the new nurse college is under construction. Joe Neel, NPR hide caption

itoggle caption Joe Neel, NPR
A nurse hostel on the Bel-Air hospital grounds.

Many of the 60 nurses on staff stay at a hostel on the grounds of the Bel-Air hospital while the new nurse college is under construction.

Joe Neel, NPR
Patients and families stand outside a Bel-Air Hospital building. i i

Patients, families and friends gather outside a Bel-Air Hospital ward. Erica Frenkel hide caption

itoggle caption Erica Frenkel
Patients and families stand outside a Bel-Air Hospital building.

Patients, families and friends gather outside a Bel-Air Hospital ward.

Erica Frenkel
The international school. i i

The private international boarding school attracts many wealthy students from Mumbai and other cities. The school, run by Karyilakulam's mission group, will generate $300,000 in annual profit for the hospital when it is fully operational. Joe Neel, NPR hide caption

itoggle caption Joe Neel, NPR
The international school.

The private international boarding school attracts many wealthy students from Mumbai and other cities. The school, run by Karyilakulam's mission group, will generate $300,000 in annual profit for the hospital when it is fully operational.

Joe Neel, NPR

Some 160 miles south of Mumbai, one Catholic priest and the Indian Red Cross have created what some say is a model for AIDS care in the developing world.

The combination hospital and community center provides charity care without depending solely on charity itself.

Bel-Air Hospital is an old tuberculosis sanatorium, once famous for its advanced care. It was started in 1912 in a thick forest on top of a mountain.

When Father Tomy Karyilakulam, a Catholic priest widely recognized as "Father Tomy," came upon it about 15 years ago, Bel-Air's 50 or so buildings were crumbling; trees were growing through windows and rooftops.

"As a human being, I just felt bad," Father Tomy said. "I just said, how can one allow such a good institution to go away?"

Father Tomy vowed to save Bel-Air and persuaded the Indian Red Cross Society, which owns the hospital, to allow him and his mission to rebuild it.

"There is no other place these people can get help from," Father Tomy said. "And I think that that is a situation which you cannot allow to happen."

At Bel-Air, Father Tomy has achieved what no other rural hospital in India has done: He has assembled the latest technology and doctors needed to practice sophisticated Western-style medicine. This led to his ability to get access to the government-controlled supply of drugs to fight HIV.

"The way we look at patients and deal with it is with dignity, with love, and with care," Father Tomy said. "We do not have any discrimination against any [HIV] positive person here."

Compassion and Care for All

Even the poorest of the poor can qualify for free AIDS drugs. Those who can pay are charged modest fees.

But by the time they get to Bel-Air, patients can be very sick. They've spent months getting care from underqualified doctors claiming to be AIDS experts, or from outright quacks, Father Tomy said.

The doctors go on writing the wrong prescriptions, Father Tomy said, and they give out vitamins or antibiotics that don't do anything against HIV or TB. This is why the wrong drugs and wrong dosages can create drug resistance and relapses.

"They make a mess," Father Tomy said. "They just make life for people hell. This is what is happening."

Counterfeit drugs are hurting patients, and Father Tomy said there is no quality-control system to keep people from getting bad medicines.

Beyond Charity

Bel-Air is so unusual that health experts from all over the world come to see what Father Tomy has been able to create. Bel-Air now has 250 beds and four operating rooms. Its staff includes two dozen doctors and 60 nurses.

Father Tomy is a master at fundraising. But, unlike most charities, he doesn't rely solely on grants or government aid; he's setting up several money-making enterprises.

Just down the road from Bel-Air is a brand new, private boarding school, run by Father Tomy's mission. The building has long, cool hallways, spacious classrooms, verandas and fans. The school attracts the wealthy from Mumbai and beyond. Its substantial profit goes to Bel-Air.

That is 12 million rupees annual net flow, Father Tomy said. It's equal to about $300,000 a year.

"Yes, yes, that is the college of nursing coming up," Father Tomy said, pointing to the edge of a nearby cliff.

A four-year college of nursing is rising quickly out of the red dirt. While it may turn a profit, it, more importantly, will provide 80 nurses and students to staff the hospital — nurses that will be needed as the demand for AIDS treatment continues to rise.

Bel-Air Hospital Rises from the Ruins

Father Tomy Karyilakulam

Father Tomy Karyilakulam helped bring Bel-Air Hospital in Panchgani, India, back from the ruins. He worked with the Red Cross to stop the hospital's buildings from destruction and repair its Colonial-era buildings. Erica Frenkel hide caption

itoggle caption Erica Frenkel
Women helpers at a Bel-Air construction site.

Women are employed to carry dirt and rocks away from the construction site of the new college of nursing at Bel-Air Hospital. Erica Frenkel hide caption

itoggle caption Erica Frenkel
Dr. Sister Anita is an American-trained physician who treats Bel-Air's TB and HIV patients.

Dr. Sister Anita is a physician who treats Bel-Air's TB and HIV patients. Joe Neel, NPR hide caption

itoggle caption Joe Neel, NPR

Bel-Air Hospital near the resort town of Panchgani in India's Western Ghat mountains was originally built to care for people with tuberculosis.

The clear air and hygienic surroundings of Bel-Air, founded in 1912 by Dr. Rustom Billimoria, were promoted as therapeutic and restorative. The hospital's lush campus, spread out over 44 acres, grew to 50 buildings over the next few decades.

Today, 95 years later, the bucolic setting of Bel-Air is still seen as healing — this time for patients with HIV, many of whom also have TB.

And the hospital now is able to offer more than air. There are free drugs for TB and the infections related to AIDS, which help keep patients alive long after they leave.

Some of the patients also qualify for drugs that fight HIV. There aren't enough drugs for everyone, but about 25 percent of the people who need medication get it. This percentage is expected to rise as a new government program takes effect this summer, said Father Tomy Karyilakulam, the hospital's director.

Struggle to Survive

Like many of the patients here, Bel-Air has cheated death. In the 1980s, it fell into near ruin as the hospital's owner, the Indian Red Cross Society, curtailed services after cutbacks in government funding for the hospital.

Also, new TB drugs were eliminating the need for a hospital stay, though improper use of the drugs worldwide would later become a major problem.

When Karyilakulam, a Catholic priest from the Missionary Congregation of the Blessed Sacrament, happened upon Bel-Air while on vacation, there were just 25 TB patients left, living in two buildings. There were no doctors or nurses in sight.

Karyilakulam found that some of the buildings had been turned over to people in Mumbai and were being used as a resort. He saw this as unacceptable in a country with so many unmet health care needs.

"I knew that India needed a lot more health care centers and that a dying health care facility can be revived to help people," he said in a recent interview.

AIDS a Surprise

He worked with the Red Cross to stop the land grab. One of the Red Cross trustees, Homai N. Modi, stepped in to help. She went on to aid Karyilakulam in raising tens of millions of rupees, amounting to well over a million dollars. With this, Karyilakulam and his congregation began repairing Bel-Air's buildings.

The plan was to build a general hospital to serve the surrounding area — a rural impoverished region in the southern part of Maharashtra state south of Mumbai.

"HIV was an absolute accident," Karyilakulam said. "I never imagined it would be so big."

Last year, more than 1,000 patients with HIV were treated at Bel-Air.

Community Opposed

When the hospital started treating people with AIDS, word got around quickly.

The reaction in neighboring Panchgani was severe. Local residents feared that having a large number of people with HIV so close would depress the resort's attractiveness.

Local attitudes were so adverse that an armed mob charged the hospital one night and threatened to kill Karyilakulam. He was put in protective custody in the town's jail.

"Instead of walking out, which most people would've done, he stuck on," Modi told a Mumbai filmmaker last year. "It was a place that was really sinking at that time."

Rejection High

What stirred Karyilakulam into action against AIDS was the discrimination and stigma he saw all around him, he said. Doctors from around the region were sending extremely sick patients with AIDS to him. They would tell stories of how they were not given treatments — or the wrong treatments. Surgeons refused to operate on them. Nurses would not touch them.

It even happened at the newly revived Bel-Air.

As Karyilakulam tells it, an HIV-positive man who was in a bad motorcycle accident, with several major fractures, came to Bel-Air for critical surgery after three other facilities rejected him. But he didn't find immediate acceptance at Bel-Air.

"When I saw my doctors rejecting ... I was mad," Karyilakulam said. "I just felt that we cannot not help, and we needed to do something about it. So, I jumped into the fray."

He persuaded the surgeon to operate, but it took considerable time to locate an anesthetist. And he found that his own nurses, who had willingly treated people with AIDS before, were reluctant.

"I said how can we allow this? Can we allow this man to die in this situation without care?" Karyilakulam said. "I won't force you to do it," he said he told the nurses and sent them off for the night. "When they returned the next morning, they said they'd do it, and they did it."

Now Stigma-Free

Today, Bel-Air performs three to four operations a day on people with AIDS and "nobody's afraid," Karyilakulam said. "Absolutely any patient comes in and we do it."

At Bel-Air, the emphasis is on removing the fears that many people have about AIDS and treatment. Though discrimination levels in India are lower than in the past, many people report being ostracized by their communities and rejected by medical facilities.

Bel-Air requires that patients arrive with at least one family member or a friend. The aim is to help teach this person what's needed to care for someone with AIDS – but it's also designed to spread a non-discrimination message back to the community.

Health workers also spend considerable time counseling patients.

"When they go back home, they don't know how they're going to be received by their near and dear ones or their neighbors," said Sister Dr. Anita, a Franciscan nun who has received training in the United States.

Treatment of HIV has eased some of the stigma and fear of the diagnosis, but psychological reactions can still be extreme and require treatment.

"Once sick, you can become depressed," Sister Dr. Anita said. "And that depression can kill you."

A major change that she's seen recently is that patients are getting well and returning months or years later for a second visit.

"We are making a difference," she said.

Training Grounds

The renovation of Bel-Air is nearly finished. The old Colonial-era buildings are freshly painted. Windows are no longer broken. The wards are clean and tidy.

Karyilakulam has set out to expand Bel-Air's reach. He's building a two-story nursing school at the edge of a cliff — with one of the best views of the green valley below. The four-year baccalaureate program graduates 40 nurses a year.

Many nearby hospitals and facilities have agreed to help with the training and to send their nurses and doctors for education in how to treat HIV and AIDS. And the University of Illinois-Chicago is helping structure the curriculum.

Joe Neel is a Kaiser Family Foundation Media Fellow this year.

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