Not many patients thronging the All India Institute of Medical Sciences (AIIMS), the country’s premier government-run hospital and medical college, get to hear of Vishnu Sureka. Even fewer among them would connect him to a Delhi High Court directive to the centre last month to allot space within the institute to a charitable trust to provide medicines at subsidised rates. Yet, Sureka, who took a lot of persuasion to be featured and photographed here, is the man who has battled official apathy and possibly entrenched vested interests in his philanthropic bid to open an outlet to sell medicines at subsidised rates. Having been repeatedly rebuffed by the AIIMS management, Sureka has been running his unique Helpline Pharmacy, in the neighbouring Yusuf Sarai market, which sells genuine medicines at below-cost prices, up to 50 percent less than the printed maximum retail price (MRP), which has proved a boon to patients during the past five years.

Ask Subhash Kumar, who bought medicines worth Rs 779.14 for Rs 573 from the pharmacy, run by the Sureka Public Charity Trust (SPCT). A week after his 17-year-old brothe Praveen underwent a heart surgery at AIIMS, Kumar took the prescription to the pharmacy and returned with the medicines at the discounted prices. “I came to know about this pharmacy from other patients at the hospital. I wish I had known about it much earlier. I used to buy the medicines from the shops closer to the hospital,” says Kumar, showing the bill that mentions both the MRP and the price charged.

Praveen had been suffering from palpitations and considerable difficulty in breathing. His family came all the way from Bihar to consult the specialists at AIIMS who suggested a bypass surgery. But Praveen’s father, a small farmer, just couldn’t afford the Rs 1.4 lakh cost estimated by the hospital. The family then approached the health ministry, through the social welfare office at AIIMS, and managed to get the surgery performed free of cost. Though they did not have to spend on the operation, they ended up spending more than Rs 25,000 on just the medicines.

Many more like the Kumars are drawn to this pharmacy, with a modest yellow and green hoarding that declares in Hindi that the medicines are sold at 50 percent less than the MRP. “Drugs sold in India either fall under the ambit of the Drug Price Control Order (DPCO) directive or are unregulated. The profit margin for the retailers set by the government on the DPCO regulated drugs, which are mostly inexpensive, cannot exceed more than 10 to 20 percent,” says Dinesh Khanna, a pharmacist at Helpline Pharmacy. “Retail prices of most life-saving drugs in India are unregulated. All anti-cancer drugs and drugs for kidney treatment are sold at huge profit margins, making them unaffordable to the poor.”

Thousands of patients who land up at AIIMS can barely afford the journey from their native places across the country, let alone the prohibitive cost of treatment. The narrow strip of shade around the circumference of hospital buildings in the campus is lined with cloth and plastic sheets where such patients and their attendants sometimes spend months. The pavements serve as their home often until they are drained of all hope and the last penny in their pockets. In many cases, more than the expense of the surgeries involved, the cost of the medical investigations and the prescribed drugs empties bank accounts.

Sureka,  a businessman who runs factories in Faridabad and elsewhere, has been beseeching the authorities to let him step in and provide some succour to such families. He has been pleading that his pharmacy needs to be located within the hospital complex for this purpose but to little avail. “I have no objection if the AIIMS authorities name the shop as theirs, employ their hospital staff and take entire responsibility of the pharmacy,” he says. “I am willing to pay salaries to the employees working in the pharmacy. But I just want them to let me provide cheap medicines to the poor.”

Despite several meetings with the officials of the hospital and the health ministry, Sureka could never ascertain why his plea was never accepted. The hospital formed two committees – in 2008 and in 2009 – to look into the pros and cons of the proposal. The minutes of the meetings held by these committees, with prominent officials of the hospital on board, show that though they recognised the need of a pharmacy inside the hospital campus they still decided against the proposal.

The authorities refused to budge even as Sureka’s credentials were impeccable – since 2000 he had been running a dharamshala inside the hospital complex and providing food at subsidised rates. Besides that, his trust had been running an ambulance service which charges just Re 1 per kilometre and that too just to prevent misuse.

“There is no need for a pharmacy inside the AIIMS campus. There are over 50 shops within a radius of one kilometre of the hospital and they all sell medicines at competitive rates,” Dr D K Sharma, medical superintendent of AIIMS, who was also a member of the committee in 2009, told Governance Now a few days before the high court gave its directive.

Since 2009, the SPCT has been filing applications under the Right to Information (RTI) Act to find out just why its proposal was getting nowhere. With recommendation letters from the president’s office to the health ministry, Sureka wanted to know why the authorities were so apprehensive in granting him space for a noble venture. The replies, however, failed to answer his questions.

A reply filed by AIIMS in December 2009 simply said, “The reference to your proposal for opening of charitable chemist shop at AIIMS campus has been examined by the institute but same has not been acceded to.”

When nothing seemed to work, the SPCT filed a public interest litigation in the Delhi High Court in April. On May 17, the division bench of Justice Sanjay Kishan Kaul observed, “If space can be allotted to existing barber shops, tailor shops and beauty parlours, certainly a space/spaces can be allotted for such charitable purpose.”

While asking the centre for a compliance report by September 10, the court said, “We are of the considered view that there can be really no dispute about the advisability or requirement of having a space/spaces allotted to charitable institutions for giving free/subsidised medicines to poor patients who visit AIIMS.”

Before the matter went to the court, though, Dr Sharma (who could not be reached subsequently) said, “We cannot allow opening a pharmacy in the hospital premises without following proper procedure. First of all, we do not have space for a shop. And in case we plan to open a pharmacy, we’ll release a tender and invite applications. There is a procedure which we have to follow.”

Dr Y K Gupta, public relations officer at AIIMS, who was part of the two committees formed to discuss the SPCT proposal, however, said, “We have not yet received the copy of the court order. Once we get it, we will do whatever has to be done. Court orders have to be obeyed. There is no question about it. But we have to see the order first and the policy arrangements, logistics issues will be framed accordingly. Space will be allocated after this. We never refused the proposal. It is for public benefit. But we were considering the best options.”

Sureka says there is no way he can compete in an open tender. “The bids are going to go as high as Rs 50 lakh. I cannot afford that. The pharmacy inside the hospital will not be a profitable venture. In fact, my expenses will increase if I get space in the hospital,” he says. “The hospital authorities say they do not have space. They can have space for banks, ATMs, Mother Dairy, tea shops and canteens but how can a hospital not have space for a pharmacy?”

Interestingly, Delhi health minister Kiran Walia had offered to provide space to Sureka’s trust in the hospitals run by the state government. But Sureka says that since none of the other hospitals handles quite as many patients, his efforts would be most beneficial at AIIMS.

Why subsidised medicines, though? Why not a small nursing home or a hospital? The genesis of his big idea dates back to the time when his father was on his deathbed and needed a life-saving drug, Albumin, which retailed at Rs 3,000. Later, Sureka found that the manufacturing cost of Albumin was just Rs 1,200. Taken aback by the difference, he opened Helpline Pharmacy within five years to do his bit for society.

While AIIMS refused to buy into Sureka’s idea, the other pharmacies in the vicinity turned out to be far more appreciative. So much so that they started using lookalike banners to wean away customers from the real discount-rate chemist shop. Helpline Pharmacy has, therefore, spawned shops with names such as ‘Super Helpline Pharmacy’, ‘Helpline Chemist’, ‘Helpcare Chemist’ and ‘Help Pharmacy’. Some of these don the familiar yellow-and-green hoarding as well. And in their bid to outdo Helpline Pharmacy, some even claim to offer 70 percent discount against Helpline Pharmacy’s offer of up to 50 percent.

“Patients go to other shops thinking it is Helpline Pharmacy and they do not get a discount on medicines,” says Khanna, the pharmacist at Helpline Pharmacy. “We cannot even patent our shop’s name because ‘Helpline’ is a common name.” So the pharmacy has pasted A4-size pamphlets on its glass door and near the cash counter inviting customers to report any shop selling a drug cheaper. The pharmacy purchases medicines directly from the manufacturers or authorised distributors, so it is sure about both the quality and its prices.

With a fixed expenditure of Rs 6 lakh that goes towards rent, salaries, wages, bills and housekeeping, the pharmacy spends Rs 24 lakh every month on free medicines and food as it also supplies medicines to more than a hundred NGOs and charitable hospitals in and around Delhi.

“We are running a loss of Rs 10-12 lakh per month in our pharmacy,” says Sureka, “but at the same time we are saving Rs 25-30 lakh for the patients.” Most people who come for treatment at AIIMS have to buy medicines from the shops outside and are not aware of the benefits they can get at Helpline Pharmacy. If we have an outlet in the hospital campus, we’ll serve patients 24 hours a day, 365 days a year.”

Once that happens, because of the intervention of the high court, patients and their attendants will no longer have to go looking for the shop number 18/4 at the Yusuf Sarai market, which is hidden behind the Delhi Metro Rail Corporation construction site boards. That will be a relief because, after all, as Sureka says, “You can survive without food for a few days, but for medicines there is no alternative.”


What patients say -   

Amar Shukla
Shahjahanpur

“The government should support those who are willing to help hundreds of people who cannot afford costly medicines. A hospital like AIIMS, which is one of the country’s premier hospitals, should itself provide medicines free of cost to the poor coming for treatment. If the hospital authorities cannot do so, they should at least not come in the way of people wishing to do such social service.”

Shamil Rashid
Badarpur, New Delhi

“Medicines for cancer and life-saving drugs are very costly. When we ask the hospital authorities to give us such medicines, they tell us these are out of stock. People who can afford such medicines or are resourceful get medicines easily from the hospital. If a person like Vishnu Sureka really wants to help so many needy people then the AIIMS should not have any problem.”

Munna Lal Shukla
Shahjahanpur

“What we saw was simply a rigid attitude of the hospital authorities. They are not bothered about a common man’s problems. It makes no sense in not allowing a person who wants to help the general public.

Rajesh Kumar Mishra
Shahjahanpur

“You can see so many people lying down in passages outside wards. When they can’t afford a proper meal, how can they purchase these costly medicines? The AIIMS should have permitted Vishnu Sureka to open a shop within the complex much earlier and not after the Delhi High Court’s intervention.”

Siddhant Satapathy
Orissa

“It is definitely a welcome move. There are a lot many people who cannot afford costly medicines. Many a time medicines are out of stock in the hospital and the authorities ask patients to purchase these from outside and that is too costly. A person who has taken up the social cause should be appreciated for it.”

“If someone is really giving medicines cheap out of charity, the common man will certainly benefit. But authorities should ensure that the stocks kept at the shop are well tested and are not past the expiry date.”

Rajkumar Mahapatra
Orissa

“We need to know why the AIIMS authorities refused the man who wanted to set up a shop within the complex to sell medicines at discount. There must be some reasonable grounds for not allowing him. The cause is definitely worth praising. But at the same time medicines are often a matter of life and death and so one cannot take any risk.”

Intezar Ahmad, 40, suffered from high fever and dizziness due to a swelling on his left cheek for a year. The lump grew bigger and he had it operated at a private hospital five months ago when he realised it was cancerous. The swelling appeared again and he moved to Delhi from Meerut, Uttar Pradesh, for treatment at AIIMS. He underwent chemotherapy three months ago. Working as a daily wage worker, he brings home no fixed income. Feeding and educating his five children have also become difficult now with no work due to his illness.
He has spent Rs 90,000 on his treatment so far. “The doctors gave him free medicines just once. Later, all the medicines had to be purchased from outside,” says his wife Shabnam. His uncle Habib Ahmad recounts that once he went to purchase a medicine which was available at shops near AIIMS for Rs 1,200 but he got it for just Rs 185 at Helpline Pharmacy.

Kaushalendra Singh buys medicines from Helpline Pharmacy for his four-year-old son, Chotu Kumar Singh, who is admitted in AIIMS with a swelling in his abdomen.

Singh was staying in Faridabad when one night Chotu Kumar was rushed to the emergency ward at AIIMS. From there, he was sent to Safdarjung hospital, where the doctors told him that they didn’t have the facility to treat his child and that he should take him back to AIIMS, which finally admitted his son and his treatment is on. A resident of Faruhabad, Singh is a farmer and a daily wage worker. He spends Rs 200 to Rs 300 every day on medicines. The amount, he says, would have been much more had he been purchasing it from anywhere else but Helpline Pharmacy.

Ramchandra, 45, paid Rs 100 for medicines worth Rs 150 which he bought from Helpline Pharmacy for his wife Pushpa, 40. 
Pushpa has headache for the last five years and regularly visits Safdarjung hospital for her treatment. They have to buy medicines every 10 days and since last year they have been coming to this pharmacy.

“The attendants at the shop are very polite. They treat the customers very nicely. We have benefited from the discount they give us. For the handicapped, they give extra 10 percent discount on the total bill” said Ramchandra, who has polio.
Residents of Madangiri village, both Ramachandra and Pushpa iron clothes and earn around Rs 7,000 per month.