The Indian Journal of Social Work, Vol. XXV, No. 3 (October 1964). ...
The Indian Journal of Social Work, Vol. XXV, No. 3 (October 1964).
MEDICAL SOCIAL W O R K
S. P. AIYAR and Miss M A L A T H I K, R A O
IN BOMBAY
This article is a slightly modified version Medical Social Workers, we had the benefit
of a chapter in Hospital Administration in of meeting them often, and talking to them
BombayA Report. The study was under-
informally about matters relating not only
taken as part of the research programmes to their own work but also about hospital
of the Department of Civics and Politics, administration in general. In many cases,
University of Bombay.
indeed, they were the most friendly persons
in these hospitals.
The Survey was an inquiry into general
aspects of administration in three hospitals
Of the three hospitals (herein referred to
run by the Bombay Municipal Corporation. as X, Y & Z, X had the largest number of
It sought to inquire into the personnel workers. In fact this was the first hospital
relationships among different categories of to appoint a Medical Social Worker in
nursing staff, of their relationship to the September 1954; and since then six more
administration, their attitude to nursing in workers have been appointed. Hospital Y
general; the nature and quality of service had two Medical Social Workers and
rendered to the patients, the attitudes of the Hospital Z had only one.
Resident Medical Staff and the role of the
Medical Social Worker.
Since Medical social work is a com-
We were interested in the role of the Medi-
paratively a new concept in India, a brief dis-
cal Social Worker for medical social work was
cussion of its nature may provide a useful
a new field in hospital administration, so background to the actual findings of this
far as India was concerned. We were there-
Survey.
fore interested in their attitudes; and in the
Medical social work may be defined briefly
attitudes of other members of the hospital as 'the application of the methods of social
staff, towards them. We may here record service work in the sphere of health and
our appreciation of the work done by the more especially in the hospital setting'. It is,
Medical Social Workers in these hospitals. in other words, a form of social service. This
They worked in an environment not ideal of service finds its fullest expression in
altogether conducive to efficient work per-
a hospital; here the doctor, the nurses and
formance and, some of them at least, struck the rest of the hospital staff are all engaged
us as dedicated. Indeed, some of them helped
in social service because their work is
us immensely in the drawing up of the essentially humanitarian, viz. the cure of
questionnaires.
disease and the alleviation of suffering. Today
The general method of inquiry was that however, the term social worker is applied
of administering questionnaires and conduct-
to the trained social worker for whom social
ing personal interviews, but in the case of the work is both a vocation and profession.
Dr. S. P. Aiyar is Reader in Public Administration at the University of Bombay.
Miss Malathi K. Rao was Research Assistant in the Department of Civics and Politics
from 1959 to 1963.

250
S. P. AIYAR AND M i s s M A L A T H I K. R A O
Social service in hospitals has been the ground and history. T h e r e had to be then
result of the revolution in the attitude of some agency which would provide the doctor
doctor to patient. Traditionally, it h a d been with data bearing on his patient's illness,
the practice to treat a disease from the whether this pertained to his earlier medical
strictly medical point of view. But the history or to certain non-medical factors
inadequacies and anomalies of such an connected with his illness. Hospital social
approach soon became apparent. T h e earlier service came into being to perform this
approach h a d led to a negligence of and function and to fill the gaps in medical
unconcern for the non-medical aspects of treatment. It did not however, merely
illness. For instance, doctors did not realise supplement medical treatment but proved to
that a patient's inability or reluctance to be its necessary complement. Until the social
undergo specified medical treatment might worker entered the hospital, the clinical
be due to financial, social or psychological picture h a d been an incomplete one. T h e
reasons. T h e few who might have suspected trained social worker brought to medical
the operation of non-medical factors were treatment her special training and skill with
in no position to confirm their suspicions. h u m a n beings. In so doing, she helped to
Where a patient was discharged from hospital modify the hitherto impersonalised hospital
after treatment, there was no way of ensuring treatment.2
that the prescribed after-care would in fact
T h e primary aim of the social worker is
be taken. Within the hospital, there was a social service through case work. In the
startling lack of co-ordination—thus the same hospital, she functions as part of the
patient might be treated at different times medical staff. This implies an interest in
by different departments for apparently un-
and a general knowledge of medical treat-
connected illnesses but there was no method ment for effective functioning. Because she
by which a doctor would automatically learn is part of the medical team bringing to it
the patient's medical history. In most cases, her own special knowledge of human
the doctor would be too-pressed for time to behaviour, she is designated the medical
go into such details himself. T h e family social worker (MSW). Medical social work
doctor who had an intimate knowledge of came into being because some doctors and
the patient and his relatives and possessed nurses realised the need for making the
other background information about the patient well and keeping him well. It is in
patient's family, had a distinct advantage this sense an extension of medical treatment.
over his counterpart in the hospital, for his
treatment was influenced, albeit uncon-
T h e M S W ' s function may be summarised
sciously, by this additional knowledge. T h e briefly as 'relief, information and listening'.3
hospital doctor might rely on his colleagues Under the head of relief, her functions are
for professional information of various kinds fairly clear. If for any reason the patient
but there was no one to whom he could turn is unable to maintain himself, it becomes
for information about the patient's back-
the duty of the medical social worker to t a p
1 E x a m p l e s of this are given by H. S. Richardson in "Patients Have Families".
2 " O n e of the chief differences between private practice and hospital practice is tha t the
latter always tends to become impersonal". Francis Peabody in " T h e Care of the Patient"
quoted by Leonara B. Lubinow in "Hospital Trends and Developments1940-46" edited
by Bachmeyer A.C. and H a r t m a n G. (The Commonwealth Fund, New York, 1948).
3 M . Antoniettee Cannon , " T h e Use of Medical Social Work " In Dors Goldstein (ed )
"Readings in the Theory and Practice of Medical Social Work" p. 29. (University of
Chicago, Second Impression 1958, published 1954).

MEDICAL SOCIAL W O R K IN BOMBAY
251
available resources. At times, when the doctor finds t h a t a patient does not respond
patient suffers from a prolonged illness, it to treatment as he should or t h a t he is
m a y be necessary to provide relief for the reluctant to undergo the treatment prescrib-
family also. This is generally done by ed for him, he turns to the M S W for help.
getting into touch with institutions or T h e M S W by skilful interviewing and
agencies devoted to such relief work and sympathetic approach tries to discover the
arranging for the family's needs. In case reason(s) for the patient's reluctance or
of accidents, the M S W m a y arrange to lack of response. She familiarises herself
secure compensation and at times even with his family background and the n a t u r e
employment.
of his difficulties, financial or psychological.
She seeks to understand the patient. For
H e r duty does not end there. She is also her the patient is more than a patient—he
responsible, to a significant extent, for is a human being with his own problems;
ensuring t h a t the best results will be got his hopes and fears. She adopts an approach
out of the treatment. In the past the that will enable the patient to confide in
effectiveness of medical treatment was often
her and this task calls for an exceptional
reduced by the patient's unwillingness or degree of skill. Her only concern is the
inability to follow the doctor's instructions. need of the patient in relation to the ability
Where hospitalisation was not necessary, it of the institution to meet it. This task over,
was difficult to ensure the patient's co-
she passes on the information she has
operation. In cases where the patient was collected to the doctor so as to provide him
treated in hospital, the doctor's care was with the necessary background for his
brought to nought by the patient's ignorance
treatment. It is equally her duty to win
or neglect of necessary after-care. Today it over the patient by explaining to him the
is the M S W who ensures t h a t the patient necessity of his active co-operation with the
does in fact carry out the doctor's instruc-
doctor and by helping him to overcome
tions by providing for what is known as such difficulties as might stand in his way.
follow-up. care. It is the M S W ' s duty to Where the patient suffers from an incurable
undertake this either by personally visiting disease or is faced with the permanent loss
the patient at his home or by arranging for
of a limb or organ, the M S W can help a
the patient to visit the hospital periodically patient to accept the situation. She can
for medical check-up. Medical treatment, prevent him from becoming a burden by
one might say, is extended beyond the showing him how to make the most of what
hospital and reaches out to the patient in he has. In fine, she can put him on the path
his home. Richardson points out that, " I t to rehabilitation—physical and emotional.
is the adjustment of the medical treatment
It is particularly in this last respect that
to the conditions of the home which I have
the MSW's role as a "listener" emerges. For,
always regarded as characteristic of medical
the severest blow to a patient—and the
social service".4 This is a process which, consequent necessary readjustment—is often
according to him, requires the "individuali-
emotional. Increasing realisation of this fact
zation of cases".
has led to a shift in emphasis and attention
from the environmental to the emotional
T h e phrase "individualization of cases" is
factors in a patient's illness. This has
incidentally, the key to the method of her
naturally affected the nature of medical social
work, viz. 'case work'. For instance, if a
4H. B. Richardson, "Patients Have Families", p. 210.

252
S. P. AIYAR AND M i s s M A L A T H I K. R A O
work5 and greater stress is laid today on the
what the M S W is trying to accomplish or to
emotional problems of the patient. By her
gauge the results of her efforts. W h e n there
concern with individual cases she provides is no clear grasp of her role, there is a con-
the patient with an outlet for emotional stant temptation to allot to her administra-
release and this release of tension helps him
tive duties and more so in view of the fact
to adjust to changed circumstances. T h e that she possesses skill in interviewing and
M S W is peculiarly fitted to play the role of
ability to co-ordinate administrative matters.
a sympathetic listener, both by training and
Thus the admission and discharge of patients,
because of her position in the institution. She
routine follow-up care and clerical work may
is part of the hospital staff and partakes of
be entrusted to her. But to involve the M S W
its authority and prestige. T h e patient there-
in time-consuming activities of this nature is
fore, is ready to go to her even if he is not
to undermine her true function in the
aware of the social or emotional factors in hospital.
his illness. At the same time it is possible for
the M S W to establish a personal relationship
T h e M S W is the link that connects the
with the patient. T h e M S W does not issue hospital to the various social agencies of the
orders. She can appreciate his difficulties and
community. Her responsibility for relief, re-
the patient can talk to her without the habilitation, compensation, institutional place-
embarrassment and loss of status that a visit
ment, transport, etc. means that she tries to
to any outside social agency may imply. By be in contact with the different agencies
talking to the M S W the patient is able to catering to these needs and to tap their
clarify his own attitudes; she, on the other resources when necessary. The community
hand, gets an opportunity to study his case
on the other hand must be prepared to co-
individually and report to the doctor.
operate and act in an organised manner to
try and meet the demands of the hospital.
Within the hospital, the M S W has an This implies that the community should have
important place as the link between the a sympathetic awareness of the needs of the
doctor and the patients. While bringing her sick and disabled and that it should be
peculiar talents and knowledge to bear upon
prepared to meet those needs as far as possible
medical treatment she nevertheless functions by the provision of adequate resources. To
as part of the medical team. T h e medical the community agencies, the M S W appears
worker functions in an area in which the as the representative of the hospital autho-
doctor expects co-operation from those who rities. Changes in hospital policy or even in
assist him—the ward-sister, the nurses and the methods of hospital care have repercus-
the rest of the staff, including the menial sions on the community and the M S W in its
staff who help in ward work. Yet her contri-
eyes may become wrongly identified with
bution is not easy to evaluate. She has no
such a policy. It is necessary to remember
doubt certain 'concrete' duties, but her that the M S W is not finally responsible for
primary role as a case worker does not lend the policy a hospital may follow. Of course,
itself to evaluation. T h e main thing is of
the nature of her knowledge and her capa-
course for the doctor to realise that there is
city for social research make her co-operation
more to medical treatment than diagnosis and
in policy-making indispensable and it would
prescription. Even when this becomes be desirable to associate her with its forma-
obvious, it is not always easy to understand
tion. But care must be exercised to see that
5Ibid., p. 218.

MEDICAL SOCIAL W O R K IN BOMBAY
253
her true role is not misunderstood. T h e fact
of the Senior A M O . By 1959, the number
that the hospital is generally unable to meet
of MSWs had been increased to 7. T h e
the needs of the community gives occasion for
objectives of the Social Service wing as
blame and the M S W may find herself the defined in the Annual Report of the Hospital
target of criticism which will render her suggest that the functions of an M S W were
task difficult. T h e opposite may happen. clearly understood.
A policy followed by a voluntary social The Report states : —
agency may be such as to make co-ordination
This Department is an integral part of
between it and the hospital difficult. This
medical-care arrangement at this Hospital.
lays the agency open to the charge of lack
It helps in finding out the social, economic
of sympathy and non-cooperation while it
and environmental factors associated with
frustrates the objectives of medical social
the onset of diseases, whether these factors
work. An awareness of the inter-relatedness
are interfering with the satisfactory pro-
of hospital and community needs is therefore
gress in the treatment and thereafter the
essential if the M S W is to function efficiently
final rehabilitation of the patient is done
and effectively.
to reasonable physical and mental
In India, in addition to her normal tasks,
efficiency. From this point of view social
the M S W has one additional responsibility.
and emotional aspects of the patient's ill-
This is to make known the values and
ness were carefully investigated and the
necessity of medical social work. Whereas in
treatment was so adapted as to obtain
the West, its importance is today an acknow-
maximum benefit from the treatment.
ledged and accepted fact, in our country it
H o m e visits, whenever necessary, were also
is still a new concept. Its full and universal
paid in cases where family as a unit h a d
acceptance will take time and patience and
to be studied. Case-work service was
it is up to the MSWs w h o are already in
rendered particularly in psycho-somatic
the field—thanks to a few enlightened
illness in consideration of each patient's
institutions—to prove the value of their work.
personality and social environment.
This will not be easy. For the M S W does
Patient's intelligent cooperation is brought
not work in the limelight. An effort has to be
about by giving him an insight into the
made if medical social work is to achieve its
nature and problem of the disease and
due recognition and this is the responsibility
every possible help is extended towards the
of the MSWs themselves.
completion of treatment. M a n y outside
We might recapitulate what we have said
community resources were tapped in
so far by a definition of the M S W suggested
order to assist the needy patients. After
by Theodore Sould:6 " T h e interpretation of
the completion of treatment, follow-up of
physical disability, the exploitation of commu-
patients was carried regularly to find out
nity resources for treatment, and the relieving
the degree of improvement maintained by
of anxieties and fears concerning ill-health
them and to assist them if necessary by the
are essentially the functions of the medical
way of medical and social help.
social workers."
Medical social work was introduced in
Of the three hospitals studied in this Survey
Hospital Y with one M S W in 1955; later on
Hospital, X was the first to engage the services
another M S W was engaged: Hospital Z
of a MSW. In September 1954, 2 trained followed in 1956 with one M S W and
MSWs were appointed under the supervision
there has been no addition since.
6Ibid., p. 218.

254
S. P. AIYAR AND M i s s M A L A T H I K. R A O
Thus, during the period when the Survey do. They did not just get caught up in this
was carried out, the total number of MSWs
work by accident as is the fate of graduates
in the three hospitals was 10. Their ages in other fields. A desire to do some sort of
varied from 23 to 29 years. Their educational
social service was the chief motive for most
qualifications were good: 6 were graduates of the MSWs interviewed. T h e hospital was
(one in Science), and 4 had taken their chosen as one of the best means of fulfilling
Master's degree (of these, 1 had a degree in
the desire to help the needy. T w o M S W s
law also). 6 of the MSWs graduated from had participated in social activities in college
the University of Bombay and the remaining
and were therefore attracted to this
4 were from Lucknow, Poona, Nagpur and profession. O n e M S W came from a family
Banaras. Of the 10 MSWs, 9 had a diploma
whose members were working in related
in Social Service Administration, 1 had a fields and was inspired by their example
degree in medical social work. It is interesting
For another M S W , the decision grew out
to note that 7 of these h a d taken their of a personal experience. An illness in the
diploma from the T a t a Institute of Social family revealed to her the necessity of help
Sciences (one h a d in addition a diploma in such cases and she decided to m a k e this
from P o o n a ) ; 1 was from Nirmala Niketan, profession her career. Only two MSWs refer
1 had studied at the London School of Eco-
to the salary attached to this job as an
nomics and 1 had a degree from Baroda attraction. One M S W declined to answer
University.
O n e might conclude t h a t for most the work
itself was the chief attraction—they were
Only 2 MSWs had been abroad and of willing and indeed eager to utilize their
these 1 h a d received her training in the talents in a cause which appeared to them
London School at her own expense. Both to be noble.
of them, agreed that their experience in foreign
countries had been valuable. Three MSWs
Since medical social work has been only
were scholarship holders and of these 1 was recently introduced in the hospitals, few.
an assisted student.
have experience of any considerable length.
T h e majority—7—have less that 2 years'
T h e nature of the MSW's work brings her
experience, and 3 of these have been working
into contact with people from all walks of for periods between a fortnight and two
life speaking different languages. A know-
months. Only 3 M S W s have experience
ledge of languages spoken in the region there-
ranging between 3 and 5 years.
fore becomes indispensable. It is therefore
We have mentioned earlier t h a t the M S W s
gratifying to learn that most of the MSWs in Hospital X were placed under the super-
can speak 3 languages or more—English and
vision of the Senior A M O . There is no full-
Hindi are spoken by all. Eight MSWs know
fledged Department of Social Service as such
M a r a t h i and 5 know Gujarati (these are and so is the case with the other two hospitals.
not necessarily their mother-tongues), 3 speak
T h e organisation in this matter appears to
Konkani. Other known languages are be flexible. There is no hierarchy in Hospital
K a n n a d a , Sindhi, Tulu, Bengali and X and at least 4 of the 7 MSWs there are
German—each spoken by 1 M S W .
happy with the present arrangement. T h e
An interesting fact that emerges is that other 3 were, however, in favour of a more
most of these MSWs have taken up this rigid and formal structure. In Hospital Y
profession by choice, fully aware of the nature
the position appears to be slightly ambiguous.
of the work they would be called upon to O n e M S W maintained that there was some

MEDICAL SOCIAL W O R K IN BOMBAY
255
sort of hierarchical arrangement but the other
take some interest, some of them actively co-
M S W claimed t h a t this was unnecessary operate. T h e M S W does not comment on
(with only 2 MSWs in this hospital, it is the attitude of the medical students. Probably
easy to appreciate her position). In Hospital
she does not come into contact with them.
Z with only 1 M S W , the question did not
This, if correct, would m e a n either t h a t their
arise at all.
instructors do not point out the importance
of medical-social work and therefore students
If there is one thing on which all the are ignorant of its nature or that the students
MSWs are agreed, it is that the nature of
are themselves indifferent to it. ( T h e findings
medical-social work is not clearly under-
on the whole would favour the former pre-
stood by the members of the staff. Medical-
sumption) . In Hospital X, M S W s are
social work was often thought to be merely unanimous in saying that the institutional
the provision of financial or medical aid to head has shown interest; as well as extended
the patients. T h e M S W then comes to be co-operation. Where the departmental heads
regarded as part of the administrative are concerned, the majority claim that they
machine and her contribution to the treat-
too are co-operative, but 1 M S W with con-
ment of the patient is but dimly understood.
siderable experience opined that the attitude
According to the MSWs, the rest of the staff
varies from person to person so that while
were not sufficiently aware of the social some of them take an interest, the rest remain
aspects of medical treatment except perhaps
largely indifferent. T h e attitude of the R M O s
in those cases where physical rehabilitation is said to vary from one of co-operation to
was found to be necessary. It was left to indifference while 1 MSW claims that some
the MSWs themselves to try and get the of the RMOs are positively antagonistic to
staff interested in their work and also to medical-social work. Two other MSWs add
explain their role. This they have to some that RMOs are in general indifferent and
extent attempted to do. However, the degree
show no appreciation of medical-social work.
of awareness as well as the response to the Almost half of the MSWs hold that nurses
M S W s ' efforts varies with the different are indifferent and uninterested; according
categories of hospital personnel.
to the rest attitudes range from cooperative¬
In Hospital Y, for instance, both the MSWs
ness to indifference though there is no
found the H e a d of the institution ready to antagonism.
co-operate; but as far as the departmental
heads were concerned, 1 M S W expressed the
T h e r e is a significant similarity in the
opinion that they were very co-operative, the
reasons given by the M S W s for staff attitudes
other felt that they displayed only a passing
towards medical-social work. All the M S W s
interest. Both agree that the R M O s do take
feel t h a t there is a lack of understanding
some interest in their work while the medical
about the n a t u r e of their work. This they
students are indifferent to it. According ascribe to the fact t h a t the social aspects
to 1 MSW, this indifference is shared by of medical treatment are not included in
the nurses but the other feels that the nurses
medical studies. Further, there is a half-
do take some interest. In Hospital Z, the yearly turn over of the resident medical staff
M S W found the head of the institution and
which is not inclined to take any active
the departmental heads to be co-operative as
interest in the functions of the M S W . T h e
well as interested. About the R M O s it is R M O s are concerned only with getting some
difficult to state categorically—some show experience and training. They are generally
interest, others are indifferent. T h e nurses over-worked and so the necessity of referring

256
S. P. AIYAR AND M i s s M A L A T H I K. R A O
What were the kind of cases referred to
now and then to the M S W naturally appears
the M S W ? T h e answers given seem to com-
to them an additional burden which could
prehend a fairly wide range—financial aid,
well be avoided. Among some of them the
medical aid, institutional placement, rehabi-
feeling persists that medical-social work is
litation, supply of drugs and appliances,
unnecessary. As 1 M S W pointed out, so much
transfer and discharges of patients, follow-up
of the MSW's work lies in the field of
care, the investigation of psychological and
'invisible' or 'intangible' social relationships,
social difficulties that cause the patient to
that the results of their efforts are not always
resist treatment, social histories and economic
apparent (as in the case of ancillary services
information concerning the patient and his
like Physical Therapy or Occupational
family, and finally, the causes of marital
Therapy) ; consequently there is no realisation
discord and attempted suicides.
of the true n a t u r e or necessity of medico-
social work. T h e M S W is regarded as a
O n e M S W from Hospital X said that on an.
rather well-paid superfluity whose services average 400 cases were handled by a single
could easily be dispensed with. O n e M S W MSW in one year and of these about 60
observed that where the departmental heads or 15% directly involved case work, relating
themselves showed lukewarm interest, the rest
to psychological, emotional a n d social pro-
of the staff could hardly be blamed for not
blems. T h e nature of work done may be seen
being cooperative. For instance, the R M O from the figures given below for Hospital
who is mainly interested in getting experience
X for the year 1960: —
cannot be expected to bother about an indi-
Medical, Surgical, Paediatric and Gynae-
vidual patient's case. O n e might say that
cology cases:
there is an inherent defect in the training
given to medical students. This conclusion Social data for diagnostic purposes 3,352
is borne out by the almost unanimous opinion
Medical Aid, appliances 1,415
of the MSWs t h a t medical students are totally
Case work, follow-up 898
indifferent to medical-social work. T h e fact
that the rest of the staff is overworked and
Arrangements for discharge, institu-
has its own problems only adds to a basic
tionalisation and convalescence 153
attitudinal short-coming. Narrow attitudes Rehabilitation 80
and hazy conceptions about the function of
Families of patients suffering from
the M S W also serve to restrict interest to the
T.B., Meningitis referred to Organis-
obvious field of her operation. There seems
ed Home Treatment Clinic for
to be an inability on the part of the staff
family X-Ray and B.C.G. Vaccine 93
as a whole to realise t h a t the M S W is an
indispensable part of the team. As 1 M S W
In addition to such work, the MSWs in
puts it, there is a lack of both cooperation Hospital A' now give lectures to internees.
and coordination. O n e M S W interpreted the
This has brought about an increase in the
desire to avoid referrals to the M S W as an
number of cases referred to MSWs. O n e
attempt to escape responsibility by finishing
M S W believed that these lectures helped to
off with the case as quickly as possible. Only
arouse interest in medical-social work: "They
1 M S W admitted that perhaps they—the now know about medical social work", she
M S W — h a d not done their best to awaken emphasised.
in the staff an interest in medical-social work
In spite of this, in none of the hospitals
or a recognition of its importance.
is there a full-fledged department of medical-

MEDICAL SOCIAL W O R K IN BOMBAY
257
social work.7 In Hospital X, the MSWs are
to research and study. We would like to
attached to the Department of Social and stress particularly the undesuitabilily of
Preventive Medicine. They do not have allotting to MSWs duties not directly
facilities for their work. Hospital X has allotted
connected with medical social work. Four out
three rooms for the use of the MSWs, but of the 10 MSWs claim that they are called
even here there is no guarantee of privacy.
upon to perform such duties.
For patients who approached the M S W with
W h o directs patients to the M S W ? T h e
personal problems like family planning,8 this majority of patients who approach the MSW
can be very embarrassing. T h e M S W also do so on the advice of the doctor or nurses.
finds it difficult when she has to interrogate
Sometimes the ancillary services get into
patients regarding details of their family touch with the MSWs and on occasion, the
history or of financial problems. In such MSWs directly approach the patients. Of
cases, the M S W asks her colleagues to move
the MSWs interviewed 8 mentioned the
out of the room for a short while during ancillary services as a source of referrals and
the interview this arrangement is obviously 7 claimed that they got into contact with the
unsatisfactory.
patients on their own initiative. All of them
We are also pained to note that the MSWs
mention the doctors as referring cases but
are not provided with any clerical assistance.
only 4 MSWs said that the nurses directed
Requests for such help have been made the patients to them.
according to 1 M S W but apparently without
H o w do patients learn of the activities of
success.. This means that case histories have
the M S W ? According to 5 MSWs, the
to be written out by hand by each M S W . patients were directly aware of their work;
Such a procedure besides being time-
8 said that their source of information was
consuming and tiring, makes the maintenance
the doctor and 6 mentioned the nurses and
of records rather unsystematic, and dis-
the ancillary services as the agency guiding
courages research. No copies are taken as and directing the patients. Two MSWs
there is no provision for duplication so t h a t
claimed that patients were indebted to
each report has to be maintained carefully "other patients" for their knowledge of
in the original and in the varied hand-
medical-social work.
writings of the MSWs. It might be argued
that since the MSWs are not normally called
T h e M S W first learns of a patient's pro-
upon to do any work outside their sphere, blem through the referring agency—doctor,
they should not mind doing the routine work
nurse, etc—except in these cases where
connected with their job. After all, nurses patients directly approach or are approached
too maintain records though their work is by the M S W . However, all the MSWs
more taxing than that of the M S W . This emphasised that a real understanding of the
(possible) argument does not impress us. patient's problem could be had only by inter-
We feel t h a t the valuable time and energy viewing the patient himself. At times indeed,
lost in the clerical work and maintenance relatives a n d / o r employers may be inter-
of records might more fruitfully be devoted
rogated and this may be followed by visits
7This was also remarked upon by one of our investigators in her report. She observed
that a MSW is attached to one department or the other. There is no separate department
or departmental head who can take an interest in their work and guide them. "When
the hospital staff is indifferent towards them it becomes very difficult for them to work.
Perhaps this is their main grievance."
8It should be noted that cases for family planning are not referred to the MSW and this
work is done by her largely on her own initiative.

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S. P. AIYAR AND M i s s M A L A T H I K. R A O
to the patient's home to learn at first hand
that the allocation of these funds is left to
the patient's circumstances, but by and large,
the discretion of the hospital authorities. We
the interview remains the chief source of approached the hospital authorities to find
information.
out as to why so little was being spent on
immediate patient care and were informed
All the hospitals maintain a fund—the that "the surplus cash balances in the fund
Poor Box F u n d —from which patients who
after meeting all expenditure are invested in
are in need are supplied with medical and public securities and Bank deposits with a
financial aid in the shape of drugs, ampules,
view to earning interest as an additional
surgical appliances, travelling allowance, etc. source of income to the Fund"—an explana-
If the patient is not poor, he may be asked
tion which we are constrained to remark is
to pay at least half the cost of the medicine,
not very enlightening. For what we would
or alternatively, to contribute to the Fund. really like to know is why there is such a
Social welfare agencies and, charities are large surplus.10 Can it be seriously suggested
tapped for aid and the physician's samples that the patients who go to municipal hospital
received by the Dean and the doctors are are for the major part well able to provide
donated by them to the Fund. A feeling of
for themselves? Moreover, our Survey reveals
inadequacy of supplies of drugs etc. voiced that patients are largely ignorant of the
by 1 M S W is borne out by interviews with
existence of the Poor Box Fund, and seek
t h e other categories of staff.9 There is a fair
its assistance when directed by doctors or
consensus of opinion as to the lack of essential
nurses. They are too busy to inquire into the
drugs which makes it difficult for doctors financial condition of the patients so that the
to prescribe such medicines and this is attri-
latter are deprived of assistance to which they
buted largely to paucity of funds. We there-
are entitled. T h e M S W cannot be expected
fore consulted the annual reports wherein to do this on her own except when she
details regarding the Poor Box F u n d are directly approaches a patient.
given. We found that out of the total receipts
of the Fund, only a limited portion (about
Nor it this her job. H e r task is to render
2 0 % ) is spent on immediate patient care material aid where necessary—normally on
i.e. on supply of costly medicines and injec-
the suggestion of a doctor or nurse—but
tions, appliances, blood transfusion charges, chiefly to extend 'social treatment'. She must
travelling expenses etc. A considerable portion
help the patient to understand his problems
of the receipts are invested in public securities
and persuade him to undergo the necessary
or held in cash form with t h e banks. We medical treatment if he appears to be reluct-
have been assured t h a t there is no municipal
ant to do so. In those cases where an opera-
regulation governing the amount and nature
tion is indicated, she must prepare the patient
of these investments and our inquiry reveals for possible after-effects. At times, she may
9 Thi s is also borne out by the remarks of one of our investigators: " T h e Medical Social
Service Department worked with various handicaps, the main being limited financial
resources. T h e majority of the patients referred to them were those needing financial
help or drugs, and with the little they had at their disposal, they had to derive the
maximum advantage,—with the result that not many could be helped. Only the very
deserving could be helped. This has an indirect effect on the number of cases referred.
If R M O ' s feel that there is not much the MSW can d o ; he will naturally be reluctant
to send patients to her. Our investigation pointed out that "as the results were not
very significant, many R M O ' s were reluctant to refer their cases." She adds that the
majority of cases referred were TB cases, i.e. that (anti-TB) drugs were in demand.
If these are not readily forthcoming the R M O ' s tend to lose interest in the MSW's work.
1 0 T h e position is similar in all th e three hospitals studied.

MEDICAL SOCIAL W O R K IN BOMBAY
259
have to approach other outside agencies for inadequate facilities and proportionately too
help. T h e services offered by the M S W to great a demand (1 M S W ) , and sheer avoid-
out-patients and in-patients are practically able delay (1 M S W ) .
the same. These services are, as mentioned
T h e hospitals do not subscribe to any
earlier, rehabilitation and institutionalization, journal which is directly connected with
placement and employment, transport and medical-social work, though they do subscribe
arranging for compensation, and follow-up to medical journals and journals on public
care where indicated. Case-work is however, health. Nine of the MSWs do not read any
the most important means of helping patients. journals and only 1 reads journals on Public
In addition to her professional work, the Health. One MSW refers to the library of the
M S W undertakes to give lectures so as to Tata Institute of Social Sciences. Three
help spread the knowledge of medical-social MSWs contribute articles and 1 is planning
work. In Hospital Y, the MSWs lecture on to do so.
medical social work to the ancillary pro-
fessions (though not to students). In Hospital C O N C L U S I O N : —
Z the M S W delivers lectures to both students
Since medical social work has been
and the ancillary professions. In Hospital X, introduced only recently in Bombay's
2 out of 7 MSWs give talks on the nature municipal hospitals, we were particularly
of their work to the ancillary services and to anxious to know how the MSWs had been
medical students. These lectures, it is felt received by the hospital staff and how far
have succeeded in drawing attention to the they had been accepted as a necessary com-
social aspects of medical treatment. All MSWs ponent of the medical team. The main con-
agree that medical students should have a clusion that can be drawn from the Survey
course in medical-social training as part of is that authorities at the highest level are
their studies since, in their opinion, students found to be cooperative but cooperation at
are generally ignorant of and indifferent to the level of doctors and nurses is not readily
medical-social work.
forthcoming. T r u e , there is no antagonism
but there is indifference especially among
T h e MSWs have maintained contacts the medical students. Partly this is due to
with various trusts, charity organisations and defects in medical education which ignores
welfare agencies in the city. Nine of the 10 the social aspects of the cure of disease.
MSWs are satisfied with the response of It is also to some extent a result of the
these agencies to their needs, which they paucity of funds which limits the usefulness
feel is ready and good. T w o M S W s mention of the MSW in those areas where doctors
occasional indifference on the part of these are most likely to ask for help, viz. the
organisations and 1 M S W felt t h a t though supply of drugs and medicines. For where
help was forthcoming it was at times unduly doctors have approached the MSW for
delayed. Of late it would appear that there information about the social or non-medical
has been an improvement in the willingness background of their patients, the MSW has
' of welfare agencies to cooperate though no generally been found to be helpful. However,
reason has been suggested for this. Where such referrals do not appear, on the evidence
there is lack of cooperation, it is probably of the RMOs, to be very frequent.
due to lack of funds (5 M S W s ) , lack of
personnel (1 M S W ) , lack of organisation
T h e R M O s have by and large agreed that
(1 M S W ) , time involved in investigation of the M S W is a necessary part of the hospital
the genuineness of the appeal (1 M S W ) , staff but there seems to be little realisation

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S. P. AIYAR AND M i s s M A L A T H I K. R A O
of her true function. To some extent this and no clerical assistance to relieve her of
conclusion is borne out by the fact t h a t routine task.
there is as yet no separate Department of
Finally, though the MSWs claim that they
Medical Social Work. This means that the have tried to orient the hospital staff towards
M S W has to be attached to some other a realisation of the importance of their work,
Department—usually the Department of it is surprising that none of them appears
Preventive and Social Medicine—and share eager to keep in touch with her subject by
its facilities. She has no private room to see relevant literature or conducting research of
her 'clients' (this is not true of Hospital Z) any kind.