Celebrating a Century of Care

The Van Allen Hospital is celebrating a century of caring for you – friends, family and our neighbors in Kodaikanaltown and the surrounding villages. In the 100 years that Van Allen has been part of the Kodaikanal community, our goalhas remained the same. We were established in 1913 by a group of Christian missionaries to be a place where peoplecould receive quality medical attention in a picturesque setting of comfort and caring. While a great deal has changed inhealth care and medical technology, the hospital is still a place of compassionate care that would make our foundersproud. From our kitchen staff and office personnel to our experienced medical staff, that pervasive spirit of caringinspires every area of operation at Van Allen.

Since our modest beginning, Van Allen has grown to meet the expanding needs of the community we serve. To meetthe healthcare needs of changing times, we have built new buildings, improved medical techniques, acquired newtechnology and welcomed-aboard dedicated doctors. Today, we are proud to be able to respond to a broad range of healthcare needs, with the help of modern equipment and qualified staff. Our chief concern is your health; we want ourcommunity to be comfortable and secure, knowing that the best possible healthcare is just minutes away from home.Now, entering our second century, we will continue to expand our medical services and technology with your support.

This year we commemorate our centennial, and 100 years is no small accomplishment. We’ve made the journey,thanks to the hard work of our founders and countless hours of dedicated physicians, medical professionals, boardmembers and benefactors. We owe our success to the support of our community. Building upon our 100-year foundation,we will continue, in the spirit of Christian service to provide the best medical assistance to all who walk through ourdoors.

In the beginning…

It was beautiful, wild countryside, rural in every regard, when the firstforeign settlers arrived here in Kodaikanal around 200 years ago. WhenLieutenant B. S. Ward, an Englishman surveying the Palani hills, firsttraveled through Kodaikanal in 1821, he would have found rolling hills, lushsholas, clean air and a pleasant climate.

Life for Europeans and Americans in the South Indian plains duringthe early 1800s was difficult due to the scalding heat and perilousepidemic diseases, such as malaria and typhoid. These were especiallyinfectious during the summer months, when temperatures could reach 130- 140 degrees Fahrenheit. In dire need of a haven of cooler climes, theBritish were constantly looking for places with “salubrious air devoid ofmalarial vapors, lofty enough to escape the scourge of typhus and otherparasites” and even more important - where they would be untroubled bythe region’s rapacious mosquitos.

The discovery of Kodaikanal by Lt. Ward, followed by a series ofAmerican missions, revealed its wonderful climate and scenic beauty tothe Europeans settlers, prompting them to visit the area more often.Kodaikanal was also located above the mosquito line and was thereforemalaria free. Its high elevation made it cool enough to decrease the riskof many tropical diseases. This encouraged a slow but steady stream ofsettlers wanting to ‘escape to the hills’.

Subsequently, the hill station was established as a summer retreat foradministrative and military officers and their families in the mid-1800s. Whilethere were around 75 Europeans and Americans in Kodaikanal in 1879, thisnumber increased to 400 during the summer season. Retired Army civilians,wives and small children remained in the hill station throughout most of theyear.

American missionaries from Madurai began to arrive in Kodaikanalin 1834, followed by missionaries from many parts of Europe includingSwitzerland, France and Germany. “To force missionaries to live on theplains all year when the temperature remained above one hundreddegrees Fahrenheit day after day was to open the door to illness andthus was a false economy” recalls Eugene P. Heideman in his book‘From Mission to Church: The Reformed Church in American Missionto India’. “The mission then relented and fully accepted the traditionthat missionaries would go to Kodaikanal in the hot season …By theturn of the century, Kodaikanal had become a focal point for missionaryspiritual renewal and social life”. The Kodaikanal Missionary Unionwas then formed in 1890 to encourage missionaries from differentdenominations and nations to work together in the spirit of comradeship.

In

C e l e b r a t i n g 1 0 0 Y e a r s O f S e r v i c e

The Van Allen HospitalCompiled by Pavithra Sagar

Painting by G.D. Paulraj

Roots of philanthropy

The Europeans and Americans in Kodaikanal generally enlistedthe services of missionary doctors on vacation in the hills for theirhealth needs. Missionary families would go to East House to betreated for minor ailments such as tonsillitis, and babies weredelivered at home. It was soon apparent however, that the everincreasing mission community needed a hospital, as well asmaternal and child care services.

As the requirement for the hospital grew, support came frommany sources. The Kodaikanal Missionary Union envisioned aspart of their mission the opportunity to provide medical expertiseto the community to keep their friends and neighbors safe andhealthy. The K.M.U sponsored large scale art, music, and dramaproductions to raise the required funds, and Swedish missionariesdonated the land for the construction of the hospital.

For several years, two prominent doctors of the AmericanMadura Mission, Dr. Edward Wheeler Wilder and Dr. ChesterVan Allen were the driving force behind the building of thehospital, and were largely responsible for its opening in 1913.Both doctors had previously been actively involved in theconstruction of a hospital in Madurai. Both had seen first-handthe value of ensuring access to quality medical care.

“There are fewer milestones in the development of a hospitalthan in almost any other institution. The program, while a mostrewarding one, is always very simple one”, Dr. Wilder and Dr. VanAllen opined in an edition of the American Madura Mission AnnualReport. “To the doctor there comes no small degree of satisfactionwhen he is able to apply newly discovered remedies which bringquick relief. Therefore every new discovery in the fieldof medicine enlarges the usefulness of the hospital”.

When the building construction was complete, severalsuggestions were made for it to be named after Dr. Wilder, but hedeclined. Therefore when the hospital opened in 1913, it was namedthe Van Allen Hospital in honor of his colleague.

Above: Dr. WilderBelow:Dr. Van Allen

1913

As one of the main objectives of the hospitalwas to start a maternity ward and a child carecenter for missionary families, the first two wingsof the hospital were constructed to accommodatethis need. The first wing of the Van Allen Hospitalwas built at the entrance of Coaker’s Walk in 1913.When the hospital opened, it had an outpatientward, an operation theatre, a maternity ward, anurse’s station and a cloak room.

Reverend Frank Van Allen, the brother of Dr.Van Allen, described the newly constructedhospital on the back of a picture:

“Kodi Kanal is a hill station in south In-dia (6000 feet elevation) when in May and June allwhich people (especially mothers with theirchildren) go to escape the extreme heat of theplains. Nearly all who go are ill before starting tothe hills. Many surgical operations have to be doneat Kodi. The arrangements have been, till now,most primitive, but it was long felt that anoperating room well equipped, was a crying needin this beautiful hill station. By popularsubscription this operating room building was putup. Back of it stands the nurses quarters. It is builton a hill side as is clearly seen. It was opened freeof debt and with a small sum of cash in hand. April1914.”

Since its foundation, Van Allen has continuedto provide an unbroken record of service to womenand babies. The community had good reason tofeel enormous pride in the hospital as many peoplehad contributed time and money for itsconstruction, interior furnishings,medical beds, andeven the operating room equipment.

Header: Picture of Kodaikanal in 1913Middle: Rv. Frank Van Allen’s written description of thehospitalBottom: Rv. Van Allen’s photo of the newly constructedhospital in 1914

1923- 1980

The second wing of the hospital was built withcontinued support from the Kodaikanal MissionaryUnion in 1923. Stones for the construction were broughtin from the nearby Pasumalai and Azhagar Kovilvillages. The second building was built overlookingCoaker’s Walk; patients in this wing would have abeautiful view of the mountains and plains. As this wingwas designed to be a maternity and child ward, it hadfour furnished rooms and a kitchen.

Baby boys were placed in The ‘Blue Room’, whilebaby girls were fussed over in the ‘Pink Room’.Children were cared for in the ‘Green Room’ while oldladies held sway in the ‘Orange Room’. A smallmaternity room was set aside for mothers. Soon, patientsstarted to come to the hospital in growing numbers.

“The number of patients in these has increased”,described Dr. Thomas of the Van Allen MaternityHospital and the Kodaikanal Operating Room, in theAmerican Madura Mission Annual Report 1929. “Thesurgical section especially has been well patronized,both by Missionaries and others. The income has beenchiefly from fees for surgical operations…FifteenMaternity cases were received and 15 major and 20minor operations and treatments were performed”.

The first nurse at the hospital,Mrs. Rebecca Enos was appointed at the hospitalin 1924. Nursing superintendentsMrs. Pristen and Mrs. V. Norrisjoined the hospital presently tocare for patients in the maternityWing, where they sometimes hadto look after up to 66 patients at atime. Indeed, Mrs. Norris whoworked at the hospital from1955- 1971 was so well knownfor her kindness that she wascalled ‘The Mother Of Van Allen’

out of affection by staff and patients.

Of the first Van Allen nurses, Dr. Thomas writesapprovingly that “A large increase in the item for salaries isdue to the fact that during the season a nurse trained inRainy Hospital was engaged to take charge of the operatingtheatre, sterilization etc. as it was found to be too much forthe nurse in charge to manage this in addition to theMaternity section and the provision of diet. This is found towork very satisfactorily and it is hoped that a similararrangement can be made for the ensuing year”.

The number of patients at Van Allen Hospital continuedto soar between 1923 and 1980. In 1958, Cathy Slater, astudent in Kodaikanal School recalls “Eventually I foundmyself in the Fifth Grade. We were taught for a while byMrs. De Jong until she gave up to have her baby Bruce. Ournew teacher took the class a few at a time to visit Mrs. DeJong in the Van Allen hospital to see the new baby. I hadnever seen a baby that new, and was very impressed!”

After Indian Independence, thehospital offered its services toforeigners, Kodaikanal’s localresidents and individuals fromnearby villagers, reflecting VanAllen’s commitment to providemedical care to its entirecommunity. A hospitallaboratory was opened in 1961and the hospital acquired newmedical equipment, includingtwo x-ray machines, of whichone was formally presented bythe Pudukkottai Rajah.

Above: The Puddukottai Rajah inaugurates an x-ray machineLeft: Lab technician MS. Curlene holds a Japanese lady’snewborn baby in the mid-70s

1980 - 2013

Once again, with the support of community donorsand other sponsors, the years from 1980 to the NewMillennium were those of growth and expansion. Thehospital was operating near capacity due to an increaseddemand for hospital services. It had to increase itsfacilities and modernize equipment. Yet, the hospitalpersevered in continuing to provide high quality, medicalcare in a convenient, comfortable setting.

A third hospital wing was constructed facing BryantPark in 1983 so that more inpatient wards could beaccommodated. New facilities were added, including aDoctor’s Room, a Hospital Reception, Pharmacy and aDental Clinic.

In 1986, Mrs. DeJong registered the Van AllenHospital in the Registrar under The Coordinating Councilfor Social Concerns in Kodaikanal (CORSOCK). Afterthis, the management of the hospital was turned over tolocal administrators.

A new Intensive Care Unit (I.C.U) building wasconstructed adjacent to the Maternity wing in 1992,which also contained a 24-bed Emergency Care Unit(E.C.U) staffed with well-trained medical personnel. In1993, Mrs. Henderson who was Van Allen’s treasurer,generously gifted her house and property to the hospital,which is now used as the Doctor’s Quarters.

An extension to the ICU wing was built in 1995 -1996, to make available a new operation theatre, an X-rayroom and a blood bank. Furthermore, an extension for theOut Patient Department (O.P.D) was completed in 1998.The out-patient attendance in the years 1994 - 95 alonewas reported to be 16, 300.

Throughout this period of growth, the Van Allenhospital continued to exemplify the community spirit in

which it was founded “A Hospital from the people ofKodaikanal for the people of Kodaikanal” proudlystates a booklet celebrating Van Allen’s 80 years ofservice. “The times have changed, but this goal hasnot. We want Van Allen to be the people’s hospital intimes of need, to serve the haves and have-nots”.

The new Millennium proved to be a busy andmomentous decade in which the hospital expanded itsservices in response to medical and technologicaladvances to offer improved benefits for patients.

Header: Picture ofVan Allen when the thirdbuilding was constructed

Right: Patients waitingin the OutpatientDepartment

Below: Mr. Bowden, theChairman with hospitalstaff on the day the thirdbuilding wasinaugurated in 1983.

A legacy of outstanding physicians

From its inception , Van Allen’s history is filledwith anecdotes of dedicated doctors and nurses who workedtirelessly to take care of their patients. The hospital’sphysicians stepped up to meet the challenges of medicalemergencies and everyday health problems. Indeed, retiredx-ray technician Ms. Curline David recalls the early days ofthe hospital when Dr. Edward Edmund used to performsurgeries by candlelight. Doctors treated the common coldand fevers as well as TB and cholera epidemics. Cases withunknown etiology were managed with skill, compassionand prayers. With each passing year, medical techniquesand knowledge was developed and promoted.

The earliest doctors who worked at the Van Allenhospital were missionary physicians who visitedKodaikanal, as well as doctors from the Madura AmericanMission, such as Dr. Van Allen and Dr. Wilder. After theMaternity wing had been built, missionary doctors from theChristian Medical College, Vellore such as Dr. LewisScudder and the beloved Ida S. Scudder worked at thehospital during the summer. It was Ida Scudder who startedthe first maternity register in 1927. Other doctors who alsoserved at the hospital included Dr. Holly (`27-`28) andDr. Annam Atto (`28-`47).

Kodaikanal School’s Dr. Rosenthal also worked at VanAllen from 1945-1953. Lizzie Hierbert, a student inKodaikanal, recollects that Dr. Rosenthal (an elderly Jewishlady) was the doctor in charge of her sister’s delivery. “InJuly of 1949, Lois was born at the Van Allen Hospital inKodai. Dr. Rosenthal was Mother's doctor for thisdelivery” she recalls. “It was a difficult birth, both becauseof Mom's age and the size of the baby. Dad was veryworried; thus we also worried about it. When news camethat Lois was born and both she and Mom would be fine,we cried and went to tell our friends.”

Like Dr. Rosenthal, Dr. Thomas too worked at KodaiSchool and Van Allen from 1955- 1963, and his successorDr. Edward Edmund, who is known as one of the hospital’smost dedicated doctors. Dr. Edward Edmund worked atVan Allen in 1963 to 1964.After India gained Independence

from the British, the family of the Pudukkottai Maharaja andDr. Edmund opened the hospital to all of Kodaikanal’s localresidents. The first in-patient was Mr. Shankaran who wascarried in a palanquin from Vellagavi village up to Kodai fortreatment. Dr. E. Edmund was known for going beyond thecall of duty to ensure that medical care was available toeveryone. Every Saturday he would hike to all the villagesaround Kodaikanal, taking medicine to treat the villagers’illnesses. On another occasion, he went to the governmenthospital to bring Mr. Royer back to Van Allen for anemergency obstruction surgery. There were no taxis at thetime, so the doctor had to bodily carry his patient back to theoperation theatre!

Another doctor remembered fondly is Dr. Kirloskarwho worked from 1965 to 1972 at Van Allen. Ms. CurlineDavid recalls a dramatic incident when Dr. Lockwoodcollapsed in the church, and was quickly brought to thehospital. Dr. Kirloskar and Dr. Wilson had to reach throughDr. Lockwood’s ribs and manually pump the heart inorder to save his life.

Dr. Leela Oommen (`72 -`81) contributed almost 20years of service to the hospital. Under her direction, thehospital started to serve complementary well-balanced dietand food supplements for TB patients.

Mr. Bob King, Illeyarajah Vijayaragunath Thondaiman, Dr.Leela Oommen, Mr. Okanson of Swedish School, and Mrs.DeJong with Van Allen staff

Rev. Bradshaw, Mr & Mrs. Engineer, Mrs. Nichol, Dr. Frank JayaSingha, Dr. Leela Oomen with Van Allen staff

During Dr. Leela’s tenure, Dr. Tegenfeldtstarted his term as the Administrator of Van Allen. Hestarted a hospital outreach program to treat childrenwith Polio at the Mel Malai and Keel Malai villages. Healso implemented the hugely impactful Van Allen RuralIntegrated Health And Development (VARIHID)community outreach program.

“In addition to the 140,000 living in thevillages, there are at least another 15,000 migrantlaborers who are Tamil repatriates” writes Dr.Tegenfeldt in his article ‘A Health Care Program in theKodai Hills’ outlining the need for the program. “Theonly medical care that any of these 155,000 people haveit through the hands of some herbal practitioners intheir village or in the several hospitals and clinics inKodai town. So you can understand the challenge thatseveral of us working in the field of medicine in Kodaihave felt to try to help with medical care out in thehills”.

“Kodai town itself is fairly well taken care ofwith a government hospital,” Dr. Tegenfeldt continues.“Van Allen Hospital and sic clinics run by sisters ofseveral catholic congregations. It may be of interest tonote that Van Allen has changed from at hospital forforeigners to one which not only has about 95% of itspatients from the Indian population but last year gaveconcessional or free care to over one-third of thepatients who used its services. This was made possiblethrough funds from CORSOCK.”

VARIHID was initiated through the efforts ofMr. Vetrivel from Vellagavi and Annette Stixrud, anurse, and maintained with help from many individualsand organizations. “The project uses Van AllenHospital, also a part of CORSOCK, as a center towhich village patients who need hospitalization can besent as well as a teaching resource for trainingvolunteer health workers from the villages”, writes Dr.Tegenfeldt. “The project is indebted to the ChristianFellowship Hospital Rural Health Project at Ambilikkaiand a very enthusiastic and capable health educator,Mr.Kumaresan, who under the guidance of AnnetteStixrud, is managing the project.”

VARIHID first focused on teaching volunteersfrom villagers health education.“The project has heldits first four week course for voluntary health workerswho were selected by health committees in eachvillage” Dr. Tegenfeldt reports. “The first “batch” of15 are now actively involved in their own villages. Inaddition to working in four villages(Poothur, Kukkal,Palangi and Vellagavi), several have been trained tostart work among the Sri Lankan repatriates. Three ofthe 15 took a parallel course as a day care centerteachers and enrolment has started in three of thevillages.

Soon it was clear that VARIHID was becoming awidely accepted way of improving health in thevillages and was succeeding in making beneficialhealth changes. Dr. Tegenfeldt writes “This is a veryhumble start considering the extend of the need, but atthis point the project is progressing faster than wasinitially anticipated and other village leaders areenthusiastically requesting project participation intheir villages.”

On the next two pages, you will find an old typedreport describing the mission of the programme and itsdevelopment.

Above: The Van Allenhospital family with Dr.

Tegenfeldt’s family

Right:A cross outsidethe hospital gives

patients and visitorsstrength and

courage.

Doctors Mary Karkada who joined in 1983 and Dr.Tegenfeldt were the initiators behind the expansion offacilities when the third wing of the hospital wasconstructed.

After the expansion in the hospital, a series ofdoctors joined Van Allen including Dr. Bruce DeJong,Dr. John V. Anand, Dr. Subramanynam Acharya,Dr. Mathews, Dr. Ramraj Kumar, Dr. Catherine andDr. Prasad Rao.

In the latter years, the hospital has also benefitedfrom a tie-up of Van Allen and Odenchetrum’sdoctors. Specialist doctors would come to the hospitalonce a month to help with difficult cases.

Van Allen has also held several health camps forlocal residents. Recently, a free check-up was providedby heart specialists, with an offer from Apollo Hospitalto provide free surgery, related stay and medicine forthose who needed the assistance.

It is to the credit of the institutional leadership atall levels – medical and para-medical staff, andadministration, that the Hospital has not only kept upwith the changing milieu but continuously positioneditself as a place of compassionate care and healing.While it is unfeasible to list all those who have guidedthe hospital to its centennial celebration, it is importantto recognize the service ofDoctors Holly, Bosch, Syeda, Roberts, Turkwood,Freeman, Vadamalayan, Millray, Nycurk, Couten,Pickmen, Southwell, Monahan, Galon Scudder, CarolJameson, Fletcher, Pickard and Gigler;Government Doctors Ananthan, Chittur, Ganabathy,Rao, Mannen, Ramnath and Dentist Dr. Shyam;Nurses Packiam Jesudass, Amni Thomas, EmmiEdwards, Jyothy Williams, Alphonce, Ruby Lazarus,Mrs Vinotha ; X-Ray and Lab Technician CurlineDavid;Hospital Administrators Mr. Jai Singha,Mr.Armstrong, Mr. Engineer, Mr. Dustoor, Mr. Louis,

Mr. Paul Wiebe, Mr. Bob King,Mr Cowsie, Mr. Root,and Dr. Kamraj Kumar;Board Members and past Chairmen Dr. KurianAbraham, Dr. Paul, Dr. Weibe and other principals ofK.I.S, Father De Silva, Mr. Immanuel Babu;Vice Chair of the K.I.S Board and lawyer AbdulHameed;Hospital Chairmen Mr. J.T. Jayachandran, Mr. TyronRosaire, Mr. Sam Babu and the current Chairman Mr.Sam Abraham.

The history of the Van Allen Hospital is the storyof the lives of countless men and women involved inthe development of the institution over the past onehundred years. The anecdotes mentioned above areonly a sample of decades of accomplishments andchallenges.

Regretfully, there are many contributions thatcannot be adequately represented in a volume that hasbeen deliberately kept within a size limitation. Thelegacy of all those who dedicated their lives to takingcare of the Kodai community and Van Allen Hospitallies not in these pages but in the people whose livesthey have touched and made better.

As the hospital looks toward the future, anyprogress will always owe tribute to their generosity.

Our hospital today

Ever since Van Allen first opened its doors in 1913,the hospital’s mission has been to meet the needs of thecommunity. While the treatments and technologies havechanged since the hospital’s early days, we are steadfast inour resolve to offer the best medical care and the utmost incompassion.

The hospital is still located on St. Mary's Road, nearCoaker’s Walk. With the north side of the hospital facing thegrey-stoned stained-glass C.S.I Church, the south side facingthe quaint St. Peter’s Church, the colorful flowerbeds inBryant Park on the west and it’s east wing overlooking theblue mountains and panoramic view of the plains, the beautysurrounding the hospital creates an atmosphere of serenityand wellbeing.

The Van Allen Hospital has grown to be a 35-bedfacility with a total of 32 employees. The medical staffconsists of three dedicated attending physicians – Dr. MaryKarkada who is the Gynaecologist and the Chief MedicalOfficer, and Medical Officers Dr. Meenakshi and Dr.Karthick Kumaran. Specialist consultants include Dr.Alexina Margaret (Dentist), Dr. Sounderajan (Surgeon),Dr. Geetha Abraham (Dentist), Dr. Arun Kolhatkar(Orthopedic Surgeon), Dr. Radha Krishnan (Physiotherapist)and Dr. S.A.R. Krishnan (Skin Specialist) enable the hospitalto care for patients, whatever their healthcare needs. In thelast year alone (2011-2012), the hospital treatedapproximately nearly 900 inpatients and more than 10,000outpatients, while more than 150 babies were born at VanAllen.

The expanded services of the hospital today includea general ward, six private rooms, an Intensive Care Unitwith 4 beds, pulse oximetry, fibulator and incubator, a 24-hour Emergency ward, emergency ambulance, a full servicelaboratory, x-ray, pharmacy, operation theatre, obstetrics andneonatal department, a pediatrician room with a neonatalincubator and baby warmer, dental services andphysiotherapy.

For a century, we have been building upon a solidfoundation of medical expertise and advocacy that keeps ourpatients safe and healthy. Today, we are poised to embarkupon a new era of health care.

Above: Van Allen hospital’s receptionBelow: Dr. Mary Karkada with Van Allen staff

Responding to a need

At Van Allen, we’re facing the reality that anincreasing number of people in our community will need ourservices in the coming years. Patients and tourists suffering arange of injuries, conditions and diseases seek the help of thehospital continually. We plan to take into consideration themultitude of issues facing our community's health care needs—most notably by providing for added medical, surgical andemergency services.

It is our aim to have the latest equipment available toensure our patients receive the very best medical attention.Funds for the addition of a blood bank, cardiac monitors, pulseoximeters and a defibrillator would enhance our ability todeliver up-to-date care.

Many patients have been saved through the quickresponse of our ambulance, a service we’re keen to developthrough your support. With few ambulances available inKodaikanal, an additional specialized hospital emergencyambulance will ensure that anyone needing medical care can bereached by our ambulance at any time of day or night foremergency assistance.

The hospital plans to improve the delivery of medicalsupport from a distance through the implementation ofTelemedicine. This would allow doctors, nurses and otherhealth professionals to consult with specialists in the countryabout a patient's condition through two-way video, e-mail, andother forms of telecommunications technology. Telemedicinewould help our physicians to select the optimal treatment basedon expert advice for the best possible outcomes.

We would also like to reinstate the VARIHID to bringmedical care back to villagers around Kodaikanal.

For more than 100 years the Van Allen Hospital hasbeen providing exceptional care, thanks to the generosity of ourcommunity and sponsors …..and we will be here for the next100 years. By planning and implementing improvements todayand with your continued support, we’ll be prepared to maketomorrow’s reality better for us all.

Above: Hospital bed in the I.C.U wingBelow: Sign post directing patients and visitors todifferent hospital areas