Express Healthcare June, 2013

VOL.7 NO.6 PAGES 76

Strategy Reforming rural healthcare Knowledge Personal genomics and its role in creating lifelong wellness Hospital Infra LED lighting for hospitals

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GE Healthcare

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INSIGHT INTO THE BUSINESS OF HEALTHCARE

VOL 7. NO 6, JUNE 2013

Chairman of the Board Viveck Goenka Editor

Strategy

Market

Viveka Roychowdhury* Assistant Editor Neelam M Kachhap (Bangalore) Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Delhi Shalini Gupta

Reforming rural healthcare ................30 Service quality in hospitals................33

MARKETING Deputy General Manager Harit Mohanty

Knowledge

Assistant Manager Kunal Gaurav PRODUCTION General Manager B R Tipnis Production Manager Bhadresh Valia Asst. Manager - Scheduling & Coordination

Personal genomics and its role in creating lifelong wellness ..................36 Cartilage regeneration: Bringing in a new revolution..................................38

Arvind Mane Photo Editor Sandeep Patil

Hospital Infra

DESIGN Asst Art Director Surajit Patro Chief Designer Pravin Temble

Page 11

Senior Graphic Designer Rushikesh Konka Layout Vivek Chitrakar

Cardiac Care Centre opens at Godrej Memorial Hospital ................................15 National Forum on TB launched ..................................................................15 $5.5 billion six year plan to get rid of polio globally by 2018 ..........................16

CIRCULATION

Goldman Sachs invests in BPL Medical Tech ................................................16

Circulation Team

Manipal Hospital group forays into allied healthcare delivery formats ............16

Mohan Varadkar

Vitamin D deficiency fast becoming a global and

LED lighting for hospitals ..................42 ‘Emergency department beds, should be five per cent of the total bed capacity of the hospitals’ ............44

national health concern: Study ....................................................................17 Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15

MSD For Mothers launches initiative to reduce MMR ....................................18

RNI Regn. No.MAHENG/2007/22045

PD Hinduja Hospital bags award ..................................................................18

Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian

Indraprastha Apollo organises medical education programme on

Express Press, Plot No. EL-208, TTC Industrial

neurosciences ..............................................................................................18

Area, Mahape, Navi Mumbai - 400710 and

'This partnership is an effective approach leveraging Abbott’s

Published from Express Towers, 2nd Floor,

Life

Nariman Point, Mumbai - 400021. (Editorial &

diversified healthcare expertise' ....................................................................20

Administrative Offices: Express Towers, 1st Floor,

AMEN to organise workshop on disaster management in hospitals ................22

Nariman Point, Mumbai - 400021)

2nd Annual Hospital Expansion Summit ......................................................24 *Responsible for selection of news under the PRB Act.

Rotary International organises two-day meet to sustain efforts in eradicating polio ..........................................................................................25

Copyright @ 2011

UK delegation seeks business opportunities in Indian healthcare ....................26

The Indian Express Ltd. All rights reserved

Pushpanjali Crosslay Hospital organises 1st Medicine Update (PMU-2013) ......28

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Hanging out at hospitals ....................47 PR insights: Better communication for better results ................................49

Regulars

prohibited.

Letters ..........................................................................................................................................................10 People ...........................................................................................................................................................50 JUNE 2013

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Editorial

This IPL’s knights in blue scrubs? umbai-based Jaslok Hospital’s advisory to its doctors to stop prescribing drugs manufactured by Ranbaxy has raised some eyebrows within the healthcare community.

Why did the hospital choose to go public with this advisory? Was it a reaction to patient perception on the quality of medicines from this company? Ranbaxy’s $500 million rap on the knuckles by the US Department of Justice was widely publicised, both by print and electronic media, for over a week and no doubt, Jaslok had to field queries from patients and their relatives.

This might explain the hospital’s decision to put on public display what should have been an internally circulated advisory to doctors on its staff. The pharmacies of all hospitals routinely receive alerts from local FDA authorities on which lots of drugs have been found sub-standard and these lots are required to be withdrawn from circulation. But these alerts are restricted to certain lots, with specified batch numbers. The Jaslok advisory seems to be a blanket ban on a company's products and this is quite contrary to standard procedure. In fact, certain companies have a monopoly on certain drugs and in such cases, a blanket ban might adversely affect patient health.

The hospital did withdraw the advisory from its reception front desk, clarifying that it had put certain queries to Ranbaxy and was awaiting replies, and would roll back the advisory if it was satisfied with the responses. The concern is definitely justified and the Indian Medical Association (IMA) too had added its voice by asking the Drug Controller General of India (DCGI) to conduct its own investigation into the quality of drugs manufactured by Ranbaxy.

But by then the ‘damage’ had been done, with the Ranbaxy stock reportedly sliding a few percentage points on the Sensex and rumours that other hospitals might follow suit in order to be seen as serving patient interest. The pharma company is already in damage control mode and today finds itself under fire, from not just the regulators and lay public but also the doctor community.

Did the move serve the purpose of alleviating patient concerns? The jury is still out on that one, but it's clear that not just Ranbaxy, but the Indian Pharma League, as a composite entity, seems to be headed for a crisis of confidence. This is unfortunately mirroring the misfortunes of the other IPL: the Indian Premier League. Just as the average cricket devotee today questions the integrity of each player, the average person buying medicines is bound to look with suspicion at all medicine brands.

To the lay person, it does not matter that most big pharma companies, MNC or Indian, may not actually make most medicines, but only market or promote them. It is possible that more incidents of falsification/manipulation of data may be unearthed at Ranbaxy or other companies.

Jaslok’s move, premeditated or not, highlights the role of hospital managements as well as individual doctors, both in hospitals as well as in their private clinics, in either building on such perceptions or explaining the issue with some cool headed logic.

Many hospitals managements have since clarified that they would not be issuing such a blanket ban, because they saw no merit in the argument and in fact termed it as an 'overkill'.

The lots approved by the concerned local authorities would remain available, and alerts concerning specific batches would result in a recall. By the same logic, the US FDA may have issued an import alert on one of Wockhardt's export-oriented units in Aurangabad but until hospital pharmacies receive specific alerts from local authorities concerning medicines being circulated in the India market, all approved Wockhardt's medicines would be stocked and available.

Was this just an individual case of a well intentioned move backfiring? Will the so-called doctor-pharma company nexus kick back in or will the end-consumers, i.e. patients drive this discussion forward in another direction? Only time will tell.

M

Doctors and hospitals will play a crucial role in rescuing the reputation of this IPL (Indian Pharma League)

Viveka Roychowdhury viveka.r@expressindia.com

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JUNE 2013

Letters QUOTE UNQUOTE

An industry relevant publication

Informative magazine

Thank you for publishing industry relevant issues.

Read few times and it is very informative.

JP Pattanaik pattanaikjp@gmail.com

INSIGHT INTO THE BUSINESS OF HEALTHCARE

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JUNE 2013

UPFRONT Karnataka hospitals get 15 per cent cut on electricity tariffs Raelene Kambli, EH News Bureau he Karnataka Electricity Regulatory Commission (KERC) has announced a 15 per cent reduction in tariff rates for hospitals within the state after hearing a plea from the Association of Healthcare Providers of India (AHPI).

It comes as a respite for hospitals within the state because as per the tariffs determined by the Electricity Regulation Commission, hospitals are charged at par with cinema halls and other commercial properties. This causes hospitals to spend around two to four per cent on electricity bills, thereby impacting the cost of services they provide. However, as per the new rate card for hospitals, they will be entitled to pay Rs 6 per unit for the first one lakh units and Rs 6.50 per unit, beyond one lakh units.

These consumers paid Rs 1.50 more than what they will be charged henceforth. But the demand charges of Rs 170 per kilovoltampere (KVA) are applicable to them.

Commenting on this new development, Dr Director General, AHPI said, “Government treats healthcare as a commercial business which is completely unfair.

Hence, we approached the KERC to reduce the tariff rates for hospitals. Prior to this the KERC had announced a hike in tariff through all sectors; however now they have withheld the hike for hospitals. They have now reduced the rates by 15 per cent for hospitals. This step will benefit hospitals significantly as they spend nearly 60 per cent of their cost on patient consumption. So reduction in electricity tariff will surely help them to bring down their cost of services in the time to come.”

Dr Alexander Thomas, Director & CEO of Bangalore Baptist Hospital and National Vice President of AHPI said, “Earlier, we spent around Rs 1.5 – 2 crores on electricity bills, with this new development we can now serve more poor patients. I would like to thank MR Srinivas Murthy, Chairman, KERC for lending his support and also Dr Devi Shetty who spearheaded this initiative.”

T

JUNE 2013

Market 'This partnership is an effective approach leveraging Abbott’s diversified healthcare expertise'

UK delegation seeks business opportunities in Indian healthcare

Vivek Mohan,Senior Director, Global Integrated Health, Abbott

Express Healthcare was the media partner; moderator of the panel discussion

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Page 26

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anchi – the city of waterfalls and lakes – is one of the fastest growing cities in India. Located on the southern part of the Chota Nagpur Plateau, Ranchi has a picturesque topography and was once considered a hill station. Rapid urbanisation, after Jharkhand became a separate state in November 2000, has turned Ranchi into an urban jungle and taken away the hill station tag. With investments pouring in from public sector undertakings (PSUs) and private players, Ranchi is gaining momentum as an economic centre. With six industrial areas, Ranchi, along with Jamshedpur and Bokaro, is an integral part of the industrial set-up of the state of Jharkhand. The city accounts for nearly 18 per cent of the national mineral production.

According to World Bank's report 'Doing Business in India 2009', Ranchi stands at number nine on the ease of doing business in India. The report is the first country-specific sub-national report, which analysed 17 cities while measuring business regulations and their enforcement across India. That Ranchi is a city of opportunities becomes clear from the influx of investments in the area across sectors like infrastructure, retail, real estate, education etc. Sadly, the city with a population of about 30 lakhs that is bustling with consumerism, is lacking in good healthcare infrastructure, forcing people to travel to other cities for their healthcare needs.

R

Needy healthcare scenario Before 2000, the healthcare landscape of Ranchi was dotted with trust-run charitable hospitals (Seva Sadan) and Christian Mission Hospitals (St Baranabas Hospital). Apart from these, there were a few doctor-entrepreneur run nursing homes that provided primary and secondary healthcare services. “In the seventies, there were only three PSU hospitals serving the people of Ranchi.

Later, Seva Sadan and Raj Hospital changed the way healthcare was provided in this region,” informs Dr HD Sharan, Medical Director of Santevita Hospital, Ranchi.

Until recently, the city lacked super speciality service despite increasing number of cardiovascular diseases, kidney ailments, cancer etc.

“When we did a study of the region we found it was terribly under-served in cancer care,” laments Dr Ajaikumar,

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Chairman, HCG Hospital Bangalore.

Additionally, the city grapples with increased incidence of seasonal diseases like malaria, chikungunya, jaundice, typhoid and other communicable diseases like TB and AIDS. At the same time, it is combating high infant and maternal mortality rates as well as poverty and malnutrition. Surprising then is the lack of good network of healthcare facilities in this area which has a huge catchment population. “Total population of Ranchi is 29,12,022, with huge catchment areas - Angara, Bero, Burmu, Bundu, Itki, Chanho, Kanke, Lapung, Mandar, Namkum, Ormanjhi, Ratu, Nagri, Silli, Sonhatu, Tamar,” says Dr Raajiv Singhal, Regional Director (Delhi I, Chhattisgarh and Uttarakhand), Fortis Healthcare.

The patients in need of medical attention would then go to neighbouring metros like Kolkata or Delhi for treatment. Says Dr RS Das, President, Indian Medical Association (IMA), Ranchi, "The only option for treatment of patients requiring tertiary care was outside the state. While some chose to go to Kolkata, most of them went to Vellore. Those who were unable to afford private treatment went to AIIMS. Other destinations where patients from Ranchi seek healthcare is Sankara Nethralaya, Chennai, LV Prasad Eye Institute, Hyderabad, and Tata Medical Hospital, Mumbai."

The reason for investors shying away from the healthcare sector in Ranchi may be hidden in the fact that healthcare was considered as a philanthropic activity and the existing hospitals were charging negligible fees thereby making it difficult to break through the price barrier.

“Some of the hospitals charged as little as Rs 5 for OPD consultations and patients were accustomed to paying less,” says Dr Sharan.

Any corporate set-up would have had a long gestation period with little profit margin. Besides, healthcare is a capital intensive investment and until recently Ranchi was a middle income, Tier-III city with slow growth rate.

“Investors did not see healthcare as a viable investment option as compared to other business.

Plus skilled manpower was difficult to find and retain,” informs Dr Sharan.

Another deterrent in this www.expresshealthcare.in

Because of the CNT Act it is very difficult to acquire land in Ranchi. Moreover owners choose to build commercial complexes, malls instead of hospitals Dr HD Sharan

Political reality in the state is disappointing, and is not focussed on healthcare. Ranchi has potential but affordability is thin

MEDICAL DIRECTOR, SANTEVITA HOSPITAL, RANCHI

CHAIRMAN AND MD, MEDANTA - THE MEDICITY

region is the Chhota Nagpur Tenancy Act (CNT) of 1908 that protects ownership of tribal land. It restricts transfer of tribal land to non-tribals.

“Because of the CNT Act it is very difficult to acquire land in Ranchi. Land in the city is already restricted and owners choose to build commercial complexes, malls instead of hospitals,” informs Dr Sharan.” “There are hurdles almost everywhere,” says Dr Naresh Trehan, Chairman and Managing Director, Medanta - The Medicity, “but cost of creation and operation is high in Ranchi.”

Changing for the better However, the scenario i s changing as Ranchi has gained not only political prominence but also enhanced its industrial, infrastructural and educational portfolio.

Similarly, the healthcare sector is also turning a new leaf. The region has got one tertiary care superspeciality hospital and a cancer care centre. Following this, a few good secondary care centres have opened up in the city. Now, large hospital chains like Fortis and Medanta Medicity are looking at Ranchi as a favourable destination. Diagnostic facilities have also changed for the better. “There has been good amount of investment in the diagnostic sector, especially MRI, CT, USG and pathologyhaematology and biochemistry,” reveals Dr Das.

Game changers The first wave of change in the healthcare scenario in Ranchi came when a decade back the Apollo Hospital Group, in association with Chota Nagpur Regional Handloom Weavers Co-operative Union, started Abdur Razzaque Ansari Memorial Weavers Hospital (ARAM) in

Dr Naresh Trehan

Ranchi. ARAM is the only tertiary care hospital in the region with super-speciality facilities. With an aim to provide the latest medical technology to the people of the region and to stop them from going outside the area seeking treatment, the Union and the members of the family of the late Abdur Razzaque Ansari started the ARAM Hospital, located at the IRBA area of Ranchi, in 1996 with 130 beds.

Today, ARAM Hospital is the first hospital in Ranchi to do regular cardiac cath, dialysis and kidney transplant, advanced neuro surgery, gastrointestinal surgery and cosmetic surgery. “The hospital is fully equipped to handle cardiac, neuro, orthopaedic, nephro, gastroenterology and haepatology surgery among others,” informs SA Ansari, Chairman, ARAM. “All modern diagnostics and imaging facilities are also available at the hospital. The equipment includes a multi-slice CT scanner, high end ultrasound machines with Doppler and multiple dedicated probes, a mammography unit and static high mA X-ray machine with an IITV fluoroscopy is available for various examinations and procedures. A 1.5 Tesla MRI unit is also available,” he says. This centre of excellence has been conferred with many appreciations and awards from different societies including Mother Teresa Missionaries of Charity, Rotarians for excellent nursing, Jharkhand Ratna Award to Cardiac Surgeon, Bharat Ratna Nirman Award from All India Business Development Association Delhi for its contribution in providing medical facilities in the rural area.

The hospital is associated with International Labour Organisation, Fujita Health JUNE 2013

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University, Japan; Rotary International Confederation of Indian Industry (CII) and The Government of Jharkhand. In 2008, a joint venture of Bangalore-based Health Care Global Enterprises and SAC Hospital Management & Consultancy Services - a firm run by SA Ansari, started the Curie-Abdur Razzaque Ansari Cancer Institute, the only comprehensive cancer care provider in the area. “The 100-bedded facility with two operation theatres, linear accelerator, three dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), brachytherapy (HDR) besides imageguided radiotherapy (IGRT) is the first in this region,” explains Dr Ajaikumar.

Kashyap Memorial Eye Hospital is another trendsetter. The present day state-ofthe-art first tertiary care eye hospital was inaugurated in February 2008 but the roots of the hospital go back to 1966 when it started as a modest eye hospital. It is the only hospital in the region to get NABH accreditation and ISO 9001-2008 certification.

The hospital offers cataract services, cornea and contact lens, glaucoma, paediatric ophthalmology, oculoplasty, vitreo retinal, medical retina and uveitis services, surgical retina and lasik laser in modern settings.

repeat Orchid's model.

However, another hospital took it a step further.

Santevita Hospital is the new age posh 80-bedded multi speciality hospital located in the heart of the city of Ranchi. It is a centrally airconditioned hospital with modern clinical and surgical facilities comparable to the best. It has the state-of-the-art building infrastructure with tastefully done interiors and a very focussed and hospitable staff.

The hospital has an ultra modern modular operation theatre complex, well equipped and spacious ICU, neonatal ICU, dialysis services and 24 x 7 critical care ambulance service, pharmacy and diagnostic services. “We have the latest integrated hospital information system for patient billing and storage of medical records in digital format of our patients. We are proud to have introduced new healthcare concepts like natural birthing clinic with

pre-natal and post natal classes, daycare facilities, a modern sleep lab etc to Ranchi and Jharkhand. We have a strong infection control team to minimise hospital acquired infections in patients,” says Dr Sharan.

He further adds, “We are planning to get NABH accreditation shortly to ensure standardised and quality healthcare services. Santevita Hospital is committed to provide its patients with quality healthcare services at com-

petitive prices. We aim to become one of the most advanced and progressive healthcare institutions in this part of India.”

On the other hand, established national hospital chains have also found their footing in Ranchi. Like the Fortis Escorts Heart Institute has a footprint in Ranchi through a Heart Command Centre in Alam Hospitals and Research Centre. Alam Hospitals and Research Centre (AHRC) is a multi-

Creating new benchmarks In early 2012, Orchid Medical Centre, a 100-bedded multi speciality hospital opened its doors for Ranchi, bringing swanky healthcare services to its people. Even though Orchid Medical Center’s services came at a premium rate, its OPDs were soon running to full capacity.

The hospital provides newage patient experience with unrelenting attention to clinical excellence and patient comfort.

The hospital brought the air of consumerism to healthcare services with its centrally air-conditioned facility and hospitable staff. A multi-speciality hospital with comprehensive diagnostic facilities, Orchid Medical Center has expertise in the fields of cardiology, urology, oncology, diabetology, ophthalmology, dentistry, general surgery, gynaecology, obstetrics, orthopaedics, neuro-surgery, neurology, ENT, medicine, psychiatry, radiology, paediatrics, physiotherapy etc.

The trend soon picked up and many hospitals tried to JUNE 2013

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speciality 150 bedded hospital, primarily focusing in general surgery.

“The motive behind the hub-and-spoke model is to provide the same level of high quality cardiac care as the Fortis Escorts Heart Institute, New Delhi, but at a comparatively cheaper price.

The Heart Command Centre is manned by highly qualified doctors who are a part of the Fortis clinical team,” informs Singhal.

The centre is equipped with the latest equipment and facilities as well as skilled medical teams that are adept at performing procedures such as angiography, angioplasty, fitting pacemakers, valve replacements and peripheral bypass surgeries.

This is of great convenience to local patients and cuts down considerably on tedious travel time.

Government initiatives Rajendra Institute of Medical Sciences (RIMS) is one of the biggest and oldest hospitals of Ranchi.

Government hospitals like the Central Institute of Psychiatry (CIP) and Ranchi Institute of Neuro- Psychiatry and allied Sciences (RINPAS) are famous throughout the country for psychiatric treatment.

Private players' enhanced activity in the sector has prompted the state government to revamp and upgrade its facilities. A testimony to this is Ranchi’s Sadar (district) hospital's ambitious 500-bed expansion plan.

Though the building is ready, the hospital which was supposed to be managed by a large private hospital from Gurgaon on a PPP model is yet to start receiving patients.

However officials say that once completed, the revamped hospital will certainly help address healthcare needs of the downtrodden in a holistic manner.

“In district hospitals, there has been a gradual increase in the number of beds from 100 to 300. In fact, 24 districts hospitals have been sanctioned and an upgraded district hospital is also about to be inaugurated in the city soon,” informs Dr Das. The state government has sanctioned a budget of Rs 90 crore for RIMS in the coming five financial years including 2012-13. Some of the proposed government projects are: ● Regional Cancer Centre at RIMS ● Pilot project for hospital waste management in Government hospitals. ● Financial assistance to

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● ● ●

●

selected government institutions for emergency care centres in towns and cities on National Highways.

Establishment of blood banks in 19 district hospitals of Jharkhand.

-Regional Institute of Opthalmology at RIMS. Burn unit at RIMS, Ranchi.

Trauma centres at the three medical colleges of the State.

10-bedded mental health units at three district hospitals (Ranchi, Jamshedpur, Dhanbad)

Projects in the pipeline Ranchi’s dream to have a super-speciality hospital on the lines of New Delhi’s AllIndia Institute of Medical Sciences (AIIMS) may be fulfilled soon. Ranchi’s superspeciality hospital, also known as regional AIIMS, is among the seven ‘AIIMS-like’ hospitals proposed in the country. Patna, Bhubaneswar, Jodhpur, Bhopal, Rishikesh and Raipur are the other cities where regional AIIMS has been planned.

Situated in the sprawling campus of the Rajendra Institute of Medical Sciences (RIMS) in Bariatu locality of the State capital, the Rs 120 crore hospital would be of great help for the patients suffering from cancer, renal disease, cardiac malfunctioning and kids requiring specialised surgery.

The centre has already despatched critical medical equipment worth over Rs 50 crores to be installed in different departments of the hospital. Apart from oncology, the regional AIIMS will have separate departments for urology, nephrology, cardiology, cardiac surgery and paediatric surgery at the initial stage of its operation.

The Mission Hospital (TMH), a Durgapur-based group, is said to invest in a super-speciality hospital on Ranchi’s outskirts in the Tupudana Industrial Area.

The state government is in the final stages of completing land lease formalities. Ranchi Industrial Area Development Authority (RIADA) is said to lease a 3-7 acre plot to the healthcare investor on a longterm basis to set up the 200bed hospital, initially for cardiac and kidney cases. The project, estimated to cost over Rs 100 crores, will start construction soon.

Eminent cardiac surgeon Dr Naresh Trehan, who created a fountain-head of all new knowledge and therapy www.expresshealthcare.in

When we did a study of the region we found it was terribly under-served in cancer care Dr Ajaikumar

Total population of Ranchi is 29,12,022, with huge catchment areas - Angara, Bero, Burmu, Bundu, Itki, Chanho, Kanke, Tamar etc

CHAIRMAN, HCG HOSPITAL, BANGALORE

REGIONAL DIRECTOR (DELHI I, CHHATTISGARH AND UTTARAKHAND) FORTIS HEALTHCARE

Medanta Medicity - has expressed interest in opening a wing of the much talked about Medicity in Ranchi.

His company has already held several talks with the state government on its intent. “We are happy to work with the Jharkhand government and very keen to partner with them but we need to align our interests,” Dr Trehan said.

Medica Hospitals, Kolkata-based super-speciality hospital, has also got Ranchi on its radar. As part of its expansion plans the company plans to have a super-speciality hospital at Ranchi. The company is in talks with Bhagvan Mahaveer Jain Trust to manage their hospital at Hotwar near Khelgaon, Ranchi.

Alchemist Group Chairman, KD Singh, who is a member of Rajya Sabha, has said that he will set up two hospitals in Jharkhand – one in Ranchi and the other in Dumka. The group’s multi-speciality hospital in Chandigarh is headed

by P Venugopal, former AIIMS Director.

In the current scenario, while existing hospitals are introducing cutting edge technology and new players are rushing in to grab a pie of the market, the ultimate beneficiary will be the patient. Although, a sizeable chunk of the population resides in the rural areas around Ranchi and may not be able to reach these services, these new hospitals will have to find a way to reach this population. Similarly, paying capacity of the people has to be supplemented by large investments in the insurance sector. At present the insurance penetration in the area is minuscule. The government will have to look at increasing insurance

Dr Raajiv Singhal

penetration and devise schemes like the Yeshasvini health insurance scheme to help the BPL people avail super-speciality healthcare services. “Political reality in the state is disappointing, and is not focussed on healthcare.

Ranchi has potential but affordability is thin,” says Dr Trehan. “The government has to address the cost of land, creation and operation,” he adds.

The government will also have to take care of power, water and other infrastructural needs of the hospital setups as the present availability may not suffice the future hospitals. Human resources are an integral part of successful healthcare delivery and three medical colleges producing 200 doctors a year may not be sufficient. The need for medical and technical colleges as well as nursing schools is gigantic in this area. Government should facilitate the entry of private institutes and invest in government colleges. In addition the existing medical, nursing and technical colleges have to be brought at par with existing standards. Better infrastructure and capacity of hospitals will also bring back talent, that currently seeks employment opportunities in the metros.

In time to come In the past few years, Ranchi has grown at a rapid pace. The healthcare segment is just starting to take off but will continue to grow. But, there is a large divergence between healthcare needs, investment requirements, and the capacity to invest, maintain and operate. A more realistic plan and even stronger will is needed to enhance healthcare landscape of Ranchi. mneelam.kachhap@expressindia.com JUNE 2013

Government Initiative

M|A|R|K|E|T NEW LAUNCH

Cardiac Care Centre opens at Godrej Memorial Hospital Centre equipped with 40 beds of which 10 beds will be allotted to intensive cardiac care

National Forum on TB launched The forum on TB will help raise awareness of TB in India

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he National Forum on Tuberculosis (TB) was launched in the capital. Convened by Dalbir Singh, Head of Dept, All India Congress Committee, the forum was launched in the presence of Sheila Dikshit, Chief Minister, Delhi, AH Khan Choudhury, Health and Family Welfare Minister Delhi, and Deepa Dasmunsi, Union Minister of State for Urban Development. The launch was supported by Global Health Strategies (GHS) a health organisation which works on TB, cervical cancer and childhood diseases.

The forum launch brought together parliamentarians, policymakers and civil society representatives to discuss the challenges for TB prevention and control.

The event also saw the release of a handbook on TB in India.This handbook provides a comprehensive overview of the challenges around TB control in India and the role of policy makers and parliamentarians in this regard.

Singh, said, “The National Forum on TB will serve as a platform to bring together various stakeholders to highlight and address the complex challenges facing TB in India, a disease that is easily preventable and treatable.”

The National Forum on TB will work to raise awareness on the need for improved TB control. The members of the forum will meet several times in a year to discuss critical challenges in TB control. Based on these discussions, the members will formulate key recommendations to address these challenges which will then be presented to the Ministry of Health and Family Welfare for further action. As representatives of the world’s largest democracy, policy makers, parliamentarians and the civil society play a pivotal role in influencing policy decisions.

The forum will aim to leverage this power to make an impact on the TB landscape in India.

EH News Bureau JUNE 2013

he Godrej Memorial Hospital has set up an Advanced Cardiac Care Centre to provide modern cardiac and vascular care to residents of Mumbai and suburbs. The speciality care centre is to conduct angiography, angioplasty, bypass and valvular surgery. Along with cardiac cases, the

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centre is well equipped to perform neurological procedures in a minimally invasive manner.

The new centre is equipped with a cath lab, a dedicated operation theatre and an intensive cardiac care unit. The centre will be reportedly functional round the clock and open to all. At

www.expresshealthcare.in

this centre 40 beds will be dedicated to patients undergoing treatment, 10 of which will be allotted to intensive cardiac care and served by eminent cardiologists and cardiac surgeons. The hospital promises to maintain the nurse – patient ratio at the recommended level of 1:1 for the 10 intensive cardiac

care beds.

The cath lab is supported with the technologies like fractional flow reserve (FFR), road mapping and haemo-dynamic monitoring which is expected to enable advanced cardiac treatment and be of use in neurological emergencies.

EH News Bureau

EXPRESS HEALTHCARE

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Investment

Goldman Sachs invests in BPL Medical Tech Rs 1,100 million funds to support continued expansion of medical device biz

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PL Medical Technologies, a leading medical device company, has secured an equity commitment of Rs 1,100 million (approximately $20 million) from Goldman Sachs, a leading global investment bank.

BPL Medical Technologies is a group company of BPL. The investment will be used to further expand the company’s medical device business and is subject to customary approvals.

Ajit Nambiar, Chairman and MD, BPL said, “This landmark investment reinforces our vision to build on the BPL brand and well established sales and service network to create India’s leading, indigenous medical device company. We are keen to partner with Goldman Sachs to expand our product range and geographic footprint.

Goldman Sachs brings a unique global perspective, coupled with extensive experience investing in India.”

Ankur Sahu, Co-Head of private equity in Asia, Goldman Sachs, said, “This investment reflects our continued focus on the Indian healthcare sector where we will continue to fund segments that have a great need and large untapped potential.

Leveraging our global healthcare expertise and relationships, we are excited to partner with the BPL Group to build a high-quality medical device leader in India.”

Ankur Sahu and Harsh Nanda, an Executive Director at Goldman Sachs, will join the Board of BPL Medical Technologies.

EH News Bureau

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M|A|R|K|E|T INITIATIVE

$5.5 billion six year plan to get rid of polio globally by 2018 Experts have said that by the end of 2018, the world could be free from polio with a robust $5.5 billion vaccination and a monitoring plan lobal Polio Eradication Initiative (GPEI) announced a fresh vaccination plan to eradicate polio footprints globally, at the ‘Global vaccination Summit’ recently held in Abu Dhabi. This is the first six year plan made to eradicate all types of polio disease (both wild polio virus and vaccine derived cases) simultaneously. At the Summit, commitments and pledges helped $4 billion of the $5.5 billion needed to implement the six year plan.

The plan incorporates the lessons learned from India’s success becoming ‘polio free’ in early 2012 and cuttingedge knowledge about the risk of circulating vaccine derived polio viruses. India is being commended as the nation that could help guide the three endemic nations – Pakistan, Afghanistan and Nigeria - to attaining similar success through their experience. The country is en route to completing three years without a case of polio that

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makes it eligible for the regional polio-free certification in 2014.

The total $5.5 billion six year budget requires sustaining current yearly spending to eradicate polio. It also includes the costs of reaching and vaccinating more than 250 million children multiple times every year, monitoring and surveillance in more than 70 countries, and securing the infrastructure that can benefit other health and development programmes.

“After millennia battling polio, this plan puts us within sight of the endgame. We have new knowledge about the polio viruses, new technologies and new tactics to reach the most vulnerable communities. The extensive experience, infrastructure and knowledge gained from ending polio can help us reach all children and all communities with essential health services,” said Margaret Chan, Director-General, World Health Organization (WHO) .

Rotary International, the

India is being commended as the nation that could help guide three endemic nations – Pakistan, Afghanistan and Nigeria flagship donor to the GPEI, pledged its commitment through 2018 to raise funds and mobilise support of the endgame strategy. “India is a live example of success. Uttar Pradesh has already been announced as polio free and we are hopeful that finally we will be able to defeat polio by February 2014 with continuous efforts and enough fund commitments backing the initiative,” said Deepak Kapur, Chairman, Rotary International’s India Polio Committee. Supporting the

plan, various philanthropists from all across the world endorsed the value of investing in the end of polio. At the summit, Bill Gates announced that his foundation would commit one-third of the total cost of the GPEI’s budget over the plan’s sixyear implementation, for a total of $1.8 billion. Other philanthropists present at the summit pledged contributions amounting to an additional $335 million toward the plan’s six-year budget.

Public health experts say if the polio eradication campaign succeeds, the world would not only declare its second eradicated disease smallpox was wiped out in 1979 - it would also be billions of dollars richer. A 2010 analysis found that if polio transmission were to be stopped by 2015 the net benefit from reduced treatment costs and productivity gains would be $40 billion to $50 billion by 2035.

EH News Bureau

EXPANSION

Manipal Hospital group forays into allied healthcare delivery formats This venture will be called Manipal – Ankur Andrology & Reproductive Services anipal Health Enterprises has invested growth capital in Ankur Healthcare, a speciality centre, focused in delivering comprehensive services in the areas of reproductive medicine-IVF, andrology and men’s health. This investment also marks the beginning of Manipal Hospital’s foray into allied healthcare delivery formats in partnership with established players in specified clinical areas.

This venture will be called Manipal – Ankur Andrology & Reproductive Services (MAARS).

The founders of Ankur Healthcare Dr Vasan SS and Dr Bina Vasan will lead the new entity. Dr Vasan SS will be the CEO and Medical Director while Dr Bina will

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head the Reproductive Medicine Division.

Commenting on the partnership, Rajen Padukone, MD and CEO, Manipal Health Enterprises said, “Manipal Hospitals has invested in the growth capital in Ankur Healthcare thus foraying into allied healthcare delivery formats with andrology and reproductive Services. Our focus on allied healthcare delivery formats will ensure that key traits like quality, technology, ethical practice and affordable care, values will continue as top priority.

Our new initiative, MARS would be one of a kind venture that would create a chain of specialty hospitals focusing on andrology reproductive medicine and men’s health in the country. This www.expresshealthcare.in

This investment also marks the beginning of Manipal Hospital’s foray into allied healthcare delivery formats in partnership with established players synergy will initiate new benchmarks and new medical trends in our country”.

Dr Vasan SS said, “This initiative will enable us to take our unique model of

comprehensive Infertility and men’s health services to a national scale. Over the years we have created this and built unique services in andrology, reproductive medicine and men’s health – all under one roof to address problems of both male and female infertility.”

The venture will continue to be led and managed by Dr Vasan. He aims to expand the existing four centres to 12 over the next 18-24 months, with new centres located in existing hospitals of Manipal Health Enterprises, standalone centres in cities like Chennai, Pune, Hyderabad, Indore, Chandigarh etc. as well as setting up such facilities within other hospitals.

EH News Bureau JUNE 2013

M|A|R|K|E|T RESEARCH

Vitamin D deficiency fast becoming a global and national health concern: Study The study states that any deficiency of Vitamin D in the human body is bound to affect normal functioning of all organs having Vitamin D receptors study conducted by the Diabetes Foundation of India revealed that around 80 per cent of the Indian population has Vitamin D levels less than normal. However, the bigger concern is that the population at large is not even aware of Vitamin D deficiency and its consequences.

The study further revealed that we might live in a country full of sunshine but Indians are still deprived of the sunshine vitamin, Vitamin D – which is called a pro-hormone that influences the expression of more than 200 genes within the human body. According to the study nearly every tissue in the human body has receptors of Vitamin D, be it brain, heart, skin, kidney, pancreas etc.

Any deficiency of Vitamin D in the human body is bound to affect normal functioning of all organs having Vitamin D receptors.

Commenting on the same, Dr Banshi Saboo, Founder of Diabetes Foundation of India, said, “Earlier Vitamin D was thought to be responsible for maintaining calcium homeostasis to prevent osteoporosis and maintain bone health.

But, in the past decade research has established the strong association of Vitamin D deficiency in diabetes, immunity, asthma, TB, high blood pressure, neuro-muscular function, etc.

Dr Saboo further added, “Low level of Vitamin D is associated with higher incidence of Type II diabetes and correcting Vitamin D deficiency improves insulin sensitivity and helps in better management of hyperglycaemia.

Also, Vitamin D deficiency has been associated with high incidence of Type I diabetes.”

As the mother is the sole source of Vitamin D substrate for her developing foetus, Vitamin D status is very important during pregnancy.

Maternal deficiency of Vitamin D is linked with abnormal foetal growth and gestational diabetes.

Sunscreen lotions, staying indoors, clothing habits, pollution and minimal exposure to direct sun light (during the period of 10 am to 3 pm) are the major reasons of such widespread deficiency in the Indian population.

Endocrinologist from Mumbai, Dr Manoj Chadha said that Vitamin D deficiency

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JUNE 2013

has no defined signs or symptoms. “People who complain of back pains, unexplained muscle pains, general fatigue are the most likely to be Vitamin D deficient. Vitamin D deficiency can be easily corrected by Vitamin D supplementation or some lifestyle changes. In a Vitamin D defi-

cient person, oral 60,000 I.U per week for eight weeks followed by maintenance dose of 60,000 I.U per month is a reasonably safe method to correct the deficiency,” he added.

Although there are few major studies carried out in India to determine the optimum (sufficient) levels of

www.expresshealthcare.in

serum Vitamin D 25(OH) D to be maintained to prevent chronic ailments, globally there is a consensus that Vitamin D deficiency is defined as serum 25(OH) D levels less than 20 ng/ml and insufficiency as serum 25(OH) D less than 30 ng/ml.

Whereas serum 25(OH) D lev-

els above 30 ng/ml is found to be sufficient.

Maintaining Vitamin D levels in blood above 30 ng/ml may ensure normal functioning of the body organs and protect many from the suffering from chronic ailments.

EH News Bureau

EXPRESS HEALTHCARE

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M|A|R|K|E|T

Award

COLLABORATION

MSD For Mothers launches initiative to reduce MMR

PD Hinduja Hospital bags award The award was introduced for the first time to recognise and award organisations for their initiatives taken in Maharashtra

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D Hinduja National Hospital & Medical Research Centre bagged the “Best Information & Communication Technology (ICT) enabled hospital in Maharashtra” award at the e-Maharashtra awards & Healthcare Conference. The award was introduced for the first time to recognise and award organisations for their initiatives taken in Maharashtra through innovative use of ICT’s . The award was presented by Rajesh Aggarwal, Secretary IT, Government of Maharashtra.

Joy Chakraborty, Director Administration and Mahesh Shinde, Director Information Technology (IT), received the award on behalf of Hinduja Hospital.

Chakraborty said, “Over the last six decades, Hinduja Hospital has pioneered several clinical and non-clinical practices to lead healthcare industry. During this period it has been realised that, efficient and effective healthcare delivery, needs to be supported by information and technology. Several initiatives have been taken by the hospital to be on the forefront of healthcare IT. PACS along with digitisation of imaging records and reporting system is one amongst those initiatives taken few years back by Hinduja Hospital. This was with the intention to bring down the turnaround time of reporting and better image archival facility in imaging department of the hospital. It has resulted into significant enhancement and improvement in patient satisfaction.

We are happy that this initiative has been recognised by the government.”

Shinde added, “We thank the Government of Maharashtra for appreciating our efforts as regards to the progress in the healthcare IT. Hinduja Hospital’s PACS is amongst the first few in India to have PACS with voice recognition system.“ EH News Bureau

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It is a $10 million commitment to improve access to maternal health services in areas with high rates of maternal deaths SD for Mothers has launched its global initiative for helping reduce maternal mortality in India. It is partnering with three leading non-governmental organisations to improve the quality of healthcare that pregnant women in India receive through the private sector. MSD for Mothers is a 10-year, $500 million global initiative launched in 2011 by Merck Sharp & Dohme (MSD), known as Merck in the US and Canada, to help create a world where no woman dies from complications of pregnancy and childbirth.

The Hindustan Latex Family Planning Promotion Trust (HLFPPT), Pathfinder International with World Health Partners (Pathfinder), and the White Ribbon Alliance for Safe Motherhood

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with Gram Vaani (WRA) together will reach nearly 500,000 pregnant women in Uttar Pradesh, Rajasthan, and Jharkhand – areas with some of the highest rates of maternal mortality in the country.

“We have made great strides towards Millennium Development Goal 5, but we know there’s more work to do to reach that target,” said Mamta Sharma, Chairperson, National Commission for Women said speaking at the India launch.

“These new partnerships demonstrate innovative ways of working together to address this issue and bring India closer to our goal.”

“Maternal mortality is one of the oldest and most preventable health tragedies in the world today. While India has made progress in addressing this, there is still a

lot that can be done collectively by the Government, NGOs and the private sector,” said Naveen Rao, Lead, MSD for Mothers. “Our focus in India is to work with partners who have the capability to improve maternal health care services delivered through the private sector and ultimately decrease the number of women still dying during pregnancy and childbirth.”

MSD for Mothers and its partners are working to accelerate India’s progress towards the United Nations’ Millennium Development Goal 5, reducing the global maternal mortality rate by 75 per cent by 2015. This goal is not currently on track to be achieved. While India has reduced its rate by approximately 67 per cent since 1990, Indian women are still dying during pregnancy and

childbirth and there is still a lot that can be done to help prevent maternal mortality.

These partnerships will complement the government’s initiatives to reduce maternal mortality. Specifically, efforts in India will focus on: ● Making private care more affordable by offering private providers standardised tools, protocols, and branding across networks of health facilities; ● Improving quality of care by training doctors, nurses, and health workers and offering women new ways to rate the care they receive; and ● Connecting women in remote areas to doctors and nurses in cities through telecommunication and Internet.

EH News Bureau

MEDICAL EDUCATION

Indraprastha Apollo organises medical education programme on neurosciences The programme was focused on delivering a series of stimulating, interactive and practical learning experiences via lectures, case-centric discussions and workshops ndraprastha Apollo organised a National Continuing Medical Education (CME) programme on Neurosiences.

The programme was for medical practitioners to discuss issues related to management of the unconscious patient, PET MRI in neurosciences, interventional radiology, management of the patient with head injury, backache, epilepsy surgery, surgical management of movement disorders, chronic headache, approach to a patient of vertigo, management of ischaemic attacks, transient ischaemic stroke and a young patient of stroke.

As a part of providing quality healthcare and upholding its policies and practices by maintaining and upgrading competence in its doctors, the programme was focused on delivering a series of stimulating, interactive and practical learning experiences via lectures, case-centric discussions and work-

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The programme was for medical practitioners to discuss issues related to management of the unconscious patient shops based upon topical issues addressed by renowned speakers.

Enlightening the attendees on the management of transient ischaemic attack (TIA) Dr PN Renjen, Senior ConsultantNeurology, Indraprastha Apollo Hospitals said, “A TIA, also known as a mini-stroke, is similar to a stroke, but the symptoms do not last as long. However, it should still be treated as a medical emergency. Such attacks are important risk factors for recurrent strokes; they precede 23 per cent of strokes within 90 days.

Identification of patients at high risk of developing furwww.expresshealthcare.in

ther strokes is essential to allow early intervention and avoid the catastrophic outcome of strokes.”

Dr Mukul Varma, Senior ConsultantNeurology, Indraprastha Apollo Hospitals addressed the gathering on chronic headaches. He said, “Some people develop very frequent headaches, as frequent as every day in some cases. When a headache is present for more than 15 days per month for at least three months, it is described as a chronic daily headache. Most people with chronic daily headache have migraine or tension-type headache as the underlying type of headache.

They often start out having an occasional migraine or tension-type headache, but the headaches became more frequent over months or years. Some people with frequent headache use headache medications too often, which can lead to ‘medication-overuse headaches.’”

Addressing the gathering on epilepsy surgery, Dr VP Singh, Senior ConsultantNeurosurgery, Indraprastha Apollo Hospitals said, “Over the last 15 years, Epilepsy surgery has proven to be a successful option for curing patients with seizures that cannot be treated with medicines. In India approximately five people in every 1000 suffer from epilepsy. 70 per cent can be treated with a single drug, 15 per cent with 2-3 drugs and the rest 15 per cent are potential cases where surgery can help.”

EH News Bureau JUNE 2013

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In

M|A|R|K|E|T INTERVIEW

'This partnership is an effective approach leveraging Abbott’s diversified healthcare expertise' Vivek Mohan, SENIOR DIRECTOR, GLOBAL INTEGRATED HEALTH, ABBOTT

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bbott has entered into a three-year partnership with the Government of Puducherry to provide quality healthcare service within the Union Territory. Vivek Mohan, Senior Director, Global Integrated Health, Abbott speaks to Raelene Kambli about the focus of the partnership, strategy adopted and Abbott's future plans

What is the focus of the MOU that you have signed with the Government of Puducherry? Why did you plan to initiate such a PPP? The MOU signed with the Government of Puducherry is a first-of-its-kind agreement for integrated health management services to improve awareness of non-communicable diseases (NCDs) like diabetes, hypertension, dyslipidaemia (cholesterolrelated disorders) and thyroid disorders. The partnership aims at reducing disease burden and improving patient outcomes by way of spreading awareness among patients and healthcare providers.

With an estimated 61.3 million people living with diabetes, India currently accounts for almost 17 per cent of the global diabetic population. A further 77.2 million people in India are at risk of developing diabetes. An Indian Council of Medical Research (ICMR) study suggests that the country’s incidence rate for dyslipidaemia is estimated to be 37.5 per cent amongst adults aged between 15-64 years. And thyroid disorders in India are characterised by a high prevalence (approximately 11 per cent of adult population), minimal diagnosis, low awareness and low involvement of doctors in treatment.

The partnership programme will reach out to the Union Territory’s citizens and screen over seven lakh people who are thirty years or above. It will also build the skills of local healthcare providers through continued medical education.

The partnership will address issues of disease awareness and management, and implement unique solutions that will leverage the public-health ecosystem.

Ultimately, this will help to drive better health outcomes for patients, thus reducing the disease burden in Puducherry.

The company believes that

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combating NCDs is a shared commitment and industry needs to support innovative, responsible and sustainable business practices, which in turn will play an important role in building a healthy society. Partnerships with government will help to prevent and manage these diseases effectively; in particular, by strengthening the healthcare ecosystem addressing NCDs and the systemic barriers.

What is the government's role in this partnership? ●

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What is Abbott's role in this partnership?

The Government of Puducherry will provide the infrastructure and the necessary permissions and logistical arrangements in the Union Territory to run the project, while Abbott will provide subsidised diagnostics, educational support to healthcare providers, patient awareness material and will conduct diet guidance camps. Abbott will also provide non-communicable disease management kits (including supplies to measure blood pressure, body mass index and blood glucose) and 150,000 glucose test strips to support monitoring of diabetes.

Abbott shall co-operate with the government to create awareness, educate and assist the concerned department of the government to achieve the objectives of the project. Towards this Abbott will: ● Train doctors and paramedics (both government and private workers) as may be advised by the government; ● Assist the government in spreading education awareness about lifestyle disorders, both to trained doctors and paramedics as well as the population aged 30 and over; ● Provide information posters, conduct camps in primary healthcare centres (PHC) and increase awareness through government machinery; ● Create a lifestyle disorder database with the information collected during the project; ● Assist in screening lifestyle disorders through government machinery ● Make available a lifestyle disorders screening machine for screening as per Department of Health’s suggestion. ● Assist and advise the government to procure the diagnostic test kits at subsidised rates. www.expresshealthcare.in

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The government shall facilitate necessary permission for government doctors, paramedics and health workers to participate in the training.

Government shall issue an appropriate binding communication to this effect; Government will also provide necessary logistical and staff support in PHCs and other government hospitals to screen patients for lifestyle disorders; Moreover, the government shall provide glucose meter strips and reagents for conducting screening tests It will also put in place an appropriate regulatory mechanism to ensure that private medical practitioners also undergo lifestyle disorders training; Lastly, the government shall arrange for all the necessary permissions, approvals, sanctions, no objection certificates and such other clearances as may be required for fulfilment of its obligations by Abbott.

How will this partnership benefit the company?

Abbott’s strategy in India revolves around increasing access -- meeting medical needs, ensuring the healthcare community receives appropriate information and ensuring patients have access to our medicines -- as well as sustainable business growth.

Abbott partners with the Union Territory of Puducherry in its endeavour to implement a comprehensive, patient oriented and outcome-driven end-to-end healthcare solution.

This partnership is an effective approach, leveraging Abbott’s diversified healthcare expertise in areas such as diagnostics and pharma therapies to build patient awareness, public health capability and use existing public health infrastructure to better manage NCDs.

Do you wish to replicate this model elsewhere?

Puducherry will serve as a model Union Territory to address issues of disease awareness and management, and implement unique solutions that will empower the public-health ecosystem to drive better health outcomes for patients, ensuring

better healthcare for people and this reduce the disease burden. The partnership with Government of Puducherry is first-of-its-kind in the country and I believe some of the other progressive states would look to leverage similar integrated healthcare approach as it accelerates greater citizen access to healthcare solutions. We do look forward to working with other governments but currently our key focus is Puducherry.

How do you plan to monitor the impact of the initiative?

Are you planning to take support of a disease management tool for the same?

This partnership for integrated health management is the first-of-its-kind to be initiated by a government in India to capture and assess reliable population level screening/monitoring data.

This data will help to create health risk maps to forecast the burden of a number of diseases, facilitate early intervention, and ultimately help reduce disease burden in the Union Territory of Puducherry.

Abbott will provide access to an internationally recognised disease risk assessment tool.The risk assessment tool — know your number (KYN) — is an internationally-recognised tool, which will help the Government of Puducherry assess lifestyle diseases at the patient and population-based levels. The customised version for India allows the government to understand and stratify its entire 'at risk' population in a way never possible before. This is the first time that the tool will be used in the Indian public sector. It will support the identification of highrisk patients to aid better treatment decisions and help create a population-level database of diabetes, hypertension, cholesterol and thyroid disorders, thereby enabling a targeted approach to reducing the Union Territory’s lifestyle disease burden.

What are your plans in the future taking this partnership?

With this partnership, we at Abbott, look forward to working with the Government of Puducherry and make a difference to the lives of people in Puducherry. raelene.kambli@expressindia.com JUNE 2013

Health and hygiene are a clear priority for the healthcare sector, but it’s also important to create a comfortable environment for patients, and good working conditions for staff. Tarkett has a solution for every area, from brilliant colours for children’s wards to static-control for an operating theatre, from traffic and stain-resistance for reception to slip-resistant and waterproof floors.

Hygienic and ultra-hard, easy to clean and maintain, our floors offer optimum return on investment while reducing staff workloads and improving patient comfort and care. www.tarkett.com

Flooring solutions for healthcare

Health and hygiene are their priority We provide the solutions they need Tarkett India 132, 1st Floor, Rec.-1, D-4 District Center Saket, New Delhi + 110017, India Tel: 011 435 240 73 Fax: 011 435 240 79 E-mail: thomas.schneider@tarkett.com

M|A|R|K|E|T PRE EVENT

AMEN to organise workshop on disaster management in hospitals Slated to be held on June 15, 2013 in Bangalore, the workshop aims to help participants learn from real time case studies n an effort to spread the message of healthcare safety and with the objective of making hospitals and healthcare facilities safe from disasters and its consequences, AMEN is organising a one-day workshop on 'Disaster Management and Preparedness for Hospitals' on June 15, 2013 at Bangalore, India.

The conference is being touted as a one-stop solution to all queries pertaining to disaster management in hospitals. Topics and issues like understanding types of disasters and the disaster management cycle; hospital preparedness for a disaster... processes, codes and protocols; pre and post disaster preparedness; triage and its execution during a disaster; effectively executing a disaster management plan; effectively managing an internal disaster; staff role and responsibility during a disaster; training the disaster management team;

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architectural and other technical considerations during a disaster will be covered by pioneers and eminent speakers from the healthcare industry.

The workshop is expected to help participants gain hands-on experience and knowledge from real time case studies including the Case

Study of Disaster Management at Yashoda Hospital, Hyderabad during the February 2013 bomb blast.

Participants would include healthcare promoters, CEO’s, administrators, healthcare management consultants, emergency/casualty staff, support staff involved in emergency services, PRO’s, front

office executives and students.

"It's very important for hospitals to be prepared for any kind of mass casualty at any time and hence this workshop. We also plan to take this workshop to other parts of the country in the near future," shared Paniel Jayanth, the Founder & Chief Strategist of AMEN.

CONTRIBUTOR’S CHECKLIST Express Healthcare accepts editorial material for the regular columns and from pre-approved contributors/ columnists. ● Express Healthcare has a strict non-tolerance policy towards plagiarism and will blacklist all authors found to have used/referred to previously published material in any form, without giving due credit in the industry-accepted format.

As per our organisation’s guidelines, we need to keep on record a signed and dated declaration from the author that the article is authored by him/her/them, that it is his/her/their original work, and that all references have been quoted in full where necessary or due acknowledgement has been given. The declaration also needs to state that the article has not been published before and there exist no impediment to our publication. Without this declaration we cannot proceed.

If the article/column is not an original piece of work, the author/s will bear the onus of taking permission for re-publishing in Express Healthcare. The final decision to carry such republished articles rests with the Editor. ●

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Express Healthcare’s prime audience is senior management and professionals in the hospital industry. Editorial material addressing this audience would be given preference. ● The articles should cover technology and policy trends and business related discussions. ● Articles by columnists should talk about concepts or trends without being too company or product specific. ● Article length for regular columns: Between 1300 - 1500 words. These should be accompanied by diagrams, illustrations, tables and photographs, wherever relevant. ● We welcome information on new products and services introduced by your organisation for our Products sections.

Related photographs and brochures must accompany the information. ● Besides the regular columns, each issue will have a special focus on a specific topic of relevance to the Indian market. You may write to the Editor for more details of the schedule. ● In e-mail communications, avoid large document attachments (above 1MB) as far www.expresshealthcare.in

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Articles may be edited for brevity, style, relevance.

Do specify name, designation, company name, department and e-mail address for feedback, in the article.

We encourage authors to send a short profile of professional achievements and a recent photograph, preferably in colour, high resolution with a good contrast.

Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare

JUNE 2013

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2nd Annual Hospital Expansion Summit Summit provides a platform to discuss current issues, challenges and opportunities facing hospitals while providing relevant solutions he second annual Hospital Expansion Summit organised by Noppen, an international company facilitating business across Asia and Europe, was held at the Eros Hilton, Delhi from 9-10 May. The two day summit saw panel discussions and sessions addressing various challenges facing the healthcare industry. The topics covered by the speakers on the first day ranged from designing energy efficient and green hospitals, public private partnership and its relevance, maternal health, better patient care management and of course the future roadmap for all stakeholders.

Ravi Kumar Dhulipalia, Head-Strategic markets, Ingersoll Rand India, outlined the role of heating, ventilation, and air-conditioning (HVAC) systems on helping reduce hospital infections. Taking an example of the situation in the US, he said that one out of 22 patients coming to a hospital acquire secondary infection, with airborne infection affecting nine per cent of the population. ICUs contribute to more than half of the infections. With 65 per cent of energy bill derived from them, energy

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efficient HVAC systems can not only help reduce cost, but also reduce energy consumption of the hospital.

Dr Praneet Kumar, CEO, BLK Hospital gave a bird's eye view of the challenges, trends and opportunities in the sector today. He cited the lack of architects and project management agencies specialising in healthcare, which is the need of the hour. He also opined that soft skill development should be the main focus of doctors when it comes to their interaction with patients, but our model is service delivery oriented.

He also enumerated that primary care, long thought to be a domain of the public sector, has seen enterprising ventures in the past few years with hospitals increasingly moving into Tier II and II cities.

The role of elevators which account for 12 per cent of a building’s energy consumption was also

highlighted along with reducing bacterial transmission. Transport solutions are crucial in a hospital with time management being a key, reiterated Ramgopal Yadavalli, Major Project Sales, Kone elevator India.

Tier II and II cities are fast emerging as the destination of choice, but operating there has its own challenges, that were explained

by Dr Gurbir Singh, Medical Director, Fortis, Mohali. He added that a low doctor to patient ratio, unavailability of nurses and technicians, funding problems, and inferior contractor quality further compound the issue.

Narendra Malhotra, Managing Director of Agra based Rainbow Hospitals stressed that maternal and neonatal health is the pillar of a nation’s healthcare index and cannot be discounted for. He gave an overview of the situation in South Asian countries including India, Nepal,

The two-day event saw enthusiastic participants from major hospitals in the country and healthcare professionals

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Bangladesh and Sri Lanka, with the latter emerging on top having reached its MDGs. The day ended with a panel discussion on PPP models in healthcare that can help optimise capital investment and at the same time reduce the cost of delivery to a larger population base to help themaccess quality healthcare. The panelists agreed that until there are no defined frameworks in which robustness of the model can be tested, we'll keep going in circles.

The second day saw speakers delve into how design, renovation and other technological applications, including implementation of a digital touch can benefit hospitals alongwith signages and better hardware solutions. With India famous as the diabetes capital of the world, a discussion on the disease epidemic also ensued. Dr Rahul Kashyap from Mayo Clinic delved into the implications of clinical research and evidence-based medicine. The two-day event saw enthusiastic participants from major hospitals in the country and healthcare professionals network and partner with each other and indulge in discussions.

JUNE 2013

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Rotary International organises two-day meet to sustain efforts in eradicating polio Deliberate on the way forward in the wake of ‘zero’ polio status in the country otary International’s India National PolioPlus Committee (INPPC) recently organised the ‘National Orientation and Planning Meet’ (NOPM) on polio in New Delhi. The event began with the inaugural ceremony at Hotel Le-Meridian amidst senior officials from the India Polio campaign. The meet, recognising the role Rotary leaders (all volunteer members from different professional fields) play in their community, deliberated upon the way forward for the campaign, particularly in sustaining the eradication goal in the wake of ‘zero’ polio status in the country.

At this annual meet on polio, incoming Rotary leaders (2013-2014) were entrusted and motivated to lead the polio eradication effort. The meet was attended by representatives from Government of India and from partner agencies like WHO, UNICEF along with the Rotary International’s senior leaders, National Committee Members, District Governors, District PolioPlus Chairmen and other special invitees.

The new Rotary leadership from 34 Rotary districts across the country committed themselves to advancing Rotary’s humanitarian goals, foremost being global eradication of polio. Observing India’s role in guiding other endemic nations in the fight against polio, Dr Robert Scott, Chairman-International PolioPlus Committee of Rotary International said, “Considering the demographics, sheer size of India, the programme implementation and dedication from all and the achievement is commendable. If India can do it for polio, so can the others.

India is a shining example and the endemic nations are looking up to it for lessons and best practices”.

Anuradha Gupta, Additional Secretary and Mission Director (NRHM), Ministry of Health and Family Welfare, Government of India was also present during the meet. She stressed on the importance of routine immunisation in preventing polio and other childhood diseases.

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India is only nine months away from achieving the regional polio-free certification. “India reported the last wild polio virus type 1 case in Howrah, West Bengal, on

January 13, 2011. If the eradication effort is complacent now, polio could rebound quickly, potentially paralysing thousands of children a year,” said Deepak

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Kapur, Chairman India National PolioPlus Committee, the volunteer body that is entrusted to spearhead the campaign for Rotary in India.

“Polio still exists in Pakistan, Nigeria and Afghanistan, where it has never been stopped,” informed Dr Sunil Bahl, Deputy Project Manager,

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NPSP – WHO, the technical expert who manages the surveillance and monitoring of wild polio virus in India.

“The danger prevails as India shares borders with these neighbouring countries, where poliovirus has been rampant last year,” Dr Bahl added.

To make polio history, Global Polio Eradication Initiative (GPEI) has recently presented a six-year plan ‘2013-2018 Polio Eradication and Endgame Strategic Plan’.

Public health experts have said that if the polio eradication campaign succeeds, the world would not only declare it the second disease to be eradicated after smallpox; it would also save billions of dollars and not to mention millions of children from a crippling future. A 2010 analysis found that if polio transmission were to be stopped by 2015 the net benefit from reduced treatment

costs and productivity gains would be about $40 billion to $50 billion by 2035.

The meet called upon Rotarians from all across the country to excel their efforts in achieving Rotary’s humanitarian goals. Since

India is inching closer towards regional polio-free certification, Rotarians pledged to continue their efforts in keeping India polio-free forever.

Additionally, the NOPM served as a platform to ear-

mark new targets and milestones – particularly 100 per cent coverage on national and sub-national immunisation says (NIDs/SNIDs) and the strengthening of routine immunisation amongst others.

POST EVENT

UK delegation seeks business opportunities in Indian healthcare Express Healthcare was the media partner; moderator of the panel discussion 3 British healthcare companies and 30 delegates visited Mumbai recently, with an aim to explore ways and means to create healthy partnerships between various stakeholders within the Indian healthcare and allied space.

The delegation was led by Kenneth Clarke, Senior British Cabinet Minister and UK Prime Minister's trade envoy for healthcare.

As their first engagement in Mumbai, UK Trade & Investment (UKTI) Mumbai, hosted a panel discussion on healthcare opportunities in India and areas of collaborations. The panel discussion, held at the Taj Mahal Palace Hotel, Mumbai, brought together industry experts from the private sector, rural healthcare players, analysts, insurance players and decision makers to provide areas of opportunities to UK companies as well as to tackle the future challenges and needs of healthcare consumers and the industry.

Express Healthcare was the media partner for this discussion.

Kenneth Clarke, UK Cabinet Minister, inaugurated the event and explained

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the reason for their visit to India. “India is an emerging nation and we have come here to explore various business opportunities in different areas of the healthcare space,” he said.

Panelists at the discuswww.expresshealthcare.in

sion were Dr RV Karanjekar, Global Hospitals Mumbai; Dr BR Das, SRL; Dr Vivek Desai, Hosmac; Ashish Bansal, Director, Transaction Services, Healthcare Practice, KPMG; Bishwajit Nayak, Head of Health Claims and

Networking, Future Generali; Sudeep Kapila, Director, Swasth India Services; Dr Jayesh Lele, State Secretary, Indian Medical Association (IMA); and Dr Anil Pachnekar, President, IMA. The discussion was moderatJUNE 2013

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ed by Viveka Roychowdhury, Editor, Express Healthcare and Express Pharma, The Indian Express Group.

The panel discussion acted as an opportunity to meet and interact with the members of the UK healthcare delegation who are trying to improve UK trade links in the healthcare sector in Western and Southern India by engaging with the state governments and the private sector players on a commercial basis. Topics discussed included opportunities and challenges in healthcare, bridging the gaps between affordability and accessibility of healthcare, creating better PPP models, the role of insurance in India and healthcare financing.

Expanding on the backdrop to their visit, the UK MP said, “Many people say that the National Health Service (NHS) is the closest thing the British have to a religion. But what they don’t know is that our NHS was only actually built with the help of Indian doctors, and continues to rely on them. Now some of the most exciting British companies are being drawn to India to return the favour in kind. As a result of the NHS, people in Britain have amongst the fastest access to GPs in the world, the best coordinated care, and they suffer from the fewest medical errors. Britain is quite simply a world leader in organising and administering first class medical care. The companies I am taking with me on my visit want to bring all this expertise to India.

The historic partnership between Indian and British doctors has already saved millions of lives in Britain.

On our visit we will be meeting with senior ministers and officials, and visiting hospitals and clinics, to work out how together we can save millions more.”

The 26-member UK health business delegation included a range of universities, hospitals and private companies with interest and expertise across sectors like primary care, healthcare management and solutions, family medicine services, ICT, medical equipment, medical education, hospital design and construction, consultancy and research and training. The delegation included senior representatives from Healthcare UK, A4e, Brit Health Care, Serco Health, BMJ Group, BT Health, London Ambulance Service, Royal Free Hospital, 3DiFM, Sheffield Hallam JUNE 2013

University, PCTI, Run Healthcare, TPP, Hurley Group, Downtown Engineering Consultants, DMC Healthcare and Boomerang Consultancy.

The delegation also visited Chennai, on May 8, 2013.

During this visit Clarke visited the Chief Minister of Tamil Nadu, the Health Minister and Health Secretary and demonstrated UK’s commitment to a stronger, deeper, wider healthcare partnership with

Tamil Nadu. On May 9, he delivered a speech at a conference hosted by the Confederation of Indian Industry (CII) on ‘Indo-UK Collaboration in Healthcare’.

He also inaugurated the Haemato-Oncology and Bone Marrow Transplant Unit at MIOT Hospitals, which involves a new technology partnership with the UK’s Whittington Hospital. He will also visited Apollo Hospitals which has strong and developing links with the UK.

We Believe the Possibilities.

Congratulations

Berend Houwen Travel Award Evaluation of Immature Platelet Fraction (IPF) to predict recovery of platelet counts in Dengue patients Tina Dadu, Kunal Sehgal, Mayuri Joshi, Shanaz Khodaiji P. D. Hinduja National Hospital Mumbai, India

Dr. Shanaz Khodaiji, Dr. Charles Eby -President, ISLH & Dr. Tina Dadu

Developing a new index and its comparison with other CBC-based indices for screening of beta Thalassemia Trait in a tertiary care hospital Preeti Dharmani, Kunal Sehgal, Tina Dadu, Ranjit Mankeshwar, Anjum Shaikh, Shanaz Khodaiji P. D. Hinduja National Hospital, Mahim. Mumbai, India Dr. Preeti Dharmani

Dr. Kunal Sehgal

Establishing biological reference intervals for novel platelet parameters (IPF,H-IPF,PDW,P-LCR, MPV,PLT-X,PCT) onSysmex 1

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Ritesh Sachdev , Aseem Kumar Tiwari , Jasmita Dass , Prashant Kumar Pandey , Hemant Singh Rawat1, Divyajyoti Srivastava1, Nixon P Joseph1, Vimarsh Raina1, Monisha Sethi2 1 Medanta- The Medicity Hospital Gurgaon, India 2 Sysmex India Pvt Ltd Mumbai, India

Dr. Ritesh Sachdev

4 Diagnosis of Malaria on the Pankhi Dutta1, Monisha Sethi2, Sandhya Bastian2, Chitrangi Navadkar3 1 Kokilaben Dhirubhai Ambani Hospital Mumbai, India 2 Sysmex India Pvt Ltd Mumbai, India 3 Seven Hills Hospital Mumbai, India Dr. Pankhi Dutta

5 Immature Granulocyte percentage (IG%) in the diagnosis of sepsis Pankhi Dutta1, Monisha Sethi2, Shashikala Shivaprakasha3, Sharyu Awate4 1 Kokilaben Dhirubhai Ambani Hospital Mumbai, India 2 Sysmex India Pvt Ltd Mumbai, India

For more details on the above, please contact:

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M|A|R|K|E|T POST EVENT

Pushpanjali Crosslay Hospital organises 1st Medicine Update (PMU-2013) Over 300 physicians across Delhi-NCR participated in PMU-2013, discussed on topics of day-to-day relevance he Department of Internal Medicine, Pushpanjali Crosslay Hospital, in association with API Ghaziabad chapter, organised the 1st Zonal CME of the Association of Physicians of India called 'Pushpanjali Medicine Update-2013 (PMU-2013)'.

Reportedly, a conference of this magnitude was organised in Ghaziabad for the first time.It was dedicated to physicians and general practitioners with discussions on comprehensive topics of relevance in their day-to-day practice. Some of the pertinent topics covered during the conference were: ● Monitoring DMARD’s in

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rheumatoid arthritis Acute coronary syndrome Non resolving pneumonia Headache-made easy for physicians ● Newer approach to type-II diabetes ● Management of HIV, hypertension, sepsis in 2013 ● Symposium of Diabesity (Diabetes and Obesity) ● Introduction to interventional neuro radio imaging More than 300 physicians and general practitioners, across Delhi and Ghaziabad, participated in the day-long conference and had an opportunity of interacting with eminent national and ● ● ●

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international faculty at the CPC and Q&A sessions. Each session of the Pushpanjali Medicine Update 2013 reportedly saw an active participation with average attendance of over 90 per cent.

The conference was inaugurated by Dr YP Munjal, Former President, API and Dean, ICP who also delivered the 1st PMU oration and Dr Kamlesh Tiwari, Vice President, API was the Guest of Honour.

The event proved not just fruitful to the participating physicians but also provided a business opportunity to leading B2B companies. A dedicated space was earmarked at the venue for the

pharma and allied companies for showcasing their latest product/services.

The event was organised under the guidance of Dr Vinay Aggarwal, CMD, Pushpanjali Crosslay Hospital, Dr Vijay Agarwal, Executive Director, Pushpanjali Crosslay Hospital and Dr NK Soni, Member, Governing Body, API. The overall management of event was under the leadership of Dr Prakesh Gera, Organizing Chairman, Dr Gaurav Aggarwal, Organizing Co-Chairperson, Dr NP Singh, Scientific Chairman and Dr Neelesh Goyal, Organizing Secretary.

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EVENTS UPDATE Disaster Management & Preparedness for Hospitals Date: June 15, 2013 Venue: Bangalore Summary: In an effort to spread the message of healthcare safety and with the objective of making hospitals and healthcare facilities safe from disasters and its consequences, AMEN will host a one-day workshop on Disaster Management & Preparedness for Hospitals. The workshop is a one-stop solution to all your queries pertaining to disaster management in hospitals. topics and issues like understanding types of disasters and the disaster management cycle, hospital preparedness for a disaster processes, codes and protocols, pre and post disaster preparedness, triage and its execution during a disaster, effectively executing a disaster management plan, effectively managing an internal disaster, staff role and responsibility during a disaster, training the disaster management team, architectural and other technical considerations during a disaster will be covered by pioneers and eminent speakers from the healthcare industry.

The workshop will help participants gain handson experience and knowledge from real time case studies including the case study of disaster management at Yashoda Hospital, Hyderabad during the February 2013 bomb blast.

Participants would include healthcare promoters, CEOs, administrators, healthcare management consultants, emergency / casualty staff, support staff involved in emergency services, PROs, front office executives and students.

Contact details: Paniel Jayanth Founder and Chief Strategist AMEN Innovative Healthcare Initiatives GSM: + 91 9035189825 Email: amen.paniel@gmail.com

total of six sessions. They are Clinical trials: Current scenario and complexities; The pain points: regulation, ethics and bottom-lines; Quality Control; Emerging trends: vaccines and BA-BE; Quality by design (QbD); The combined learnings. Speakers who will take part in the summit are Dr TS Rao, Adviser, Department of Biotechnology, Ministry of Science & Technology, Govt of India; Dr Shreemanta Parida, CEO, Vaccine Grand Challenges Program, Dept of Biotechnology, Govt of India; Dr Sadhna Joglekar, Area Medical Director- India/Sri Lanka, Executive Vice President- Medical and Clincial Research, GSK Pharmaceuticals; Dr Rajendra H Jani, Senior Vice President -Clinical R&D, Cadila Healthcare; Dr Rajesh Avinash Chavan, Consultant ENT & Principal Investigator, Jehangir Clinical Development Centre; Kapil Maithal, Director, International AIDS Vaccine Initiative; Dr RS Paranjape, Director, National AIDS Research Institute [NARI]; Dr Siddarth S Chachad, Head Global Clinical Development, Cipla; Dr Prasad Kulkarni, Medical Director, Serum Institute of India; Dr Khalid Saifuddin, Group Head-Central Continuous Remote Monitoring (CCReM), GCOOBD, Novartis Healthcare; Dr Deepa Arora, Global Head, Drug Safety & Risk Management, Lupin; Dr Himanshu Gadgil, Vice President, Intas Biopharmaceuticals; Dr Ranjeet S Ajmani, Chief Executive Officer, PlasmaGen BioScience; Dr Shravanti Bhowmik, General Manager- Clinical Research, Sun Pharma Advanced Research Company.

Contact details: Tikenderjit Singh Tel: +91 20 6727 6403 / +91 20 6727 6412 Tel: +971 4 609 1570 Email: tikenderjit.singh@fleminggulf.com

11th National Conference of IART Date: November, 22-24, 2013

Venue: Jawahar Lal Nehru Auditorium, AIIMS, New Delhi Organiser: Department AIIMS, New Delhi

of

Radio-diagnosis,

Summary: The 11th National Conference of IART will bring together experts from the field of radiology to deliberate on topics such as radiography, radiological imaging, radiology equipment, professional issues related to the subject, radiation protection, patient care and many more Contact: Organising Secretary Department of Radio-diagnosis, AIIMS, Ansari Nagar, New Delhi-110029 Tel: 09868398808, 01126546230 Email:ramesh_sh@hotmail.com

66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA Date: December, 13-14, 2013 Venue: Scudder Auditorium, CMC Campus, Bagayam, Vellore Organiser: Department of Radiology, Christian Medical College, Vellore and the Vellore subchapter of the TN & PY chapter of IRIA Summary: The 66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA will lay emphasis on the ongoing and upcoming trends in the field of radiology and diagnostic imaging.

Contact: Department of Radiology, Christian Medical College, Vellore Tel: 0416 228027 Email: registration@iria2013vellore.in; radio@cmcvellore.ac.in

Healthcare Finance Date: June 27-29, 2013 Venue: Bangalore

To tie up with

Summary: Management Development Programme Contact details: Paniel Jayanth Founder and Chief Strategist AMEN Innovative Healthcare Initiatives GSM: + 91 9035189825 Email: amen.paniel@gmail.com

Clinical Trials Asia Summit Date: September 26 and 27, 2013 Venue: Hyderabad

for Media Partnerships Contact kunal.gaurav@expressindia.com

Summary: Clinical Trials Asia Summit will have a

JUNE 2013

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Strategy 'NCDs are responsible for almost half of deaths worldwide and 24 per cent of all deaths in India'

Service quality in hospitals Dr J Sivakumaran, Senior Vice President, SPS Apollo Hospitals explain how the service quality of a hospital can be measured

Nata Menabde, WHO's Country Head, India

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MAIN STORY

Reforming rural healthcare Ameera Shah, MD & CEO of Metropolis Healthcare expounds on the rural healthcare scenario in the country and shares insights on the means to realise the fundamental right-to-healthcare for our rural population alking of rural healthcare solutions, there lies a fundamental ideology. The ideology of inclusiveness. This statement might sound absurd to some private company affiliates, as business and inclusiveness appear so disjointed from each other.

So, before I share my thoughts on rural healthcare, let me give you a rationale for 'inclusion' as the basic ideology for rural healthcare. More inclusion… more customers….. greater sustainability! Although 'inclusion' might appear as an ideological argument from scholars like Amartya Sen; it indeed has a bearing on business ideology as well.

However, going rural is not an apple-to-apple affair, but a conscious effort to understand the rural customer, and not trying to sell them urban-product-copies. Rural customers' paying capacity, ethos, needs and demands are drastically different from their urban counterparts.

Probably from these differences emanates the idea of National Urban Health Mission being a distinct entity and not merely an extension of the National Rural Health Mission.

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AMEERA SHAH MD & CEO, Metropolis Healthcare

dogmatic understanding of the rural economy is our prime mental barrier.

Same size doesn’t fit all!

I don’t intend to reemphasise on the topic, but to explore the magnanimity and dynamicity of our rural population which covers 70 per cent of our population, 833 million individuals, contributing 33 per cent to national savings, 45 per cent to the total GDP and 57 per cent to the total contribution.

Such are the encouraging figures of rural India. Yet, despite all the encouragement, our efforts to go rural fall short. The reason is a lack of understanding that 'same size doesn’t fit all' and the necessary effort to understand 'what exactly fits'. Another important factor is a complete or partial disregard to the paying preferences and capacity of the rural consumer. We rule out a rural business possibility by focusing too much on their paying capacity with a limited understanding of their paying preferences. How many of us have conducted studies on rural customer understanding and stratification? The

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So what will?

So if same size doesn’t fit all, then what will fit our rural fellows? I am going to plunge into my business to address this question.

At Metropolis, by and large we undertake four categories of tests: routine, semi-specialised, specialised and super-specialised tests. However, in the case of a rural customer, often this categorisation gets altered and some of our general tests also tend to fall under the semi-specialised category.

This flux is due to the doctor-prescription driven demand for the tests. In an urban health centre, a thyroid test would be a routine test, but for the rural masses this test would actually shift to semi-specialised. Why? Primarily because of the disease pattern, secondly due to the lack of trained medical personnel. The demand dynamicity changes. Given the case, there are two major growth

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drivers here. One is increasing the levels of awareness and the other is training of rural healthcare staff. Providing cost-effective solutions which a rural patient can afford to respond favourably to the generated demand.

Cost efficiency and innovations registry When I think of diagnostics, point of care (POC) devices come first to my mind for their cost-efficiency. While an urban family’s point of care might begin at home (take the Glucometer example); in a rural setting these POC devices could be provided as an institutional service. However, we are so focused on tertiary care that we fail to see simpler solutions. Since we lack a centralised database of technological innovations where business potential could be sought, I am sure many such innovations get shelved. These shelved innovations from an intelligent country like India have enormous potential. We don’t even know the depth and the extent of such innovations. Hence, if JUNE 2013

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we are to pick and choose game-changing technological innovations, a centralised healthcare innovations registry with a special focus on rural innovations is indispensable. This digital era is most favourable to make an innovation registry available and accessible.

Unfortunately, such rural healthcare innovations registry is nowhere in the picture. As a business leader, I would be more than compelled to visit these innovations and explore ideas that could help make diagnostics cheaper.

Furthermore, it is important to cut off the frills on healthcare innovations and reduce the excess cost of getting them transferred to the consumers. Rural customer marketing is no-nonsense marketing, if your service is good; the cultural setting allows free word-ofmouth marketing. The service acceptance hinges on doctors, fellow folks and opinion leaders.

Financial access to health All demands cannot be addressed by POC devices; neither can reducing prices alone ensure improved accessibility. The financial

own way, and has a huge potential to reduce cost of health insurance.

Government support – if not complete intervention

Rural customer marketing is no-nonsense marketing, if your service is good; the cultural setting allows free word-ofmouth marketing means to access healthcare services is an equally important demand determinant.

Although there have been some efforts towards national health insurance, many more financial innovations

are needed. The microinsurance projects should be further studied and explored, and innovations in financial packages should be tried by both Government and private players. A laudable innovation in the national insurance programme is that of engaging private service providers in direct healthcare delivery as well as in third party administration.

This is an innovation in its

I will echo my budget comments, which remain unheeded. Government cannot provide all services and it needs private sector reinforcement to reach the rural population. The most practical example from the diagnostic industry is the taxes on reagent costs and unexplored indigenous reagent market. With these baseline challenges any peripheral innovation to reduce the diagnostic cost wouldn’t lead to the desired level of price control. Such baseline challenges have kept the rural markets inaccessible for private players, while the government infrastructure continues to remain inadequate. Measures like tax exemptions on reagents and financial incentives could propel the private players towards the rural landscape.

Rural India is an unexplored treasure island of opportunities and success.

We need to map out the means to reach it.

INSIGHT

Learning lessons from hospitality for healthcare Dr Vandana Jain, MD, Advanced Eye Hospital & Institute and Consultant Ophthalmology, MGM Vashi talks about service delivery in hospitals and means to enhance it by following some strategies adopted by the hospitality sector ospitals are supposed to function just like any other service industry but what is surprising is that it does not function as a service industry at all. In fact, in many respects, healthcare has not applied many principles that other industries, service or otherwise, have used to improve their performance. There is a prevalence of tunnel vision on quality.

Historically, healthcare organisations relied on traditions of quality performance as their primary differentiating strategy in the marketplace. What the healthcare delivery industry is yet to understand is that clinical quality alone is not a sufficient differentiator.

Despite the fact that our society is changing to one of enhanced consumerism and there is intolerance for poor service and impatience, many organisations continue to fall back on ‘clinical quality’ as their distinguishing fea-

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DR VANDANA JAIN

Managing Director, Advanced Eye Hospital & Institute, Consultant Ophthalmology, MGM Vashi

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ture. Non-clinical touch points can far outnumber those that a patient has with a physician or caregiver. They also are often the first and last impression that a patient has of the organisation. As a result of healthcare's historical lack of focus on the service elements of its operations, healthcare delivery is in fact a service industry that doesn't act like one.

Healthcare delivery has become more competitive.

Patients have more choice of hospitals and information available to them now than ever before, and they are increasingly acting as consumers. This makes gaining customer loyalty as important as managing costs and revenues, and hospitals need to innovate to retain customers and maintain profitability. With this imminent reality, making a strategic choice to provide patients with the best experience is a proactive and sustainable way to create competitive www.expresshealthcare.in

advantage in this dynamic marketplace. This strategy requires providers to reassess their organisations from the perspective of the patient. We need to ask a lot of forwardleaning questions: what will the world look like in the next five years? What are the long-term trends that are shaping patients' desires?

And how do we align ourselves with those trends?

Armed with a thorough understanding of patient expectations and experiences, the organisation can begin to develop a compelling vision of the future.

Five basic themes were noted about patients’ expectations of their healthcare experiences in a recent survey: ● Personalisation: Patients want to be known to their healthcare providers as individuals. ● Security: Patients expect their privacy and security to be protected ● Operates like a business: Patients want their healthcare

providers to be ‘easy to work with’ ● Dependability: Patients want predictability, consistency and dependability ● Transparency: Patients, and their families, want to ‘see’ and understand what is happening to them Understanding these five attributes and how they relate to touch points for specific patient populations, is the first step in making the strategic choice to deliver an enhanced patient experience.

Armed with a thorough understanding of patient expectations and experiences, the organisation can begin to develop a compelling vision of the future.

To create a differentiable ‘patient experience’, healthcare providers need to cultivate the ‘customer experience’ capabilities successfully employed by consumeroriented businesses such as: ● A clear vision and strategy of delivering an exceptional customer experiEXPRESS HEALTHCARE

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ence based on a deep understanding of the service expectations of their customers; ● Internal delivery capabilities, both operational and technology-enabled, that are focused on delivering the envisioned experience and agile enough to evolve with the customer; ● A structure and culture that empowers and rewards employees for superior delivery; ● Measurement capabilities to identify and track customers’ evolving service expectations.

There is a need for the healthcare industry to be more responsive to customer wants, needs, and expectations for convenience, comfort, information, and personal control in the patient experience.

Healthcare providers should consider developing these “customer experience capabilities” in their efforts to successfully create and deliver their targeted patient experiences.

Approach and philosophies that can be borrowed from the hospitality industry are as follows:

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Several tools for hiring can be used to assist this process.

Post hiring orientation is important to ensure that everyone understands the culture and the nature of the work prior to actually starting the work. ●

Start at the top

Leadership at every level is the key for customer service success. For example: when a visitor/patient asks for directions, the employee, whether it’s the CEO or a staff member, can guide him or her to the destination.

There is a need for the healthcare industry to be more responsive to customer wants, needs, and expectations for convenience, comfort, information, and personal control in the patient experience acting to educate staff and keep them at the top of their game. There should be a zero tolerance for poor presentation to patients.

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Instill the spirit to serve (culture shift)

When customers ask for a service and you deliver it, you’re just meeting their expectations. Instead, aim for giving patients a 'wow!' experience. To achieve a wow experience, people need to stay ‘in the moment’ or, as Ritz-Carlton puts it, ‘radar

Instilling the spirit to serve begins with talent management—getting the right people in the right jobs. All the employees need to be screened well to identify what strengths and talents the person has. There is a need to focus on people’s strengths, not weaknesses.

Creating the 'wow' experience

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on, antenna up’. In essence, staff should be so attuned to patients and families that they can anticipate what’s needed, even without a verbal request. It doesn’t cost anything to stay in the moment. Health care staff may say they are too busy to worry about creating a wow experience; it’s hard enough to get the work done in an era of short staffing. Every industry runs into the “busy factor.” “If one has the spirit to serve, it can be overcome.

We can use role play and

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We at our organisation, Advanced Eye Hospital and Institute, have vitality sessions twice a day, which are attended by all the employees and the doctors. This is a 15minute meeting. Each day, one aspect of culture is reviewed, so the mission and credo are reviewed regularly, not just when something goes wrong. Also inspiration stories, wow experiences and feedbacks of patients are shared.

Leaders should pay attention to ‘the systems behind

the smile.’ Constant nonmedical crises can inhibit the staff from giving great service. Starting with attention to detail, adding care and connection, and getting rid of flawed processes is the key to success. ●

Serve the employees

The internal customers i.e. the employees who provide customer service should not be forgotten.

Work-life balance for employees is important.

Every attempt should be made to make it easier for them to come to work and decrease their stressors.

The best service comes from a human connection.

Several factors have been identified that influence the success of implementing change within an organisation such as hospitals: leadership support of the change initiative, communicating the vision for the change, including all levels of employees in the change initiative, utilising a measurement tool to gauge success, clarifying and defining employee’s roles and responsibilities, and institutionalising the changes into the existing organisational culture.

The time is right, we all should make a concerted effort to create a great experience for the patients.

Additionally, legendary and individualised service in healthcare institutions can improve its financial performance as well.

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Service quality in hospitals Dr J Sivakumaran, Senior Vice President, SPS Apollo Hospitals, Ludhiana, Punjab, explains how service quality of a hospital can be measured f a comparison is made between any two leading branded hospitals of a city, we can always find that the facilities/infrastructure/ equipment/technology are all at par with each other. Even in the tariff, difference would be minimal. Other parameters being equal, what is driving the patients to prefer a particular hospital? For example, when all the nationalised banks offer the same interest rate, why we chosse to operate with a particular bank?

Social scientists have found that service quality is an important element in this decision making process.

Hospitals may appear to offer the same variety of services but the quality may not be the same. Superficially, the services may look alike but the experiences will not be alike. So, if service quality is the main criteria for choosing a hospital, how do we measure whether a hospital has met the expected level of service quality or not?

Measuring of service quality is always not an easy task. Products can be measured as they are tangible, homogeneous and separable.

But services are totally different. The services are intangible, heterogeneous and inseparable. When there is no object to measure then how far will anyone be successful in assessing and measuring service quality?

This is the challenge before us. The only way to do it is

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DR J SIVAKUMARAN Senior Vice President, SPS Apollo Hospitals, Ludhiana, Punjab

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by measuring consumers’ perceptions of quality.

There is no yardstick to quantitatively measure the consumers’ perceptions which are more subjective.

The consumer’s judgment on overall excellence of a service is the perceived quality.

Perceived service quality is the degree of variations between consumers’ perceptions and expectations.

Quality ought to be seen as manifested and felt as expected.

Hospitals have two types of quality. One is technical quality and the other is functional quality. Technical quality is 'what patients get' and functional quality is 'how they get it'. In other words, technical quality is the level of accuracy of the diagnoses and procedures while functional quality is the manner in which the services are delivered.

Assume that a patient has a heart problem. Right from diagnosing the blockage, assessment of patient, doing the procedure, post operative care etc., till medicine prescribing before discharge is classified as a technical quality. The waiting time at OPD/ b i l l i n g / c a t h l a b / OT / d i s charge, well behaved hospital staff, communication on progress of the patient to relatives, neatness of the room/linen/wash rooms, taste of food served etc., would form part of functional quality.

Knowledge of technical

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quality of healthcare services remain within the purview of healthcare professionals. The patients do not have sufficient knowledge to understand and assess the technical quality. In the absence of this, they only try to observe, understand and asses the functional quality. There are evidences to suggest that perception of functional quality is the single most important variable influencing consumer’s value perceptions.

In association with the Marketing Science Institute, a scale called SERVQUAL was developed by researchers. It measures the gap between perception and expectation of the patients and this is considered to be the yardstick for judging the quality of a hospital. For a scientific evaluation of a hospital, questionnaires based on SERVQUAL scale have to be answered by patients before and after the service experience. After analysing these questionnaires, we will come to know the level of satisfaction of the patients and quality of service provided by the hospital.

This will be a time/resource consuming exercise. But this is a scientific method authenticated by researchers.

In any activity, if there is a difference between expectations (before availing services) and experience (after availing services), there will be a gap of unfulfilled satisfaction. The more the closeness of these two, the less

will be the gap. Based on the SERVQUAL model, there are five identified gaps which are essential for hospitals to identify and narrow down to improve the quality. These five gaps are (1) Knowledge gap (2) Standards gap (3) Delivery gap (4) Communication gap (5) Perception /expectation gap (net result of gaps 1 to 4).

Gap 1: The knowledge gap arises out of the differences between the expectations of the customer and management perceptions of customer expectations. For example, hospitals will have a mix of rooms to suit various strata of society. Assume that based on a market survey, a hospital is constructed with more number of rooms in private/suite category and less number of rooms in general/semi private category. But if the patients’ demand is more for general/semi private rooms than private/suite rooms, then there is a mismatch and gap. Not understanding the market pulse and insufficient market research would lead to these problems.

Gap 2: The standards gap is the difference between the management perceptions of customer expectations and service quality specifications.

This arises due to the inadequate commitment to service quality by the management, absence of service quality goals and the lack of perception of feasibility. For example, in a sample collection room, proper identification of patients, using a disposable vacutainer, using disposable gloves for each patient, proper protocol for labelling the sample etc. are required as standards to improve quality.

In the absence of such standards, quality will downslide and a gap will arise.

Gap 3: The delivery gap is the difference between service quality specifications and actual service delivery.

This happens due to the role ambiguity, role conflict, poor employee or technical knowledge fit, poor supervision and lack of team work.

If the standards mentioned in the example of Gap 3 is only at a policy level and not implemented and followed by the concerned staff, then there is a gap. Mere documentation of standards will EXPRESS HEALTHCARE

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not be sufficient but it should be functionally in place to avoid this gap.

Gap 4: The communication gap is found, when service delivery promises do not match the actual delivery.

This is due to the inadequate horizontal communication between various departments and due to the habit of over promising by the hospitals to attract the patients. Always hospitals should try to propagate what could be actually delivered by them. The level of expectations of the patients shall be in line with the promises made. But if the actual delivery is not up to the promised level, then there will be a gap.

Gap 5: The perception/ expectation gap is the resultant of Gaps 1 to 4. This happens due to a difference between the patient’s expectations and the actual experience on a particular/overall service. The expectation of a patient about a hospital or a particular service in a hospital is influenced by external communication, word of mouth messages, past experiences and brand knowledge.

The level of satisfaction will be directly proportional to the level at which the per-

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ceived expectations match with the actual experiences.

If a patient’s expectations are not met, then he is dissatisfied. If his expectations are met he is satisfied. If it exceeds, he is delighted.

Hence, it is necessary for the hospitals to focus on creating patient delightfulness to build up the reputation and image. This exercise could not be done on an on-going and a day-to-day basis.

Though patient feedback forms are not an alternative to SERVQUAL method of evaluation, the patient feedback forms, if it is utilised properly, are more informative, practical and useful. It should be ensured that every patient is filling up this form before discharge happens. If these forms are genuinely analysed with intention to improve the service, we will

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get lot of clues from this. It is not possible to rectify/implement all the suggestions given by them. Hospitals will have lot of financial/space constraints.

But complaints/suggestions which are having possibilities of rectification/implementation by the hospitals should be attempted without delay.

This will highlight how much scope is there for hospitals to improve. For example, if a general ward patient wants toilet to be nearer his bed, it will be difficult to modify and satisfy the patient. But if the general ward patient suggests having a call bell inside the toilet room (to call someone in case of emergency), it will be a useful suggestion and could be implemented without much cost. If we treat the complaints as a gift given by the patients, then sky is the limit for improvement.

References: 1.Crosby & Philip B. (1979).

Quality is Free; The art of making quality certain. New York: New American Library.

2.Gravin, David A. (1983, Sept.Oct.). Quality on the Line.

Haward Business Review, pp. 68-73.

3.Parasuraman, A., Berry, L.L., & Zeithml, V.A. (1988). SERVQUAL: a multiple-item scale for measuring consumer perception of service quality. Journal of retailing, 64(1), 12-40.

4.Lam, S.S.K. (1997).

SERVQUAL: A tool for measuring patients opinions of Hospital Service Quality in Hong Kong.

Total Quality Management, 8(4), 145-152.

5.Babakus, E. and Mangold, W.G. (1992, February). Adapting the SERVQUAL scale to hospital services: an empirical investigation.

Health Services Research, 26(2),767-786.

6.Parasuraman, A., Zeithaml, V.A. & Berry, L.L. (1994a).

Alternative scale for measuring service quality: a comparative assessment based on psychometric and diagnostic criteria.

Journal of Retailing, 70(3), 201230.

7.Parasuraman, A., Zeithaml, V.A. & Berry, L.L. (1985a). A conceptual model of service quality and its implications for future research. Journal of Marketing, 49(4), 41-50.

8.Parasuraman, A., Zeithaml, V.A. & Berry, L.L. (1994b).

Reassessment of expectation as a comparison standard in measuring service quality: Implication for further research. Journal of Marketing, 58(1), 111-124.

JUNE 2013

S|T|R|A|T|E|G|Y INTERVIEW

'NCDs are responsible for almost half of deaths worldwide and 24 per cent of all deaths in India' Nata Menabde, WHO'S COUNTRY HEAD, INDIA

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HO has been at the helm of setting up standards in health, pushing for advocacy and awareness in neglected areas.

WHO's Country Head, India, Nata Menabde reveals the organisation’s efforts and her opinion on several key topics, in a conversation with Shalini Gupta

We are still battling with infectious diseases and yet to meet our MDGs on maternal mortality even as the challenge to tackle NCDs rears its head. What kind of approach do we need to tackle this?

We do not have the luxury to choose between communicable and non communicable diseases. Commitment to reach MDG target and goals is strong, some on which India has done well with difficulty on some targets. There has been several efforts to scale up on maternal and infant mortality. and improvements are clear.

That doesn't mean that the task is accomplished even if the MDGs are achieved. We will need to have a next target which is even more ambitious.

However, that said, we also face a growing burden of noncommunicable diseases. We live in a transitional society with social inequities and hence there will be different reasons for different disease burden. India's disease problems can't be solved by just having vertical diseases programmes for tuberculosis, HIV etc. Rather, a comprehensive approach that establishes the problems, gives proper advice on risk factors and healthy behaviours to reduce them, provide access to healthcare and medications to ensure a healthy recover is needed.

Since risk factors are also shared between diseases, so if you tackle one risk factor like tobacco smoking you can have a hold on several diseases.

The 12th five year plan as a part of the Universal Health Programme has this aim in mind to integrate healthcare thus making it more equitable and efficient.

Elaborate on NCDs as a priority for WHO globally.

NCDs are a growing probJUNE 2013

lem, not only for India but for the entire world. It is alarming and threatening, contributing to almost half of deaths worldwide (three out of five deaths globally) and 24 per cent of all deaths in India. If nothing is done and the same pattern continues, this number might almost double for India. NCDs have huge human and economic costs, affecting population, taking them out of the economic and productive sector alongwith extensive costs for treatment and access to services and technologies required to sustain. With an increasingly ageing population, India's cardiovascular disease burden is also set to increase, and this requires collaboration from not only health but other sectors as well. Risk factors include those associated with healthy lifestyle, better conditions at work, opportunities for exercise and access to sufficient amount of fruits and vegetables for people. It requires a comprehensive approach since a solution needs to be worked out in conjunction with both public and private sectors wherein other sectors such as agriculture, distribution, infrastructure, roads and also food habits and economic capacity of people are looked into.

How do you see the whole debate on access to medicines?

When the preventive measures have not been effective and people fall sick, then medicines are the most effective way to treat those conditions provided the diagnosis has been made. Access to medicines is just one dimension towards an effective solution, alongwith resources to ensure proper diagnosis and patient management. However, given the huge proportion of medicines in the overall health expenditure of India- 70 per cent of entire out of pocket expenditure, which in itself is 60 per cent of the total cost, it is not surprising that the government has put Universal Health Coverage and access to essential medicines as the first priority. In Tamil Nadu, logistics and information systems have been put in place to ensure uninterrupted access to public facilities while we have www.expresshealthcare.in

Access to medicines is just one dimension towards an effective solution, alongwith esources to ensure proper diagnosis and patient management seen great start of the Rajasthan free medicine scheme. So more utilisation of public facilities along with an electronic system for stock and procurement management is needed. Better quality and rational prescribing is also imperative which brings in a whole range of pharma policy issues at stake.

This brings us to the issue of safe medicines. What is WHO doing on this front?

The safety of medicines or that of biologicals and vaccines is an issue of concern.

Recently fake antimalarial medicine was found in the distribution channel in Africa which did not have any active ingredient at all. Its a recurrent problem and requires a strong regulatory authority that sets strong regulatory standards, licensing manufacturers who bring these products to the market while also monitoring side effects. This, alongwith the ability to withdraw spurious medicines and sufficient capacity of drug inspectors, to inspect both at the manufacturing as well as distribution channel is needed.

WHO has been traditionally strongly engaged with Indian government on this. We have done a lot of work in setting up GMP standards and ensuring that private manufacturers meet them. We are also running pre-qualification of medicines programme since 2001 with an objective to bring consistency into quality standards and reduce cost for regulatory assessment of those medicines.

Both manufacturers and regulatory authorities are assessed and those who pass can sell

their products through UN supply channels.

What were the points of discussion at the meeting of international pharmacopeias held recently?

DCGI and Indian Pharmacoepia Commission hosted a meeting which saw 20 representatives from different pharmacoepia discuss and draft guidelines on good pharmacoepias including harmonising standards and rules.

That is very important in the context of global trade of medicines. It won’t resolve all the issues but its a right move in the right direction. With every country having its own standards that evolved differently from the other, the effort was to focus on setting up as unified standards as possible and ensure best practices in ensuring quality and standards of medicines as well as procedures for assessment.

Has the NRA recognition come late, given India's domination in vaccine production?

The process of assessment of NRA functionality parameters is not the first one for India. It started in 2001 and every two years there was an assessment which gradually increased the standards. So from assessment to assessment India just did not have to maintain its level but improve it. In 2007, India could not pass this assessment, wherein it could not meet the parameters defined. So even as we had good vaccines from good companies manufactured in the country, they could not be sold through UN channels (UNICEF, GAVI). After that India was given recommendations. Between 2009-12, WHO called an expert committee meeting to review indicators which India then passed last year. It only reflects that India has been regularly investing in strengthening its capacity and has passed assessment of functionality. This helps children worldwide to be at the receiving end of high quality cheap vaccines, as disease preventing interventions. India can continue to be major exporter of those products. shalini.g@expressindia.com

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Knowledge MAIN STORY

Personal genomics and its role in creating lifelong wellness Pankaj Mankad, Director – Physician, Xcode Life Sciences, Chennai, looks into the role and current limitations of personal genomics in health and disease

PANKAJ MANKAD Director – Physician, Xcode Life Sciences, Chennai

t was just a decade ago that the complete human genome sequence was established by a 13-year-long — Human Genome Project — an international collaborative research programme, at the cost of circa $2.7 billion.

Genomic science, since, has progressed in leaps and bounds with a potential to influence our daily life, health and wellness. Peri passu commercial translation of this modern research into personalised medicine is already here in India.

It is not a question of if, but when and how these recent advances will be integrated into medicine and have a noticeable impact on our lives? At this early stage, the question for consumers could be ‘Is this all Hype or is there Hope?’

Here, we shall address this question objectively, looking into the role and current limitations of personal genomics

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in health and disease.

Personal genomic information has the potential to influence our health through several domains. These include: ● Disgenomics plus oncogenomics – Science which assesses our genetic predisposition/risk of developing various chronic diseases and certain cancers; ● Pharmacogenomics – Study of how our genes regulate drug responses, ● Nutrigenomics –Science related to interaction between nutritional components and our genes.

Let us first examine the basics.

The basics Genes, storing our unique personal information, are located in 23 pairs of chromosomes, present in every single cell in our body. One member of each chromosome pair is from the mother;

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the other is from the father. Genes consist of DNA which has four nucleotide bases and they must remain in pairs to help form proteins for bodily functions.

The nucleotides are: A (Adenine), T (Thymine), C (Cytosine) and G (Guianine). There are millions of these bases in a chromosome. They always have their fixed location. If a single base is replaced by another base, say A by C, it results in a variant gene and in medical terms it is called as Single Nucleotide Polymorphism (SNP).

Not all SNPs are harmful but all problems arise because of SNPs and other gene abnormalities. Over the past two decades, candidate gene association studies and, more recently, Genome Wide Association Studies (GWAS) and International HapMap project have established tens of thousands of SNP JUNE 2013

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associations with common chronic diseases, cancers and metabolic traits.

These form the basis of personal genomics in maintaining health and wellbeing.

A particular SNP may either increase or even reduce the risk of developing a disease. Once genome test is done, statistical association of every relevant SNP with many important common diseases is made to derive one’s relative risk of developing a disease. Although ethnic genetic data about Indian population is sparse, it is fair to begin this process using available information from the Caucasian population and if possible, creating weighted database to suit our population. Failing this, we will never be able to catch up with the science, let alone even begin the process.

Chronic diseases, disgenomics and personalised medicine Today, chronic non-communicable diseases (NCDs) form nearly two thirds of total disease burden in our country.

Deaths due to NCDs are more than double compared to communicable diseases (WHO data). Adverse financial impact of these in the society is devastating. The good news is that nearly three in every four chronic conditions are preventable. Prevention becomes much more focused when one’s risks are known. Genetic assessment, however, is not alone in this game. Genetic predicted risk combined with information about a person’s lifestyle, diet, environment, and medical history will enable doctors to treat diseases much more effectively and in many cases even prevent it.

This is personalised medicine. It is a broad and rapidly advancing field of healthcare that is informed by each person’s unique clinical, genetic, genomic and environmental information. Use of this information in an integrated and evidence-based manner to individualising personal care across the continuum from health to disease is the best way forward.

We know that heart disease risk can be reduced by lowering dietary intake of fat and salt, exercising more, and taking a cholesterol lowering medication.

However, heart disease is not simply a condition caused by excess fat and cholesterol. There are many other modifiable risk factors, some genetically influenced, which can predispose a person to heart disease.

For example, many people, as high as 40 per cent in some studies, have a genetic inability to properly metabolise folic acid in the body (MTHFR gene).

This can lead to a build-up of homocysteine in the bloodstream, causing increased risk of blood clots and atherosclerosis. For a person with this genetic variation, the only way to reduce risk is to take the active form of folic acid, which is not found in common vitamin supplements.

Thus, genomics-enabled medical technology can run various ‘what-if’ scenarios and combine related genetic data to disease risk and show whether diet, exercise, medication, or some other factor or combination of factors has the greatest statistical likelihood of reducing that risk.

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The greatest promise of personal genome information is its potential to offer individualised drug treatment Epigenetics If I have a genetic susceptibility to develop heart disease, with a strong family history, is it not the final nail in the coffin (pun intended)? No, not at all. Here comes the science of Epigenetics. In order for a disease to develop, the genes must be expressed in abnormal proteins. Gene expression is governed by the cellular material — the epigenome — that sits on top of the genome, just outside it (hence the prefix epi-above). It is these epigenetic 'marks' that tell the genes to switch on or off. A gene that is turned off can cause little harm. It is through these epigenetic marks that environmental factors like diet, stress, exercise, prenatal nutrition etc can make an imprint on genes and is even passed from one generation to the next. So our good habits now may also be beneficial to our children in future!

Pharamcogenomics and personalised medicine The greatest promise of personal genome information is its potential to offer individualised drug treatment.

Genetic variation has been shown to influence drug selection, dosing and adverse events. People metabolise drugs at different rates; however, doctors often prescribe drugs and select dosages based on a 'one-size fits all' paradigm.

Patients who metabolise a particular drug more slowly than others might need a lower dose and thus could experience adverse side effects if prescribed the standard dosage.

Pharmacogenomics has already been successful in improving drug prescription and dosing. Most prescriptions are written with a ‘one dose fits all’ approach with adjustments based on gender, weight, liver and kidney functions or allergies. Some drugs have more laborious dosing calculations such as the anticoagulant warfarin. Warfarin dosing is traditionally determined by a time-intensive ‘guess and test’ method, until the coagulation tests stabilise.

Pharmacogenomics identified several SNPs, such as CYP2C9 and VKORC1, affecting dosing of warfarin. One study found that a hypothetical pharmacogenetically driven clinical trial of the anticoagulant warfarin could save up to 60 per cent of the cost and reduce possible adverse events. Similar studies have been applied to thiopurines trastuzumab and imatinib for cancer, clopidogrel, tramadol, anti-psychotics, abacavir, carbamazepine, clozapine and many other drugs that all have significant genetic associations.

Caveats and challenges A few caveats about the genomics

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opportunity are in order here. First, the available databases of known diseasecausing genetic mutations, although vast, are still evolving and subject to interpretative error. Prediction studies so far have been rather simplistic in the sense that most were based on a small number of variants that by themselves explain only a fraction of the genetic variability.

Interpretation of results should be also be done with caution, particularly by a lay person. It is important that a medical doctor and preferably a geneticist are involved in interpretation and discussion with a person. Negative risk should not provide false reassurance and be regarded as a licence to indulge!

Remember that most conditions are based on many factors; genetics is only one of them.

One of the unknowns is the extent to which genomic information can motivate people to change their health-related behaviours. Can the specificity and personalination of genomic information—i.e., being told that you have an Xfold increased risk of heart disease can motivate change? Ignorance is bliss or Knowledge is power? Time will tell.

Use of the personal genome also raises ethical concerns. If someone has access to an individual’s genetic profile, it could affect decisions made regarding that person, such as denial of employment or life insurance. In the US, the Genetic Information Non-discrimination Act of 2008 protects against discrimination by health insurers and employers on the basis of DNA information.

Despite the need for caution, personal genomic testing provides an opportunity for us — all of us, both providers and patients — to learn about genomics and its role in predicting disease risk and adverse drug responses. It can also provide an opportunity to investigate your heritage and network with others who share similar genealogy and disease risk.

Need of the hour Critical to the widespread acceptance of the role of personal genomics in health and disease is the need to educate physicians and the public about the realistic benefits and risks of such an analysis to prevent over interpretation and misuse of this valuable information.

It is important for everyone to educate themselves on these topics. Two authoritative resources include the Personal Genome Project and the Personalized Medicine Coalition.

The cost to sequence a full human genome is falling like a rock. Estimates suggest that it could be less than $1,000 by the end of this year. What’s more, our ability to analyse the terabyte of data generated by sequencing one genome is also improving. This is a very rapidly evolving field of medicine not only for scientists, researchers, and clinicians but also for investors as dozens of big data start ups and a torrent of venture capital money is pouring into the hot new genome interpretation space. Let us not sit back but remain informed and take proactive steps to lifelong health and wellness.

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Cartilage regeneration: Bringing in a new revolution Dr Sumit Singh Khurana, Assistant Consultant – Orthopaedics, Indian Spinal Injuries Centre elaborates on cartilage regeneration, its benefits, and the various methods adopted to get it done f you suffer from knee pain, you’re not alone. Each year, more than 12 million people visit their doctors because of knee pain — half of them with damage to cartilage, called articular cartilage. Most of these people have had to live with joint pain and physical limitations. But thanks to new medical advances in cartilage repair, that time has passed. Today, innovative and exciting new developments are revolutionising orthopaedic surgery, enabling surgeons to repair, regenerate or replace cartilage without resorting to the use of artificial joints.

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What is articular cartilage?

Articular cartilage is a firm, rubbery material that covers the ends of bones in the knee joint. It reduces friction in the joint and acts as a ‘shock absorber.’

When cartilage becomes damaged or deteriorates, it limits the knee’s normal movement and can cause significant pain. If damaged cartilage is not treated, it can worsen and eventually require knee replacement surgery.

Why does the cartilage not heal by itself?

Cartilage is unable to heal itself as it is avascular and gets its nutrition from the joint fluid itself. Hence, any damage to the articular cartilage is permanent and leads to pain and stiffness.

What are the benefits of cartilage restoration ?

Benefits of cartilage restoration include: ● Pain relief without the placement of artificial substances in the body; ● Preventing the onset of arthritis; ● Re-established performance to preinjury levels; ● Slowed progression of cartilage damage; and ● Delayed need for joint replacement surgery

How can articular cartilage be restored?

For years, the concept of harvesting stem cells and re-implanting them into one's own body to regenerate organs and tissues has been embraced and researched in animal models. Similar techniques using autologous cultured mesenchymal stem cells have now shown successful cartilage growth in human knees. Advantage to this approach is that a person's own stem cells are used, avoiding transmission of genetic diseases.

What are the new techniques available today?

Microfracture: This procedure is performed arthroscopically. During microfracture, small holes are created in the knee bone. The surface layer of the bone is hard and lacks good blood flow. Creating holes in the bone allows bleeding. Blood contains bone marrow cells that stimulate cartilage growth

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and form fibrocartilage, which covers the injured area.

Osteochondral autograft (OATS): In this technique the surgeon transplant sections of bone and cartilage.

First, the damaged section of bone and cartilage is removed from the joint.

Then a new healthy dowel of bone with its cartilage covering is removed from the same joint and transplanted or grafted into the hole left from removing the old damaged bone and cartilage.

The healthy bone and cartilage are taken from areas of low stress in the joint so as to prevent weakening the joint.

Mosaicplasty: Depending on the severity and overall size of the damage multiple plugs or dowels may be required to adequately repair the joint.

Each plug is a few millimeters in diameter. When multiple plugs are moved to the damaged area, it creates a mosaic appearance.

Autologous Chondrocyte Transplantation (ACI): This is a twostep procedure. First, healthy cartilage cells are arthroscopically removed from a non-weight bearing area of the knee.

The cells are then grown in the laboratory for around six to eight weeks. An open surgical procedure, called an arthrotomy, is then done to implant the newly grown cells. The newly grown

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cells are injected into the defect and held in place by a gel based scaffold or using a periosteal patch.

ACI is most often recommended for younger patients who have single defects larger than 2 cm in diameter.

ACI uses a patient’s own cells, so there is no danger of a patient rejecting the tissue.

How are these procedures done?

Most of these procedures are done by arthroscopy (camera surgery). In some cases a mini-arthrotomy (small opening of the joint) may be required.

What are the results?

Long-term results have shown the regeneration of new healthy and viable cartilage which is capable of normal function.

JUNE 2013

K|N|O|W|L|E|D|G|E INSIGHT

Prostatic disorders: Awareness for cure Dr NK Mohanty, Director, Urology Sciences, Saket City Hospital, talks about various diagnostic measures to treat prostate cancer

DR N K MOHANTY

Director, Urology Sciences, Saket City Hospital

Introduction: Lower urinary tract symptoms (LUTS) are common in men, affecting up to 78 per cent of the elderly population. The most common LUTS are urinary frequency, urgency, hesitancy, weak stream and nocturia. The increase in the prevalence of LUTS with advancement of age is an accepted fact. The prevalence of LUTS was lowest in France (14 per cent) and Scotland (18 per cent) and highest in the US (38 per cent) and Japan (46 per cent). The preliminary data reported in one Indian study indicate that LUTS, due to specific diseases in Indian male population, is around 36 per cent (480 out of 1329).

About 14 per cent of the total subjects had benign prostatic hyperplasia (BPH).

Anatomy of the prostate gland The prostate is a gland about the size of a walnut that is only present in men. It is located just below the bladder neck and surrounds the proximal part of urethra, the tube through which urine flows from the bladder and out through the penis.

BPH: Pathophysiology A man's prostate gland usually starts enlarging after 40 years of age. This condition is called benign prostatic enlargement (BPE). As the prostate gland enlarges, the urethra is pinched tighter and tighter within the prostate. As the tube narrows, urine has a much harder time making its way through the urethra and out of the body. This results in obstructive and irritative LUTS.

Kidney

Ureter

Bladder Prostate

Urethra

Prostate Gland and Surrounding Structures retention can result, causing severe pain and discomfort.

Catheterisation may be necessary to drain urine from the bladder to obtain immediate relief.

Diagnosis Various methods are used to diagnose problems in the prostate. Some of them are: ● Digital rectal examination (DRE) ● Prostate specific antigen (PSA ) test ● Uroflowmetry test ● Post-void residual (PVR) ● Urodynamic study (UDM)

Treatment for enlarged prostate (BPH) ●

Symptoms and signs Many men with an enlarged prostate have no symptoms. Common symptoms may include: ● Frequency ● Urgency ● Urge incontinence ● Nocturia ● Poor flow of urine ● Hesitancy ● Intermittency ● Sense of incomplete void ● Blood in the urine dribbling after voiding. ● Leakage of urine ● Pushing or straining to begin urination In severe cases of BPH, another symptom i.e. acute urinary retention (inability to urinate) or chronic urinary JUNE 2013

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Self-care and precautions at home: Some precautions can help to avoid worsening of symptoms caused by prostate enlargement and complications till you see the urologist. Do not delay to urinate once you experience an urge. Urinate as soon as you feel the urge, and empty the bladder completely. Avoid alcohol and caffeine, especially after dinner. Don't drink a lot of fluid all at once.

Avoid drinking fluids within two hours of bedtime. Cold weather and lack of physical activity may worsen symptoms.

Medical (non-surgical)

treatment of BPH are: 1.alpha-blockers 2.5-alpha-reductase inhibitors ● Surgical treatment for BPH: Generally, surgery is considered for men who don't get relief from symptoms using drug treatments or have absolute indications of surgery ie. hematuria, recurrent urinary retention, bladder stone, recurrent uinary tract infection (UTI) etc. The surgical treatment techniques include: 1. Transurethral resection of the prostate (TURP, Mono-polar) is traditionally the most common endoscopic operation for BPH. But with advent of newer technologies, it is done far less frequently because of its limitation of use up to only 70 to 80 gms of gland and associated multiple serious complications like fluid overload, electrolyte disbalance, TUR syndrome and need for long time catheterisation (3-5 days).

2. Transurethral resection in saline (TURIS) with the BIPOLAR technology is the latest alternative to TURP. It is safe, effective and quick with comparable results to all other techniques used to treat

LUTS, due to specific diseases in Indian male population, is around 36 per cent (480 out of 1329) www.expresshealthcare.in

BPH. In this technique, normal saline is used instead of distilled water to prevent electrolyte disbalance and TUR syndrome. Its faster technology makes it applicable to larger glands and for the patients with multiple comorbidities and on antiplatelets.

3. HoLEP is holmium laser enucleation of prostate where prostatic lobes are first enucleated with laser fibre and then the lobes are removed piecemeal with the help of morcellator.

4. KTP green-light laser prostatectomy is an upcoming laser technique which has an advantage over HoLEP and all other techniques that can be used safely to treat patients with cardio-vascular co-morbidities and on antiplatelets.

5. Open prostatectomy is only rarely recommended now for men whose prostate is very large and bipolar or laser technology is not available.

Other benign prostate conditions Prostatitis: Prostatitis is an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. The term prostatitis is defined as microscopic inflammation of the tissue of the prostate gland, which spans a broad range of clinical conditions. Prostatitis most commonly affects men in their 30's and 40's, but can also affect men of an older age. About 40 per cent of men will suffer from some sort of prostatitis at some time in their life.

Management Treatment of prostatitis can be done with long-term antibiotics, alfa blockers, and anti-inflammatory medications.

Prostate cancer: Magnitude of the problem in India Incidence rates show that prostate cancer is the fifth most common malignancy worldwide and the second most common in men (Parkin et al, 2005). Prostate cancer makes up 11.7 per cent of new cancer cases overall, 19 per cent in the developed countries, and 5.3 per cent in the developing EXPRESS HEALTHCARE

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countries. However, the actual number could be much more as it is reported far less frequently in developing countries, secondary to poor data recording system and patient’s inaccessibility to a healthcare system. According to a recent study, Asian Indians have a greater tendency for higher Gleason scores (seven or more) in both the pre-operative prostate biopsy and final histopathological analysis and a significantly higher incidence of extra prostatic extension was found in Asian-Indians versus Caucasians (32.3 per cent versus 16.5 per cent, respectively). Another study regard-

ing prostate cancer in AsianIndians suggests that the incidence in five major Indian cities including Delhi appears to be rising.

Causes of prostate cancer The specific causes of prostate cancer remain unknown. The primary risk factors are age and family history. Men who have first-degree family members with prostate cancer appear to have double the risk of getting the disease compared to men without prostate cancer in the family. This risk appears to be greater for men with an affected brother than those with an affected father.

Symptoms of prostate cancer Patient may present with LUTS as found in BPH. Depending on the growth of the malignancy and its local spread, it may cause irritative and obstructive LUTS. Other less common symptoms are: ● Blood in the urine ● Blood in the semen ● New-onset erectile dysfunction (impotence) ● Bone pain (especially in the lower back, hips, or ribs) in cases of metastasis

Diagnosis of prostate cancer Following tests are done to diagnose prostate cancer: ● Digital rectal exam (DRE) ● Prostate specific antigen (PSA) ● Abdominal ultrasound ● Transrectal ultrasound and prostate biopsy ● MRI and CT scan – for staging of cancer ● Bone scan

Management of prostate cancer Management of the disease depends upon the stage of the disease atwhich patient presents to the urologist.

Prostate cancer staging Staging is a method to describe how advanced a cancer is. Prostate cancer staging is done in the following ways: ● Stage I (or A): The cancer cannot be felt on a digital rectal exam, and there is no evidence that it has spread outside the prostate. ● Stage II (or B): The tumour is larger than a stage I and can be felt on a digital rectal exam.

There is no evidence that the cancer has spread outside the prostate. ● Stage III (or C): The cancer has invaded other tissues neighbouring the prostate ● Stage IV (or D): The cancer has spread to lymph nodes or to other organs Stage 1 and 2 prostate cancer (organ confined prostate cancer) can be treated with curative intent by the following methods: ● Open radical prostatectomy ● Laparoscopic radical prosatatectomy (LRP) and lap assisted robotic radical prostatectomy (LRRP) ● Radiation therapy for localised prostate cancer ● High intensity focused ultrasound (HIFU) Stage 3 or more (advanced prostate cancer) cannot be cured. Progression of the disease is inevitable but treatment is available to slow its progression and to alleviate the symptoms.

Treatment of hormone sensitive prostate cancer ● ● ● ● ●

Hormone therapy Medical castration LHRH analogues GnRH analogues Surgical castration (Orchiectomy)

Treatment of castration resistant prostate cancer ●

Chemotherapy: First line and second line chemotherapy

Treatment of metastatic CRPC ● ●

Immunotherapy Palliative therapy for bone pain and other symptoms

Conclusion With better understanding of the disease, the survival of patients has increased significantly over the last few decades due to early detection and improved therapy.

Improved socioeconomic status and better access to health care has also played a major role in countries like India.

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‘Such a study may provide robust genomic markers for risk prediction, disease progression’ Dr Ranjit Roy Chaudhary, CHAIRMAN- TASK FORCE FOR RESEARCH, APOLLO HOSPITALS EDUCATIONAL AND RESEARCH FOUNDATION (AHERF)

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n a major research project, Apollo Hospitals Educational and research Foundation (AHERF) has found out that there is possibility of a connection between the risk factors for coronary diseases and the human genes among Indians. Dr Ranjit Roy Chaudhary, Chairman-Task Force for Research, AHERF gives an understanding of the study conducted and its benefits, in an interaction with Raelene Kambli

What are the genetic factors responsible for increasing incidence of myocardial infarction (MI)?

Cardiovascular diseases (CVD) have a complex, multifactorial aetiology and the presence of 'metabolic syndrome' (MS) more than doubles the risk of CVDs. The features of MS include an abnormal lipid profile, high blood pressure, presence of diabetes and other features that increase the chance of blood clotting or inflammation. Many of the features of the MS, such as diabetes and lipid abnormalities themselves have a strong genetic component.

What was the rationale behind this study?

The rationale was to find out why Indians are more susceptible for CVDs at a younger age. No study in India has been conducted to measure a whole genome sequel in patients. This study, done for the first time in India, aimed to demonstrate if it works. In the recent times, India is witnessing a rapid increase in non-communicable diseases (NCDs) like coronary artery disease, diabetes, hypertension and cancer.This increase in NCDs over the last decade is a matter of great concern.

It is widely accepted that myocardial infarction (MI) occurs a decade earlier in Indians as compared to other ethnicities. Any possible diagnostic tests for predicting susceptibility to CVDs would be very useful in introducing life style changes and enhancing abilities to manage this forthcoming epidemic. Hence, it is difficult to identify the contribution of genetic risk for MI per se, especially for the early events seen in our population.

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To date, seven genome-wide association studies have been conducted in the area of CAD/MI, identifying thirteen genomic regions. Of these, only three studies have been exclusively dedicated to MI. Only one major Asian Indian population cohort study had been conducted in this area.

Therefore in a context where India has become the capital of cardiovascular disease, the assessment of risk for MI is challenging and there is a lack of studies exclusively focused on young Indians.

Hence, the study undertaken

and 52 years respectively for the controls.

All the blood samples from the four centres were sent to Institute for Genomics and Integrative Biology (IGIB), New Delhi, for performing the genomic analysis. Unbiased and agnostic choice of 1.14 million genomic markers was made and DNA sample of each individual was genotyped for these markers in National Institute for Biomedical Genomics (NIBMG) using the Human Omni 1 Quad v1.0 DNA Bead Chip. This was the most complete genome-profiling platform that was avail-

The study involved analysing the 10 genetic markers, showed the highest significant association with MI. These are located on chromosomes 10 (4), 4 (4), 2 and 20 (1 each) and some of these SNPs (markers) are located close to known markers for various CVD risk factors such as obesity

by AHERF has the potential to contribute to answering critical questions which may potentially lead to genomic biomarkers and disease progression enabling new management algorithms.

AHERF used a state-of-theart technology platform, to perform genomic data analysis for detecting genome specific signatures and associations in a small exploratory study. The study involved recruitment of younger patients who are under the age of 50 years at the time of a definite MI event. In order to provide a high contrast and enhance the possibility of finding genes underlying MI susceptibility, control population was chosen from among those who were a decade older, without any history of MI, diabetes or hypertension. Both patients and controls were recruited from Chennai, Delhi, Hyderabad and Ahmedabad. A total of 109 MI patients (92 male) and 101 controls (76 male), fulfilling inclusion and exclusion criteria were recruited for the study.The mean age of the patients was 42.3 for males and 42.6 for females while it was 63 years www.expresshealthcare.in

able at the time of the study. It may be pointed out that IGIB, a CSIR Institution and NIBMG, a DBT Institution, are two of the leading centres for genetic research in the country.

Statistical Quality control analysis performed at NIBMG, revealed exceptionally high quality data. Except for a few number of patients excluded as a result of poor data quality, most markers could be included in the final analysis. Data on 941882 genetic markers on each of 189 individuals (patients and controls) were included for analysis. Although patients/controls were recruited from multiple locations, only three individuals turned out to be genetically variable from the remaining individuals.

This is of importance, as genetic heterogeneity is usually neutralised in a larger population.

However, in a small cohort like the present study, it would compound results. After making all essential adjustments and corrections, 941882 SNPs were analysed in a total of 189 individuals.

How did you conduct this

study? What findings?

were

the

The study involved analysing the 10 genetic markers, showed the highest significant association with MI. These are located on chromosomes 10 (4), 4 (4), 2 and 20 (1 each) and some of these SNPs (markers) are located close to known markers for various CVD risk factors such as obesity.

What was the cost of conducting this study?

This ambitious project was funded internally by Apollo Hospitals and conducted by AHERF over a period of 16 months. Apollo Hospitals spent almost Rs 1.5 crores to fund this project.

How will this study help to control the growing incidence of MI? The encouraging results of this pilot study stimulate us to believe that the genetic factors contributing to the high incidence of MI at a younger age in Indians can be possibly screened out if a large or fullscale prospective study is undertaken. Such a study may also provide robust genomic markers for risk prediction, disease progression etc., which can then lead to development of new management algorithms. Such new management algorithms may lead to preventive healthcare programmes which may help in decreasing the incidence of MI. such study also helps in early diagnosis and preventions.

Will you be presenting this study at any national or international meeting?

There is potential to analyse the available data further and post the same, AHERF alongwith its collaborators may be in a position to decide the next steps.

Are there any specific plans in the pipeline in relation with the study?

AHERF is in the process of looking for potential collaborators who would be interested in conducting a full scale prospective study to assess the feasibility of moving towards biomarker development. raelene.kambli@expressindia.com

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Hospital Infra MAIN STORY

LED lighting for hospitals

M Neelam Kachhap gives an insight into the role of lighting in efficient healthcare delivery and the current trends in hospital lighting

ealthcare delivery in India is becoming increasingly competitive and the designs for modern hospitals are becoming functional. But, the demand to provide a healing environment, both from the patients and the staff, has led professionals to realise that patients' perception of the physical environment in a hospital can affect their sense of well-being and, potentially health.

In fact much research has been done on the subject and experts believe that healthcare facilities’ physical structure is linked to improved care. They also believe that improved patient comfort shortens hospital stays, lessens recovery time, and increases the medical team’s satisfaction and productivity.

Today, designers apply varied methods to create healing environments and a lot of attention is paid to detail, colour, form, light and shade. Some of the key factors such as fresh air, light and peaceful surroundings are design drivers.

Still, green hospital design or creating healing environment are considered a fad. Hospitals needed budgets for investing in costly technology and manpower. Who had the money to spend on design considerations? Think of the electricity bill that a hospital generates every month. It's a huge burden for hospitals and for the environment. Healthcare is considered as one of the most energy intensive industries and hospitals are the sector’s largest energy consumer and producer of greenhouse gases. Industry experts will tell you that the hospital’s reliance on non-renewable energy sources contributes to the emission of greenhouse gases, driving climate change and impacting public health from air pollution.

However, many hospitals are able to lower their carbon footprint and their energy bills by incorporating green hospital designs. While there are many methods and products to confront these issues, use of energy efficient lighting increases sustainability and reduces energy costs.

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rent directly into light, eliminating that waste of energy.

For a long time, people thought LEDs were only for aesthetic use but advances in the field have allowed the use of highefficiency LED lighting for commercial applications. Today, LEDs are the preferred lighting choice at hospitals across the world. “LEDs are totally a hassle free lighting solutions with very robust and durable lighting fixtures,” says Arun Gupta, Global CEO, NTL Lemnis.

Benefits for the hospital LEDs are used in patients’ rooms, waiting area as well as procedure suite as it is using low-maintenance, energy-efficient lighting system. LEDs help to maintain light levels for critical visual tasks like in the OT. “LED produce highly focused and uni-directional light, that means, there is very less light wastage. Focused light is also better in maintaining the required lux levels for specific visual task. The high level of CRI (Colour Rendering Index) shown by LEDs means better observation of colors under artificial light. The frequency spectrum of visible light in LEDs is superior to fluorescent lights,” says Gupta.

“Also, for healthcare sector special LEDs with high R9 can be specified,” he adds.

LEDs are not only energy efficient but they control infections too. “LEDs are the most energy efficient light source till date,” explains Gupta. The energy savings can go up to 90 per cent in case of LED’s as compared with some other conventional light sources. “As far as infection control goes, since the number of times that an LED lighting fixture needs to be changed owing to its longer life, the chances of spreading an infection outside a specific area where the lights are installed is very less. Because of this LED fixtures are more tightly sealed and chances of any suspicious emission are far reduced,” he adds.

Durability and lifespan Light-emitting diodes (LEDs)

LEDs are very durable as they are solid state devices which does not contain moving parts, filaments, or fragile LEDs have been around for a long time. Made up of glass to break, eliminating the risk of damage during transsmall semiconductors, they can be used to produce a lot portation, installation, or operation. of different colours and brightness levels, using fraction of “LEDs are new generation light sources which have a the energy used by traditional lighting methods. technology shift from conventional filament-based light genTraditional lighting technologies such as halogen and eration to solid state light generation. Since LEDs do not have incandescent sources use a fragile metal filament to be a fragile component like a filament, they are more heated until it radiates light, wasting large amounts durable as compared to conventional filament-based of electrical energy through infra red radiation.

White diode light sources,” informs Anil Bhasin, Sr Vice President, LEDs on the other hand converts an electrical cur-

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H|O|S|P|I|T|A|L|I|N|F|R|A Havells India.

“LEDs being solid state lighting have a long rated life of almost 70000 burning hours. However, the actual life span of LED lights depends on the efficiency of the thermal management of the total enclosure, wherein the design capability of the brand becomes important,” he further adds.

“LEDs have a longer life-cycle as compared to conventional lighting solutions. Theoretically they can last up to 50-60k hours, but as of now the industry is assuring life of 20-50k hours. LEDs work on semi conductors and semi conductors generally have an unlimited life.

Moreover, the lighting fixtures that are used by LED lighting solutions are made up of sturdy materials as compared to CFLs and incandescent bulbs, imparting a high resilience and robustness to it,” adds Gupta.

LED as compared to traditional lighting

LED lights bulb

To be able to see how well LEDs function in comparison with the incandescent bulbs the different parameters that need to be considered are: Energy saving: A bulb’s performance is brightness, and this can be measured in lumens (lm) whereas efficiency is sim-

ty they are considered more cost efficient.

“LEDs currently involve a higher capital cost but have a payback period of less than a year, when we compare them with incandescent lamps,” says Bhasin.

“Incandescent bulbs are the least expensive lighting solution available as of now while LED-based lighting is a still high-priced as is the case with every new and revolutionary technology. However, the total cost of ownership for LEDs is lower than incandescent lamps particularly in the view of the ever increasing energy cost. Consumers are yet to understand its benefits and adopt them. In near future, with evolving technology, LEDs will take a major share in the lighting industry, which will help in reducing the lamp cost,” explains Gupta.

Less operations cost for hospitals Healthcare executives today face energy costs that continue to rise, creating very difficult challenges in managing the facility’s operating budget. Lighting contributes to 17 per cent of the total energy consumed at a hospital. By incorporating LEDs this cost can be significantly reduced. “LEDs have a significantly lesser operational cost than other lighting solutions. First of all LED saves tremendously on electricity bills.

Secondly, the maintenance costs are negligible as compared to incandescent and CFLs, hence the cost of getting it replaced over and over again is saved. Therefore, over the long lifespan of the LEDs these all costs are saved, this makes LED a true value for money product,” shares Gupta.

In use at hospitals

ply the amount of energy used for the brightness. It is calculated by dividing the lumen output by the wattage necessary to power the bulb. “Incandescent lamps are filament-based lamps which uses the basic I2R principle of electrical engineering wherein the electrical energy is converted into 85 per cent heat and 15 per cent light. The efficacy of these lamps is close to 10Lm/W. The high amount of heat however puts an indirect load on the air-conditioning plant,” shares Bhasin.

“The LEDs are however solid state light sources with lower amount of heat generation and efficacy as high as 135Lm/W,” he further adds. Agreeing to this Gupta says, “LEDs are the most energy efficient lighting solutions created till date. LEDs are 90 per cent more energy efficient than incandescent lamps and 50 per cent more energy efficient than CFLs.” Lifespan: Lifespan of a bulb is measured in burning hours. “Incandescent bulbs have a life of approx 1,000 hours, CFLs have a life span of around 5000 6,000 hours. LED bulbs can last up to 50,000 – 60,000 hours, but as of now industry is assuring life of 20,000-30,000 hours,” informs Gupta.

Cost: Currently, LED lights cost more than incandescent bulbs and CFLs but due to their longer lifespan and durabiliJUNE 2013

LEDs can be used in various hospital areas but the most important areas to use LED lighting is an MRI room. Lighting in MRI suites is challenging as MRI facilities require non-ferrous lights. Though the tungsten filament of incandescent bulbs is non-ferrous in nature even minute impurities are affected by the high intensity magnetic field of an MRI facility. This results in frequent bulb replacements.

The life of a standard incandescent bulb may be reduced to as low as 700 hours in an MRI suite.

Fluorescent lights can’t be used either because they generate noise artefacts on patient scans. Some imaging facilities experience weekly light outages, which shuts down the MRI suite for maintenance. However, LED lights are MRI safe because they do not use filaments that are affected by magnetic fields, nor do they emit radio frequencies. Additionally, by not having a filament, LED lighting eliminates the potential for white pixel noise, which can be generated when an incandescent bulb's filament is at the point of failure.

“In an MRI centre, it is important to have all the elements to be of non-ferrous nature as the ferrous impurities and components interfere with the operation of MRI equipment. LEDs by nature are nonferrous and hence are easily compatible with the MRI centre of hospitals. Long maintenance free life of LEDs means fewer and shorter downtime period and hence helps in a better utilisation of the MRI facility,” informs Bhasin.

“LED tubes and bulbs are dimmable making them ideal for CT scan and ultrasound rooms where dimming may be needed for better observation and patient

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comfort. “In places like CT scan rooms, where dimming is required, LEDs offer an easy solution,” explains Bhasin.

Further, hallways, corridors and general lighting are switched on 24x7. Using LEDs in these areas would deliver the best returns on investment. “LEDs being a small light source, can easily be used for backlit displays and hence reducing the patient stress considerably. LEDs have long life and hence poses fewer downtime periods in public areas like corridors, OPDs,” Bhasin opines.

OT lighting has been particularly impacted by LEDs. LED bulbs and tubes deliver high quality light but do not generate high temperatures. Removal of heat from surgical lights increases both patient and doctor comfort and reduces air conditioning requirements.

In addition, body tissue can be seen in its natural colours, and there is no risk of drying of tissue. The lights therefore make the surgeons work easier and are safer for the patient. “Another advantage is that instead of a single point light source light is produced by multiple points. This results in fewer shadows and allows the physician to comfortably examine the patient,” says Gupta.

“LEDs have a flicker free, instant start. Hence it is soothing and stress free for the doctors as well as patients,” Bhasin adds.

LED and LEED certification for hospitals Using LED also adds credit points for LEED certification of a hospital. “If a hospital is using LED lighting solutions then the chances of the hospital getting certified by LEED are high, as LEDs have a better (LPD) Light Power Density as compared to other light sources. So, having a better LPD means high credit points in LEED certification system. Also, LEDs cause less light pollution that causes reduced light trespassing onto bordering properties, improved night time visibility through glare reduction, reduced skyglow for increased night sky access and reduced developmental impact on nocturnal environments. All these benefits make LEDs an ideal choice for lighting up a hospital, if it wants to get certified by LEED,” divulges Gupta.

Incidentally, some traditional light fixtures use mercury. Today, mercury in dental fillings has been replaced by better and safer ceramic fillings and mercury containing sphygmomanometers by aneroid devices. Similarly, fluorescent lights could be replaced by LEDs. “LEDs have no mercury content and hence are environmental friendly.” informs Bhasin. “Besides, LEDs help in having better rating of LEED certification and hence becomes a potential source of earning carbon credits,” Bhasin concludes.

Hospitals that invest in LED lights are poised to gain from its various benefits.

In addition, new research in the sector will make these lighting products less costly. In future new research in wireless networking with the help of LEDs will be immensely beneficial to hospitals as the use of radio frequencies in limited there.

Investing in this futuristic lighting technology is a must for hospitals looking for cost advantage and better patient and staff satisfaction. mneelam.kachhap@expressindia.com EXPRESS HEALTHCARE

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‘Emergency department beds, should be five per cent of the total bed capacity of the hospitals’ Dr Paresh Navalkar, HOD-PRE HOSPITAL CARE, ZIQITZA HEALTH CARE LIMITED

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chieving specialised emergency medical services in India is the need of the hour. However, this can be made possible only by creating infrastructure that suits an ideal emergency unit.

Dr Paresh Navalkar, HOD-Pre Hospital Care, Ziqitza Health Care Limited (ZHL) explains to Raelene Kambli the need and pre-requisites for specialised infrastructure for emergency medical services in India

Infrastructure in hospitals has become a major safety concern for public health in India, especially with incidences such as the AMRI fire and the wall collapse in Kasturba Gandhi Hospital that resulted in the loss of many lives.

What should be the infrastructure prerequisites for a hospital emergency unit in order to deal with inhouse tragedies?

Hospitals are mandated to have a ‘Hospital Emergency and Disaster Response Plan' but unfortunately, even if one is prepared, it remains only on paper. But in actuality, training is needed to execute the plan and carrying out an 'Emergency Management Exercise' once a year is absolutely necessary to identify the gaps, review the plan and make necessary changes to it. The plan is dynamic and prepared for the existing infrastructure, manpower, patient needs and in alignment with the disaster plan of the local authorities. During exercises, structural and processes weaknesses come to fore and get focused attention. This, in turn, helps to take corrective measures in

order to prevent impending disasters within the hospitals.

Describe an ideal emergency unit. What are the basic infrastructure requirements for the same?

Emergency department beds, going by the thumb rule, should be five per cent of the total bed capacity of the hospitals with a capacity to handle a surge in cases of mass casualty incidents or disasters. It should have a dedicated area for triage and decontamination. There should be demarcated beds for each triage priority with all the necessary equipment dedicatedly provided alongwith a fully equipped resuscitation area, nursing station, stores, doctors' consulting room, documentation counter and waiting area for relatives.

What are the aspects that are needed to be considered while designing an emergency unit within emergency medical vans?

Emergency ambulances are of two types – basic and advanced. They should have sufficient space within them to permit emergency technicians (EMTs) to work on the patient.The design of the interior and placement of equipment should be at an arm's length from the head of the

patient, where the EMT sits.

The equipment should be kept in standardised locations across the fleet for smooth functioning. The labelling of the drawers and containers is a must. Infection control systems and biomedical waste storage facility should be on board.

A basic ambulance should have oxygen delivery systems, suction device, spine boards, scoop stretchers, adjustable patient trolley with restrains, devices for monitoring patients' baseline vitals, bandaging, splinting, resuscitation kit (adult and infant), AED, laryngeal tube, delivery kits, nubuliser, glucometer, medications- adrenaline, salbutamol respules and first aid kit.

An advanced ambulance, over and above the equipment should have a defibrillator, transport ventilator, advance airway management devices and medication for use under online medical guidance (as per the approved systems).

Tell us about your experience of setting up EMS units in various states within the country. What were the infrastructural challenges that you faced during the endeavour?

Each state has a different requirement depending on its needs. So in order to cater to those needs, we create client

The challenge is not in creating infrastructure but in getting the right manpower to work on the ambulance and their training

specific infrastructure and SOPs. The challenge is not in creating infrastructure but in getting the right manpower to work on the ambulance and their training since till date we do not have a trained EMTs pool.

Are there any kind of guidelines that you follow while establishing an EMS unit?

The best practises that are followed in the developed countries like the UK, the US are adopted. As we are supported by the London Ambulance Service and our partners are the US’s largest ambulance providers we have in-house access to the world’s best practises and processes.

We adopt them, but after amending them to suit Indian conditions and available infrastructure.

How can we build better infrastructure for emergency medical services in India? What is the need of the hour?

To build EMS systems, the ambulance structure, design and certification of equipment should be standardised at the national level by taking inputs from EMS system operators.

National EMS councils should be established to facilitate this process and to review it from time to time. Similarly, state EMS councils are a necessity to oversee, regulate and develop the EMS systems. National registry of EMTs has to be maintained.

The Emergency Medical Technician Course's content for basic and advanced EMS programme which has been approved by the Society of Emergency Medicine should be adopted as the National Standard Curriculum. This will ensure high quality of training and uniform assessment of the paramedics.

Standardised training modules for drivers, with higher emphasis on safe driving, need to be adopted. They too have to be trained in first aid.

EMT-B and paramedics should be recognised as allied healthcare professionals to attract talent in this sector and develop jobs and growth prospects. raelene.kambli@expressindia.com

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Radiology RADIOLOGY HIGHLIGHTS

Maharashtra govt in a PPP with GE Technology and Ensocare 22 district hospitals to be equipped with advanced diagnostic imaging facilities at an investment of Rs 150 crores n a bid to elevate the healthcare system within the state of Maharashtra, the Government of Maharashtra has entered into a PPP with General Electric (GE), and Ensocare. The partnership, in which GE will act as the technology partner and Ensocare as the operating partner, aims at bringing technology at an affordable price point for the people of the state. GE has invested around Rs 150 crore in this project.

“I am indeed very happy to witness the launch of this new initiative in healthcare, particularly in the diagnostic segment which has fortified today. The idea behind this was to call the private sector to provide the initial investment and the government would provide infrastructure support in order to make diagnostic imaging services available to thousands of people within Maharashtra.

The aim is to increase the volume of patients who would seek these services which in turn will drive down the price of diagnostic imaging,” expressed Maharashtra CM, Prithviraj Chavan, while announcing the launch.

According to the Government, this PPP agreement is the largest in terms of scale and includes the installation of four units of

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64 slice CT scanners, 13 units of advance 16 slice CT scanners, eight units of cutting edge 1.5T magnetic resonance imaging systems, 22 high end digital radiography systems, 39 colour Doppler’s and 39 analog X-ray units.

These will be installed at 22 district hospitals initially.

These imaging systems will reportedly allow the district hospitals to provide early and accurate diagnosis on a 24x7 basis in clinical speciality areas. It will provide services at government recommended rate cards for the benefit of a broader population. Orange and Yellow ‘Below Poverty Line’ (BPL) card holders will be entitled to receive free diagnostic services under the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) scheme at all 22 facilities which are expected to be operational within a year.

Adding to this, Fauzia Khan, State Minister for health, Government of Maharashtra said, “Technology has been brought to the level of district hospitals to provide better healthcare to the people of the state. Maharashtra has been taking various steps to uplift the current healthcare system, especially in the last three to four years we have been able to make a transparent and effective health-

care system with the help of various schemes introduced.

This is yet another milestone achieved in this regard.

Explaining the effort taken in this sphere and the idea behind this PPP model, Suresh Shetty, Minister of Health and Family Welfare, Government of Maharashtra, informed, “We started working on this project in June 2011 and the MOU with GE was signed in December 2012. Taking this partnership forward, today we are launching the first diagnostic centre in Maharashtra. The diagnostic centres will be soon functional after we provide power supply to GE.” Moving forward, Terri Bresenham, MD, Wipro GE Healthcare and President & CEO of GE Healthcare South Asia explained GE's role in this partnership. She said, “We have found PPP a proven and effective way of improving quality healthcare access to more people around the world. GE has successfully participated in several projects targetted at addressing problems faced by public hospitals. These include the need for capital investment for equipment, a shortage of trained manpower, the efficient running of facilities, timely maintenance of equipment and at the same time meeting the Government’s commitment

in providing affordable healthcare to all. It is GE's pleasure to power this partnership. Maharashtra has been a very progressive state in terms of thinking innovative strategies.”

Commenting on the new partnership and few plans, John Rice, Vice Chairman, GE said “This partnership is one step towards our commitment of being the best global player catering to the needs of several people. We assure that we will make this partnership a success.

We are looking for more opportunities like these and will continue to invest in technology and capabilities which allow the dreams of this great country to be realised. We are delighted to playing our part towards a healthier India and in helping to bridge the healthcare disparity.”

This tri-party partnership, if made successful, will benefit many people within Maharashtra, especially those living below the poverty line. The partnership will provide services at a cost which will reportedly be almost 50 per cent less of the market price, informed a GE resource. Further in the pipeline is a major project for emergency services within the state.

EH News Bureau

HTIC-Forus collaboration delivers affordable and accessible eye-care Develop a custom image computing solution for 3nethra-based on HTIC’s Eye-PAC technology ealthcare Technology Innovation Centre (HTIC) of IIT Madras has created Eye-PAC, a computing technology for extracting information from eye images. Eye-PAC technology can reportedly be deployed to create screening and diagnostic solu-

H

JUNE 2013

tions for a range of vision-threatening diseases, such as diabetic retinopathy, glaucoma, and agerelated macular degeneration.

Forus Health, an Indian med-tech company has indigenously built 3nethra, a revolutionary ophthalmic

imaging system. HTIC collaborated with Forus to develop a custom image computing solution for 3nethra based on HTIC’s Eye-PAC technology.

This custom solution enhances visual appearance of eye images pro-

www.expresshealthcare.in

duced by 3nethra and locates disease signs that may lead to vision loss at a very early stage.

Dr Shyam Vasudevarao, President and Chief Technology Officer of Forus Health said, “Translational R&D undertaken by EXPRESS HEALTHCARE

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R|A|D|I|O|L|O|G|Y HTIC accelerated product development at Forus, adding great value and synergy to us.”

Eye-PAC technology’s intelligence in extracting clinically important information enables screening for eye diseases even when an expert is not available. Those who are tested positive during screening can later be sent to an expert for referral and diagnosis. This capabili-

This custom solution locates disease signs that may lead to vision loss at a very early stage ty of Eye-PAC combined with 3nethra’s ability to perform eye-examination without dilatation (which saves time for patient and operating personnel) is expected to be instrumental in enabling affordable and large scale

screening.

K Chandrasekhar, Founder & CEO of Forus Health informed, “Powered

by HTIC’s Eye-PAC technology, 3nethra has now reached over 140 installations across 10 countries, namely India,

China, France, Thailand, Guatemala, Sri Lanka, Nepal, Oman, Mauritius, and Somalia.”

Dr Mohanasankar, IIT Madras faculty, who heads HTIC said, “Joining hands with Forus provided HTIC team an excellent platform to realise our vision of benefitting society, while adding value to our industry collaborator.”

EH News Bureau

Fujifilm's Amulet at Mahajan Imaging Centre Touted as one of India’s first full field digital mammography with 50 micron resolution, it reportedly offers enhanced visualisation of the breast and more accurate diagnosis ujifilm has installed 'Amulet' a low dose 50micron full field digital mammography system with computer-aided diagnostics (CAD) system, at Mahajan Imaging Centre, New Delhi, to help doctors detect breast cancer early. The Amulet was launched at a summit on ‘Advances in Medical Technology in the Fight against Breast Cancer’ organised by Fujifilm and Mahajan Imaging.

Chander Shekhar Sibal, EVP, Medical Division informed, "Amulet, derived from the Latin word 'amuletum' means an object that protects a person from troubles, brings good luck and fortune".

Amulet, at Mahajan Imaging is reportedly India’s first full field digital mammography with 50 micron resolution, equipped with Fujifilm's direct conversion flat panel detector (FPD) technology.

This apparently enhances visualisation of the breast and offers greater details of abnormal areas such as micro classifications and tumours, thus helping more accurate diagnosis. The ergonomic design of the system provides comfort for women.

“We have seen a sea change in mammography technology over the last couple of decades, it started with screen-film mammography and gradually moved to CR based mammography, which is still the most popular form of mammography in India today,” said Dr Harsh Mahajan, Founder of Mahajan Imaging Centre and honorary radiologist to the

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President of India.

“Today, with the 50 micron resolution of the Amulet, full field digital mammography system, we have the capability to see the breasts with much more clarity than ever before. The computer aided diagnostics system installed with the www.expresshealthcare.in

machine helps direct the radiologist in the direction of lesions that would normally not be seen by the naked human eye,” he added.

According to Dr Mahajan, the new breast cancer detecting machine is the first of its kind in India and is one of the most advanced mam-

mography systems in the world. It uses artificial intelligence algorithms to assist the radiologists in detecting abnormalities that would not normally be seen by the naked human eye. There is not much difference in the cost of mammography using Amulet and it will continue to cost around Rs 3,000 per person.

Dr Urvashi Prasad Jha, Senior Gynaecologist, Laparoscopic and Cancer Surgeon, Fortis Group of Hospitals, talked about her own battle against breast cancer — from diagnosis to treatment and coming back to work. She said, “I got my own scan done majorly out of curiosity. I never thought it could happen to me. I was lucky, we caught it in the early stages and I could successfully fight it off. My message to all women out there would be to not ignore their health.”

Speaking at the summit Dr Ashok Vaid, Chairman, Department of Medical Oncology at Medanta Medicity Hospital said, “One of the biggest advantages of detecting breast cancer in its early stages is that it can be treated much more easily, and the treatment outcomes are also much better.”

Sushma Swaraj, Leader of the Opposition, Lok Sabha said, “There should be a study to find out why cancer cases have become so common in India— is it because the increased use of pesticides, the increasing use of devices emitting radiation, etc., – so that preventive measures could be taken.”

EH News Bureau JUNE 2013

MAIN STORY

Hanging out at hospitals

Shri Gangaram Hosptial, Delhi

Hospital lounge is not intimidating anymore, thanks to cafes and bakeries, providing comfort and food in an inviting ambiance enhancing customer experience and emerging as major brand differentiators for the hospital, says M Neelam Kachhap JUNE 2013

t's no secret that hospitals are booming in India. The Indian healthcare industry was $65 billion during 2011-12 and is expected to reach $280 billion by 2020. Increase in patient population, increasing lifestyle-related health issues, awareness of preventive healthcare disorders, improving health insurance penetration, government initiatives and focus on public private partnership (PPP) models and large investments by private players are some of the reasons for this growth. This tremendous business growth has also drawn some unconventional partners to associate with

I

hospitals. Food retail is one such sector which sees immense opportunity in this setting.

usually found waiting at hospitals and thus the need for continuous refreshments,” he adds.

The sector

Lucrative location

The food service and catering market was estimated to be worth Rs 90,825 crore in 2009-10 of which the organised retail market stood at 10.7 per cent or Rs 9,737 crores. Food retail has about 15 per cent of its business coming from hospitals. “At hospitals there is a need for quality, hygienic food and beverages,” says K Ramakrishnan, President Marketing, Café Coffee Day. “There is always a significant number of people who are

It’s known that location is a major factor leading to a retailer’s success or failure. A good location may let a retailer succeed even if its strategy mix is mediocre. Hospitals are considered a good location for retail business. A hospital gift shop may do well, although its assortment is limited, prices are high and it does not advertise.

Today, a 300-bed multi-speciality hospital may get a foot fall of 300-500 people every day. These would largely

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Au Bon Pain, HCG Hospital, Bangalore comprise patients and attendants and people who may be students, business associates, axillary workers etc. “Large hospitals may get almost 1,000-1,500 outpatients per day, a multi-speciality hospital may get about 300 outpatients a day and smaller ones can pull a crowd of about 100 people a day,” explains Mudit Mathur, COO, HCG Global, Bangalore.

Changing tastes ‘Food on the move’ is the new mantra of the consumers. Besides hospitals have become hot waiting zones where people spend a long hours waiting for consultations, diagnostics, etc.

Day surgeries and process also account for this trend. Interestingly, people are willing to spend money to drink a cup of coffee or tea in comfort. While the cafes provide customers with an option to relax and drink coffee, other formats caters to the hunger needs of consumers on the move or those wanting to take a short snack break. “The kiosk system is a hugely successful takeaway concept and provides fast, healthy, convenientto-eat food and beverages offerings at great prices,” says Ramakrishnan.

Serving cafes Many F&B companies in India have already stepped into this sector. Cafe Coffee Day and Au Bon Pain have already made a mark in this segment, with a large number of small brands also dotting the arena. Others like Tata Starbucks and Barista are still contemplating their entry move. The maximum share, however, belongs to the unorganised food retailers with individual setups at single hospitals run by local catering channels.

Today, Cafe Coffee Day has the largest number of set-ups in hospitals in India. One of the biggest F&B company in India CCD was an early entrant and has definitely got the early advantage.

“Coffee Day Xpress (CDX) is present in

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almost 100 hospitals across the country, which is about 11 per cent of its outlet base. CCD is present in 19 hospitals,” informs Ramakrishnan.

Au Bon Pain has one outlet at Cradle, a maternity hospital and another in HCG a cancer tertiary care hospitals in Bangalore. The bakery chain has outlets in 60 hospitals in the US and 10 hospitals in Bangkok and is now looking at West Asia and India as potential growth markets for this format.

Tata Starbucks is the youngest company on the block and is also aware of the opportunities in the segment.

“Globally, Starbucks has a strong footprint in this segment,” said Avani Saglani Davda, CEO, Tata Starbucks.

Win-win for both Having a food retail set-up not only brings profit to the F&B company, but is also beneficial for a hospital. “Whether it’s a CCD cafe or the CDX, Coffee Day has been extremely successful at hospitals,” shares Ramakrishnan. “The potential for growth is excellent and we are looking at expanding in this sector,” he adds In addition to providing a unique, experience to the patient it also obviates the necessity of the worried attendant and patients to look for hygienic, adequate food. In some instances the F&B company also shares profits and pays rent to the hospital. However, the hospitals say that this is not the core focus of the hospital and these set-ups are not for profits. “Our core focus is to provide world class healthcare facility,” observes Mathur. “F&B set-up is a value add for patients,” he adds.

He further says that today patient comes in with a wider exposure and demands likeable food. They are also aware of what they can or cannot eat and have an enhanced pallet. Then there are international patients and attendants who are not familiar with local food and would be comfortable

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with a menu closer to their pallets. “F&B setups are plug-n-play solutions, that provide good ambiance and cater to the customer in a wholesome manner.

There is a comfort factor, and they have become an integral part of hospitals and a differentiating factor for brand,” Mudit explains.

Looking ahead With an increasing number of large and medium hospitals on the horizon, this business opportunity for food retailers will never die down. “Cafe Coffee Day has a variety of café formats which makes it possible for us to cater to different hospital requirements,” informs Ramakrishnan. “The plan now is to launch more cafes and kiosks in such locations. Due to the growing need for quality and hygienic F&B services at hospitals to cater to the number of people visiting and waiting at hospitals, it is a good business model and has shown significant growth both in terms of revenue and new launches.” he adds.

The company is looking forward to better connect with their consumers and grow along with the trend. “We are already associated with several big hospital chains in India. We expect to grow along with this trend and foresee a huge opportunity not just in terms of business but also in terms of consumer connect,” he further says.

Tata Starbucks is also planning to build a strong presence in the segment.

“Tata Starbucks is committed to India for the long term and focused on working thoughtfully to build a strong presence in the market,” said Davda. “We are committed to providing our customers here a high quality coffee house experience which may take on varying store formats depending on customer and neighbourhood requirements. We will explore the opportunity that this segment presents in India at an appropriate time,” Davda concluded. mneelam.kachhap@expressindia.com JUNE 2013

L|I|F|E INSIGHT

PR insights: Better communication for better results Eden Menon, General Manager,William Mills Agency, India gives insights on communication’s role in enhancing the image of a healthcare set up ne of the most effective ways for the hospitals to build its reputation in the community, win patients’ trust and strengthen the relationships in the healthcare industry is to focus on its communication efforts. Many organisations value the strength of communication but end up with a series of disconnected communications tactics, which fail to achieve any significant objectives. By taking a little time to tighten the focus of public relation efforts, a hospital can better synchronise its communication tools and accomplish major strategic goals.

O

EDEN MENON

General Manager William Mills Agency, India

Identify your target audiences The first way to tighten the focus of a communication programme or PR initiative is to take a hard look at whom the hospital seeks to reach through the programme. Few examples of target audiences include patients, doctors, community (NGOs), vendors, etc.

Oddly enough, many hospitals have not taken this crucial step, causing communications efforts to be less effective and more costly.

The list of target audiences often evolves over time and needs to be reviewed and updated on a regular basis depending on the medical conditions, modified organisational goals or changing demographics in the area served by the hospitals and other factors.

Each communications tool (as listed below) should be geared to one or more of these audiences. A common mistake many hospitals make is to distribute information that is not aimed at any of their target audiences. These hospitals find themselves without any valuable results from their public relations programme.

Formally identifying and gaining a better understanding about the needs of each target audience is the best way to fix this problem and improve the way the public relations programme delivers focused and more effective messaging.

JUNE 2013

By taking a little time to tighten the focus of public relation efforts, a hospital can better synchronise its communication tools and accomplish major strategic goals Define your patient benefits Another communication issue challenging the healthcare industry is that they do not define the benefits they provide their patients.

Be aware that offering patients ‘superior service’ may seem to be a perfect example of a key benefit; however, target audiences are increasingly disdainful or suspicious of such claims.

One reason for this is because too many other hospitals label themselves as providers of ‘superior services’, making it harder for people to determine which of these claims is actually true.

If you are trying to promote your hospital’s superior service, be sure to have data that can back up your claim. Solid examples would be, recognition within the industry or a superior service award.

Develop key message points A third way to more tightly focus a communication plan is to evaluate the hospitals key message points, which are derived from the list of patient benefits, successful surgeries, contribution to the society, new technology in treatment etc. Many hospitals either do not have key message points or have not updated them.

This causes the concerns to try to promote it using faulty or dated messages that are often ineffective.

Important features of good message points are that they are simple enough to avoid being misunderstood but still powerful enough to make the point, and they include searchable terms in order to boost search engine optimisation too.

These message points www.expresshealthcare.in

should also include perspectives from front-line staff working directly with the patients. Do not assume an entry-level staff member or member of middle management has nothing to contribute to the company’s public relations efforts.

Proper use of communications tools to reach target audiences The fourth way to enhance the focus of a public relations programme is to properly use each communications tool to achieve maximum impact. Often, these tools are not fully understood and their misuse causes many organisations to fail to achieve the communications success they strive for.

Each communications tool should be geared towards one or more of the target audiences and include relevant message points.

Carefully scheduling the use of each of the tools helps coordinate a communications effort and increases the strategic impact of the public relations programme.

The most common public relations tools and the ways to deploy them include: News releases: Background information prepared by the hospital and sent directly to the media: ● Offer details about newsworthy events such as milestones, successful surgeries, new packages, recruitment of a famous doctors, free health check up camps and services or public recognition like awards etc. ● The frequency of releases depends on the size of the hospital. While larger hospitals might send out one each month, smaller hospitals and specialised clinics can send one

every quarter The information/release should also be posted on the hospitals website.

Feature stories: Articles about the hospitals or its successful treatments: ● Stories can be generated about a specific successful case handled by the hospital ● The hospital’s contribution toward the society/ charitable initiatives etc ● One-to-one interviews should be scheduled with a company executive or a successful doctor when there is something important for them to share with the media Organisations’ website: Acts as a platform for hosting releases and other news about the hospital.

Additional elements to include on the website are: ● Contact information for the company’s public relations executive/ media agency ● Media section which includes the articles about the company published in the media ● Online media kit, which includes an overview, fact sheet, executive biographies and graphics such as a logo ● A satisfied patient’s feedback can work wonders for hospitals reputation.

Hence, every hospital must have a patient’s feedback section in their website Social media: This is the latest and one of the most effective communication tools for any organisation.

Through a social media presence the hospital can actually communicate its information without any extra cost.

Hospitals in India continue to find themselves in an increasingly competitive landscape and a more focused public relations effort is one way to give them an edge. By avoiding some of the most common mistakes and following some basic communications tips, hospitals can improve the way they reach their target audiences and be more successful at growing and serving their patients. ●

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People Prof Dr S Natarajan receives Padmashri He is one of the founding members of the Vitreo Retinal Society of India (VRSI)

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rof Dr S Natarajan, Executive Chairman & MD, Aditya Jyot Eye Hospital has been recently conferred with the prestigious Padmashri from the Governor of Maharashtra at Darbar Hall, Raj Bhavan, Mumbai. He received the award for his skills in Vitreoretinal (VR) surgery in India. Team Aditya Jyot under the guidance of Dr Natarajan has completed around 27,000 surgeries till date.

This third generation ophthalmologist did his MBBS from Chennai. In 1982 he completed his post graduation in ophthalmology from Chennai and was trained as a Vitreo Retinal Surgeon, under Dr SS Badrinath, at Sankara Nethralaya, Chennai. In 1988 he joined the Taparia Institute of Ophthalmology, Bombay Hospital. He set up the vitreo retinal department at Bombay Hospital and continued working there

till 1990. In the year 1990, he took the decisive step of laying the foundation stone for Aditya Jyot Eye Hospital and has continued serving the institution. He is one of the founding members of the Vitreo Retinal Society of India (VRSI), the umbrella organisation for all the vitreo retinal specialists of the country.

Dr Natarajan is considered as one of the most proficient and high profile young surgeons involved in

academics and innovations in his clinical practice and he has been honoured with accolades from around the world. He is a recipient of the American Academy achievement Award, Late Shri Sandeep Wagh Award, Gusi Peace Award, Indira Gandhi Sadbhavna Award, Lion’s Eye Specialist Award, IIRSI gold medal which was awarded by Sheila Dikshit, Chief Minister of Delhi.

Swaminathan Dandapani appointed as Executive Chairman of Manipal Health Enterprises He will drive the growth of the company’s business through large scale investments

M

anipal Health Enterprises (MHE) has appointed Swaminathan Dandapani as its Executive Chairman. He has taken over this position with effect from May 2, 2013. In his new role, he will be responsible to drive the growth of the company’s business through large scale investments.

MHE is looking forward to an even more formidable presence with its plans to enhance growth in the cities that it is already present in and to enter newer geographies, a mission

that will be guided by Swaminathan.

“This is the most opportune time to hand over the reins to a new visionary to help the company pursue its ambitious goals. Swami brings with him over 35 years of rich and varied professional experience in General Management.

Under his leadership, the company would grow its business through large scale investments in appropriately located hospital facilities, making sure that the hard won reputation

gets enhanced through even higher standards of patient care, efficient and ethical business practices,” said Dr Ramdas Pai—the outgoing Chairman of MHE. Swaminathan, popularly known as Swami, comes with rich experience in the fields of General Management, Finance and Accounting, Sales and Marketing, International Trading and Human Resources Management. He has reportedly handled multiple roles across sales, marketing and

operations, leading global teams in several manufacturing and service industries and has also been associated with infrastructure projects in India and overseas.

Swaminathan has had successful stints in leadership positions with global corporations.

Prior to his appointment as Executive Chairman at MHE, Swaminathan was with Infosys BPO from 2004 till his recent retirement, as its Managing Director and CEO.

She was able to establish that homeopathy has a definite role in treatment of TB, especially in cases where allopathic treatment fails

and Hospital, New Delhi; as professor of Medicine for over 25 years. She is also a member of Faculty of Homeopathy, London for 18 years. She has the experience of integrating homeopathy with main stream medicine, allopathy for over 30 years. She has been actively involved with homeopathy in the treatment of tuberculosis and life style disorders like diabetes, hypertension and obesity.

Pushpanjali Crosslay Hospital expressed it pride in Dr Chand’s recognition and declared that her achievement is a matter of pride the country as a whole.

Dr Kusum S Chand awarded Dr Roger Prize Receives award for her poster on “Homeopathy in Treatment of Tuberculosis”

D

r Kusum S Chand, Senior Consultant & HOD, Homeopathy at Pushpanjali Crosslay Hospital, Ghaziabad, has won Dr Roger Prize for Best Poster Presentation (among 83 entries) in London.

For the last 12 years, she has been actively working on the role of Homeopathy in treatment of multi-drug resistant Tuberculosis (TB) as a project initiated by the Government of Delhi. She was able to establish that homeopathy has a definite role in treatment of TB, especially in cases where allopathic treatment fails due to various side effects.

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The topic was ‘Homeopathy in the Treatment of Tuberculosis: Clinical Experience’. Dr Chand is a post graduate in Medicine

from Maulana Azad Medical College, University of Delhi. She has been associated with Nehru Homeopathic Medical College www.expresshealthcare.in

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Experiment With The Truth Bacteriological Incubator Blood Bank Refrigerator Cooling Incubator Deep Freezer

ISO 9001:2008 Autoclave Vertical Model Horizontal Model

Cooling Incubator Blood Bank Refrigerator

Deep Freezer

Incubator

Autoclaves

Address: B-44, New Empire Industrial Premises, Kondivita, J.B. Nagar, Andheri (E), Mumbai - 400 059 Tel.: +91-022-28320880/ 28390487; E-mail: info@osworldindia.com; Website: www.osworldindia.com

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Trade & Trends 'Our integration with Linde Group gives us a vantage of being a part of a globally renowned technology and innovation driven organisation' Biswarup Ghosh, Head of Healthcare -India, Linde speaks about the company’s growth strategy

BISWARUP GHOSH

Head of Healthcare - India, Linde India

Can you please elaborate on the re-branding exercise carried out by the company recently? Now, how do you plan to position Linde India's Healthcare division in the country?

Linde India (formerly known as BOC India) has been a member of the Linde Group (the world-leading gases and engineering company) since 2006, following the Linde Group’s acquisition of the BOC Group worldwide.

However, on February 18, 2013, we formally re-branded as Linde India. The name change was a part of the rebranding exercise and in phases our assets- trucks, cylinders and storage tanks would be re-branded. Our integration with the Linde Group gives us a vantage of being a part of the globally renowned technology and innovation driven organisation.

Linde India Healthcare is a quality product supplier under Indian Pharmacopoeia (IP) 2010 standards and employs best operating practices in safety and manufacturing.

Under this light, Linde India Healthcare would be a total gas solution provider for supplying oxygen and anesthetic gases; including the intricate medical gas pipeline services (MGPS) to a large number of customers across India like it does to the existing customers like All India Institute of Medical Sciences (AIIMS), Fortis Healthcare etc. We are the one stop shop for all your hospital care business.

Tell us about the new initiatives planned by Linde India's Healthcare Division.

Linde India Healthcare understands the pulse of the consumer and hence provides customised, innovative solutions like Total Gas Management for our large liquid medical oxygen consumers.

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To cater to all the innumerable issues of managing medical gases like supply, monitoring, system maintenance, medical gas compliance standards and regulations, comprehensive solution like QI Medical Gas Services encompasses specialist support to ensure your medical gas supply systems and routines meet best practice standards for quality, safety, reliability and efficiency.

Among other initiatives, we wish to have a pan-India foothold and hence look forward to setting up medical gas manufacturing facilities in Tier-II cities.

The company, it is learnt has invested on creating a world-class infrastructure for manufacturing, storing and pipeline distribution.

Can you elaborate on the same?

Linde India has been a follower of best manufacturing and best operating practices from across the globe in its quest to advance further in the industrial maturity road map. Linde India owns and operates India’s largest air separation plant in Jamshedpur and runs more than 20 production facilities and filling stations across the country. Our state-of-the-art production sites adhere to stringent norms of safety (employees & customers), quality thereby delivering and assuring reliability of the products. The gases cylinders used by Linde India Limited are PESO standards while our manufacturing plants ISO 9001 and ISO 14001 certified.

Safe and timely distribution and delivery of gases are critical components of your business. How do you plan to strengthen the system further to ensure safety and quality of the product?

Linde Healthcare is committed to quality care and www.expresshealthcare.in

patient safety, supported by pharmaceutical and medical device regulations and standards, from the selection of raw materials through production to the administration of the gases. The critical components of safe and timely distribution is thoroughly followed by the National Scheduling Centre (NSC), that tracks each GPS-enabled truck during its journey; knowing their precise location and even driving speed.

While on the other hand, our Liquid Medical Oxygen installations have a telemetry device that helps the same NSC to monitor our customer’s stock level and manage their stock without any hamper in the supply of the precious life-saving gas.

Linde India is a leader in the field of medical gases. Tell us about the wide range of medical gases produced by the Company and your strengths in this regard.

Linde Healthcare is committed to quality care and patient safety, supported by pharmaceutical and medical device regulations and standards, from the selection of raw materials through production to the administration of the gases. Our medical gases production portfolio offers medical oxygen, Entonox, medical air, medical carbon dioxide, medical nitrogen, pulmonary function test gases and gases for blood gas analyzers. We also provide oxygen concentrators for home oxygen therapy.

We stay aligned with clinical progress and continue to design and redesign solutions that meet the unique needs of healthcare professionals and patients. We support our customers in every aspect of the delivery and use of medical gases, including logistics, safety systems, technical solutions, service, training and extensive customer service which culmi-

nates as our strength areas.

The Indian healthcare sector is growing annually at 12-15 per cent, in light of this what kind of opportunities and possibilities does it offer to Linde India Healthcare in terms of new business generation?

Linde India Healthcare perceives huge opportunities.

We expect super specialty hospitals sprucing up in Tier-II cities like Ahmedabad, Guwahati, Vizag, Trichy and Kochi. We continuously strive to innovate for our customers with a passion to excel, empowering them in the process and our global footprint ensures we thrive through diversity.

Our product offering of complete hospital care business of medical gases and medical gas pipelines should be the key driver for new business generation.

What has been the response from the healthcare institutions of the country and especially from the eastern region?

The response from the healthcare institutions of the country has been tremendous.

We have a long legacy of serving the healthcare institutions both private and government in the Eastern Region for the past seven decades. Our customers have been extremely positive and encouraging about the new initiatives we propose like total gas management, safety trainings or clinical trials.

Tell us about your future plans.

We expect to grow in homecare segment of our business for starters in Kolkata, our power zone; typically for serving chronic obstructive pulmonary disease (COPD) patients who are prescribed to undergo long term oxygen therapy (LTOT).

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'We make your vision into a concrete reality' Durico ultrasound thermal paper for video printers

VIKESH CHOPRA

Managing Partner CT Medicals

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urico’s Super Ulstar brand direct thermal paper for video printers is used for printing high resolution ultrasound scan images. Medical doctors around the world depend on Durico’s Super Ulstar High resolution image capability to make accurate and high sensitive medical diagnosis.

Durico’s Ulstar thermal media is UV-cured and has a high surface, perfect resistance to water and extra high optical density. Durico thermal paper are used for printing video images on the diagnostic ultrasound device monitor, with thermal type video printer.

Durico use the same base material (Yupo’s Film) and apply the same coating technology to manufacturing direct thermal synthetic Film. Smooth surface of Durico thermal media provides perfect matching with

D

any thermal printer head for long life, and prevents unnecessary noise.

Why you pay more for same quality Rigid quality control systems Durico enforces rigid quality control in each manufacturing process of production line in compliance with ISO9001 (Quality Management Systems). This rigid quality control systems ensure consistent quality and eliminate quality deviation due to contamination or human error. Through final inspection after production they achieve decimal point variation in percentage.

Medical image printing requires high precision available from thermal printing method. Durico’s Ulstar prints black and white video images on medical ultrasound diagnostic systems

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Durico’s Ulstar thermal media is UV-cured and has a high surface, perfect resistance to water and extra high optical density and perfectly fits Sony and Mitsubishi printers. Durico’s Ulstar is Certified ISO 9001 and 14001 and also registered with FDA. They also provide cleaning kits for all make of ultrasound thermal printers as it is recommended that after printing 10 rolls of paper the printer be cleaned as per instructions.

Durico’s Ulstar ultra-

sound thermal paper is available 70 countries through their global partners in the world, and CT MEDICAL SYSTEMS are the authorised dealer in India. Vikesh Chopra is working for medical radiology field from last 23 years and has many years of experience in X-ray radiation protection products, provides lead shielding for every application. He share his experience in most of the medical and radiology conferences and exhibitions in India and abroad.

The company also provides superior quality imported and Indian X-Ray lead aprons in all quality, lead gloves, lead glass, lead goggles etc. We are also dealer of JPI Grids of Korea and Corning Lead Glass in all sizes and quality. We also have a very strong dealer network throughout the country.

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Westcoast Corp introduces Vittal8 DDR retrofit kits D These kits convert old analogue X-ray systems into digital X-ray machines

R retrofit X-ray kits will become "big business" as cost-conscious buyers in India and developing countries, in Asia and Africa are looking for inexpensive ways to upgrade film/analogue X-ray equipment to digital.

Prices for retrofit X-ray kits have fallen an estimated five to 10 per cent a year under intense competition from the half dozen or so major manufacturers flat panel detectors (FPD).

Demand for the retrofit products will also go up as CR’s are getting outdated and analogue X-ray equipments have to be dumped whenever a new DR system is installed.

Thus the retrofit fits fine into a market segment wherein

buyers retain the analogue equipment and upgrade the same to a DR at less than half the price that needs to be invested in a new DR system Introduced about six months ago, retrofit X-ray kits 'Vittal 8' has been getting a very good market response according to Vijhay J Shetty, CEO, Westcoast Corporation.

“We use wireless digital flat panel detectors that fit into the same slots used by film cassettes in X-ray rooms or mobile systems to turn them into digital devices along with our work station and software at fraction of the cost of a new DR,” says Shetty. Rather than spending huge amounts for a new digital radiography room, a hospital or diagnostic centre could buy two retrofit systems

for the same price to convert two analogue rooms.

However, the current market is quite small, DR retrofit systems make up no more than one-sixth of the total X-ray market by the volume sold.

But this number is expected to grow by 15-20 per cent a year.

Retrofitting of good quality existing analogue and mobile X ray machines is going to be the main focus area of the company because it's a cost-

effective way to maintain a digital standard but still use equipment that already exists, informs Shetty.

Contact: Vijhay J Shetty, CEO, Westcoast Corporation Email: info@westcoastcorpn.com Mob: +91-9322676992 Website: www.westcoastcorpn.com

Food hypersensitivity and ways to tackle it An article from Omega Diagnostics on food hypersensitivity, its symptoms, causes, effects and means to deal with it

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or some people, eating certain foods or additives can cause an adverse physical reaction. This foodhypersensitivity can involve the immune system (the body’s defence against attack) and is called a food allergy. If it doesn’t involve your immune system immediately, the reaction is called food intolerance.

The nation is in the grip of an epidemic, but one very different from those usually written about, such as obesity, diabetes and binge-drinking.

What makes this epidemic unusual is that it is not an illness or condition in itself, but the false belief that something is wrong with you. This mass delusion affects around 45 per cent of people in this country, and it’s getting worse. It’s food hypersensitivity.

Ever wondered why there are some foods that you simply can't eat no matter how hard you try? Or that there are certain foods items that make you want to throw up? Food reactions are common, but most are caused by food hypersensitivity rather than a classical food allergy. Food hypersensitivity can cause

some of the same signs and symptoms as a food allergy, so people often confuse the two.

If one has food allergy, even a tiny amount of the offending food can cause an immediate, severe reaction.

Digestive signs and symptoms may include nausea, vomiting, cramping and diarrhoea.

Other signs and symptoms can include a tingling mouth, hives, and swelling of the lips, face, tongue and throat. A lifethreatening allergic reaction known as anaphylaxis can cause breathing trouble and dangerously low blood pressure. If you have a food allergy, you'll need to avoid the offending food entirely. This is known as a Type-I food allergy and involves the production of IgE antibodies.

IgG mediated food hypersensitivity symptoms generally come on gradually and often many hours after eating the problem food due to a delayed-onset of reactions. If you have IgG mediated food hypersensitivity, you may be able to eat small amounts of the offending food without trouble. Typical symptoms include IBS, headache, migraines, insomnia, asthma, www.expresshealthcare.in

and arthritis. This is also known as a Type-III food allergy and involves the production of IgG antibodies.

Hence, devising a diet plan after determining the food hypersensitivity status of a person, would add more effectiveness in implementing a long term change and improving the health and wellness of a person. Commonly performed allergy tests like skinprick tests do not yield any outcome if the person is suffering from IgG-mediated food hypersensitivity. Detection of food-specific IgG antibodies is recognised as a reliable method to identify the problem foods that may be causing symptoms and to guide and design elimination diets based on the IgG antibody results.

Currently, tests for IgG mediated food hypersensitivity are being offered at various diagnostic centres using ELISA technology. The food detective kit tests for 59 India-specific foods and requires only a finger-prick blood sample to perform the test. A more comprehensive and exclusive IgG mediated food hypersensitivity test is also available at certain reputed reference labora-

tories and hospitals using the MicroArray technology based Genarrayt System, which can classify intolerance to over 220 foods, including vegetarian and non vegetarian food, vegan food and herbs and spices.

The test is fully quantitative and the level of IgG antibody detected for each food is provided in a personalised test report. If one has been found to be suffering from IgG mediated food hypersensitivity, following an elimination diet for three months usually results in an improvement in symptoms and well-being.

However, the elimination diet needs to be designed in conjunction with the food IgG antibody test results and nutritional advice, to ensure that a balanced diet is maintained.

Therefore, it should only be done under supervision of qualified medical practitioner.

Contact: Kandarp Vyasa Technical Services Manager Omega Dx (Asia) 508, 5th Flr, Western Edge-1, Kanakia Spaces, Borivali (E), Email: kandarpv@omegadiagnostics.co.uk EXPRESS HEALTHCARE

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In-house quality assurance of diagnostic radiology equipment P Diagnostic radiology machines have been a great boon to the healthcare industry and numerous people have benefited from the useful information they provide

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roviding top-class healthcare infrastructure is one of the priorities of modern-day hospitals in our country. The investment in state-of the-art equipment is only a start towards this goal.

It is extremely essential to maintain the quality of highend equipment procured to provide high quality healthcare. One of the difficult areas of maintaining this infrastructure is within the diagnostic radiology department.

Radiation cannot be seen, heard or smelt. Hence, to check the quality of radiation producing equipment, intuitive methods of detection seldom fail. Checking the quality of image might give an indication of performance of radia-

tion equipment, but can be often misleading. The quality of diagnostic radiation equipment directly affects the diagnostic image quality and unwanted exposure to staff.

Poor diagnostic image quality can lead to faulty diagnosis.

Diagnostic radiology machines have been a great boon to the healthcare industry and numerous people have benefited from the useful information they provide. At the same time, these powerful machines need to be checked for their operation. Quality assurance (QA) programmes contribute in providing highquality health care. The basic purpose of QA in diagnostic imaging is to improve diagnostic information content,

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reduce radiation exposure, reduce medical costs and improve departmental management.

QA programmes for diagnostic imaging include both quality control techniques and quality administration procedures. Quality control techniques are used to test the components of radiological system to verify that the equipment is operating satisfactorily. A quality administration procedure involves a management system wherein a check is implemented at each level of all the diagnostic imaging procedures to verify quality control techniques and implement a corrective action wherever required. QA programmes in diagnostic imag-

ing can be generic as well as tailored for a particular segment, such as QA in paediatric radiology does not differ from general radiology besides that children are more sensitive to ionising radiation and QA is therefore even more stringent.

QA programmes for medical exposures includes measurements of the physical parameters of the radiation generators and imaging devices at the time of commissioning and periodically thereafter and verification of the appropriate physical and clinical factors used in patient diagnosis or treatment. QA practices are defined at the global level by many organisations such as the

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Fully automated Urine Flow Cytometers from Sysmex R UF-1000i and UF-500i can help improve laboratory turnaround time and serve as reliable urinalysis tools

PRAVIN GUNDEWAR

Application Specialist- Urinalysis Sysmex

outine urine sediment analysis typically involves a number of manual steps including centrifugation, re-suspension, microscopy and finally manual documentation of the results. These numerous steps can make the process time consuming, laborious and at risk for transcription errors.

Sysmex India is happy to introduce its fully automated urine flow cytometers, UF-1000i and UF-500i which employ high performance, laser-based Fluorescence Flow Cytometry (FCM) that give reliable, quantitative results.

These systems can reportedly improve laboratory turnaround time and offer a worry-free urinalysis tool that can be totally relied upon.

FCM is a Sysmex core competence. It has been employed in their X-class haematology analysers and the company swears by its accuracy and reliability.

The analysers also offer value added clinical information of UTI, red cell morphology, and conductivity and is able to accurately detect RBC, WBC, epithelial cells, casts, bacteria, crystals, yeasts and sperm in urine sample by using three different scatters:

Forward scattered light-information on cell size ● Side scattered light- information on internal cell structure ● Side fluorescence light- information on RNA /DNA contents.

UF series from Sysmex also offer excellent capabilities for the best differentiation and quantification of urine particles. It provides standardisation in urinalysis that complies with ISLH ●

guidelines by analysing un-centrifuged native urine sample.

Contact: Sysmex India 308, Ascot Centre, Sahar Airport Road, Andheri- East, Mumbai-400099 Tel:- 022- 28224040/28365064 Email: sysmex@sysmex.co.in, gundewar.pravin@sysmex.co.in

ZHL and AMR unite to conduct training programme on CPR Z The training was conducted in Mumbai and close to 50 people participated

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iqitza Health Care (ZHL) which runs the Dial ‘108’ & ‘1298’ Ambulance service in states of Kerala, Punjab, Bihar, Odisha, Maharashtra and the American Medical Response (AMR) have united to train thousands of people across the above mentioned states to save lives through Chest Compression – Only CPR (Cardio Pulmonary Resuscitation) in observation of National Emergency Medical Services Week. AMR is one of the largest providers of emergency ambulance services in the developed world. It is a key investor in ZHL which operates over 900 ambulances in India.

As part of the initiative in Mumbai the training was conducted in which close to 50 people participated. In Mumbai, it was done in association with the ZHL staff of 1298 Ambulance service. This initiative is being conducted simultaneously along all the states where ZHL Ambulance service is operational.

“1298 Ambulance often reaches an emergency site within minutes but dur-

Mangal, CEO, ZHL. According to the American Heart Association, Compression – Only CPR is easy, less invasive and allows bystanders to keep lifesaving blood flowing through a victim’s body just by pressing on the chest in a hard, fast rhythm. It does not require mouth-to-mouth resuscitation and has been found to be effective in saving lives.

People who attended the session shared their experiences. “The training was very knowledgeable and beneficial, now in case of any medical emergency I will not just be bystander but will try to take charge of the situation to mitigate further risk” says Akhtar Shaikh, a participant.

ing cardiac arrest every second is critical. This type of CPR can help save lives and is easy to perform. We hope the people who got trained in this opportunity can make our community an even safer place to live. Our primary goal is to save as many lives as possible, we hope to get more people excited about learning CPR by being part of this event”, said Sweta

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Contact: Ruchika Beri Assistant Manager , Marketing and BD Ziqitza Health Care Limited Sunshine Towers 23rd Floor, Ambedkar Road Elphinstone Road (W) Mumbai- 400013, India.

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