Express Healthcare (Vol.9, No.3) March, 2015

VOL.9 NO.3 PAGES 84

www.expresshealthcare.in MARCH 2015, `50

TATA INSTITUTE OF SOCIAL SCIENCES V.N. Purav Marg, Deonar, Mumbai 400088

School of Health Systems Studies Admission Open to Executive Post Graduate Diploma in Hospital Administration (EPGDHA) The School of Health Systems Studies (SHSS) of Tata Institute of Social Sciences in Mumbai, pioneers of Hospital Administration education in the country, invites application for their prestigious EPGDHA programme. It is a 12-month (two semesters), dual mode programme consisting of online learning and two-weeks of contact programme in each semester.

The programme is intended to enhance the knowlege and skills of working personnel in the hospital.

Eligibility: Graduates in any discipline with a minimum of 2 years of experience and currently working in hospital. Candidates sponsored by hospitals will be given due preference.

Total Seats: 50 only.

Application form and admission: Candidates are required to apply online through the E-application process only, website: www.tiss.edu. Candidate having difficulty in applying online or where there is no internet facility may contact below numbers.

The application fees is Rs. 1,030/- (if being payed by Credit card / Debit card / Net Banking) or Rs. 1,000/- + bank charges (if being payed through bank by cash). The last date of receiving application is May 4, 2015.

Admission will be based on the interview at TISS, Mumbai.

Programme Fees: The total fees for the programme is Rs. 1,00,000/- (One Lakh Only), payable in two installments. The fees include tuition fee, learning resources, library and computer services and other programme related expenses.

CONTACT Telephone: 022-2552 5527/ 022-2552 5530 / 022-2552 5523 or E-mail: epgdha@tiss.edu

CONTENTS Vol 9. No 3, MARCH 2015

Chairman of the Board Viveck Goenka Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bangalore Assistant Editor Neelam M Kachhap Pune Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr Raghu Pillai - South Sanghamitra Kumar - East Harit Mohanty - West Marketing Team Kunal Gaurav G.M. Khaja Ali Ambuj Kumar E.Mujahid Yuvaraj Murali Ajanta Sengupta

GUARDING AGAINST HEALTHCARE CYBER ATTACK Rajesh Maurya, Country Manager, India & SAARC, Fortinet warns against cyberattack in hospitals and how imperative it is to take steps against such an occurence| P54

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AETHLON MEDICAL COMPLETES HEMOPURIFIER CLINICAL STUDY PROTOCOL

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KARNATAKA GOVT PARTNERS WITH REMEDINET TECHNOLOGIES

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SANOFI TO INVEST INTO APOLLO SUGAR CLINICS

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IIM CALCUTTA FORAYS INTO HEALTHCARE MANAGEMENT

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TISS CONDUCTS CONVOCATION CEREMONY FOR EPGDHA

P21:INTERVIEW: PAULA WILSON President and CEO, JCI

INTERVIEW: PRABHU VINAYAGAM Asia-Pacific MD, JCI

P23:INTERVIEW: RUPAK BARUA Group CEO, AMRI Hospitals

P24:INTERVIEW: DR MOHAN GUNDETI Director, Pediatric Urology, UChicago Hospitals PG 34-50

P25:INTERVIEW: SHAHNAZ HUSAIN Chairperson, The Shahnaz Husain Group

WO M E N ’S DAY S P E C I A L

KNOWLEDGE

PRODUCTION General Manager B R Tipnis

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Manager Bhadresh Valia Scheduling & Coordination Rohan Thakkar CIRCULATION Circulation Team Mohan Varadkar

MARKET

ADVANTAGES OF LASER THERAPY IN ENHANCING MEDICINE

LIFE

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IT@HEALTHCARE

51

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DR GREGORY LEVEY, CEO & CO-FOUNDER, FIGURE 1

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HONORARY FELLOWSHIP OF PUNJAB ACADEMY OF SCIENCES TO DR TS KLER AND DR NEELAM KLER FOGSI ELECTS NEW PRESIDENT FOR 2015

Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright @ 2011 The Indian Express Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

A lost opportunity

T

he healthcare sector had great expectations from the Union Budget 2015-16 but reality did not live up to the hype. Prime Minister Narendra Modi's often stated goal of universal health coverage had built up expectations that the budget would increase allocation to the central health ministry but with an increase of a mere two per cent, it fell far short of requirements.

The five new AIIMS in Jammu & Kashmir, Punjab, Tamil Nadu, Himachal Pradesh and Assam plus an AIIMS-like institute in Bihar are steps in the right direction. These will go a long way towards filling the gaps in the public healthcare infrastructure and making health services more accessible in these states. In spite of the direct link between the Swachch Bharat Mission and healthy practices, there was no direct push for preventive and curative care at the primary level which could have had an immediate impact on healthcare outcomes.

Similarly, the Finance Minister's decision to add more countries to the visa-on-arrival list from 43 to 150 countries will be music to the ears of private healthcare players as it will expand the medical tourism industry in India.

The fact that the government has not indicated too much increase in the percentage of GDP spend on healthcare leads us to believe that the government is encouraging patients to pay from pocket and hence the increase in tax incentives on health insurance.

Perhaps, the best take away is the devolution of a larger part of central taxes to the states as recommended by the Fourteenth Finance Commission (FFC). Now the states will have more funds at their disposal and hopefully they will be able to design health schemes more in tune with each state's needs, rather than having to follow the centre's diktat.

But here too, the recommendations have stopped short of providing direction. The intent is good, but implementation remains hazy though Health and Family Welfare Minister J P

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The union budget 2015-16 will probably be remembered as a lost opportunityto push for change.Will the achhe din chant change into kachhe vaade? Or is it too soon to judge this administration?

Nadda has assured us that adequate funds have been provided to ensure that all flagship healthcare programmes will continue.

Similarly, it’s good that health insurance premium exemption has been increased to about Rs 25,000 with Rs 5,000 set aside for preventive health checkup but more clarity will be required on the breakup pf this Rs 5000 across various heads.

Analysts have pointed out that the budget has expressed the intent to promote more PPP projects wherein private investments are catalysed by public investments. A reduction of corporate tax (from 30 to 25 per cent over next four years) could also increase private investments in the healthcare sector. The extension of service tax exemption to all ambulance services provided to patients is also a welcome move.

In summary, the union budget 2015-16 will probably be remembered as a lost opportunity to push for change. Prioritisation on primary and preventive healthcare, using the same zeal as the pulse polio programme, could have seen the eradication of many more such public health concerns like tuberculosis, etc. Will the achhe din chant change into kachhe vaade? Or is it too soon to judge this administration?

It is left to visionaries from the private sector, like Dr Devi Shetty, Founder Chairman of Narayana Health to step in to fill the gaps. Dubbed as the ‘Henry Ford of cardiac surgeries’, he has both compassionate care and economics close to his heart.

Do read our cover story (‘Breaking ground on the way to success’, pages 29-33) for a detailed analysis of how he is breaking new ground in productivity, profitablity and affordability.

In our Women’s Day special, (‘Waking up to women's health’, pages 34-50) we focus on issues that are not only detrimental to women’s health and well-being but also deter the progress of our nation.

After all, a healthy woman is the building block for not just a healthy family, but the nation.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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QUOTE UNQUOTE

ARUN JAITLEY

J P NADDA

Finance Minister

Union Health Minister

“Good health is a necessity for both quality of life and a person's productivity and ability to support his or her family”

HEAD OFFICE Express Healthcare MUMBAI: Kunal Gaurav The Indian Express Ltd Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821089213 Email Id: kunal.gaurav@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Ltd Business Publication Division Express Building, 9&10, Bahadur Shah Zafar Marg, New Delhi- 110 002 Board line: 011-23702100 Ext. 668 Mobile: +91 9999070900 Fax: 011-23702141 Email id: ambuj.kumar@expressindia.com CHENNAI Yuvaraj Murali The Indian Express Ltd Business Publication Division

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New No. 37/C (Old No. 16/C) 2nd Floor, Whites Road, Royapettah, Chennai- 600 014 Board Line: 044- 28543031/2/3 044- 42285522 Mobile: +91 9710022999 Fax: 044- 28543035 Email id: yuvaraj.murali@expressindia.com BENGALURU G.M. Khaja Ali The Indian Express Ltd Business Publication Division 502, 5th Floor, Devatha Plaza, Residency road, Bangalore- 560025 Board line: 080- 49681100 Ext. 108 Mobile: +91 9741100008 Fax: 080- 22231925 Email id: khaja.ali@expressindia.com HYDERABAD E.Mujahid The Indian Express Ltd Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com

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“Provision of Rs 33,150 crore will provide a quantum jump in healthcare in the states of Jammu and Kashmir, Himachal Pradesh, Punjab, Assam and Tamil Nadu, Bihar and the neighbouring areas”

AHMEDABAD Kunal Gaurav The Indian Express Ltd 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015 Mobile: +91 9821089213 Email Id: kunal.gaurav@expressindia.com BHOPAL Ambuj Kumar The Indian Express Ltd F-102, Inner Court Apartment, 1st Floor, GTB Complex, Behind 45 Bungalows,Bhopal - 462 003 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com JAIPUR Ambuj Kumar The Indian Express Ltd S2, J-40, Shyam GHP Enclave, Krishna Marg, C-Scheme, Jaipur- 302 001 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com

Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.

MARKET NEWS

Aethlon Medical completes hemopurifier clinical study protocol Aethlon Hemopurifier provides broad-spectrum elimination of infectious viruses from circulatory system AETHLON MEDICAL announced that the first patient enrolled in the company's FDA approved feasibility study has completed their full hemopurifier treatment protocol without any device-related adverse events. The study protocol, which is being administered at DaVita Med Center

Dialysis in Houston, is enrolling ten chronic dialysis patients infected with Hepatitis C virus (HCV) to receive a six treatment protocol of Hemopurifier therapy. The Aethlon Hemopurifier is a bio-filtration device that provides the broad-spectrum elimination of infectious viruses from the

circulatory system of infected individuals.

The feasibility study will contribute safety data to advance the hemopurifier as a candidate therapy to address chronic conditions such as HIV and HCV, as well as acute bioterror and pandemic threats that are not addressed

STATEMENT ABOUT OWNERSHIP AND OTHER PARTICULARS OF EXPRESS HEALTHCARE, MUMBAI, AS REQUIRED UNDER RULE 8 OF THE REGISTRATION OF NEWSPAPERS (CENTRAL) RULES, 1956 FORM - IV (SEE RULE 8) 1. Place of Publication 2. Periodicity of its publication 3. Printer's Name Whether citizen of India Address 4. Publisher's Name Whether citizen of India Address 5. Editor's name Whether citizen of India Address 6. Name and address of individuals who own the newspaper AND Shareholders holding more than One per cent of the total capital

: Express Towers, 2nd Floor Nariman Point,Mumbai-400 021 : MONTHLY : MS. VAIDEHI THAKAR : Yes : Express Towers, 2nd Floor Nariman Point,Mumbai-400 021 : MS. VAIDEHI THAKAR : Yes : Express Towers, 2nd Floor Nariman Point,Mumbai-400 021 : MS.Viveka Roychowdhury : Yes : Express Towers, 1st Floor Nariman Point,Mumbai-400 021 : The Indian Express Limited Express Towers, 2nd Floor, Nariman Point, Mumbai 400021 : Indian Express Holdings & Entp Limited Express Towers, 2nd Floor, Nariman Point, Mumbai 400021 : Mr. Viveck Goenka & Mr. Anant Goenka Express Towers, 2nd Floor, Nariman Point Mumbai 400021 : Mr. Shekhar Gupta & Mrs. Neelam Jolly C-6/53, Safdarjung Development Area New Delhi 110 016

I, VAIDEHI THAKAR., hereby declare that the particulars given above are true and to the best of my knowledge and belief.

Date : 1/3/2015

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sd/VAIDEHI THAKAR Publisher

with proven drug or vaccine therapies.

"With our feasibility study now under way, we will initiate our previously communicated plan to file Humanitarian Use Device (HUD) submissions that provide a potential FDA market clearance pathway to treat viral indications that

affect fewer than 4,000 individuals in the US each year," stated Jim Joyce, Chairman and CEO of Aethlon Medical.

To date, Hemopurifier therapy has been administered outside the US in the treatment of Ebola, HIV and HCV-infected individuals.

EH News Bureau

Practo announces expansion to 35 cities in India and abroad Raises $30 million Series B Financing from Sequoia Capital and Matrix Partners PRACTO ANNOUNCED its expansion plans to 35 Indian cities and more than six international locations by March 2016. It has raised $30 million Series B Financing from Sequoia Capital and Matrix Partners.

Reportedly, it is one of the largest investments into digital health globally and the largest for any Indian healthcare technology company.

“Practo is revolutionising healthcare by enabling consumers to find the best doctors, book instant appointments and make better, more informed health decisions. It is our privilege to work with Shashank ND and Abhinav Lal, the founders of Practo, to scale and bring Practo

to millions of consumers around the globe,” said Avnish Bajaj, Co-Founder and MD, Matrix India.

“From our first seed investment in Practo in 2011, the company has come a very long way, thanks to the hard work of an incredibly committed entrepreneurial team. The company has now scaled to being the market leader in online healthcare in India, a category that has created multiple multi-billion dollar companies around the world.

We are deeply committed to Practo’s goals and aspirations to transform access to healthcare and positively impact society,” said Shailendra Singh, MD at Sequoia Capital.

EH News Bureau

Karnataka government partners with Remedinet Technologies Remedinet to provide technology support for Rajiv Arogya Bhagya and Jyothi Sanjeevini REMEDINET TECHNOLOGIES has been signed on as the technology partner for Karnataka Government’s ‘Rajiv Arogya Bhagya’ and ‘Jyothi Sanjeevini’ cashless health insurance schemes. While Rajiv Arogya Bhagya Scheme aims to cover 33 lakh families above poverty line (APL) for catastrophic illnesses, Jyothi Sanjeevini scheme would support 5.6 lakh Karnataka Government Employees and their dependents.

Aimed at providing affordable, cashless healthcare, both these schemes would run on the Remedinet payer provider network.

Remedinet Technologies (earlier known as Healthsprint Networks) through their SI partner would facilitate capturing and exchange of relevant claim settlement data in a structured and electronically readable format. By eliminating inaccuracies in the data exchange process, Remedinet solutions aims to make the claim settlement process faster, accurate and hassle free for the end beneficiaries. As the technology partner, Remedinet would enable various participants in the claim settlement process to monitor the progress, thereby bringing in more transparency.

Munish Daga, CEO, Remedinet Technologies said, “Our association with the Karnataka Health Ministry for their Rajiv Arogya Bhagya and Jyothi Sanjeevini schemes is indeed a proud moment for us. By providing technology support to these schemes, we aim to contribute our bit in facilitating adoption of latest technology in the Indian health insurance sector.”

EH News Bureau

EXPRESS HEALTHCARE

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March 2015

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MARKET

Sanofi to invest into Apollo Sugar Clinics Both Apollo and Sanofi would endeavour to expand Apollo Sugar to provide superior value to patients and doctors with an enhanced geographic reach

APOLLO HEALTH and Lifestyle, a wholly owned subsidiary of Apollo Hospitals Enterprise, announced that Sanofi-Synthelabo (India) has invested into Apollo Sugar Clinics.

Apollo Sugar offers access to an integrated diabetes care solution via a combination of high quality clinical infrastructure including early detection and protocol driven treatment of diabetes, complemented by a robust set of lifestyle management programmes. Through this investment, both Apollo and Sanofi would endeavour to expand Apollo Sugar to provide superior value to patients and doctors with an enhanced geographic reach, and provide high quality outcome oriented set of services Commenting on the collaboration, Dr Prathap Reddy, Chairman and Founder, Apollo Hospitals Group shared, “Over

Sangita Reddy, Chairperson, Apollo Sugar and Shailesh Ayyangar, Managing Director, Sanofi India

the years, Apollo Hospitals has benchmarked global best practices in quality healthcare delivery with stringent alignment to approved standards and protocols. With the increasing burden of diabetes in our society, we need to act quickly and with a sense of purpose to arrest the disease from claiming more lives. I am confident that with this invest-

ment, Apollo Sugar Clinics is even better positioned to offer patients advanced care and counselling for diabetes management. This is a good start towards improving the diabetes management programme in India and I am delighted to be partnering with Sanofi, a global leader in diabetes management. Our shared vision will provide a

new approach to diabetes care to benefit patients in India and other parts of the world.”

Sangita Reddy, Chairperson, Apollo Sugar and Joint MD, Apollo Hospitals said, “We have presented at the American Diabetes Association conference and have been recognised for delivering exceptional clinical outcomes in managing diabetes, some of which were attempted and successful for the first time in India.

However, we as a country are still battling with the image of being the diabetes capital of the world. We understand that a diagnosis of diabetes and pursuit of necessary lifestyle changes is daunting for patients. At Apollo Sugar, a patient with diabetes has access to information, the right treatment, co-morbidities management, counselling, care and treatment to sustain-

ably manage diabetes. We are now keen to take Apollo Sugar’s comprehensive offering to many more parts of India.”

Commenting on the investment by Sanofi, Neeraj Garg, CEO of Apollo Health & Lifestyle said, “At Apollo Sugar, we offer best in class clinical care delivered in our conveniently located facilities, and combine it with a comprehensive, 360° patient lifestyle management programme to help patients to successfully manage diabetes and avoid related complications. The investments made by Sanofi, and the strong support of both our shareholders, enables us to grow our footprint to offer our services at many more clinics across India, and provide millions of diabetic customers’ access to world class care at their doorstep.

EH News Bureau

Apollo and Republic of Macedonia sign MOU to develop healthcare services The MoU provides for observerships and training courses APOLLO HOSPITALS Group and The Republic of Macedonia signed an agreement that will reportedly raise the standards of healthcare for the Republic and the region. Anne Marie Moncure, CEO, Southern Region, Apollo Hospitals Group and Toni Atanasovski, Ambassador of the Republic of Macedonia in India on behalf of its Ministry of Health signed the MoU.

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The MoU provides for observerships and training courses for medical specialists, nurses, technicians and other health professionals from the Republic of Macedonia at various locations across the Apollo Hospitals network in India.

Further the agreement involves the numerous tertiary specialities including internal medicine, surgery,

cardio surgery, thoracic surgery, vascular surgery, cardiology, paediatrics, gynaecology, anaesthesiology, neurosurgery, orthopaedic surgery, ophthalmology, ENT, neurology, dermatology and venereal diseases, radiology, radiotherapy, urology, plastic surgery, nuclear medicine, robotics and transplant.

“We have a special relationship with the Republic of

Macedonia and have crafted this partnership to bring the benefits of Apollo’s healthcare model to them. The purpose behind this union is to provide quality education, training, and development to healthcare workers of the Republic of Macedonia. We also plan to launch telemedicine services that will help physicians and patients living in Macedonia.

We thank the Government of

Macedonia for giving this unique opportunity to collaborate on a range of subjects,” said Moncure.

The initiative was welcomed by Atanasovski, who stated that the Republic welcomes the Apollo Group to develop health infrastructure and help in capacity building in the health sector.

EH News Bureau

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MARKET

IIM Calcutta forays into healthcare management Introduces one-year Healthcare Executive Management Programme (HEMP) in partnership with Glocal Hospitals

INDIAN INSTITUTE of Management Calcutta (IIMC) is foraying into healthcare management education space with its one-year Healthcare Executive Management Programme (HEMP). The programme is jointly organised by IIMC and Glocal Hospitals.

The Healthcare Executive Management Programme combines healthcare management education with field-based learning across Singapore and India. Prof Saibal Chattopadhyay, Director, IIMC said, “This course is certainly a milestone in the glorious history of IIMC.

It marks a new chapter that makes the institution stand out, internationally. Given the country's current demographics, there's is a dearth of healthcare professionals. With more than 30 students enrolling for the course, we are hoping for a long successful journey ahead for the programme.”

The first batch of 31 students consists of doctors, other medical practitioners, technical and marketing professionals with prior work experience in the healthcare industry. All the students, with their previous experience in

the related fields, are looking at accelerating their career and achieving a bigger entrepreneurial goal in life through this course.

Dr Sabahat Azim, CEO, Glocal Healthcare Systems, who has taken a significant role in designing the programme said, “There’s dearth of leadership in healthcare, thus this course spans the entire spectrum of healthcare facility with the biggest market players interacting with the students.

The opportunities are just the beginning.” Throughout this one year period, students will

have the opportunity to interact with the finest minds of the healthcare industry. The course is designed in such a way so that all aspects are covered to create the leaders of tomorrow to fuel the healthcare industry which is currently pegged at five trillion dollars, globally.

The course will span across six months of campus-based learning that will include classroom teaching methods, case based learning etc and six months of international industry exposure. The ‘international immersion’ pro-

gramme, with field-based learning in Singapore, will help the students to aquire the requisite knowledge of working in global healthcare industry.

Prof Anindya Sen, Dean (Academic), IIMC said, “With this course, we give the students, a specialised learning expereince from day one.

They not only have hands on industry experience, but they also strike the appropriate balance with classroom education. The students receive a holistic training, making them industry ready.”

EH News Bureau

IIHMR Bangalore signs MoU with Netherland's Maastricht University The two institutes will seek opportunities to cooperate in research and will seek to facilitate student programmes

IIHMR BANGALORE has signed a Memorandum of Understanding (MoU) with the Netherlands' Maastricht University’s Faculty of Health, Medicine and Life Sciences (FHML). Reportedly, the scope of activities between the two will focus on innovative student-centred and outcome-based learning methodologies, research as well as exchange of faculty and students.

To provide higher education of the highest quality the two partners will apply innovative student-centred and outcomebased learning methodologies.

Both parties will share knowledge, experiences and educational research results and

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(From L-R) Xavier Infant V M; Dr Biranchi N Jena, Director, IIHMR Bangalore; Dr G Giridhar; Dr Thomas Krafft; Professor, School of Public Health and Primary Care, Netherlands and Dr Usha Manjunath, Dean-Academics and Student Affairs, IIHMR Bangalore

to support each other in further educational development.

Among other things, this mutual support will include curriculum development, the development and application of innovative

methodological approaches such as problem-based learning, student assessment, educational quality assurance, programme content development, internationalisation of the curriculum,

student support service, and management of education. Visits by academic staff members will be encouraged for the mutual benefit of both partners.

Suitable arrangements will be

made for the exchange of visiting scholars for collaboration in teaching and in research. The two institutes will seek opportunities to cooperate in research and will seek to facilitate student programmes.

Dr Biranchi N Jena, Director, IIHMR Bangalore said, “Our tie up with Maastricht University’s FHML will further add to our global outreach and provide world-class facilities to our students.”

Dr A Scherpbier, Dean of FHML, Maastricht University said, “Our new partnership with IIHMR Bangalore will further enhance our globalisation efforts.”

EH News Bureau

MARKET POST EVENTS

TISS conducts convocation ceremony for EPGDHA 25 students had received their EPGDHA during the convocation

SCHOOL OF Health Systems Studies (SHSS) of the Tata Institute of Social Sciences (TISS) celebrated its first convocation ceremony of Executive Post-Graduate Diploma in Hospital Administration (EPGDHA)

recently at Library Conference Hall, Main Campus, TISS, Deonar, Mumbai. At the convocation, 25 students received their EPGDHA. Amit Bandari, VP-Health Underwriting and Claims, ICICI Lombard General

Insurance Company was the Chief Guest of the function.

The ceremony began with the Institute song, followed by a welcome address by Prof CAK Yesudian, Dean, School of Health Systems Studies. Prof

Yesudian emphasised on the role of TISS in bringing the changes in the field of hospital administration over four decades. Dr M Mariappan, Chairperson of Continued on Page 18

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MARKET Continued from Page 17

TISS conducts..

Center for Hospital Management, highlighted that the executive diploma is especially designed for working executives from the hospital industry. He added that despite the challenges of merging the online and offline teaching mode, the academic and research activities of the course had flourished. The Chief Guest Amit Bhandari and Registrar CP Mohan Kumar had presented the Diplomas to the graduating students.

While delivering the convocation speech, Bhandari stressed on the need to blend theory and practical knowledge for coming up with creative leaders for the healthcare industry. He emphasised to the graduating batch that through their continuous engagement with the alma mater, TISS graduates would be able to become torchbearers in hospital management as well as in the advancement of the nation and society at large.

Throughout the programme, the sense of pride and achievement was visible among the students, their families, the faculty and staff of the Institute. Reportedly, the convocation ceremony ended with a ray of hope and joy that is sure to inspire the students and faculty of this Institute in the years ahead.

The students felt that the course has contributed significantly to their learning and in developing practical skills in the field of hospital administration. Moreover, it also offered strong challenges to cope with while working and learning. Furthermore, few studentions mentioned, “We knew it wasn’t going to be easy to cope up with the new environment and excel. This new start, however, helped us to gain unique knowledge and experience that set us apart from our counterparts in other institutes.” The valedictorian emphasised that it was now the task of the graduated students as alumni of TISS to show professionalism in hospital administration.

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ReDx-Redesigning Diagnostics showcases low-cost healthcare diagnostics Organised by the Camera Culture Group, MIT Media Lab and WeSchool, go-to-market prototypes were presented at the grand finale of ReDx

THE ‘REDX-REDESIGNING Diagnostics’ presented by the Camera Culture Group, MIT Media Lab, US with IIT-B, Hinduja National Hospital and WeSchool successfully concluded in an ‘Open House’ at WeSchool campus in Mumbai in the presence of Vinod Tawde, Minister for Education & Culture, Government of Maharashtra and other dignitaries.

ReDx is an important initiative of WeSchool, to participate in the larger national agenda, through design of unique innovative healthcare product/ services, supporting their conversion to scalable businesses and also mentoring the entrepreneurial spirit of its young MBA students.

The ‘Open House’ inaugurated at the hands of Tawde was a showcase of the outcome of a weeklong workshop where 100 innovators from across India have been collaborating and sharing ideas across boundaries of disciplines, institutions and cultures, striving towards creating diagnostic devices to bring high quality and low cost medical solutions to millions of people. The innovative prototypes displayed how the confluence of talent, technology, finance and innovation can create better healthcare that is available to all.

A group of 16 students across diverse programmes like general management, business design, e-biz and healthcare from WeSchool had participated in ReDx under the mentorship of Prof Ramesh Raskar and his colleagues, Anshuman Das and John Werner, Camera Culture Group, MIT Media Lab, along with expert faculty from IIT-B, Hinduja Hospital and WeSchool.

Prototypes presented were: ◗ Stethocardiogram - A lowcost, handheld screening

Student participants of ReDx Camp with Prof Dr Uday Salunkhe, Group Director, WeSchool; Abhay Dadhe, Chairman, SP Mandali; Vinod Tawade, Education Minister of Maharashtra; and Prof Ramesh Raskar, MIT Media Lab

device for valvular heart disease ◗ Low-cost X-ray machine ◗ Vein Detection using augmented reality and oxymetric mapping ◗ Anterior segment ocular imaging ◗ iLABLEit for retinal imaging annotation ◗ DAAnt - an automated device for early detection and continuous monitoring of dental health ◗ Otoscope for visualising ears ◗ Cardio24 - An integrated platform that enables automated diagnosis of cardiac health ◗ Super Stereo – A low cost wearable modular platform for eye diagnosis ◗ Skinspect- A handheld device that uses spectroscopy to detect skin-lesions ◗ Hydrospect- Modifying a pulse oximeter to be able to quantify and access hydration monitor ◗ MIT Smart Toilet Initiative Personalised health bioanalytics at home ◗ Sleep apnea for rest analysis and monitoring ◗ Skin perfusion photography – Analysing wounds, burns and other skin conditions using

blood flow perfusion maps Prof Dr Uday Salunkhe, Group Director, WeSchool said, “The collaboration between MIT Media lab and WeSchool is a milestone in our journey towards creating the future.

WeSchool’s efforts at creating an ecosystem for convergence of design thinking, technology and empathy has created this wonderful platform for bringing participants from diverse streams to design these much needed healthcare diagnostic devices which will have immense innovation value and social impact in the years ahead. During ReDx, WeSchool students have helped translate potentially high impact ideas/ solutions sourced from health researchers and doctors and turned these challenges not only into working prototypes but also into executable business solutions, thereby boosting their entrepreneurial spirit that will lead to new plans, new strategies, dreams and visions.”

Tawde applauded the efforts made by all the collaborators and said, “India faces major challenges in healthcare.

Today, an early diagnosis is a priority for every family and we

need to provide facilities to enable them for self-care and to avoid hospitalisation. WeSchool and MIT have made a wonderful beginning, now the government must step in to take it forward. We will certainly facilitate such projects which will help create accessible and affordable healthcare solutions for the common people. The huge population of students in Maharashtra is our asset and it will compel global leaders to come to the state to fulfill the ‘Make in India’ vision.”

Prof Raskar, Associate Professor, MIT Media Lab said, “ReDx, a platform focused on Healthcare challenges, is a joint venture going on in parallel in US and India. Apart from bringing in speed, our model of innovation enables us to collaborate with students, entrepreneurs, academician, researchers and government, and this convergence translates into scale and sustainability.”

Out of these convenient, affordable, do-it-yourself devices, the most promising projects will be selected for continuing development with the goal of commercialisation in the coming year.

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14th World Congress on Public Health held in Kolkata It was jointly hosted by the World Federation of Public Health Associations (WFPHA) and the Indian Public Health Association (IPHA) KOLKATA RECENTLY hosted the 14th World Congress on Public Health (WCPH) at the city's Science City auditorium. Kolkata last hosted the Congress in 1981.

The Congress aimed to contribute towards protecting and promoting public health at global, continental, and national levels and to create a better understanding of India’s public health challenges within global public health.

The 14th WCPH was jointly hosted by the World Federation of Public Health Associations (WFPHA) and the Indian Public Health Association (IPHA). Every three years, the WCPH brings together participants from a wide range of public health disciplines from many countries around the world. The focus of this year's edition was ‘Healthy People – Healthy Environment’ and was attended by nearly 2,000 participants.

Speaking at the inaugural session, Dr Madhumita Dobe, Organising Secretary, 14th WCPH, 2015 said, “Twelve Congresses have taken place so far and the opportunity comes to India after a long hiatus of more than 30 years,

during which the global public health scenario has changed with a lot of exciting initiatives. The 14th World Congress on Public Health with its theme of 'Healthy PeopleHealthy Environment'- is expected to provide opportunities to the global public health community to get together and deliberate on important issues. It will also serve as a platform to showcase India’s efforts and for sharing knowledge and experiences of public health professionals from over the world.

There will be sharing of experiences, knowledge exchanges, debate, discussion and learning about effective policies, programmes and best practices in support of the public's health.”

Dr Mengistu Asnake, President of WFPHA & Co-Chair of the WCPH Scientific Committee, recalled that Kolkata was playing host to WCPH for the second time, after a gap of more than three decades. He also recalled the contributions of legendary stalwarts like Roland Ross and others who worked towards conquering vector-borne diseases. He then talked about the upcoming

WCPH brings together participants from a wide range of public health disciplines from many countries around the world.

The focus of this year's edition was ‘Healthy People – Healthy Environment’. It was attended by nearly 2,000 participants EXPRESS HEALTHCARE

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Dr Asnake went on to note the already achieved successes, namely the significant reduction in tobacco use, lowered maternal deaths and eradication of vaccine preventable diseases like polio. He also mentioned WCPH's solidarity in standing by the victims of the Ebola epidemic in West Africa where over 25,000 people lost their lives, including nearly 9000 children.

Dr Asnake stated that he believes public health should be an agenda of not only health professionals but also everybody at large as it is an issue of global concern, especially with increasingly porous borders.

Speaking at the session, James Chauvin, Immediate Past President WFPHA & ICOC Co-Chair -WCPH, recalled the first WCPH held in West Germany in 1975, which consisted of just a few hundred people. He recounted excerpts from the proceedings of the first Congress and reflected on the current goals of WCPH – achieving the highest levels of health worldwide, while ensuring that everyone gets to enjoy basic human rights irrespective of their gender, race or creed.

Dr J Ravi Kumar, IPHA President and ICOC Co-Chair – WCPH, called for the need to clean our environment. “Eighty per cent of common illness are preventable, with a cleaner environment,” he said.

CK Mishra, Additional Secretary, Union Ministry of Health & Family Welfare and MD – NHRM in his plenary address stated that public health remains a key issue globally with new challenges like climate change giving rise to new diseases. He advocated the creation of an atmosphere of wellness, and healthcare in place of hospital care.

He noted that health professionals won't be able to make a difference alone as there are several other factors like education and awareness. Following this, he mentioned the two major challenges existing currently: health inequality across the globe and inefficiences in the ways of delivering health services, with another problem being the fact that non-communicable

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Organising Committee Members at WCPH

diseases (NCDs) are on the rise and that they cause more than 60 per cent mortality in India.

Maternal and child health were also mentioned as immediate concerns.

Dr Poonam Khetrapal Singh, Regional Director of WHOSEARO, who was the 'Guest of Honour', in her speech mentioned the key pillars in the field of public health while stating that the 21st century public health requires a 21st century approach. She mentioned that the NCDs have been costing the South-East Asian countries in trillions and that the Ebola outbreak was a major wake up call for the developing countries.

Kamalesh Sharma, Secretary General, Commonwealth of Nations & Chief Guest for the occasion spoke of the digital context in the field of public health and the very pertinent issue of the convergence of resources in order to achieve maximum efficiency in terms of health services among the Commonwealth countries.

For the first time, BRICS countries – Brazil, Russia, India, China and South Africa were represented as a group at the global conference. Brazil was the partner country of the event.

“Those are major emerging economies of the world and it is very important to have them as part of the discussion and solutions. So that is why we need

Thematic session by Bill & Melinda Gates Foundation

to have them,” said Chauvin.

“We want to see countries like India, Ethiopia and South Africa able to define what they see as the solutions and that they are not dictated to by other countries,” Chauvin added.

According to Asnake, one of the latest concerns is linking the growing economy to the health needs in these countries.

“Earlier, most of the problems were related to communicable diseases. But, with growing economy and changes in lifestyle, non-communicable diseases (heart diseases and diabetes) are becoming more prevalent. The care given in these economies is not comparable to more developed countries,” said Asnake.

Dr Vishvas Chaudhary was felicitated with the 'Dr Hugh R

Leavell Award' at the inaugural session of the Congress, in recognition of his contribution to the eradication of polio in India.

He later delivered the Hugh Leavell lecture.

The Congress hosted several plenaries, workshops, concurrent sessions, oral and poster presentations, and different exhibitions on public health. The 3rd International Students' Meet on Public Health (ISMOPH 2015), the satellite event was also held concurrently with the main Congress.

Thematic and concurrent sessions of the Congress included: public health services in India – progress and prospects; enteric and diarrheal diseases; measles elimination; universal health coverage; the story of water sanitation and hygiene

(WASH); public health in reproductive, maternal, newborn and child health; maternal death surveillance and response; heath systems development – priorities for public health (India); Japanese encephalitis and many others. On environment, there were sessions on health impacts of energy choices and environmental determinants of health.

Reportedly, the scientific sessions and the solutions platform exhibition generated great interest among the delegates and participants. It presented an interactive arena for disseminating information on various initiatives and solutions that have positively impacted public health.

The 15th World Congress on Public Health will be held in Melbourne, Australia in 2017.

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There is a lot more opportunity for JCI in India Joint Commission International (JCI) recently held an event in India for encouraging healthcare organisations to pursue accreditation. M Neelam Kachhap spoke to Paula Wilson, President and CEO,JCI and Prabhu Vinayagam,Asia-Pacific MD, JCI to understand its working and plans for India Tell us about JCI in India?

Paula Wilson: India got its first JCI accredited hospital in 2005, since then there has been steady growth in the number of organisations applying for JCI accreditation.

Prabhu Vinayagam: Currently, there are 22 organisations that have JCI accreditation; out of which 19 are hospitals and three are specialty centres. Besides, quite a few of them are going for accreditation this year.

Now, India has a lot of opportunity coming up as a lot of private investments are going into hospitals and as I go around the country I see many new hospitals coming up. So, there is a lot more opportunity for JCI in this country to work more closely.

India already has a national accreditation body called NABH, why then do we need JCI? Paula Wilson : We are somewhat familiar with NABH, it's a government accreditation body and is very important to India. We don't mean to substitute NABH but see JCI as a compliment to it.

Prabhu Vinayagam: We don't see anybody as a competitor. We are truly international in the sense that

we are the only organisation which brings in people from various countries to develop standards. Country level of accreditation must be seen as a necessity for a country like India. NABH is a very important aspect for India because only after you bring hospitals to a certain level of standard can you start thinking about achieving international standards.

NABH is a stepping process to get themselves (hospitals) to the country level benchmark, then they can look at international benchmark.

If somebody has NABH accreditation will they find it easier to get JCI? Prabhu Vinayagam: No I'm not saying that. As international standards are different there would be still some more policies to be added. What I'm saying is that the moment they become NABH-accredited the thought process of the organisation is already getting into safety and quality. Hospitals then find it easier to change their culture to suit international standards. If they start from scratch, with no accreditation in place, then it is much more harder to come into a process so I'm seeing NABH in a

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supporting role here.

JCI first started off in India in 2005 and today out of 20,000 hospitals only 19 are accredited by JCI. Why is that?

Paula Wilson : We are evaluating it (India as a market) very closely now and we think we want to have a bigger presence here.

Prabhu Vinayagam: Earlier, India was not part of the Asia-Pacific from JCI's point of view, it was part of the Middle East (ME). Till last year, ME has been a very strong growth market for us.

A lot of new hospitals are coming up in the ME area so our focus was not on India.

But now I'm on board and India is back in the Asia Pacific group. So there is renewed focus on this region.

What is your plan for India?

Paula Wilson : We are a not-for-profit company that is small in size, but we are growing very well. However, we don’t want to do too many things at the same time.

Middle East was our focus for the last couple of years but now we want to have a bigger presence in a large and important country like India.

We definitely have plans for India. We want to grow both in accreditation and education.

Prabhu Vinayagam: Our intention is not to give accreditation to all the hospitals. We intend to look at which hospitals are pro-actively working on quality and safety. And accreditation is a journey, it’s not a one-off process where a hospital applies and gets

We are evaluating it (India as a market) very closely now and we think we want to have a bigger presence here

Accreditation is a journey, it’s not a one-off process where a hospital applies and gets accredited

accredited. You have to go through a complete improvement process which takes a longer time. On an average, we have seen that from the time a hospital decides to go for accreditation until they get accredited, on an average, it takes about 1824 months. This is because there are a lot of policy changes needed. Lot of

standards need to be implemented and training needs to be conducted for the entire staff.

Accreditation by itself is not very expensive nor is the survey process expensive. What does cost money is the change that any hospital has to implement in its present structure to align with JCI standards

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Will you be focusing more on the private sector or both the private and public sector?

Paula Wilson : We focus on organisations that come to us voluntarily. We have actually accredited three public hospitals. In fact, we accreditate public hospitals in other parts of the world but the public healthcare systems differ from one country to another. We certainly wish every hospital in India gets accredited.

Prabhu Vinayagam: We have had a couple of rounds of discussions with the healthcare ministry in the last five to six months. We met the Ex-health minister Dr Harsh Vardhan and submitted a proposal to look at choosing

one public hospital as a pilot project for international accreditation.Then it can become a centre of excellence for other government hospitals to learn and understand how accreditation works. This will help not only government hospitals to grow, it will also put pressure on the private system to continuously raise the bar and that will help improve overall healthcare of the country. As there is a new minister we have to work the system again. We have also met the Director General of Health Services and put in our proposal. Once we get a clearance from there we will take it up.

Indian healthcare has a number of traditional medicine practitioners and some of them even have healthcare centres like the Ayurveda hospitals. NABH gives accreditation to these organisations, will JCI also accreditate them?

Prabhu Vinayagam: That’s not the prerogative of JCI at the moment because we are focused on scientificbased allopathy medicine. We do get inquires from China and Korea who also have a strong traditional medicine practice but we have not taken any decision on that as yet. We haven't thought about it.

We don’t have the bandwidth for it. We have a lot of work in allopathy so alternative is not in our radar.

Accreditation is a costly affair. Do you think you will have India-specific pricing for JCI accreditation.

Paula Wilson: Accreditation by itself is not very expensive nor is the survey process expensive.

What does cost money is the change that any hospital has to implement in its present structure to align with JCI standards. I'm aware that India is a very cost-sensitive market and we are trying to accommodate that to some extent.

Prabhu Vinayagam: Well, cost depends on a lot of factors. Accreditation is not very expensive from the

overall perspective.

Compared to the cost of errors happening at hospitals accreditation cost is hardly anything. Accreditation is not expensive. I always say accreditation cost will bring in profitability. The moment you standardise; you bring in efficiency it immediately impacts your (hospital’s) profitability. So it’s an investment which has got huge returns.

Do existing customers agree?

Prabhu Vinayagam: I'm not sure if they have done the maths for themselves, but this is an accepted theory. We have enough case studies from around the world that concur with this theory. But, we are yet to produce a case study from India. Surely, we will go ahead and do that.

Do you work with patients to make them seek safer hospital environment?

Paula Wilson: We work mostly on the hospital side.

We don’t really engage much with the patients. It’s not really central to our mission.

We make sure that the hospital leadership understands how important safety is. We engage with the leadership and staff to make hospital environment safe. But I think it is good that the patient be aware of the risks of healthcare.

Prabhu Vinayagam:We just finished our strategy discussion and India featured high in our discussion. In the future we would go to the patients to create awareness so that they can decide which hospital to go to. Today, they rely on other patients’ experience or recommendations but don’t look at a hospital’s performance. So, we will create awareness among the patients to have a criteria to choose which hospital is best.

Accreditation is voluntary in most of the countries so it becomes a challenge for us to show hospitals how safety and quality works and the only solution is awareness. mneelam.kachhap@expressindia.com

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'We want to reposition AMRI as one of the fastest growing healthcare players of Eastern India' After Rupak Barua took over as the Group CEO of Kolkata's AMRI Hospitals, he has brought about sweeping changes to revive the Group and has laid down investment plans to the tune of Rs 1000 crores in the coming years. He speaks to Express Healthcare and shares more details of his plans and strategies for AMRI

What is the current holding pattern of the AMRI Hospitals?

Emami Group has bought over the entire stake of the hospital from the promoters, Shrachi Group. The state government too has gradually reduced its stake to less than two per cent in the hospital.

Way back in the 1990s, the West Bengal Government had handed over the administration of 'Niramoy Polyclinic', a healthcare unit to SK Todi's Shrachi Group to develop and run on a PPP model.

What is your message to the family who lost their lives in the tragedy?

The disaster that happened was very unfortunate. We are compassionate towards the victims and the families who lost their near and dear ones.

I can only say that we have offered to pay compensation to the families of the deceased but we know that no compensation is enough to fill-up the void. I would not comment further on this, as the matter is sub judice.

What was the loss following the tragedy at the Dhakuria unit?

Till the tragedy hit AMRI, the leading healthcare unit had an occupancy of nearly 90 per cent and contributed to over 60 per cent of the revenues of the healthcare arm of the group. After it got shut down, the Group suffered a loss to the tune of Rs 250 crores and lost Rs 150 crores more by way of bank interest

and charges against loan taken for expansion.

But, inspite of the mounting losses and non-functionality of the unit, the Group did not terminate the services of the 1200-odd employees working at the unit.

This proves that the Group is caring and compassionate to the needs of the employees.

The Dhakuria unit has been reopened recently. What are your plans now?

The Dhakuria unit has three parts, main building, Annexe – I & II. In December 2011, Annexe – I was affected and subsequently the entire hospital had to be closed down.

Now in the last three years, the Group has invested Rs 75 crores on revamping the infrastructure and equipment at the Dhakuria unit. After getting all the clearances, finally the OPD has began operations in December 2013 and the IPD started operations in July 2014.

The main building has started with 170 beds and four OTs. It is equipped with PETCT from GE, 1.5 Tesla MRI from Siemens and flat panel Cath-Lab from Philips. The Annexe–II also has been restarted with a bed strength of 40. The very popular radiology and imaging department will be commissioned shortly with the most advanced SPECTCT, advanced LINAC, etc.

For the oncology unit, the Group has entered into a technical collaboration with HCG. The entire fire-fighting

The focus is to attain excellence in all three areas of clinical care, ethical standards and operations

mechanism of the hospital has been fully revamped and conforms to the latest fire-fighting norms.

What kind of HR policy changes have been introduced?

We have initiated a business process of re-engineering with the focus on the Group concept. We are

transforming, reviewing and cleansing up the old processes and practices. Now all the units have to follow the group standard operating principles (SOPs), which are being chalked out keeping patient safety and quality in mind.

The SOPs have been created to focus on protocol-based care and service-oriented treatment. The focus is to attain excellence in all three areas of clinical care, ethical standards and operations. The objective is to achieve excellence in all the three areas and to supplement this we have invested substantially in IT. We have implemented the most advanced hospital information system (HIS) with an electronic medical record (EMR) system from iSOFT. AMRI has tied up with Ziqitiza Healthcare to improve emergency medical care. It has commissioned a fleet of five fully-equipped ambulances in Bhubaneswar and will be soon launching another set of ambulances in Kolkata.

Tell us about your new healthcare project at Bhubaneswar?

It has set up a state-of-theart 400-bed hospital on the Khandagiri Bypass in Bhubaneswar, Odisha. Spread over five acres of land, the hospital has 160 critical care beds and 10 OTs. The first phase of the hospital was commissioned with 250 beds last year.

What are AMRI’s upcoming and future projects?

The Group has ambitious plans of investing Rs 1000 crores, out of which Rs 500 crores has been entailed for the Rajarhat project, Rs 100 crores has been earmarked for the expansion of its Mukundapur unit, Rs 25 crores will be spend on the revamp and procurement of new equipment for the existing unit at Salt Lake, Rs 125 crores will be spend for re-building the Annexe – I in Dhakuria and Rs 250 crores will be set aside for funding future expansion plans. We want to re-position AMRI as one of the fastest growing healthcare players of Eastern India.

AMRI is coming up with a 400-bed hospital and nursing college on a five acres plot of land at Rajarhat, New Town in Kolkata. The construction would start shortly and is likely to be commissioned by 2017. It will entail an investment of Rs 500 crores.

We would soon finalise upon the different specialties.

As per our plans, the Group will be soon setting up another tower at its Mukundapur unit, with 100 more beds. It will be equipped with 128-slice CT Scan, 1.5 Tesla MRI and flat panel Cath Lab. The Salt Lake unit will be fully revamped and will be equipped with the most advanced technology.

Besides, the management is open to invest further in greenfield or brownfield projects to expand its footprints in other tier I and tier II cities in the region. healthcare@expressindia.com

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We are working on live transmission of a paediatric robotic course from Chicago to Delhi Academic exchange and collaborations in research particularly in medical science and health form the cornerstone of new breakthroughs. The University of Chicago (UChicago), which set up its center in India last year, has been collaborating with Indian healthcare institutions since. Dr Mohan Gundeti, Associate Professor Surgery, Pediatrics and Obstetrics/ Gynaecology and Director, Pediatric Urology at the UChicago hospitals (Medical) explains more in an interview with Shalini Gupta

When did University of Chicago set up its Delhi center and what was the objective behind this?

We formally inaugurated the Center in Delhi in March 2014. It provides a base for the research work of University of Chicago faculty members in India and across South Asia.

With a commitment to free and open inquiry, our scholars take an interdisciplinary approach to research that spans arts to engineering, medicine to education. Their work transforms the way we understand the world, advancing fields of study, and often creating new ones.

Generating new knowledge for the benefit of present and future generations, UChicago research has had an impact around the globe, leading to such breakthroughs as discovering the link between cancer and genetics, establishing revolutionary theories of economics, and developing tools to produce reliably excellent urban schooling. The Center in Delhi aims to broaden and deepen the university's research in India in collaboration with local universities, institutions, and other bodies. The Center will also facilitate other forms of collaboration and engagement with India that enables The University of Chicago to bring its knowledge and expertise to bear in India. An ad-hoc

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committee of faculty members studied the issue in depth, looking at both current and potential future levels of engagement with India, before recommending the creation of the Center in Delhi.

Are you exploring collaborations with Indian hospitals or healthcare providers, doctors etc.?

In Chicago, we recently opened a new state-of-the-art hospital. This hospital was built on our experience of the Comer Children’s hospital about 10 years ago. Our experience with both these facilities has given us a unique perspective into the challenges of planning and operationalising ‘the hospital of the future’. We want to share this expertise, now, with India, to help local hospitals bring their clinical services, and their administration to reach international standards.

For example, our colleagues are helping other hospitals to improve areas such as planning, design, IT, supply chain management, infection control, patient engagement, customer service, etc. We’re also very interested in collaborating in areas where we have recognised international centres of excellence such as paediatric urology, adult urological oncology and reconstructions, gynaecology, paediatric

oncology including all medical and surgical specialities, neurosurgery and orthopaedic surgery. We have built deep expertise in advanced complex reconstructions and and minimally invasive surgeries.

Our expert faculty members, who are both dedicated and compassionate, provide a wonderful base on which all this expertise has been built over time.

Generating new knowledge for the benefit of present and future generations, UChicago research has had an impact around the globe

What similarities do you see between the Indian and US health systems?

The two health systems are different but the beneficiary and end goals are similar. Both systems have the scope to learn from each other as they strive to produce efficient and cost effective delivery.

Would the Center also look at capacity building/ workshops etc or certificate courses, trainings etc for the healthcare professionals?

Yes, in fact following my lecture at the center there was interest from the audience and we are working on the logistics of a live transmission of a paediatric robotic course from Chicago to Delhi on July 25 and 26. We will look to develop such opportunities in the future as well based on demand from the professional community in India.

What strengths and

weaknesses do you see in the Indian healthcare system?

The strength is the ability to deliver health and large volume which is essential given the country’s population.

It is difficult to talk about a universal weakness due to the fact that there are different organisations providing health care at different level within their reach and means.

Even as the health system is bursting at its seams, there are silver linings in terms of community health initiatives etc. What is the learning for the West from India? Any initiatives towards public health by UChicago?

While we don’t have a school of public health, we’re making population health management an absolute institutional priority. We have many initiatives underway, including efforts to become more accessible to vulnerable populations and ethnic minorities.

In the US, hospitals are becoming increasingly responsible for the outcomes and the life quality of their patients beyond the walls of the hospital. Over the last decade, UChicago epidemiologist, John Schneider has worked with Indian health organisations and healthcare providers, Continued on Page 26

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‘We have combined ayurveda with advanced scientific techniques effectively’ Shahnaz Husain is the undisputed doyenne of herbal care in India. The Shahnaz Husain Group is renowned in the international and domestic markets as the leader in the premium segment in ayurvedic beauty care. Interacting with Express Healthcare, Husain speaks on the growing interest in ayurveda globally and her plans to tie up with cancer centres for solutions to issues like side-effects of chemotherapy and set up spas in hospitals

You promoted ayurvedic beauty care globally at a time when the concept was non-existent. What is the relevance of such an alternative system of healing in the traditional healthcare sector, given the need for scientific evidence-based healing methods?

I adopted the concept of ayurvedic beauty care and cure because I wanted to find an alternative to chemical ingredients. Ayurveda offered safety from the effects of chemical ingredients. It is a fact that the human body responds well to natural ingredients, while it has an in-built resistance to chemical ones. Also, ayurvedic texts contain the details of a staggering number of plant products, minerals and other natural substances, along with their medicinal properties, methods of extraction, specific combinations of ingredients etc. It is true that ayurveda basically contains empirical knowledge, but today research is being conducted even in other countries to evaluate it in scientific terms. In fact, we have combined ayurveda with advanced scientific techniques most effectively.

Your expanding global network of franchise salons, spas, shops and beauty training institutes testifies to an increasing interest in ayurveda and the ‘back to nature’ trend in many countries. This has prompted study and scientific research

to assess ayurveda in scientific terms. Has India's herbal heritage been able to stand up to clinical scrutiny?

Yes, we carry out treatments with ayurvedic products. In fact, ayurveda is ideally suited to spa treatments. There is a great deal of interest in the traditional ayurvedic treatments of ‘Dhara’ and ‘Kerala Massage’. There is an increase in tourists who come for these treatments. In fact, ayurveda is still flourishing in India. We also carry out these traditional treatments. Our products have actually grown out of clinical treatments in our salons, based on massive client feedback. We have devised ayurvedic treatments and products for specific skin and hair problems and have been carrying them out with great success over the last four decades. In fact, we have become known for our therapeutic products and clinical treatments for skin and hair problems.

How are you involved in this effort to study and research ayurveda at par with mainstream remedies?

We have two R&D units and research & Development have always received high priority.

To ensure the purity of raw material, a herb and flower farm was also set up near Delhi, in order to exercise quality control from the raw material stage. This is done through rigorous testing and research.

The extraction of essential oils,

We have become known for our therapeutic products and clinical treatments for skin and hair problems

infusions, decoctions, tinctures and other extracts is carried out by the Shahnaz Husain Group. Various methods of soil culture and cultivation are being followed, using superior natural composts and fertilisers, which contribute, not only towards the purity and quality of the raw material, but towards actually creating a superior product. From the herbs and flowers, various preparations are obtained for use in the formulations, like infusions, decoctions, distillates, essences, powders, tinctures and so on, in keeping with the ayurvedic system.

These are made under strict supervision, using the latest technology. Stringent quality control tests are carried out for various dilutions. Thus, by exercising control at each stage, high quality is ensured.

The products are also clinically tested. Some formulations have remained in R&D for several years.

You believe that ayurveda can be combined with modern scientific techniques and is the healing system of the future. Could you elaborate on this philosophy with examples in specific disease conditions?

Our experience has been in treating skin and hair problems like acne, hyperpigmentation, scars, blemishes, premature ageing, alopecia, hair loss, dandruff and related conditions, etc. Herbs are actually remarkably versatile.

They can have a combination of

effects, allowing the entire scope of the problem to be treated. Neem (margosa) is one such versatile product and every part of the neem tree is used for healing purposes. We have treated acne, seborrheic skin and scalp conditions, sensitive skin and blemishes with ingredients like neem, sandalwood, basil (tulsi), mint, turmeric, clove, eucalyptus, ashwagandha (winter cherry), manjishtha (Indian madder), khus (Vetiver), carrot seed, anantmul (Indian sarsaparilla) and many others, due to their healing properties for such conditions and also for eczema, psoriasis, etc. Neem leaf infusions are very effective for skin diseases and help to relieve itching, soothe rashes, create a germicidal environment and clear inflammatory conditions.

Neem actually contains organic sulphur compounds, which have a powerful and versatile healing action. It is nature’s own antibiotic.

Hair loss problems, including alopecia and stress related hair loss, have been treated with clinical treatments, along with ayurvedic hair tonics, hair packs, rinses, etc., containing amla (Embelica officinalis) a popular ingredient for hair problems, including greying.

The ancient physician Charaka referred to amla as a medicine that delays aging, because of its high Vitamin C content. It is said that the Vitamin C content of amla is so stable that it is resistant to heat. Trifala, a combination of three herbs, has

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also been used to restore health to the scalp and promoting hair growth to curing eye ailments and soothing inflammations.

Trifala consists of amla, haritaki (Terminalis chebula) and vibhitika (Terminalis belerica). Bilva (Aegle marmalos) and brahmi (Indian Pennywort) have also been used in stress related hair loss and hair problems. Bilva helps to control Vata and cures hair problems and inflammatory conditions, while brahmi helps to control stress-related problems, as it has a calming effect on the nerves, apart from other beneficial properties.

Sandalwood is perhaps one of the most common ingredients that have been used in skin care, because of its versatility. It is said to have an effect on all the doshas, but mostly on Pitta. It has powerful germicidal and antiseptic properties, while the exotic perfume is said to have a relaxing effect on the nerves. It soothes the skin and beautifies it and is an ancient Indian cosmetic ingredient. Tulsi (holy basil) has so many medicinal uses that it has been traditionally venerated and worshipped. Modern research has revealed that it helps to purify the air, apart from its soothing and curative actions on the skin and scalp. Turmeric is a part of our traditional

Ayurveda is most relevant to our times and helps to deal with ailments that are related to our modern lifestyle beauty aids and has been in use since the ancient times. It has antiseptic and antiinflammatory properties, apart from softening the skin and enhancing its beauty. Rose has also been one of the most common cosmetic ingredients.

Oil of rose is said to have originated in India. Apart from helping to tone the capillaries, improve blood circulation and help skin texture, the fragrance of rose has a calming effect on the nerves too. It was used as an anti-depressant in ancient times, along with sandalwood, jasmine, orange flower and brahmi.

You believe that ayurveda can be integrated into the health care system in a scientific manner. Any specific plans and recommendations that you are working on?

Yes, ayurveda can be integrated into the healthcare system in a scientific manner. It is a holistic system, which also takes diet, exercise, lifestyle, massage, etc., into account.

Ayurveda is not only for those who are ill, but also for those who wish to come closer to a

perfect state of health. In ayurveda, disease is the result of imbalance in the system and the treatment seeks to achieve the ideal balance through medication, diet and lifestyle.

We already formulate products that are used in our traditional ayurvedic treatments. We also formulate neem, haldi, Trifala and anti-diabetic karela capsules, herbal teas, herbal drinks, pain relieving oil, muscle relaxant oil, immunity enhancer, etc. We have formulated our chemoline products that help to alleviate skin and hair problems caused by chemotherapy and radiation. There is a growing global market for alternative medicine, like ayurveda. This also includes essential oils, which are used in the related field of aromatherapy.

Considering our immense empirical knowledge of the healing power of plants and the scientific research in ayurveda, India can be a leader in the field.

Are you looking at tying up with established names in the healthcare space, like

corporate hospital chains, pharma companies, etc to take this vision forward?

What kind of partnerships are you looking at?

We plan to open treatment and de-stress centres along with spas in hospitals for people going through treatment can relax and rejuvenate themselves. We also plan to supply the chemoline products for skin and hair care to top cancer hospitals all over the world, that have been especially designed to help alleviate the side effects of chemotherapy and radiation.

These products draw upon the soothing and healing properties of organic ingredients and are known for their beneficial effects on the skin and hair.

Recently, the UN accepted Prime Minister Modi’s suggestion and has declared June 21 as Yoga Day. Do you think we should also have ayurveda Day? Actually, I am very happy that the Prime Minister has created the AAYUSH portfolio for promoting our traditional

medicines and practices of ayurveda, yoga, unani, siddha and homeopathy. It is totally due to his efforts and foresight that the UN has passed a resolution to celebrate International Day of Yoga every year on June 21. I definitely feel we should also have Ayurveda Day. In fact, I have already requested the AAYUSH Minister for this and I hope he will give it some thought. Today, people around the world are looking at ayurveda with enlightened eyes. It is an ancient Indian system of herbal and holistic healing. In fact, ayurveda being a holistic system, also takes yoga into account. Ayurveda is most relevant to our times and helps to deal with ailments that are related to our modern lifestyle. It can also help to counteract environmental pollution, toxic build-up and mental stress. That is why it is still flourishing in India. I have seen the global demand for ayurveda and have been able to establish a global chain of ayurvedic salons and spas. It certainly has economic potential and relevance for India. I think having Ayurveda Day will further pave the way for global recognition of ayurveda, and also encourage research and development. healthcare@expressindia.com

Continued from Page 24

We are working... treating some of India’s highestrisk populations, and working to better understand the spread of HIV. He learned in India that people’s social networks revolve around the use of their cell phones, and studying the text messages of men and women at risk for HIV infection in Southern India can help paint a map of risk and prevention opportunities.

Schneider, a network epidemiologist and infectious disease specialist in Medicine and Health Studies, has since adapted this methodology to help prevent HIV infection in

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the US, including working to understand how Facebook is used in at-risk populations.

Share your views on gaps between our medical curriculum and the developments in medicine.

Tell us about the partnership with Reliance on technology training for doctors?

This task is of the governing body responsible for training next generation doctors. We have a thorough process to look at future needs and incorporate into training. Reliance Foundation and the University of Chicago are collaborating to

develop innovative technology that will help train medical students and clinicians for better diagnoses and improved healthcare. The collaboration is also supporting doctors in real time with evidence-based clinical decision-making tools.

The partnership will develop cloud-based software applications that can train medical professionals using case studies written by experienced physicians and state-of-the-art clinical reasoning methods. Provided through technology partners iHuman Patients and AgileMD, the software will help improve

medical education and provide point-of-care clinical decision support tools for health care practitioners. These tools will work to reduce diagnostic errors, improve outcomes and help save many lives. The programme is being piloted in Reliance Foundation’s Sir HN Reliance Foundation Hospital and Research Centre in Mumbai.

What lectures/talks are planned this year and what are the plans for future?

The Center in Delhi has already hosted nearly 50 public talks, workshops, and

conferences. These events have spanned all areas of interest for the University. We plan to continue to expand programming at the Center and have several exciting programmes at various stages of planning and implementation. In the medical and healthcare space, we are conducting workshops in areas such as cancer research and anti-microbial stewardship.

We are working on the logistics of transmitting live to the Center in Delhi our upcoming paediatric robotic urology course. shalini.g@expressindia.com

EVENT BRIEF MARCH 2015 21

Medical Fair India 2015

MEDICAL FAIR INDIA 2015 Date: March 21-23, 2015 Venue: Pragati Maidan Summary: The three-day technical conference shall bring together some the eminent speakers from the medical fraternity who shall deliberate on vital issues being faced by the healthcare industry professionals.

Technical workshops managed and run by participating companies will offer solutions to specific issues and challenges faced by the medical professionals. The workshops are designed for doctors, healthcare professionals, distributors, traders and agents.

The hospital infrastructure conference programme will offer an extensive range of educational opportunities for those professionals responsible for healthcare design, planning, construc-

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tion, quality, facilities management, operations, IT infrastructure, and investment, finance and management systems in the region.

443 exhibitors from 23 countries will visit the fair.

Joint stands will be exhibited from China, Germany, Korea, Malaysia, Taiwan and the US. More than 8,000 visitors are likely to participate.

Contact Messe Düsseldorf India 302-302A, 3rd Floor Salcon Aurum Plot No. 4, Jasola District Centre Near Apollo Hospital New Delhi - 110025, India Phone: +91/11/4855-0000 Fax: +91/11/4855-0099 www.md-india.com

ULTRAFEST 2015 Date: April 10-12, 2015

ULTRAFEST 2015

Venue: The Renaissance, Mumbai Summary: Ultrafest 2015, now in its seventh edition will be organised by the Maharashtra State Branch of Indian Radiological & Imaging Association (msbiria.org). The theme this year is uro-gynaecology and obstetrics.

The keynote speakers are Dr Shweta Bhat, Dr Sheila Sheth and Dr Paula Woodward, all from the US. Topics on urology, gynaecology and fetal ultrasound will be discussed and debated over the three days of the event.

The regular features such as abstract and poster presentations, spotlight speakers, resident’s corner, quiz with interactive voting pads, Chuppa Rustum, scientific exhibits with new machine displays will be

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conducted as well.

Contact Dr Sanjeev Mani 1st Floor, Jain Arcade, CD Marg, Khar (W), Mumbai 400052 email: ultrafestindia @gmail.com Ph: 022-26463666

MEDICALL 2015 Date: July 31, Aug 1 and 2, 2015 Venue: Chennai Trade Centre, Nandambakkam Summary: Medicall brings the latest, appropriate and affordable technologies, for the benefit of all hospitals including smaller hospitals, clinics, nursing homes and physicians setting up group practice. Visitors’ profile include doctors, hospitals owners, diagnostic centres, medical directors, biomedical engineers, medical colleges,

Medicall 2015

healthcare services, investors for healthcare industry, and purchase managers.

Exhibitors’ profile include hospital equipment, surgical equipment, hospital furniture, diagnostic/laboratory equipment, dental/ophthalmology equipment, medical disposables, facility management and support services, hospital design and construction, hospital staffing service, IT provider for hospital, communication equipment, medical waste management, medical textiles, financial and health insurance services, office automation, equipment and accreditation agencies.

Contact Medexpert Business Consultants, 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai Tamil Nadu, India Phone: 91 44- 24718987

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BREAKING

GROUND ON THE WAYTO SUCCESS Determined to shape the future of healthcare in India, Dr Devi Prasad Shetty is breaking new ground in productivity, profitablity and affordability

BY M NEELAM KACHHAP

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D

r Devi Shetty, Founder Chairman of Narayana Health, is the ingenious man who wants to change the way healthcare is delivered around the world. He is celebrated world over as the man who made heart surgeries available and affordable for the poor. Taking a leaf out of CK Prahalad's famous ‘bottom of the pyramid theory’, Dr Shetty designed an inventive method to bring heart surgery closer to the poorest socio-economic group in India without compromising on quality.

He created a movement called Narayana Hrudayalaya (now known as Narayana Health-NH). Today he is expanding this idea to include complex treatment modalities like cancer and organ transplant, while adding increasing number of beds to his already large healthcare conglomerate Narayana Health.

"When I started out in 2000, I never thought all this was possible," Dr Shetty says.

"We not only proved to ourself that it could happen but also to others," he adds. Quite frankly he has achieved a lot in 15 years. Be it adding 7000 beds or health insurance at five rupees per month or building a world class health city, Dr Shetty has managed to grab it all.

Ground breaking idea Dr Shetty is world renowned for performing complex heart surgeries, mostly on new born babies, but that is not the only thing he wanted to achieve. He wanted to make heart surgery affordable.

When Dr Shetty saw that

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sequential organisation of tasks around the operating table was achieving quick turn-around time for patients in less than half the cost; he not only institutionalised the process but also shared the theory with the world. Soon he was being labelled as “Henry Ford of cardiac surgeries”.

By applying the principles of assembly line production to cardiac surgery he was able to demonstrate that world-class cardiac surgery could be performed at lower costs. He achieved this difficult feat by enhanced productivity (more number of surgeries in a day than other surgeons) which in turn translated into affordability that brought profitability to the hospital.

High volume, low cost India has a large number of patients seeking heart care.

“Every year two million Indians need cardiac surgery, but only 100,000 to 120,000 are performed,” informs Dr Shetty.

In addition there are a huge number of children with congenital heart defects that needs surgical correction.

“In India, a large number of children are born with a heart problem (600-800 per day),” adds Dr Shetty. He further says that, of these, 90 per cent perish gradually without ever getting any type of care.

Dr Shetty decided that he would not turn anybody wanting heart care back for want of funds. As a humanitarian, he wanted to help patients in need, which also allowed him to do high volumes to sustain the low cost of surgery.

Besides high volume, Dr

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THE HEALTH SECTOR CAN CREATE MILLIONS OF JOBS FOR THE EXTREMELY SKILLED, SEMI SKILLED, AND UNSKILLED WORKERS

Shetty was able to put in place a cross subsidised cost model for surgery where a poor patient's surgery was paid for by a wealthy patient and by innovating the low cost insurance scheme.

expense and earnings before interest, depreciation, taxation and amortization (EBITDA) margin. All doctors and administrators are also given a daily P&L calculation. This helps us stay above our competitors.

More importantly, if there is a course correction required it can be done immediately," shares Dr Shetty.

"For us, looking at a profit and loss account at the end of the month is like reading a post-mortem report. You cannot do anything about it.

Whereas, if you monitor it on a daily basis, it works as a diagnostic tool. You can take remedial measures," he further explains.

Innovating insurance He designed the world's cheapest comprehensive health insurance named Karnataka Yeshasvini healthcare scheme, supported by the Government of Karnataka for the poor farmers of the state in 2003.

Through the scheme, a farmer could have health insurance for a token sum of Rs 5 per month.

Today, the token amount has increased to Rs 18 and still the farmers insured can avail benefits of a variety of surgeries, including heart surgeries. “Till now over four million people have benefitted from this scheme,” says Dr Shetty. Currently, he is applying this frugal thinking to further bring down the cost of healthcare in India.

Broadly, outlining yet another disruptive healthcare financing scheme, Dr Shetty proposes an all-India insurance scheme linked to the large ubiquitous mobile phone customer base.

Dissociate health from affluence Healthcare is not only for the rich. The poor patients also need healthcare and Dr Shetty envisions India as the first country in the world to dissociate healthcare from affluence.

This can be achieved through micro-insurance schemes, he says. “In India, there are about eight million mobile phone subscribers who spend around Rs 200 every month to speak

Create volumes of workers

on the phone. If the government allows them to pay Rs 20 extra on that phone bill for health insurance, I don’t think people would mind paying that additional money and there would be a corpus for the healthcare expenses,” explains Dr Shetty. “This will happen soon,” he adds with enthusiasm.

Cutting cost not quality Dr Shetty believes that healthcare can translate into a profitable business. This profit could then be passed onto the patient. Cost-cutting is one of the ways to achieve this but quality becomes a major concern for many hospitals when thinking of cost-cutting.

Dr Shetty does not compromise on quality.

A few years back he realised that his annual bill for sutures was very high and kept rising every year. "Our annual bill for sutures was coming up to $100,000 and rising by about five per cent each year," he remembers. "We switched to less costly sutures by Centennial, cutting the expenditures in half to about $50,000," he says.

In the wake of re-evaluating costs, Dr Shetty set up a medical disposable company called Amaryllis Healthcare.

"We realised that other companies were only cutting and stitching disposable fabric bought in bulk to make disposable drapes," shares Dr Shetty.

"So, it was just a matter of procuring bulk material to make our own disposable drapes," he says. Today,

Amaryllis not only supplies NH with drapes but also exports to other countries. “Most hospitals rarely use disposable drapes, preferring linen because it is cheaper. But because of our scale, we switched and reduced our costs by 50 percent in the process,” he adds.

Profit – loss analysis Cost-cutting is not the only tool in Dr Shetty's tool-kit. Profitloss analysis is also used for diagnosing the financial health of the business."To reduce cost of healthcare one must know how much we are spending today," says Dr Shetty. "We have invested in a technology that lets us do exactly that," he reveals. "Every day at noon, I get an SMS on my cell phone with previous day's revenue,

Dr Shetty believes that workers in healthcare should be empowered to help in healthcare delivery. Technicians and executives can make a lot of difference but there are no dedicated skill enhancement programmes for people wanting to work in this area. "The health sector can create millions of jobs for the extremely skilled, semi skilled, and unskilled workers.

We are looking at innovative ways to help them educate and absorb in the main workforce," says Dr Shetty.

He also believes children from deprived background can become outstanding doctors.

"If you look at almost all the outstanding surgeons in this world, they are all children from a deprived background," he says. He believes that children from rural India aspire and have the zeal to be successful heart surgeons,

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cover ) neurosurgeons and other specialised medical professionals in fields that require more commitment and dedication.

He also feels that these children can be motivated to use their training in improving healthcare systems in their villages and small towns.

He has launched a scholarship programme in rural West Bengal, with Asia Heart Foundation (AHF) for children interested in becoming doctors and medical professionals.

At present they have 305 students taking benefits of the programme.

Insistence on accountability Accountability is one of the major challenges in the Indian healthcare sector. Patient safety and quality are there on paper but not many hospitals take firm steps to address these issues. "At NH every hospital has a committee that addresses these issues. They meet every week to discuss mortality and morbidity incidences," says Dr Shetty. "All data is collected and analysed to reduce morbidity," he adds.

He says this has helped NH reduce the incidence of bed sore at the hospital. "Bed sore incidence globally is about 8-40 per cent following cardiac surgery and we wanted to reduce it to zero per cent. We accomplished it in three years. Now our protocol is being accepted by the American Nursing Association to reduce bed sore in US," Dr Shetty says proudly.

"Like this we have various standardised processes to reduced morbidity and reduce complications," he adds.

Lobbying for better healthcare Dr Shetty is one of the healthcare evangelists lobbying for better working condition of doctors. He is also a supporter

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of ‘Save the Doctors’ campaign that advocate equalisation of undergraduate (UG) and postgraduate (PG) seats in medical colleges. "Unless the government equalises the UG and PG seats in medical colleges, (50,000 UG and 14,000 PG seats) there will not be any rural healthcare. Maternal mortality and infant mortality will not come down. Overall, no future for healthcare unless medical education is liberated from the shackles of current policies," he asserts.

Since, there are very few PG seats there is a dearth of specialist doctors. The few specialists that are available are all concentrated around urban areas and rural areas still lack specialist doctors.

"Government has to do it," Dr Shetty insists. "In India, 26-28 million babies are born every year of which one-fifth are born through C-section for which you need two lakh gynaecologists. But we only have 30,000 gynaecologists who are practising. Besides, we need anaesthetist, paellied staff it poses great concern to accountability.

"Legal framework is ill defined for doctors. Without an MD degree you cannot do anything.," laments Dr Shetty.

He also regrets the state of nurses in India. "The nursing profession may soon be extinct gal framework is ill-defined for doctors. Without an MD degree you cannot do anything," laments Dr Shetty.

He also regrets the state of nurses in India. "The nursing profession may soon be extinct in India," he says. The acute shortage of nurses in India is no secret. Nursing in India is not a preferred career choice.

Besides long work hours and minimal wages, nurses also struggle with stagnation." In developed countries nurses can specialise and become anaesthetist, intensivists but in

NH: ATA GLANCE N

arayana Health (formerly known as Narayana Hrudayalaya) founded by Dr Devi Shetty has its flagship hospital in Bengaluru at NH Health City. It houses India's largest bone marrow transplant unit at Mazumdar Shaw Cancer Centre, dialysis units and has tertiary care expertise in liver, kidney and heart transplants.

One of the world's largest heart hospitals, it has performed the largest number of successful paediatric heart surgeries in the world. The group has one of the largest telemedicine networks in the world. The Narayana Health network today has hospitals in Bengaluru, Kolkata, Jamshedpur, Raipur, Jaipur, Ahmedabad, Hyderabad, Guwahati, Durgapur, Shimoga, Mysore, Dharwad, Davangere, Kolar, Berhampore and Kuppam, in addition to its international subsidiary in Cayman Islands, North America. ◗ It conducts 40 heart surgeries every day ◗ It has expertise in liver transplants on babies less than 10 kg weight with 95 per cent success rate ◗ It is the first heart hospital in Asia to implant an artificial heart ◗ It has performed combined kidney and pancreas transplant, offers formal training programme for paediatric cardiac surgery ◗ Thrombosis Research Institute, Bangalore a division of Narayana Health is working towards discovering a vaccine to prevent heart attack.

The Institute has come up with markers to diagnose heart disease early ◗ Two units of NH, Narayana Institute of Cardiac Sciences, Bengaluru and Narayana Multispeciality Hospital, Jaipur are JCIaccredited and four others are NABH-accredited

India it’s not possible," says Dr Shetty. He says that nurses should be specialised and empowered for better delivery of healthcare in India. "We should legally empower the nurses and bring them to level of junior doctor," suggests Dr Shetty. He also says that these suggestions have been put to the health ministry and they are expected to take decision on these matters soon. "Yes! the government is listening and

(

these things may be a reality soon," says Dr Shetty.

Next big idea in healthcare Talking about his next innovation, Dr Shetty says, “The next big thing in healthcare is not going to be a magic pill, a faster scanner or a new surgery technique, it will be information technology that will change the way healthcare is delivered and consumed.”

Indeed information technology is being used today to improve the quality of care in India. “The entire healthcare will be delivered on the matrix of information technology,” he reiterates.

However, healthcare is utilising information technology at a heightened pace now, so how is it going to be disruptive in future? Answering the question, Dr Shetty says, “Information technology has not

been able to mould healthcare.

There has not been enough innovation as yet, may be because of data security concerns or due to low penetration of technology.” Emphasising on his views, Dr Shetty says, “But in time to come all this will change. Healthcare services will be delivered by information technology.”

Talking about his tryst with technology, Dr Shetty says, “We are in the process of devel-

FOCUS:LEADERSHIP

oping and testing a large number of applications for mobile phone, smart phone and internet.”

In fact, ICUs at Narayana Health, Bangalore are all paper free. “We have developed one app for the iPad. Our ICUs do not have paper, they have iPads. All the patient monitoring data is stored in the iPad and the patient is monitored through the iPad. Several other apps are being tested by us

right now," informs Dr Shetty.

Developing new technology is one of the focus areas of Narayana Health. "We have a major interest in developing technology. We are currently negotiating with one of the largest healthcare chains in US. They are very keen to take the iCare we have developed with Cognizant to the next level,” informs Dr Shetty. mneelam.kachhap@expressindia.com

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WOMEN SPECIAL

WAKING UP TO WOMEN'S HEALTH

A

s India strives to make health a fundamental right, many social constraints continue to deprive us of an all inclusive healthcare strategy. A major hurdle is India's skewed sex ratio caused by harmful practices like female foeticide.

Secondly is violence and discrimination against women. Thirdly, it is the difficulty of accessing emergency healthcare services and lastly, the lack of hygiene and sanitation. Each of these factors violates human rights and has adverse health consequences, especially on women and children.

This Women’s Day, as the voice of the healthcare industry, Express Healthcare seeks to highlight issues that are not only detrimental to women’s health and wellbeing but also deter the progress of our nation. In this effort, we present a panel of experts who share their perspectives on the ways and means to improve the health indicators among women and thereby improve the quality of their lives.

Some of the areas covered in this special segment include, the Beti Bachao Programme, the PC-PNDT Act and its

implementation, women healthcare initiatives and their effectiveness, need to improve sanitation and hygiene, as well as the security of women working in the healthcare sector.

As we set the stage for discussion, Dr Duru Shah, a social crusader speaks about the need for change in the attitude towards women. She also urges the industry to be a part of national campaigns for women empowerment.

She also opines that the healthcare industry, in their own ingenious ways, should highlight the importance of cleanliness and add to the visibility of the Clean India Campaign.

Alisha Moopen and Zahabiya Khorakiwala, young faces of the healthcare sector bring fresh views on subjects like the PC PNDT Act and ways to strengthen the health system in India.

Well, as important it is to save the girl child, it is equally vital to give them education and a healthy life. Dr Tester Ashavaid, on the basis of her research, points out the major health hazards for women in India and Mangla Dembi, being a management expert, highlights the need

for security of women at their workplace.

We also have women leaders like this year’s Padma Bhushan awardee, neonatologist Dr Neelam Kler and Apollo Kolkata CEO, Dr Rupali Basu, speak about women empowerment, drawing inferences from their own journey to the top in healthcare.

We also feature, Girindra Beehary and Sharad Agarwal, representing organisations like the Bill and Melinda Gates Foundation and HLFPTT, speak about initiatives that reach out to women and educate them on several pivotal aspects like maternal health, HIV and family planning. Rajan Samuels, on behalf of Habitat for Humanity, has been working towards providing safe housing for poor Indian families. He also talks about the need to improve housing and sanitation for women in India.

We hope these insights pave the way for improved health conditions among women in our country, because as eminent writer Harriet Beecher Stowe puts it, “Women are the real architects of society.”

Happy International Women’s Day!!

{inside} ALISHA 36 ZAHABIYA KHORAKIWALA 37 MOOPEN

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39 DRSHAHDURU

40 DRKLERNEELAM 41

DR RUPALI BASU

43 MANGLA DEMBI

TESTER 44 DRASHAVAID

46 GIRINDRA BEEHARY

48 RAJAN SAMUELS

49 SHARAD AGARWAL EXPRESS HEALTHCARE

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‘Regulations and laws can only be deterrents, they cannot bring mature perspectives to the society’ The PNDT Act is a step towards saving the girl child in India, believes Zahabiya Khorakiwala, MD, Wockhardt Hospitals. She, as an empowered woman and a representative of the healthcare industry in India, shares her opinion about the controversial Act and ways by which it can be integrated in the Beti Bachao, Beti Padhao campaign in an interview with Raelene Kambli

W

hat are your observations about the PNDT Act and its implementations?

The declining sex ratio and rampant female foeticide propelled the government to take some strict measures in the form of the PNDT Act. What ensued were stringent measures to ensure that no region in India, prosperous or not, facilitates pre-sex determination, doctors do not follow the practice, no undesired child sex abortion occurs, we have seen a considerable surge in the sex ratio in several areas, which is a good sign. However, one of the technology used for prenatal sex determination, i.e.ultrasound scan, is also used in the determination of ailments related to abdomen, kidney, heart etc., the control procedures on the use of these machines has also brought in some undesirable restrictions affecting the diagnosis and treatment of these diseases.

Do you agree that this act can be a catalyst for curbing sex determination and saving girl children in India? Kindly elaborate your view.

The Act has come up for some

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honest intentions. Indeed it has the power to curb the act female foeticide and save the girl child in India. However, it also depends on how well it is implemented. Also, this act is not a substitute for the awareness and education of masses about the subject , and incentivising the existence of the girl child in a family so that they are not considered as current or future liability, and is given due respect.

How can this act be integrated in the Beti Bachao, Beti Padhao campaign launched by the Government of India?

The Beti Bachao, Beti Padhao campaign launched recently by the government is a good push to spread the awareness on women safety. It is a good strategy to have synergy with the PNDT Act to reduce female foeticide. However, the programme implementation on the ground needs to be synchronised with a carrot and a stick approach to achieve the objectives.

What are the challenges in successful implementation of such a large scale programmes?

When one observes the sex ratio

INTERVIEW

WOMEN SPECIAL

from several states, it will be noticed that prosperous regions of India has a worse sex ratio than rural areas.

The challenge of implementation comes from the danger of losing focus in such elaborate programmes. In my view the Beti Bachao, Beti Padhao programme still has a potential to be crispier and focussed , not only to meet some milestones, but also to systemically eliminate the problems.

How can this act be bettered?

Better implementation with increase in penetration is one of the ways. Doctors who were punished under this Act were asked to give lectures to patients and members of the community about how they should not have done what they did and also talk about the Beti Bachao, Beti Padhao campaign. That is a good idea to take forward. However, faulty implementation in the past has left a considerable amount of ill will in the medical community.

There were cases where the doctors were harassed for some very minor issues of required documentation. In short, effort should be made to make the implementation easy and compliance hassle-free.

What is your message to the industry on this aspect?

If we wish to be considered a developed nation, our mindsets also needs to belong to the 21st century.

One cannot ask for a well educated and progressive nation without contribution from females.

Regulations and laws can only be deterrents, they cannot bring mature perspectives to the society.

What would bring a change in actual are societal interventions and initiatives aimed at changing the mindsets and promoting equality of sexes. raelene.kambli@expressindia.com

Alisha Moopen, Director, Aster DM Healthcare, as a young entrepreneur working for improving women’s health, feels that in India there is an immense need for continued innovation in this sphere. She talks about the need for the government, private sector and NGOs to integrate their efforts to strengthen the health system for women in India, in an interaction with Raelene Kambli

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majority of the health concerns in India revolve around women and children. What is your opinion on the same?

Women in India are depicted as goddesses and the country is called as Bharat Mata or Mother India. It constitutes this family of men and women of diverse cultures, religions and beliefs.

Despite this philosophical status for women there is unfortunately an inherent inequality towards women in India, from conception to death.

Female foeticide, although actively combated by the PCPNDT Act, which aims to prohibit sex determination prenatally, still remains a problem in many regions in India. The deeply ingrained patriarchal societal norms here glorify the birth of sons, potential wage-earners of the future, while daughters are considered a burden for whom dowry will have to be arranged.

It is the combined effect of the denial of education to women and the corresponding attitude towards them that forms a vicious cycle which gets passed through the generations. As resources are stretched in poorer families even proper access to healthcare is not given along with education to the girls in the family, which are two building blocks to improving their

status in society as well as improve their health profile.

Illiterate girls are married off as adolescents and bear multiple children without adequate spacing or awareness of how to provide for themselves or their offsprings when it comes to basics such as nutrition, immunisation and accessing primary healthcare. So in effect, the babies and children suffer, boys and girls, without discrimination as mothers are not really taught how to care for themselves and their children in a healthy manner under their existing circumstances.

I believe that although this is still a very prevalent problem, there are remedies campaigns and general awareness drives in society. If done effectively and in a focused manner, it can go a long way to alleviate these problems.

What is the most effective way to help these women access quality care, even in rural and low resource settings?

Education, information and creation of awareness are the best tools to combat these health concerns from a grassroot level.

This would ensure a sustainable solution to the issue at hand as with increased literacy and awareness, there comes an active healthcare seeking behaviour.

Programmes such as the

INTERVIEW

‘PPP is an avenue that needs to be aggressively tapped’

Integrated Child Development Services (ICDS) and the Midday Meal Scheme have been very effective in encouraging parents to send their children to school as it partially alleviates the burden of feeding them. Simultaneously, the pregnant women and new mothers are also educated regarding important aspects of pregnancy care and child care by accredited social health activists (ASHA), local women who are trained by the government to be health educators.

ASHA has been a double-edged blessing in the promotion of women’s health, as it is their duty to create health awareness and promote health seeking behaviour, and also to hold the health services accountable. They promote institutional deliveries, family planning methods, vaccination of children and are even involved in improving basic sanitation and clean water availability in their own villages. There is a need for more community health workers (CHWs) who can be trained in as little as six weeks, as opposed to the 5.5 years of training required to produce a doctor, as they have been proven to be most effective in creating awareness and a shift of attitude from curative care to preventive care.

Do you agree that integration is important to strengthening health systems, especially while providing healthcare services to rural women and children?

Geographical inaccessibility is one major reason for the unmet healthcare needs of especially rural and remote areas, even more so than financial restrictions. The lack of manpower and physical infrastructure impedes the public sector from permeating their services to these communities, while the private sector does not emerge in these markets due to lack of resource availability such as doctors in rural areas. A feasible and effective policy innovation to combat this issue would be to allow greater private sector involvement in healthcare, as the private sector is ready to tap the potential of the opportunity that lies in this region as long as the public sector facilitates resource availability and infrastructure development.

Subsidies and healthcare stamps would allow for allocation of resources to these poorest and

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WOMEN SPECIAL downtrodden of society. While Public Private Partnerships (PPP) is already prevalent in some areas in the form of credit or land allocation in return for subsidised or free care for the poor, other types of PPPs such as government financing and private provisions are still areas which can be explored and have tremendous potential.

Integration would not only help provide a platform to provide basic healthcare, but also fortify referral services, leading to better patient care.

Which are the government initiatives for women’s healthcare that you consider to be effective?

The National Rural Healthcare Mission(NRHM), which strives to provide accessible, effective, affordable and reliable primary health care has been quite successful in its endeavour since its inception. While they have not achieved their maximum potential due to lack of infrastructure, health manpower and lack of penetration of health insurance, certain components such as ASHA and Janani Suraksha Yojana (JSY) have managed to have a profound impact in improving provisions for the most vulnerable women in society. JSY has been effective in reducing MMR and IMR by promoting institutional deliveries by providing financial incentive, and also providing prenatal and postnatal care, while ASHA has tackled the issue from a different perspective by creating a shift in attitude.

Also, Mother and Child Health Wings (MCH Wings) with a focus to reduce maternal and child mortality, dedicated Mother and Child Health Wings with 100/50/30 bed capacity have been sanctioned in high case load district hospitals and CHCs which would create additional beds for mothers and children. This also allows for separation and protection from exposure of illness related diseases which is beneficial for the mother and child.

Is there an example that stands out and demonstrates the immense need for continued innovation in women’s health for development?

The burden of gynaecological and breast cancers in India is on the rise.

Both are preventable and curable in the early stages of the disease. Besides having a powerful tool such as pap smear for early detection of cervical cancers, we even have preventive measures in the form of HPV vaccinations. Despite these available provisions, the mortality associated

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with cervical cancer in India is too high. Possible interventions to alleviate this burden could be scaling up of cheaper screening techniques such as visual inspection with acetic acid (VIA), and subsidising the cost of HPV vaccination.

Similarly, mortality associated with breast cancer is very high, when simple interventions such as teaching women the importance and technique of a breast self-exam could go a long way in early diagnosis, which would drastically reduce the mortality associated with this treatable condition, which is often detected too late.

Even with so many healthcare schemes for women and children in order to achieve the MDGs, yet there are many states in India that lag behind. Do you feel that these health

healthcare per capita than states with higher per capita budget deficits.

States such as UP, Chattisgarh, MP, Jharkarkand and Bihar, with poor health indicators, can increase their current healthcare expenditure since their budget deficit is lower than states with better indicators such as Delhi, Kerala or Himachal. While this is largely a political-economical decision that has to be made, facets such as the rural health insurance should be further explored to try source funds from the private sector.

Less than two per cent of India’s rural population which accounts for 70 per cent of the population is currently insured. Micro-health insurance schemes are being studied and implemented on small scales, and have been showing tremendous potential.

With increasing rural income and geographical accessibility, the private

What, according to you, are some of the simplest ways to see real health gains in the developing world?

I strongly believe that education is our best available instrument we have to see real health gains. Educating and empowering women has been shown to not only improve their own condition physically, mentally and financially, but of the family as a whole, and in turn of the entire community.

Do you agree that the public health landscape is crowded. Governments, philanthropists, NGOs, and the private sector scramble, sometimes haphazardly, to attain health goals.

Is there a way that would make development assistance more effective?

Yes, while the intentions of all the factions involved in trying to attain health goals are similar, there is a dire

Women’s health has favourable social, economic and other far reaching consequences for the society at large programmes organised by the government are less effective in these regions and why?

Yes, there is definitely a disparity in the effectiveness of government organised programme in certain regions. Although there is an undeniable lack of financial resources at the state level, numbers show that the states which are least financially distressed are spending less on

sector is likely to heavily invest in rural healthcare infrastructure. The government needs to safeguard the sustainability of rural healthcare plans to ensure continued investment by the private sector in rural healthcare segments including telemedicine services, remote diagnostics and operation of other rural health services.

need for better collaboration and organisation within the healthcare sector. Precious resources are often going to waste due to overlapping of allocation in certain areas due to lack of communication, whereas certain spheres are completely left unattended to.

The onus is upon the government to implement a system which ensures cooperation amongst everyone involved in trying to achieve these similar goals. PPP is an avenue that needs to be aggressively tapped, whereas NGOs should be supported and encouraged by the government for the work they are doing. Most importantly, rural healthcare needs to be declared as a priority growth area by both central and the state governments.

Women’s health has favourable social, economic and other far reaching consequences for the society at large. And I hope that we can, together as a nation, tap these resources that will lead to exponential growth and prosperity for the nation as a whole. raelene.kambli@expressindia.com

Leading gynaecologist and social activist, Dr Duru Shah, Director of Gynaecworld, Center for Assisted Reproduction & Women’s Health and FOGSI representative, talks on the Beti Bachao, Beti Padhao programme, healthcare providers joining the crusade and importance of sanitation to ensure women’s health, with Raelene Kambli

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o you think that the Beti Bachao, Beti Padhao programme is needed?

The Beti Bachao, Beti Padhao programme is needed because it has brought girls into focus.

What are your observations on the its implementation in India?

Implementation in India will be a challenge because it is the mindset of the society which has to change.

Cultural norms which have been established over a long period, will take decades to change. It is the education and empowerment of women which will help women to assert their rights. But it is the education of men to understand that women are equally capable, which will finally help to take this programme further. And above all, if there is a strong political will, it will work.

How can the healthcare fraternity be a part of this programme?

The healthcare fraternity is totally devoted to this cause and would very much like to be involved in this programme. As a matter of fact, the National Association of Gynecologists, FOGSI, has condemned female foeticide and has passed a resolution to deregister any member of the association who has been convicted for this crime. Of course, as happens in every field,

there are some black sheeps who offer their services in various ways: either to assist in the detection of the sex of the baby or creating a baby with the desired sex. All this is done under wraps, hence no proof is available to nail them.

Can you name some similar campaigns which the healthcare industry has initiated in the past?

Doctors have always volunteered to participate in any such programmes which benefits the under privileged. I think as doctors, ours is the only profession which offers expertise, time and either free or subsidised services to the economically deprived, in various government and municipal hospitals in the urban areas and through camps in the rural areas. As gynaecologists, we have worked with the Health Ministry on various projects such as adolescent reproductive and sexual health, safe motherhood, 12 x 12 anaemia programme, and safe abortions, to name a few.

You have been associated with campaigns for women's health and empowerment. How is the Beti Bachao, Beti Padhao programme different or similar to the rest?

This programme has just been initiated. We have yet to see more action besides the speeches and fund

INTERVIEW

We have brilliant laws for women’s benefit, but nobody implements them

allocations. It is important to go to the grassroot level and see what’s happening. I have been into villages and the urban slums. I know the problems which women face. They have no idea about the laws in their favour, nor the rights they have. Even whilst running the Kishori programme in the slums of Dharavi, we heard of girls getting married off by the age of 16 years. Even though we have brilliant laws for women’s benefit nobody implements them. As a matter of fact, through the Kishori project we could postpone three such marriages with the assistance of the girls who had been educated and empowered with us in the project.

What should be the way to implement such programmes successfully?

The way forward could be: ❊ Involvement of all stakeholders – make them feel that it is their programme too. ❊ Involve all religious heads to remove the bias, as members of some religions strongly follow what is preached to them by their leaders. ❊ Make the law very stringent and penalties very heavy. ❊ Offer incentives to NGOs working in this area. ❊ Involve medical experts who are passionate about this cause, to offer crucial advice ❊ Encourage youth-friendly centres like our Kishori Project to mushroom all over. I would be very happy to participate and share the long experience I have had in this area. ❊ Involve the boys in this programme and educate them too.

What are the challenges in successful implementation of such a large scale programme?

The challenges will mainly be to overcome the attitudes of society.

Even some of our ministers think so erroneously when they blame women for their dress sense as the reason for provoking men to sexually abuse them. This is just one example. But I come across many such examples where there is marital violence, both - physical and emotional, even when a girl is highly educated and financially independent, only because the man feels that it is the duty of his wife to attend to all his demands and wishes.

And this happens because the son

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‘I think women are doing excellent in the medical profession’ Padma Bhushan awardee, Dr Neelam Kler, Chairperson, Department of Neonatology, Centre for Child Health, Sir Ganga Ram Hospital talks about her experiences of being a woman healthcare professional in India, with Lakshmipriya Nair

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ongratulations on receiving the Padma Bhushan. What are the major milestones in your illustrious career?

Thanks, it is a great honour. I also feel it is a great responsibility to do better. I think my returning back to India about 25 years back and the decision to practice neonatology, a speciality about which I was passionate and was trained for, was a turning point in my life. Many of my friends thought I was mad because neonatology as speciality was unknown, not only to the lay man but also among many in the medical fraternity. But, that was the time when Government of India, Ministry of Health, and large NGOs like WHO, UNICEF were beginning to focus on the huge burden of neonatal mortality and morbidity in India as well as the need for an action plan.

There were not many hospitals in India with neonatal intensive care beds. I had the support of Gangaram Hospital in developing a state-of-theart department and neonatal intensive care unit. We were the pioneers to start a three-year, National Board of Education accredited, post-graduate programme to increase neonatal fraternity and post graduates which gave a huge boost to clinical services academics research. My association with national and international organisations like National Neonatal Forum of India and Federation of Asia Oceania Perinatal Organisation gave me the opportunity to work on a larger canvas of health issues among women and newborns in India and globally. My recent endeavours for reducing healthcare associated infections have brought me closer to

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like-minded people, nationally and internationally, which has opened new doors to improve health outcomes.

How has healthcare evolved during the course of your career?

I can see great change in private medicine with bigger hospitals and better healthcare infrastructure.

But, at the same time, there is lot of over diagnosis, over treatment and absence of evidence-based practices.

We need to have accreditation of healthcare systems, as well as, internal and external audits on benchmarked outcomes. It is very pertinent to have quality in healthcare. Public healthcare has come a long way but still infrastructure is weak and there is severe shortage of healthcare workers. Moreover, the fact is that a huge population cannot afford private medicine and has to rely on a public healthcare system!

How is the playing ground for women in healthcare?

When I was a medical student, 35 years back, the number of females in a medical batch would be about 10 per cent, now it is 50 per cent. There are not only more women getting into the medical profession but also joining streams like surgery where there were less number of women. I think women are doing excellent in the medical profession.

What are the major challenges faced by women professionals? Is gender bias one of them?

This question is very frequently asked by people from developed world. I think at professional levels,

INTERVIEW

WOMEN SPECIAL like among doctors, it is not a very strong factor. They accept you as equal provided you remain very professional in your attitude and don’t ask for any favours or special exemptions. Presently, I see a lot of change in young females. They are more confident and there is more acceptance by our society.

Tell us about your work on improving neonatal intensive care We, at Gangaram Hospital, have come a long way. We have facilities to provide high frequency ventilation, brain monitoring, providing nitric oxide for babies with respiratory failure and starting ECMO and brain cooling for asphyxiated babies. But, at the same time, we are working on improving quality of healthcare, reducing risk of healthcare associated infections and focusing on clinical research.

Many Indian states have not met MDG 4 goals. How to accelerate growth in these spheres?

If you see the states which have not done so well as far as MDG goals are concerned i.e. they are the states which have poor governance, poor literacy rates, and women are marginalised, unlike women in states which are performing better. I work with a healthcare NGO called Basic Health. They look after the healthcare of poor migrant labourers in rural areas of Udaipur. Over there you would find that there are school buildings but there is a dearth of teachers. There are health centres without effective health workers. So, even if you have some infrastructure if the system is not working then it is of no use. We have to make sure that two most important areas for development of any country, education and health, receive adequate focus and they are available in urban and rural areas and most needy population. Only then can we expect development.

What is your message for other women professionals in India?

In modern India, professional women will have a great role to play.

The most vulnerable people in a society are women and children.

Professional women have to become the voice for these million voiceless, speaking for equality, empowerment and education. When they achieve that they will ask for the right to better health with dignity. lakshmipriya.nair@xpressindia.com

Dr Rupali Basu, President and CEO-Eastern Region, Apollo Hospitals Group has given a new meaning to hospital management in this region.

Sharing her insights with Raelene Kambli, she says that gender bias does not exist in healthcare, yet security of women working in healthcare is important

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hat does women empowerment mean to you?

Women empowerment has become a burning issue all over the world, including India, over the last few decades. Inequalities between men and women and discrimination against women have been age-old issues all over the world and specially in developing countries like ours.

But, with the spread of education and technology, women, both in the urban scenario and rural areas, are slowly becoming educationally and financially empowered. From working as an executive, to working in a brick kiln or heading a panchayat committee, 'women empowerment' has become a word pregnant with possibilities. Financial independence has led to financial security, a security which most women feel has made them more empowered. These are good signs. But we cannot be complacent as majority of the rural women are still under the realm of poverty, malnutrition and illiteracy.

Women empowerment will come only when these women get proper food, health and education. Until and unless they are educated about their rights and are financially independent, they won't be completely empowered in India.

Do you see gender bias within the healthcare industry?

I don't think so. There are instances of so many women doctors and managers excelling in the healthcare industry in the country today.

Is healthcare a successful career option for women? Tell us about your experiences?What does leadership mean to you?

Why not, see when I graduated in the early 1990s, I decided to pursue a course in advanced hospital management at Harvard University.

At that time, health management or hospital administration was never considered as subjects for doctors.

But it was a subject in the Western world. Now things have changed and today so many reputed B-Schools are offering courses in hospital administration and healthcare management. Boys as well as girls are coming in large numbers to opt for these courses. As the Indian healthcare industry is poised to grow in the coming years there would be more opportunities for young managers. And anyone who has the zeal to work hard and excel can become successful. Today, there are several instances of women excelling in the world of healthcare, be it medical professionals or healthcare managers. I always feel that the final output of whatever we do matters.

About my experiences, while studying in RG Kar Medical College Kolkata, I realised that clinical

INTERVIEW

‘Intelligence, integrity and energy is the key to success for women in healthcare’

outcomes not only depends on clinical expertise, but also on service excellence, facility management, technology and an environment which gives a feeling of ‘tender loving care' in a healthcare set up. I found myself keener on deft management of hospitals and made the decision of selecting the unconventional field of hospital management. This needed considerable courage since in the late 80s, the concept of hospital management was nascent and qualified doctors venturing to this little-chartered territory were unheard of. But I knew what I wanted and how to get there. Today, with an experience of varied locations and increasing responsibilities I have grown both professionally and personally. It is a great honour indeed to carry the torch of such a noble profession.

In the year 2004, while I was at the helm of Wockhardt Hospitals, Kolkata, I attended a specially designed course on hospital management from Harvard Medical International, Boston, US. It gave me an opportunity to see the quality and magnitude of the best of global healthcare very closely. This experience and exposure abroad gave me an edge to think globally in terms of healthcare quality and expertise which I could eventually introduce in Kolkata and eastern region in the following years.

Later, when I joined the Apollo Hospitals Group in 2008, as the CEO of Apollo Gleneagles Hospitals, Kolkata, my first challenge was to see us through the most coveted quality accreditation for a hospital in the world i.e., Joint Commission International of US. The entire process of preparation and implementation of JCI protocols brought a paradigm shift in our outlook and processes and has determined the success of the organisation till date. In the year 2009, Apollo Gleneagles Hospitals became the first hospital in the eastern region of the country to be accreditated by JCI and it remains the only hospital in the region to date to have done so. The JCI accreditation is valid for three years and one has to apply for reaccreditation after every three years. The audit for reaccreditation is more stringent and tough and I am very happy that we became reaccreditated twice again. Today, Apollo is a JCI-accreditated hospital.

What that means is that Apollo follows the same laws, rules,

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WOMEN SPECIAL standards and indicators that American hospitals have.

What are the challenges faced by you as a woman leader in the healthcare industry? How did you overcome these hurdles?

When it's a woman on top, it becomes imperative to talk about glass ceilings and the shattering thereof and the handling of the male egos. But, I have never faced such a problem.

I feel that your personal character and your attributes are directly responsible for how you manage yourself in the professional field. If you have certain basic things in place like differentiating between good and bad, right and wrong, then you'll be okay.

My philosophy of life never changed, whatever success came my way. I have never faced any bias or any problem like men not listening to me either at Apollo or Wockhardt. I think I have said the right things, and said them in the right tone, backed by a lot of data.

How to you ensure the security of women employees at your hospital?

What are the security provisions for women employees at your hospital?

Our staff are a disciplined lot and being a JCI-accredited hospital they have to adhere to a set of protocols, so we have never came across any such major issue. Besides, the HODs keep a

vigil on the women staff and ensure their security. Security personnel are posted at vantage points of the hospital to ensure safety of the women staff from any untoward incidents/persons.

CCTVs are also installed to maintain round-the-clock security of the women staff. We have a strict set of guidelines and policies to deal with any case of sexual harassment at the workplace.

The punishment ranges from penalties to even termination of service.

What is your message to women managers in healthcare?

Healthcare is a blend of science, arts and service. The urge to render heartfelt care to restore the smile of good health in countless faces is the goal that should keep on breathing life to all the initiatives of every individual in this sector. This is possible only when one works with the noble thought of creating a world for others. "I must

do something" always solves more problems than ‘something must be done.’ Any responsibility in the healthcare sector is a part of duty towards humanity, knowing fully well, how a single decision can have a farreaching effect on vast number of people. Hence every decision should be a precision decision. I have three tips for women working in healthcare.

Intelligence: Knowledge is very important. You need to know what you are doing. You need to know your role, you also need to understand beyond the role, and how your job impacts others. Managers don’t just look into their own thing, they look into the team. You need to put in a lot of research, a lot of understanding. We call it JDJS – Job Description, Job Specification. But often, we don't put in our own bit of knowledge to the JDJS that ben given.

Integrity: To me the right thing,

the good is very important. Those should be uninfluenceable, unchangeable in life. It's even more important in your work-life because here you are actually a part of something else. You are not just responsible for yourself, you are influencing others. So you need to be extremely focused on integrity.

Energy: You must be focused, you must put in more hours than others, you must have very high standards and you must go beyond what others are doing. Unless you do that additional bit, you won't make a good manager.

The tendency is to do a bit less than others once you become a manager.

It's very easy to sit back and let things happen, especially in Bengal. But I think it's very important to have that bucket of extra energy so that you can do more. raelene.kambli@expressindia.com

To me the right thing, the good is very important. Those should be uninfluenceable, unchangeable in life

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Industry can support... has usually been raised to think that he is superior to his sister or his wife! If we can overcome this challenge we could progress very fast.

What is your message to the industry on this aspect?

Have messages for all on TV and through various media to learn to respect women, which actually should start at home. When young boys see their mothers being treated shabbily, they think that is normal and treat their wives the same way as their fathers did.

This must change! The change has to begin from home. The industry can truly support by changing mindset of society and supporting initiatives which help in spreading the right messages.

Speaking about sanitation and hygiene in India, how does it affect

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women's health?

Hygiene and sanitation in India will improve with better infrastructure. It is the government’s responsibility to create water drainage and sewage systems, toilets etc which can serve the population even in the villages. Water conservation should be the responsibility of all responsible citizens of the country. And it should be the responsibility of each individual to clean up before leaving the toilet. Innovations have made their way in sanitation, by use of chemicals instead of water to flush away toilets. Facilities should be available to young girls to handle their menstrual periods whilst at school. We have seen villages where sanitary napkins are not used only because there is no disposal system.

Will investing money in water and

sanitation have huge return on investment in terms of increased productivity and reduced costs?

We all know that poor hygiene and sanitation lead to infections and infections are the commonest causes of diseases in our country. By not investing in water and sanitation, we are being “penny wise and pound foolish” What is your message to the healthcare industry?

The healthcare industry should use every opportunity to educate the masses on hand washing- the why, when and how of it. A simple process like hand washing before eating, after using the washroom etc. can go a long way towards a healthy nation.

How can the industry incorporate Clean India campaign as part of CSR ?

The healthcare industry could highlight the importance of cleanliness through health camps, school education programmes, TV ads, radio jingles, social media etc adding to the visibility of the Clean India Campaign. They often utilise celebrities to promote their products, they could utilise the same celebrities to give health messages. We made four short films for TV, especially one on female foeticide with none other than Amitabh Bachchan etc., but we could not reach out to many, as we could not buy commercial space on TV for these infomercials! This is where the health industry can chip in, besides promoting their products, they could create beautiful ads which would convey the right messages in a brilliant way, to the millions of Indian parked in front of the TV screens. raelene.kambli@expressindia.com

Safety of women employees is of great importance in institutions like hospitals where the chances of crime against women and children are significant. Mangla Dembi, Facility Director, Fortis Hospital as a management expert speaks about the need for provisions to ensure security of women employees in hospital, in an interview with Raelene Kambli

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aintaining security of women employees at a hospital setup should be a voluntary exercise or mandatory?

Hospitals are one of those few industries which celebrate the dominance of women workforce.

Thus, ensuring the safety of women in the workplace is of prime importance. We have various policies and measures to ensure the safety of women working with us.

How many women employees do you have at your hospital?

More than two third of the population working in our hospital comprises women.

How do you ensure the security of women employees at your hospital? What are the security provisions for women employees at your hospital?

We ensure that the female employees get a safe pickup and drop in case they have to travel at odd hours. Within the organisation, we have a very strict policy against sexual harassment.

In a hospital set up , the security would certainly include safety of women nurses from belligerent patients. So, how do you ensure security of these nurses?

Although we have not had any

such cases till now; we ensure that the nurses are safe against any such case though. We have placed security guards 24/7 at each floor. If required, they are instructed to take charge. Other than that, we do deploy male nurses in each shift who can handle such patients if and when required.

What about securing women employees from infections etc?

We have a very strict infection control policy. Every employee, irrespective of their gender or designation or the type of work, are trained on the policy. An infection control officer is always on vigil and takes corrective preventive actions as and when required. All staff members are also trained on the safety hazards in their related areas and how to safeguard themselves from these hazards.

What according to you should be the rules to maintain overall security of women employees within hospitals?

In today’s world, where women are working neck-to-neck with men and are equal contributors in their family income, they have also become prone to working late hours and thus face many safety issues.

Organisations should strive to maintain safety and security of

INTERVIEW

‘It is upon us to benchmark the safety and security standards for women workforce’

their female employees in every possible manner. It also includes their safety while commuting to the workplace. Strict measures should also be taken inside the organisation to ensure their safety.

What is your message to the industry?

Ours is an industry that personifies the empowerment of women. It employs a significantly large number of women across the nation. It is upon us to benchmark the safety and security standards for women workforce. raelene.kambli@expressindia.com

Organisations should strive to maintain safety and security of their female employees

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'If you have educated a woman you have educated a family' Dr Tester Ashavaid, Director-Lab Research, Consultant Biochemist HOD, Lab Medicine, P D Hinduja Hospital has been researching on various aspects of women related health hazards. She speaks on the major women health concerns of India in an interview with Raelene Kambli

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hich are the major women related health concerns that plague India today? How do we overcome them?

In India, only 46.9 per cent of the 246 million households have toilets.

49.8 per cent defecate in the open and 3.2 per cent people use public toilets. Situations have to improve.

Census of 2011 data collected on houses, household amenities and assets reveal that 63.2 per cent of homes have telephones. Nearly half of Indians 1.2 billion people have no toilets at home, but more people own a mobile phone. Providing toilets to every household and good sanitary conditions will safeguard women, and will provide health relief to 70- 80 per cent women in India. Bio toilets are available and they should be introduced. It will help to safeguard women and improve sanitary conditions. The government is trying but the entire programme has to become more aggressive and should be well monitored.

Health hazards by inhaling smoke from wood stoves for cooking is another aspect. Smoke inhalation from burning wood or charcoal over an open pit leads to premature deaths mostly among women and children who are often home all day. Four out of every five rural and one out of every five urban households in India primarily depend on direct burning of solid biomass fuel like fuel wood, crop

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residue and cattle dung in traditional mud stove/ three stone fire for cooking. Smoke from wood burning stoves contain a complex mixture of gases and particles. The size of the particles is directly linked to their potential for causing problems. Small particles less than 10 micrometers in diameter pose the greatest problems, because they can get deep into the lungs and some may even get into the blood stream. It causes increased respiratory symptoms eg., irritation of airways, coughing, watering of eyes or difficulty in breathing. It decreases lung functions, aggravates asthma, and develops chronic bronchitis, chronic interstitial lung disease, pulmonary artery hypertension etc. It also causes irregular heartbeat, and premature death in people with heart and lung disease due to particle pollution. Fuel efficient stoves should be introduced in Rural India.

Thirdly, according to the ICMR, cancer of the cervix is common in Indian women. It hits the younger women population whose lives are shattered after they know of it. It occurs because of viral infection caused by human papillomavirus(HPV). The incidence is higher in rural India than in metros. Herpes is one of the cause of cervical cancer which is again caused bad hygiene, too many children, low nutrition levels and early marriage contributing these

INTERVIEW

WOMEN SPECIAL women to a higher risk. 3 dose HPV immunisation coverage for routine immunisation is recommended and should be made mandatory for young women.

Breast cancer is another major cancer among Indian women. An increasing number of women are in between 25 to 40 years of age which is a disturbing trend. There is lack of awareness about the disease and hence these are diagnosed at a later stage ie. At stage III and IV and this leads to a lower five year survival rate as compared to the west. Screening for breast cancer is an ‘alien’ word for most people and hence they need to be screened early. In the west, most cancers (more than 75 per cent) detected are with mammography which present at stage1 and stage II resulting in good survival. India needs to reach this achievement which is possible only by aggressive promotion of screening and awareness (which includes self-examination ) and proper treatment.

Is there a direct link between poor sanitation and these health concerns?

Yes, there are direct link between poor sanitation and poor health. Government has taken initiatives in terms of setting up good sanitation practices but that is not adequate. India is a vast country and it need greater resources. Every household must have bio toilets (in villages) and fuel efficient cook stoves.

Schooling for girls should by compulsory and every school girl should be taught good sanitation and hygiene guidelines, breast selfexamination awareness is a must.

This will ensure a fall in cancer cervix and cancer breast.

Is there a need for a right to healthcare bill in India?

Yes, these is a need for a right to healthcare bill in India which will improve health condition of women in India.

What is your message to the industry?

It is very important for women to prioritise health. If you have educated a woman on good sanitation practices you have an educated a family.

raelene.kambli@expressindia.com

Health for all women in India Dr Araveeti Ramayogaiah, Founder, OPSDH, highlights issues in women’s health and recommends measures to tackle these problems

“Good health is more than the absence of disease and the well-being of a woman’s body, mind and spirit”.

-Where Women Have No Doctor

Pregnancy Age at marriage, child bearing, child spacing, fertility patterns, literacy percentage,

DR ARAVEETI RAMAYOGAIAH Founder, Organisation for Promotion of Social Dimensions of Health (OPSDH)

INSIGHT

Women usually suffer from health problems due to poor nutrition, reproduction issues, medical problems, work hazards, mental problems, low social status, poverty and violence.

In spite of 67 years postindependence, the paucity of statistics on women’s health is disturbing.

As per to 2011 statistics: ◗ | 61 per cent of women married before age of 16 years ◗ | Life expectancy of women was 64.2 years. ◗ | 1,70,000 deaths of women happened due to AIDS ◗ | 48.46 per cent of population related to female sex ◗ | 940 females were present per 1000 males ◗ | In 0-6 years, there were 914 girls per 1000 boys.

According to National Family Health Survey III: ◗ | 13 per cent of women were overweight ◗ | 55 per cent women were anaemic ◗ | 11 per cent of women were under 145 cm in height ◗ | 36 per cent of women had body mass index (BMI) which was less than normal. ◗ | 59 per cent women only were literate. ◗ | 16 per cent women were pregnant in teenage. ◗ | 57 per cent women were only aware about HIV/AIDS ◗ | 37 per cent women experienced domestic violence

level of education, economic status, customs and beliefs, role of women in society etc influence the nature and outcome of pregnancy.

Health risks are more if pregnancy is before 18 years and after 35 years. Age between 20-30 years is very ideal for pregnancy. The gap of three years between two successive births give good protection from several problems ‘Delay the first, postpone the second and prevent the third” as far as possible.

The risk factors in pregnancy are elderly primi, short stature, mal presentation, bleeding from vulva, eclampsia, anaemia, twins, hydromnios, still birth, intrauterine death, elderly with multiple pregnancies, prolonged pregnancy, previous caesarians, and general diseases.

All pregnant women should visit health functionaries during pregnancy, at the time of birth and after birth. Risks of child bearing can be greatly reduced with good nourishment, regular maternal care, birth assistance by skilled birth attendant, accessing specialised care at the time of need and regular checkups after child birth.

Medical termination of pregnancy (MTP) prevailing in India is right method to terminate harmful pregnancy.

Health functionaries should be humane with adequate skills. They should avoid unnecessary interventions for commercial purpose.

between her children The best contraception method is one that allows sexual intercourse and prevents conception. Contraceptive methods should be effective, long acting, safe, coital independent, reversible, available at the time of the need and affordable with minimal side effects.

Birth control is fundamental in our ability to maintain autonomy of our lives. Cafeteria choice should be the approach where an individual can choose birth control methods based on her needs.

Planning

Infertility

Family planning can influence the health of women and to: 1) Bear children at desired age 2) Choose number of children 3) Decide on the age gap

Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Both wife and husband should be tested to identify

reasons for infertility. The faults should be treated simultaneously.

Maternal Mortality Ratio Maternal Mortality Ratio (MMR) refers to death of women during pregnancy or within 42 days after delivery/ termination of pregnancy per one lakh live births. In 2010 MMR was 212 in India, 35 in Srilanka and 37 in China. The National Rural Health Mission (NRHM) launched in 2005 targeted to bring down MMR to 100 by 2012, but could not.

As per Goal 5 of Millennium Development Goals (MDGs), we have to reduce three fourth of MMR from 1990 to 2015. We may not achieve this goal.

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‘India still accounts for 16 per cent of all maternal deaths’ There exists a huge chasm in healthcare facilities for women in urban and rural India and organisations like Bill and Melinda Gates Foundation are actively trying to reach out to women in the interiors through frontline health workers to bring about a change. Girindre Beehary, India Country Director, Bill and Melinda Gates Foundation reveals more in an interview with Shalini Gupta

W

hat are the areas of focus for Bill and Melinda Gates foundation in India particularly in women's health?

We partner with the Government of India and the governments in Bihar and Uttar Pradesh to reduce maternal and child mortality. We help to improve the delivery of primary health services through the public health system, private providers and working with communities.

Much of this work focuses on the frontline health workers – ASHAs, Anganwadi workers, ANMs – to improve the quantity and quality of their interactions with pregnant mothers. This includes equipping them with the tools, skills and information they need to provide high quality, consistent information. We also work with the government to improve the quality of care in facilities, including nurse mentorship. In recent months we have given added impetus to supporting the government on improved use of data and monitoring, which we believe are critical in achieving our goals.

What have been the major

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projects undertaken over the last few years in these areas?

What progress has been achieved?

Our model aims to achieve impact at scale. We don’t just work in one or two villages, or even blocks, but – for example, in Bihar – right across all 38 districts. As a result of the enormity of the challenge and the complexity of the solution, it is difficult to show major progress, fast. That being said, we have just conducted a thorough evaluation of our work in partnership with the Government of Bihar, and the findings are very encouraging. We see that, indeed, by investing in frontline health workers, it is possible to increase the quantity of interactions between them and the women in the community – and, at the same time, increase the quality of those conversations. That’s very exciting, because it means that if we keep investing in these workers, we should slowly see health outcomes improve for both mothers and children. The frontline workers are heroes!

The sort of investments that we are making that we are now seeing bear fruit are various. There is a suite of mobile tools created by

INTERVIEW

WOMEN SPECIAL BBC Media Action, which – in the hands of the frontline worker – offer skills training and job aids.

We are seeing a new approach to incentives, focused on teams rather than individuals, working well: our partners at CARE are driving that project.

What areas of women's health has India progressed in, where does it lag behind?

While India has made good progress in achieving a number of its Millennium Development Goal targets, it will only come close to achieving MDG 4 and miss MDG 5, which focuses on maternal mortality. In fact, India still accounts for 16 per cent of all maternal deaths. And yet the aggregate numbers, do not tell the full story. Uttar Pradesh, whose population exceeds that of Brazil, has a maternal mortality rate 50 per cent higher than the national average and eight times that of Sri Lanka, whose GDP is only twice as high as India’s. On the other hand, some Indian states, such as Kerala and Tamil Nadu, have been much more successful in reducing maternal mortality.

The fact is that both the causes of maternal deaths – as well as the solutions – are well known. Many deaths can be prevented through the scale up and quality delivery of known interventions. These include simple things like preventing post-partum hemorrhage, treating maternal sepsis with antibiotics, and providing emergency transport and obstetric care. There is also a strong case for the introduction of new lifesaving interventions, including offering women a choice of high quality family planning services, so that they might choose whether and when to have a child. The provision of improved sanitation and hygiene solutions, and better nutrition, is also fundamental to saving lives.

What remains the Achilles heel in tackling maternal mortality?

Well, first of all, India spends too little on health overall. That’s a huge challenge. Right now, India spends only one per cent of GDP, which is far behind other countries: around three per cent in China and four per cent in Brazil, for example. That number needs to go up. Additionally, we need to do better in identifying

high risk pregnancies and referring these expectant mothers to the right facilities that can provide the appropriate level of care. This needs to be accompanied by an overall health systems management imperative to improve the quality of primary healthcare provision in the public system: for example, a focus on the quantity and quality of human resources committed to the system.

That is not to say that private providers cannot play a role. In fact, quite the opposite is true and the government needs to look at innovative and efficient ways to work with private providers on quality service provision. Finally, renewed attention on these management challenges must be accompanied by a genuine commitment to performance. That means truly knowing whether or not a particular facility, or health worker, is delivering quality services to their community – with implications for situations where standards are not being upheld.

Sadly, there is no silver bullet, but

Providing all women access to high quality, voluntary family planning services is essential

I remain optimistic. India has demonstrated that with the political will and the requisite resources, it can overcome challenges that seem intractable: the fight against polio is an amazing example.

What are the barriers to access to family planning and contraception? Have you done any studies/research around this?

Giving women in India access to the tools and information they need to time and space their pregnancies will improve their health, and the health of their newborns and children. In doing so, all efforts must be underpinned by the core principles of choice and quality. In India, around one in five women of reproductive age do not want to get pregnant but are not using a modern method of contraception.

Furthermore, we know that around 77 per cent of women who opt for sterilisation have never before used any other method. The reasons for this are various and complex.

However, we do know that

voluntary contraceptive methods other than sterilisation are not widely available in the country.

Newer contraceptive options that are widely used elsewhere in the world, such as injectables and implants, are especially limited.

Even condoms and OC pills can be hard to come by for women in many of India’s poorest communities, for whom primary health care services are often inaccessible and of low quality.

Providing all women access to high quality, voluntary family planning services is essential to ensuring the rights of women and girls to choose freely, and for themselves, whether, when and how many children they want. We are working with the Government of India and the governments in Bihar and Uttar Pradesh to ensure that all women – no matter where they live – can choose to access high quality family planning information, tools and services. shalini.g@expressindia.com

Continued from Page 45

Health for all women ...

Menopause Menopause is cessation of ovarian function leading to permanent amenorrhoea (stopping of menstruation). It normally occurs between 45 to 50 years of age. This may be delayed in women with good nutrition and health.

Menopause is responsible for symptoms like hot flushes, sweating, insomnia (lack of sleep), headache, irritability, depression, cancer phobia, lack of concentration and decrease in libido (sexual desire) in women. 60 to 70 per cent of women go through menopause without any problem.

Adequate diet, exercises and social work largely prevent menopausal problems. Few years back, modern medicine started using hormonal therapy for managing menopausal symptoms. This therapy is not advised in women suffering from cancer.

Hormonal therapy can cause cancer of uterus and breast,

venous thrombo embolic diseases, coronary heart diseases, gall bladder, dementia and Alzheimers disease.

Women in menopause should manage symptoms through life style changes than with medicines.

Cancer in women According to several reports, cancer is less in developing countries. 5.37 lakh women suffered from cancer and 3.26 lakh died due to cancer in 2012.

Late first pregnancy, multi-parity, obesity, tobacco use, alcohol consumption, use of hormones for longer duration, avoiding breastfeeding of babies largely contribute for cancer in women. Healthy living, safe sex practices and adequate nutrition prevent cancers to a large extent.

very rare failure. Breastfeeding soon after birth contributes for quick involution of uterus and reduction chances of post partum haemorrhage (PPH). It also helps in loss of weight, lowers chances of breast cancer, ovarian cancer and osteoporosis. Breast feeding contributes for delay in menstruation, contribute for emotional fulfillment and psychological advantages.

What ails women health Birth rate mostly is related to social development. Family planning methods are not real solutions. Child marriages, maternity at younger age, life without any choice is contributing to several health problems among women in India. Caste system and capitalism is obstructing positive changes in society.

Breast feeding Exclusive breastfeeding with at least one feed at night prevents pregnancy for six months with

Recommendations ◗ |Provisions for all social determinants of health on war

footing. Immediate priority should be given to adequate food, shelter and sanitation. ◗ |1985 Rock Feller sponsored study on “Good Health at Low Cost” should be followed. ◗ |All women should avoid tobacco, alcohol and mood-altering drugs. ◗ |Physical activity should not be neglected by women. ◗ |Sexual relations should be completely voluntary and safe methods should be practiced. ◗ |All mid-wives should be trained and skilled to help women in pregnancy, child birth and during emergency. ◗ |The state should provide emergency transport system, low-cost cancer screening, a ccessible family planning services and trained health workers. ◗ |All women should be provided medical care with respect everywhere. Opportunity should be given for health workers and groups of women alone to change.

◗ |Good education, waiting period before getting marriage, having children at appropriate time, correct decisions about boyfriends and sex contribute largely towards women health. ◗ |Best models of health in the world are in UK, Cuba, Srilanka and most of the European countries. Our nation should emulate the best models. ◗ |Nationalisation of medical education, paramedical education, nursing and medical care run by commercial organisations should be taken up.

‘Where Women Have No Doctor’, a health guide for women highlights the issues faced in women’s health. It includes early marriage, lack of knowledge about health, lack of money to pay for health services, lack of training among health workers on women’s health and lack of women’s health services.

This Women’s Day, let’s the entire nation join hands to safeguard women’s health.

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'Lack of access to decent shelter is resulting in unhealthy living conditions' Habitat for Humanity, has worked for empowering women in India for three decades.As a member of the NGO, Rajan Samuels, MD, Habitat for Humanity, speaks about their endeavours and how they have collaborated with the government to improve better housing and sanitation for women in India, in an interview with Raelene Kambli

T

ell us about your includes construction of new project/initiative? How has homes, repairs and renovation of it evolved over time? existing inadequate structures, Habitat for Humanity India began protecting families from diseases, operations in 1983 in Khammam in animal attacks and harsh weather the state of Andhra Pradesh. It is conditions. among Habitat International’s ❊ Water, sanitation and hygiene, largest country programme in the including behaviour change Asia-Pacific region, having assisted communication (BCC): more than 275000 people since its Behaviour change communication inception. For more than three focusses on breaking age old habits decades, HFH India has helped such as defecating in the open and families rebuild and recover from habits that have been passed on disasters. from generations to generations.

Habitat works with communities Behaviour change communication to provide low-cost housing on works to promote handwashing, micro-financing models and self- help sanitation and safe food handling. groups which gives financial support This is crucial for maintaining the to people who are in dire need of health of the family proper housing and sanitation. ❊ Disaster response and risk Over a period of time, Habitat mitigation: We help disaster India’s focus has included stricken families to rebuild their empowering women by providing lives through provision of proper sanitation means and emergency shelter kits (ESKs) in ownership of homes resulting in the immediate aftermath of the improved health conditions. With disaster and in the longer run help more exposure to the living in rebuilding of homes. A critical conditions of women and children, component of the ESKs is hygiene Habitat India has continued to kits which include sanitary include new interventions such as napkins, soaps, chlorine tablets to smokeless chulas, green housing, purify water and other hygiene improved technology and affordable items. This is aimed towards housing to cater to all the lower preventing epidemic and endemic sections of the society. diseases which occur as a repercussion of the disasters.

What are your focus areas? ❊ Shelter related assistance: This How does your group evaluate the

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INTERVIEW

WOMEN SPECIAL needs of your surrounding community and measure the progress of your initiatives? ❊ Habitat India, with the help of local community-based organisations (CBOs) and small local NGOs, identifies beneficiary families and gathers socio-economic data of the communities. ❊ These CBOs and local NGOs facilitate the initial surveys and feasibility studies conducted before beginning a project. ❊ These surveys and studies form the basis of assessing the needs of the local community and in deciding the nature and level of intervention necessary. ❊ The effectiveness of our interventions are measured through interviews with the beneficiary family before and after the intervention. ❊ Partnering with local CBOs and smaller localised NGOs has helped Habitat to increase our level of outreach through direct interventions.

Have you tied-up with the Government of India ?

Yes, we have leveraged on the aid that the government provides low income groups through its various schemes.

This results in lesser gap funding needed to complete projects.

However, direct partnership with the government whether central or state level has hitherto been limited.

However, one of Habitat India’s major thrust areas for the period 2014-2018 is to establish develop partnerships with the government at local, state and central level.

Tell us about your learnings so far?

One of the biggest lessons learnt

by Habitat for Humanity is that housing is one of the biggest catalysts to breaking the poverty cycle leading to improvement in all facets of the beneficiary family’s lives with the impact on women and children being the largest. This includes safety, security, health, providing the right ambience for children education and livelihood. We have also experienced that giving out grant-based homes to the beneficiary is not as accepted as a home built by contributions from the home owners. Home owners have more acceptance and ownership towards homes built with their resources. It gives them a sense of dignity and pride amongst their peer groups and builds their selfconfidence. raelene.kambli@expressindia.com

One of the oldest and pioneering non-profit organisations, HLFPTT has for more than two decades been working towards ensuring safe motherhood and better child health.

Sharad Agarwal, CEO, HLFPPT talks about the progress made so far and the company's future plans in an interview with Shalini Gupta

T

ell us something about the implementation of ‘Targeted Condom Social Marketing Programme’ in high priority districts of six states.

Since 2008, HLFPPT is promoting the idea of safe sex through increased condom usage among men in reproductive age group (15-49 years old) under the Targeted Condom Social Marketing Programme. This large-scale, multi-phase programme, funded by the National AIDS Control Organisation (NACO), particularly focuses on high-risk groups comprising migrant workers, truck drivers, female sex workers (FSWs), men having sex with men (MSMs) and general population as well. Through a cohesive social marketing approach, we are working on an end-to-end supply chain management of subsidised condoms (under the brand names of Deluxe Nirodh and Rakshak).

Basically, we endeavour to create a perpetual demand for subsidised condoms among target audience; and also work towards increasing availability and access and regular supply of condoms in rural and remote areas.

In its latest phase (December 2012-December 2014), we conducted the programme in six high-focus states including Madhya Pradesh (36 high priority districts),

Uttar Pradesh and Uttarakhand (63 high priority districts), and all across Andhra Pradesh, Delhi and Bihar. We have sold 505 million pieces of condoms through 788,575 outlets and have contacted 51.1 million men (15-49 years old) for promotion of condom usage in the last phase.

What projects are currently underway in the fields of maternal health and women’s health in particular?

HLFPPT places immense thrust on women’s health issues, particularly on mother’s health as it firmly believes that only healthy mothers can nurture healthy families. We have instituted an innovative social franchising model of hospitals and clinics, under the brand name of Merrygold Health Network (MGHN) that is serving underserved communities at urban and rural levels in the states of Uttar Pradesh, Rajasthan, Bihar, Odisha and most recently, Andhra Pradesh, through multiple partnerships. MGHN facilitates high quality prenatal and antenatal services, institutional deliveries, safe abortions and family planning services, besides general OPDs and other services at reasonable rates and promotes the idea of safe motherhood among communities at large.

INTERVIEW

‘This year we’re foraying into RCH Allied Health Services, placing due emphasis on WASH ’

It started in Uttar Pradesh in 2007, with support from State Innovations in Family Planning Projects Services Agency (SIFPSA) and USAID, where the network has now expanded across 37 districts, comprising 64 Merrygold Hospitals (at urban level), 180 Merrysilver Clinics (at rural level) and 4150 Merrytarang members (community level volunteers). So far, we have provided antenatal care to 822,537 expecting mothers and facilitated 152,531 institutional deliveries (data till March 2014).

Buoyed by its success in UP, we have eventually replicated the MGHN Model in the states of Rajasthan (supported by Merck) and in Bihar and Odisha under Project Ujjwal (supported by DFID, UK). Incidentally, these are some of the states with highest MMR, unwanted pregnancies and malnutrition in India.

In Rajasthan, the programme started in 2013 and it facilitated 2,483 institutional deliveries and 17,519 antenatal and post-natal care services through 19 social franchisees across 10 districts in its inception year. In Bihar and Odisha, 31,425 people have availed family planning and safe abortion services at 299 social franchising clinics instituted under Project Ujjwal.

Most recently in August 2014, we have taken the programme to Andhra Pradesh, where we have established nine Merrygold hospitals in five high focus districts and included around 292 Merrytarang members so far.

Which states in particular are more challenging and why?

Recount any success story of having surmounted a major obstacle.

We have been operational across 23 states in India, and to be honest, each state has confronted us with its unique challenges involving demographic, topographic, socioeconomic, cultural and political aspects. So, while covering the masses is a concern in highly populous states of Uttar Pradesh and Bihar, reaching out to disperse tribal communities residing in remote hamlets across the vast terrain of Rajasthan is not easy. We are also operational in states with volatile issues of internal security such as naxalism-hit Chhattisgarh and Jharkhand or highly vulnerable Jammu & Kashmir.

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WOMEN SPECIAL Then, there are socio-cultural dynamics. For instance, while working on one of our highly successful programme, Swagati (2004-14) which was focussed on reducing HIV and sexually transmitted infections (STIs) prevalence among vulnerable groups (FSWs, MSM and transgenders) residing in coastal districts of Andhra Pradesh, our team faced strong resistance from communities initially.

Identifying home-based sex workers, who comprised the largest group of FSWs, was extremely difficult as these were married women with families who operated in a discreet manner.

However, our two decades of experience has taught us that change doesn’t come overnight. It requires consistent efforts, building trust among communities, strong passion and commitment to create an impact.

Any challenges that you faced in the implementation of the Female Condom Project in nine states of India, particularly given the socio-economic set-up?

We essentially worked with FSWs with the idea to empower them with female condoms (FCs) as an alternative method for safe sex practice in addressing their vulnerabilities and building their negotiation skills.

Majority of FSWs were home-based sex workers (67 per cent), followed by brothel-based (17 per cent) who reported that they were familiar with FCs, however, they considered FCs only as an alternative when male condom wasn’t available. It was specifically challenging in enhancing FC usage among FSWs with regular partners. It was also difficult in investing time and efforts on FSWs preparedness for FC usage in new areas, especially with wide variation in the socio cultural and typology variance of the target population.

However, we undertook consistent behaviour change communication through peer educators and outreach workers; advocacy efforts at state/district/community level for creating enabling environment for FC; communication events; and strategic planning. Our efforts helped FSWs overcome the cultural reservations and fear of pain that were inhibiting them from adopting FCs. Eventually, majority of FWSs stated that they got so empowered with FC that they were able to handle any kind of situation as they reported that they have acquired negotiation skills. And most of them reported that their level of comfort to use FC had increased with progressive use.

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You are also working towards building capacity of health service providers on IUCD and pregnancy testing cards in high priority states of India. What gaps were observed here?

And how are they being filled?

Intra Uterine Contraceptive Device (IUCD) is among the most effective contraceptive methods for spacing that can safely be placed in women for a long period without causing any sideeffects. However, despite its wide awareness among married women (74 percent), its prevalence rate continues to be as low as 1.9 per cent in India (DLHS). A common deterrent for IUCD adoption is the associated risk of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs) due to low confidence among Health Service Providers (HSPs) on IUCD insertions and lack of essentials at health facilities.

In 2011, we conducted a study with FHI 360 (formerly Family Health International) on IUCD, which observed that in most states, capacity building of HSPs on IUCD was not in practice. Consequently, the study recommended to “provide comprehensive training of all levels of

boosted confidence level of HSPs and increased trust among women.” For hands-on-practice, we have introduced the concept of “practice on Zoe Model” followed by live insertions under the guidance of subject expert. The programme is not only confined to improving skills of HSPs, but also helps them in improving post-training performance by helping them increase number of IUCD insertions through regular follow-ups and supportive supervision.

Besides, we are functioning as effective facilitators in improving health facility readiness in providing IUCD insertions. Rural communities in intervention states are especially benefiting from the programme as three fourth of the trained HSPs are from sub centres and primary health centres at villages. Additionally, we have also introduced an online HMIS to track the performance and continuity of the services provided by trained HSPs. How many girls have been trained so far in degree colleges of Uttarakhand on adolescent and reproductive health under project Roshni? What

that such initiatives by the government authorities bring increased awareness and sensitisation among the youth, and would surely enable in balancing the sex ratio and decreasing maternal mortality rate in the long run. We also realised that adolescent health along with life skills education should be promoted for adolescent boys for nurturing a healthy society.

What are the new partnerships and projects in the coming years?

Last year has been fruitful in many ways. We have replicated our unique social franchising model – the Merrygold Health Network – to Andhra Pradesh, following its success in UP, Rajasthan, Bihar and Odisha. Going ahead, we intend to scale-up the network pan India, whereby we see immense scope to align with the corporate sector under their corporate social responsibility (CSR). Our recent partnership with The Essar Group and Suzlon Energy for operating Mobile Medical Units in West Bengal, Chhattisgarh and Rajasthan is a feather in the cap of our extending network.

In fact, our expanding CSR portfolio itself is a story to watch out

HLFPPT places immense thrust on women’s health issues, particularly on mother’s health healthcare providers on IUCD counselling, insertion and follow-ups, with special focus on supervised insertions”.

Through this programme, our quest is to make a significant contribution in addressing this gap and help India fulfil its FP2020 Commitment of “training 200,000 health workers on providing IUCDs”. So far we have successfully trained 20,000 HSPs, covering 15,000 health centres across 11 states with nearly 400 districts.

Initially, we observed low levels of IUCD acceptance among women – inhibitions and myths persisted. Also, HSPs lacked in skill and practice on IUCD insertions.

Under our programme, we started training HSPs on ‘no touch technique’; selection of right clients for IUCD; and significance of infection prevention, counselling, and follow-ups. Over the last three years, the training has

have been the learnings in this programme?

Roshni Pariyojana was a significant programme targeted at training adolescent girls in Uttarakhand on adolescent and reproductive health issues in order to bring awareness and behaviour change among them. We provided training to 26,153 adolescent girls studying in 87 degree colleges spread across the state by organising 544 sessions. The core strategies adopted were capacity building, advocacy, behaviour change communication and monitoring and evaluation. The objective was accomplished using a cascading model of training – Lead Trainers from HLFPPT who trained the 32 master trainers at state/district level, who in turn, trained adolescent girls in colleges.

Post training it was widely felt, both by the trainers as well as the trainees,

for, which is escalating not only in terms of our partners or geographical presence, but also vis-à-vis our diversifying thematic area in Reproductive & Child Health (RCH).

This year is very promising for us as we are now foraying into RCH Allied Health Services, placing due emphasis on Water, Hygiene, & Sanitation (WASH), nutrition and skill building.

We are adapting to the changing dynamics of healthcare service delivery and devising innovative, costeffective solutions like sanitary napkin vending machines and incinerators, and condom vending machines for both male and female condoms. We are already in talks with many corporates for these and would start implementing these models soon, starting from Delhi-NCR with support from Jindal Steel and Power Limited (JSPL). shalini.g@expressindia.com

KNOWLEDGE INSIGHT

Advantages of laser therapy in enhancing medicine

MARTIN JUNGGEBAUER WeberMedical Representative & International Business Development Consultant, WeberMedica, Germany

Martin Junggebauer, Coordinator of International Business Development, WeberMedical, Germany elucidates on the uses and benefits of laser therapy and its far-reaching impact

L

asers have been important diagnostic and therapeutic tools in medicine for many years now - especially for surgical indications and interventions - the field of low-levellaser therapy is becoming increasingly recognised in medical research and about to revolutionise the field of regenerative medicine.

As the name suggests, lowlevel-lasers run on comparably low power: Only lasers up to 500mW are considered low-level-lasers. Practically, most lasers in low-level-laser therapy run on even lower power, mainly between 5mW and 100mW, depending on the indication.

The range of already wellknown indications includes the stimulation of acupuncture points as highly focused red and infrared laser light is able to penetrate deeply into the body and thus functions as a pain-free alternative to metal needles. Applications in dermatology are also well-established since many years.

Nowadays, technological innovations from German company WeberMedical also facilitate various kinds of internal applications: through a special catheter technology, low level laser light can be applied either intravenously or interstitially/intra- articular.

Laser light acupuncture Laser light acupuncture means a non-invasive and pain free stimulation of acupuncture points without needles actually penetrating the skin – only the highly focussed laser

around acupuncture points in much higher quantities than in other tissue. Besides that, different colours deliver different additional biological effects to the body.

The following box shows typical indications for laser light acupuncture: Clinical effects include: ◗ Pain reduction ◗ Improvement of blood circulation ◗ Detumescence ◗ Immune modulation ◗ Regeneration on the celluar level Effects on the cellular level include: ◗ Stimulation of mitochondria metabolism ◗ Increase of ATP production ◗ Stabilisation of cell membrane

Laser light acupuncture means a non-invasive and pain free stimulation of acupuncture points without needles actually penetrating the skin – only the highly focussed laser beam penetrates the skin and delivers the energy to the acupuncture points beam penetrates the skin and delivers the energy to the acupuncture points.

Technically, the end-piece of an optical fibre that is connected to a laser diode is attached to the surface of the skin with a self adherent tube in a 90o angle. The light generated by the diode is transported through the optical fibre (at virtually no loss of

energy) to the body.

For acupuncture treatments, infrared and red are the most important colours as they can penetrate the body deeper than other colours.

Blue light is absorbed already in a depth of 1 cm, green light in a depth of 0.5 cm, red light in a depth of three cm and infrared light – which can even penetrate bones - only in a

depth of approximately six cm.

Due to the limited penetration depth, green and blue light are only used for ear acupuncture. Corresponding to their penetration depths, red and infrared light can be used to stimulate acupuncture points deep in the tissue.

The key mechanism of action is the stimulation of stem cells which are located

Interstitial/intra-articular laser therapy The so-called percutaneous interstitial/intra-articular laser therapy allows applying laser light directly in the body and thereby overcomes the 'skin barrier' which absorbs large amounts of the emitted photons. The technology is particularly important because blue and green light – which is normally absorbed by the surface of the skin – delivers different effects than red and infrared light to the body.

Thereby, a sterile catheter is the key technical component that facilitates the treatment.

It is attached to an interstitial needle that has been inserted to the body on one end and to the light fibre at the other end.

The light then makes its way through from the laser diode

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KNOWLEDGE

through the catheter and interstitial needle in the body.

Indications for interstitial laser therapies are (e.g.): ◗ Chronic spine syndromes ◗ Slipped discs ◗ Scar pain after surgery ◗ Spinal stenoses ◗ Neural lesions ◗ Deep tendinitis and strains Indications for intra-articular laser therapies are (e.g.): ◗ Knee osteoarthritis ◗ Hip osteoarthritis ◗ Chronic shoulder syndromes ◗ Ankle joint osteoarthritis Typically, red, green and blue light is used in interstitial/ intra-articular therapies. The different wavelengths deliver the following effects to the tissue: Red laser ◗ Increase of cell activity and microcirculation ◗ Regeneration of damaged tissue structures Green laser ◗ Anti-inflammatory effects ◗ Effective in treatment of pain connected to inflammations and swellings Blue laser ◗ Strong anti-inflammatory effects ◗ Effective in wound-healing ◗ Immediate reduction of acute pain Both therapies can furthermore be applied in combination with and to enhance the effects of hyaluronan injections or platelet rich plasma injections.

Intravenous laser blood irradiation There are several mechanisms of action how intravenous blood irradiation unfolds its effect in the body. In general, laser blood irradiation leads to anti-inflammatory effects and improvements of the immunologic activity of the blood.

Photodynamic laser therapy Photodynamic laser therapy is one of the most interesting and promising approaches in the treatment of different cancers and in dermatology.

The therapy is easy to perform and goes along without severe side effects.

PDT in oncology

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Photodynamic laser therapy is one of the most interesting and promising approaches in the treatment of different cancers and in dermatology.

The therapy is easy to perform and goes along without severe side effects

EFFECTS OF LOW-LEVEL-LASER THERAPY Normalisation of the cell membrane potential Stimulation of immune response, specific and non-specific Increase of the immunoglobulines IgG, IgM and IgA Stimulation of interferons, interleukins and TNF-alpha Stimulation of the proliferation of lymphocytes Increase of phagocytic activity of macrophages Lowering of CRP Improvement of the anti-oxidant enzymatic system with antitoxic effect Improvement of regeneration of erythrocytes and of microcirculation Reduction of aggregation of thrombocytes Activation of fibrinolysis Stimulation of the NO-production in monocytes with vasodilatation and improvement of endothelial dysfunction Fusion of mitochondria to “giant mitochondria”with increase of ATPproduction in the respiratory chain

The principle is the stimulation of a light sensitive drug which is injected into the blood.

Through endocytosis, the so called photosensitiser binds with high specificity to tumour cells anywhere in the body. The process takes several hours and tumour cells will have become light sensitive at its end.

Tumour tissue can then be destroyed by irradiation with light of appropriate wavelength

according to the absorption spectra of the various photosensitizers. The basic principle behind this mechanism is the development of radical oxygen species.

Until recently, due to the limited penetration depth of light effective photosensitizer stimulation and tumour destruction could only be achieved at the surface of the skin or within only a few cen-

timetre in the depth of the tissue. An effective treatment of deep tumours or metastases (e.g. liver cancer or lymph nodes) was thus not possible and therapeutic applications had so far been primarily used to treat dermatological tumours. Today, the mentioned new technological developments that facilitate “systemic photodynamic therapies” and interstitial laser therapies overcome this barrier and constitute the basis for massive growth in the field.

A combination of “systemic PDT” via intravenously applied photosensitizers and subsequent intravenous irradiation as one component and interstitial PDT with fibre optic laser catheters and direct laser activation as the other component was established as a new treatment regime for various types of cancer.

Thereby, a good many of immune reactions go hand in hand with the primary effect of the introduced treatment regime, the destruction of tumour cells: Through intravenous blood irradiation circulating tumour cells and tumour stem cells can be destroyed and concomitant infections can be treated after a photosensitizer has been given to the body.

In addition, an oxygenation system can be employed as well to improve the micro circulation and oxygen supply.

Another recommendation to support immune reactions after PDT is a immunisation therapy with macrophage activating substances, e.g.

GcMAF from Japan. It can be injected subcutaneously for several months after the PDT treatment.

Even though the results of PDT are very promising by itself, the therapy should be regarded as a complementary approach to traditional chemo therapy, not as an alternative therapy. It can for example contribute to lessen the sideeffects of chemo therapies.

Additionally, many chemo therapeutics have an absorption spectrum that allows their usage as photosensitizers.

PDT in dermatology Furthermore, the topical (external) photodynamic therapy is also highly effective in dermatology.

Here, PDT is well established to treat various kinds of skin cancer and its pre- stages.

PDT is furthermore effective in the treatment of sklerodermy, acne vulgaris, psoriasis, different kinds of hyper keratosis, virus induced vulgar warts and other chronic skin diseases.

Approved drugs in this context are: 5-Aminolavulinic acid (5-ALA) and its methylester Methyl-5-amino-4-oxopentan oat (MAOP)

Transcranial laser therapy The transcranial (infrared) laser therapy is an innovative and promising new treatment option for stroke, Parkinson’s, Alzheimer’s, migraine, vertigo, tinnitus or other cerebral disorders.

Transcranial laser application with direct irradiation Of the human brain is done with highly focused infrared lasers as infrared light is able to penetrate bones and bring the light energy into the targeted brain areas. A special head adapter can be used to facilitate a stable positioning of the laser modules.

Various experiments could demonstrate that transcranial infrared laser therapy improves intra-cerebral microcirculation and reduces the area of infarction. Additionally, activation of neuronal growth after laser therapy could be observed.

The mechanism behind this approach seems to be an induction of biochemical metabolic pathways within the neurons. The light spectrum of infrared light is equivalent to the absorption spectrum of copper ions in the cytochromc-oxidase (terminal enzyme complex of the inner mitochondria membrane).

Thus, it can be supposed that infrared laser irradiation leads to increased mitochondrial ATP production. Due to the increased energy metabolism in the penumbra and a reduced rate of apoptosis, neuro- reparative processes are achieved.

HOSPITAL INFRA FAQs ON HOSPITAL PLANNING AND DESIGN | MEDICAL EQUIPMENT PLANNING | MARKETING | HR | FINANCE | QUALITY CONTROL | BEST PRACTICE

ASK A QUESTION How has hospital design changed over the years?

DR ANOOP Indore

We have seen the three generations of hospitals: early 80s, 90s and 2000s.

In early 80s, the concept of a hospital was totally different from this era. Now, hospitals are vertically developed not horizontally. All minormajor/critical-non critical/ medical-non medical etc., department or services were available on the same floor.

Earlier, one of the main reasons behind the horizontal development was the availability of space and most hospitals were government-run.

In the 90s, the concept started changing; hospital architects started developing hospital vertically also. Big brands, trusts and private organisations started developing their hospitals in India in a more systematic manner, especially by separating each and every department according to their requirement. For example, earlier the OT was usually kept in the basement area, after some time they realised that there were chances of fungal infection and it was too much isolated in the basement, so they shifted OT to the top floor. But accessibility to the hospital staff and patients’ relatives become problematic so they planned to locate the OT in the centre of a hospital.

Now in the 2000s, the hospitals scenario has changed a lot, apart from the infrastructure and good medical and non medical staff, nowadays more importance is given to hospitality, patient safety

and other value added services, like waiting area for patients' relatives, parking facility, play area for kids, cafeteria, mobile charging points, internet café etc.

LEENA Maheshwar

As I have mentioned earlier, apart from good infrastructure and availability of medical services, nowadays people give more importance to value added services in hospitals, like cleanliness, valley parking, kids’ area, retail shop, Wi-Fi facility, bed side spa, patients’ relatives facilities, neat linen etc.

As per my experience and observations, apart from basic infrastructure, need and value added facilities; we can provide facilities to the patients like: ◗ In room registration facility ◗ Meals from the hospital ◗ Special attention ◗ Barber from the hospital ◗ Availability of medical staff, specially at the time of emergency ◗ Facilities to the patients’ relatives like: ◗ A la carte menu ◗ Laundry facility ◗ Kids play area (day care types) ◗ Canteen ◗ Internet facility ◗ TV in the waiting area ◗ Library for relatives and visitors

How important is it to facilitate comfort for the patients’family members?

How much of a differentiating factor are value-added benefits?

DOLLY Administrator Delhi

DARSHNA Ahmedabad

Nowadays it is more important to provide comfort to the patients’ relative than to the patient, because generally they have more to complain than patients. This is because hospitals are charging high for their facilities and as people are paying so they want and expect everything to be perfect. Hence, hospitals today are designed to add value for patients and their relatives.

Hospitals are increasing day by day and there is huge competition in the field of healthcare. So it becomes necessary for every hospital to provide something extra in terms of value added services or facilities for patients and their relatives. These value added services differentiating hospitals from one another.

People have also become aware about these benefits. They are now more cautious about their health and ready to pay for good healthcare services. Hence they expect good quality of medical and non-medical services and hospitals are providing them as well.

What are the factors that play on a patient’s mind while opting a healthcare provider?

POOJA Ranchi

What are the facilities or conveniences that a person accompanying a patient can avail while waiting at the hospital?

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience, shares his insights and provide practical solutions to questions directed by Express Healthcare readers

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IT@HEALTHCARE INSIGHT

Guarding against healthcare cyberattack

RAJESH MAURYA Country Manager, India & SAARC, Fortinet

Rajesh Maurya, Country Manager, India & SAARC, Fortinet warns against cyberattack in hospitals and how imperative it is to take steps against such an occurence

OUR HEALTHCARE systems, from EHR to medical devices, are more vulnerable than many of us realise.

And the stakes are too high to ignore.

Even within the healthcare industry, few people realise just how vulnerable many of our systems are to cyberattack. We talk about protected health information (PHI) and HIPAA compliance, we worry about penalties, but few organisations see themselves as targets for the sophisticated attacks that have wreaked havoc for the likes of Sony. We’re just hospitals, insurance companies, and doctors’ offices, right?

The reality though is that the black market for patient data is up to twenty times more valuable than that for credit card data often stolen in retail breaches. Healthcare data is detailed, rich and full of information that cyber-criminals can use for identity theft and fraud. More importantly, it takes far longer for patients to know their information has been compromised – it can take up to a year or more for someone to realise their patient data has been compromised. When a credit card is stolen, algorithms in the financial industry pick up unusual activity very quickly and systems often automatically provide protection. Similar kind of protections simply

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Ponemon Institute study found that data breaches cost the average healthcare organisation roughly $2.4 million over the previous two-year period.

These attacks aren’t terribly new, but their sophistication is and the ability to expose patient data is of real concern.

Cyber-criminals have developed entire malware platforms that can be customised to attack healthcare organisations. The resulting HIPAA violations can incur substantial monetary penalties, not only for medical practices but their business associates as well.

Connected medical devices

don’t yet exist in healthcare.

Attacks on big retailers, banks and media companies make headlines, but the high stakes and big payoffs mean that we’re too close to a wave of healthcare-related cybercrime for which most organisations and consumers are unprepared. Unfortunately, this is just the tip of the iceberg.

There are, in fact, three pri-

mary vectors of a healthcare cyber-attack.

Traditional cyberattacks These are the types of attacks that happen to all institutions, even if some are more likely to make headlines than others.

Malware, phishing schemes, trojans, ransomware - they’re all out there, but the healthcare industry is particularly

vulnerable because it lacks the built-in protections and underlying security mindset of other industries. These types of malicious software, whether deployed through targeted attacks, compromised websites, spam, infected mobile devices, or otherwise, cannot only expose sensitive data but create distracting and expensive IT headaches. A 2012

Today, everything from heart monitors to IV pumps can be networked, automatically interfacing with EHR systems and providing real-time alerts to healthcare providers. From the perspectives of patient care and operational efficiency, this is a good thing. From a security perspective, it's a potential nightmare.

Most of these devices, as well as MRI machines, CT scanners and countless other diagnostic machines were never designed with security in mind. Many diagnostic systems use off-theshelf operating systems like Microsoft Windows while other devices use purposebuilt software designed to collect data - not keep it safe.

Too many of these devices are eminently hackable and, once compromised, can provide hackers with unfettered access to the clinical data systems within which they interface.

And it isn’t just patient data that’s vulnerable through connected devices. Cyberterrorists could potentially manipulate machines to intentionally harm patients or shut down critical systems in hospitals. As early as 2011, one researcher demonstrated how an insulin pump could be hacked to deliver a lethal dose of insulin.

Personal and home health devices Device proliferation isn’t just occurring in hospitals. An increasing number of home health devices, mobile apps, wearables and more are collecting and transmitting personal health information. Not

Healthcare data is full of information that cybercriminals can use for identity theft and fraud. It’s not just patient data that’s vulnerable through connected devices. Cyberterrorists can potentially manipulate machines to intentionally harm patients or shut down critical systems in hospitals only do these devices and apps potentially expose patient data (or at least fail to adequately protect it), but also often interface directly with EHR and clinical data systems. When everything from a home glucose monitor to an iPhone app can become part of the attack surface, it should become clear just how badly exposed healthcare institutions are. As with clinical devices, most of these new patient care modalities are

designed for convenience and innovative functionality rather than security.

Anthem breach - A wakeup call for serious action Patient data sits in countless systems in hospitals, medical practices, insurance companies and even HR databases. These systems include legacy software, purpose-built hardware, troubled insurance exchanges and more. Those in

healthcare IT knew that it was just a matter of time before a large scale breach hit a major insurer or hospital group. But the attack on Anthem known for their Blue Cross insurance brands appears to be particularly egregious. What is perhaps of even greater concern, though, is the apparent completeness of the compromise. Anthem noted on a special website dedicated to the breach www.anthemfacts.com that all

lines of Anthem Business were impacted and all plans and brands of Anthem insurance were affected.

With so much money involved and high-value data shared in a healthcare network the Anthem breach may be the largest to date, but unfortunately, won’t be the last. More than any breach we heard about in 2014, this needs to be a wakeup call for serious action on cybersecurity, especially in the healthcare industry.

The time to address healthcare security is not when medical record breaches like the Anthem start making headlines. The time is now. The healthcare industry as a whole needs to be proactive and begin deploying systems with security baked in, protected at both the network and application levels.

The stakes are simply too high to wait.

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IT@HEALTHCARE I N T E R V I E W

‘Figure 1 can be used to connect healthcare professionals ’ Figure 1, a popular free photo-sharing platform for healthcare professionals was recently made available in India. The app enables healthcare professionals and students across the globe to connect, discuss, and share content. Dr Gregory Levey, CEO & Co-Founder, Figure 1, shares more details of the app, its uses in the Indian scenario and more, in an interaction with Lakshmipriya Nair

What are the USPs of Figure 1?

Figure 1 is a community of hundreds of thousands of healthcare professionals around the world who are sharing and discussing medical cases. Healthcare professionals can view visual cases that they might not otherwise see in their practice all in a way that protects patient privacy. Seeing cases from other healthcare professionals in other parts of the world helps them expand their experience more rapidly.

They can weigh in on these cases too, especially those that are framed as questions, which help test their knowledge in a real-world setting.

Additionally, healthcare professionals can use the community for feedback by posting images. To do this, they take an image, remove the identifying information, and upload it with relevant case information. Posts on Figure 1 generally gather a lot of discussion from many kinds of healthcare professionals within minutes.

What are the opportunities and challenges you foresee for Figure 1 in India?

We are very excited about

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the opportunities for Figure 1 in India. We think Figure 1 can be used to connect healthcare professionals across the country - especially across its large urban-rural divide. We also think that instant access to collaboration with healthcare professionals all over the world will be useful for Indian healthcare professionals. With smartphones being so prevalent in India, we think there’s a huge opportunity for all of the 800,000 physicians and 1.5 million nurses, midwives and medical students to join Figure 1.

There are challenges that come with serving a global market, which is why we’ve waited to come to India despite the demand for Figure 1. Before launching in India, we worked with Indian healthcare privacy lawyers, and we expanded the number of people on our team in order to make sure we could meet these challenges.

How will it serve in the Indian scenario which needs affordable solutions to improve healthcare access?

Figure 1 is a free tool that will help physicians in rural areas by giving them access to specialists practising in major urban centres around

the world.

Posts on Figure 1 generally gather a lot of discussion from many kinds of healthcare professionals within minutes

What are your plans for the Indian market? Any tie-ups underway?

Recently our team was in Mumbai and Delhi meeting healthcare professionals who are joining our Indian Ambassador and Fellows Programs. The Ambassador Program is made up of medical and nursing students who represent Figure 1. The Fellows Program is for practising healthcare professionals who guide the direction of the community. We are excited to start these programmes in India for the first time.

What is the revenue model for Figure 1?

We are currently funded by long-term focused investors and are not focused on revenue.

You recently raised funds worth four million dollars.

How will it be utilised?

We were excited to close a Series A funding round with Union Square Ventures (early investors in Twitter, Tumblr, Etsy and Kickstarter) last year.

Since then, we’ve used the money to help expand internationally and to hire more staff. lakshmipriya.nair@expressindia.com

LIFE NATHEALTH announces leadership team for 2015-16

PEOPLE

Johnson & Johnson Medical MD, Sushobhan Dasgupta elected as the President of NATHEALTH

Honorary Fellowship of Punjab Academy of Sciences to Dr TS Kler and Dr Neelam Kler Dr TS Kler was awarded Padma Bhushan in 2005 and Dr Neelam Kler received it in 2014

CARDIOLOGIST Dr TS Kler, and neonatologist wife Dr Neelam Kler have been conferred with an Honorary Fellowship of the Punjab Academy of Sciences, in recognition of their contributions to their respective fields.

Dr TS Kler, leading cardiologist and electrophysiologist, has contributed in a major way to several pioneering developments in the field of cardiology in India. His contributions have been particularly remarkable in developing the field of interventional cardiology that has revolutionised cardiac care and treatment. Currently Executive Director (Cardiac Sciences), Head of Department (Cardiology) and Director Electrophysiology at Fortis Escorts Heart Institute in New Delhi, Dr TS Kler was honoured with the Padma Bhushan in 2005 for his achievements and contributions.

Dr Kler recently marked a major breakthrough in the field of cardiac electrophysiology by performing India’s first pacemaker implant via ‘His Bundle’ pacing, a technique that reportedly saves more lives in the longer run as against the tradi-

tional implant procedure.

“It is a distinguished honour to be recognised for your achievements by a prestigious body of doctors, scientists and other colleagues in the medical fraternity.

Knowledge sharing and exchange of information is extremely vital if we desire to ensure that all Indians have access to good healthcare services and doctors, be it in New Delhi or a small town in Punjab.

I am humbled by this conferring of honorary fellowship and life membership and pledge to do my best in promoting the knowledge sharing activities of the Academy,” said Dr Kler.

A distinguished neonatologist, Dr Neelam Kler, has been instrumental in transforming the concept of neonatal care in India, from a non-existent field to an indispensable speciality today. When Dr Neelam Kler joined Sir Ganga Ram Hospital in 1988, new born care in India was just an emerging field.

Over last 25 years, she has worked to develop a state-ofthe-art department of neonatology.

Dr Neelam Kler is currently Chairperson, Department of

Neonatology, Centre for Child Health, Sir Ganga Ram Hospital, New Delhi; and Professor of Neonatology at GRIPMER. “As a neonatologist who has worked for quarter of a century towards a relentless pursuit of making the best neo-natal care and technology available in India, the still high neonatal mortality rates in the country, makes me immensely sad. As a community of healthcare providers we should make collective efforts to improving healthcare delivery and availability of better life-saving technology across the nook and corners of the country. I am thankful to the Academy for giving me another platform to take this message to more of my colleagues across India,” said Dr Neelam Kler.

The two eminent Indian doctors were conferred honour at the annual conference of the Punjab Academy of Sciences held at Desh Bhagat University, Gobindgarh. The Academy bestows Honorary Fellowship on distinguished doctors from diverse fields with a mutual objective of enriching its membership and recognising great achievers.

NATHEALTH announced its new leadership team for the year 2015-16. Sushobhan Dasgupta, MD, Johnson & Johnson Medical India has been elected as the President of the federation for one-year term. He took over from Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare.

Dasgupta, whilst thanking the outgoing President of NATHEALTH, Singh warmly welcomed Rahul Khosla, MD, Max India and Chairman, Max Healthcare Institute as Senior VP-NATHEALTH, and other members of the leadership team, A Krishna Kumar, Vice Chairman & MD, Philips India as VP-NATHEALTH, Suyash Borar, CEO, The Calcutta Medical Research Institute as SecretaryNATHEALTH and Preetha Reddy, Executive Vice Chairperson, Apollo Hospitals Group as TreasurerNATHEALTH. This team, along with Anjan Bose, Secretary General, will lead NATHEALTH in its goal to create a robust platform for helping in the long term growth and sustainability of India’s healthcare sector.

Speaking on emerging priorities Dasgupta said, “One of the major challenges facing India today is providing affordable healthcare to millions of unserved and underserved patients. Consider the rapidly changing demographics of an aging population, a growing middle class, the persistence of chronic diseases and the scale and complexity of the challenge is magnified. Even though healthcare is our greatest challenge, it is also

NATHEALTH will work in line with its six mission pillars for bettering healthcare in India

the greatest hope for a better future. At NATHEALTH, we are committed to work towards reaching our goal of providing accessible and affordable healthcare for everyone.”

Dasgupta articulated the vision of NATHEALTH, “Be the credible and unified voice in improving access and quality of healthcare”. He also emphasised that NATHEALTH activities and initiatives will be in line with its six Mission pillars ◗ Enable the environment to fund long term growth ◗ Help develop and optimise healthcare infrastructure ◗ Help shape policy and regulations ◗ Help bridge the skill and capacity gap ◗ Encourage innovation ◗ Support best practices and promote accreditation Bose said, “We welcome our new leadership team which will continue to work for the benefit of the people of our great country, address relevant healthcare issues and champion the progress and development of this sector.”

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LIFE

FOGSI elects new President for 2015 Dr Prakash Trivedi, a pioneer in gynaecological laparoscopy, is the new President of FOGSI

DR PRAKASH Trivedi, a pioneer in gynaecological laparoscopy and uro-gynaecologist from Mumbai, was recently instated as the President of the Federation of Obstreticians and Gynaecologists Society of India (FOGSI) for the year 2015 at an event in Chennai.

Dr Trivedi is the director of Total Health Care, NILES & Aakar IVF-ICSI Centre as well as the Professor & Head of Department of Rajawadi Hospital, Ghatkopar. He is also the current President of the Indian Association of Gynaecological Endoscopists (IAGE) (2013-15).

Dr Trivedi announced that FOGSI’s theme for the year 2015 would be “Minimal Access Maximum Care,” with the smallest incision or even no incision at all. “Minimal access is not just about endoscopy or vaginal surgery, as Indian gynaecologists are already the best skilled surgeons in the world. But it is about the latest technologies such as Assisted Reproductive Therapy (ART), sonography, urogynaecology etc., reaching the doorstep of the patient who has minimal access to healthcare,” he said. “With many women increasingly putting off motherhood till their late 30s, pregnancy in high risk mothers will be another area of focus,” he said, adding that “doctors would be trained all through the year to concentrate and identify and take care of high risk mothers to

reduce the chances of mortality.” Among several ambitious projects announced by Dr Trivedi was a plan to organise one event per month in different parts of India, for junior as well as senior gynaecologists and the introduction of teaching lectures on new and better treatment options and techniques for female patients. He also pledged FOGSI’s support for the Prime Minister’s Beti Bachhao and Beti Ko Padhao movement.

He also assured that special focus would be given to training and honing the skills of young doctors and surgeons from Yuva FOGSI. He ended his address assuring the gathering that FOGSI’s strong force would align with the government and the health ministry and help bring down maternal and infant mortality rates across the country.

Ayushakti Ayurveda CEO gets International Goldstar Millennium award by Thai Govt Ayushakti plans to launch 10 new clinics in Thailand in 2015 CHIRANJEEV SHRIVASTAVA, CEO, Ayushakti Ayurved has received ‘International Goldstar Millennium Award’ for his contribution in promoting Global integration and economic development.

This award was presented to Shrivastava by Korn Dabbaransi, Former Deputy Prime Minister of Thailand and Harsh Vardhan Shringla, Ambassador of India to Thailand during an international conference held at Bangkok, Thai-

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land on ‘Indo-Thai Friendship and Economic Co-operation’.

For this award, achievers in the field of medicine, industry, business, public life, administration, social work, educational services and culture were selected. The award has

been instituted by the National Integration and Economic Council and organised by the Citizens Integration Peace Society.

Shrivastava is the man behind building the brand Ayushakti and believes in mak-

ing Ayurveda accessible to the masses. Ayushakti Ayurveda has significant plans for Thailand. Reportedly, the company through its franchise model is launching its first Ayushakti clinic in February 2015 in Thailand followed by 10 such Ayushakti clinics in the next 10 months.

Shrivastava said, “Ayur veda is the future, people are moving back to nature. People in western countries have already started following Ayurveda and alternate therapies. Currently, ayurveda is also being endorsed by our respected Prime Minister. I believe it is time for ayurveda to reach every corner of the globe and become a key contributor towards the economic development.”

Dr Jayashree Todkar is OSSI’s new Secretary DR JAYASHREE Todkar has been appointed the Secretary of ‘Obesity Surgery Society of India’ (OSSI) for next three years. OSSI is India’s national association for bariatric surgeons and allied health professionals, involved in delivering comprehensive bariatric and metabolic surgical care.

Dr Todkar currently heads the Department of Bariatric and Metabolic surgery at Dr LH Hiranandani Hospital, Powai. Through this appointment, Dr Todkar aims to work towards creating enhanced awareness about obesity and diabetes– one of the largest killer diseases in India. Dr Todkar has made remarkable contributions to the sphere in her career.

She is the Director of International Center of Excellence for Bariatric surgery and has received accreditation from Surgical Review Corporation from US. She is also very active in research of related surgical fields with various surgical organisations at national and international levels. She has presented and published her work in laparoscopy and obesity surgery and has been invited as a speaker at many prestigious national and international forums. She is also an active and prominent part of the research in surgery for treatment of Type 2 diabetes.

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TRADE & TRENDS

Clinical Logistics: Simplifying Healthcare INSIGHT Clinical Logistics has tremendous impact on the execution of the daily operations in a hospital “CLINICAL LOGISTICS are saving patients’ lives.” This remarkable statement is a quote from a newspaper post

by Ole Thomsen, CEO of Healthcare in Central Denmark Region. In the post, Ole Thomsen cites a study revealing that mortality is nine per cent higher in overcrowded hospital wards compared to wards with a normal state of occupancy. According to Ole Thomsen, this problem can be solved with a clinical logistics solution. Regional Hospital Horsens has substantial and positive experiences from using INSIGHT Clinical Logistics for more than five years.

“Clinical Logistics enables hospitals to optimise the staff capacity to the current patient situation and avoid that single wards are put under too much strain,” Thomsen says. In his experience, clinical logistics used to involve telephone calls and handwritten notes that became quickly outdated in a busy hospital environment.

“With Clinical Logistics, we immediately find the answer in the system which always conveys a real time overview of the occupancy of the different departments. This way we avoid patients waiting unnecessarily,” Thomsen says.

Clinical Logistics is key to an efficient hospital Hospitals are always looking for ways to improve work-flows and operational efficiency so that throughput increases without compromising quality or safety in treatment.

Jørgen Schøler Kristensen is a medical doctor, holds a doctorate in haematology and is working as Chief Medical Officer at the Regional Hospital Horsens in the Central Denmark Region. He strongly agrees with the views of Ole Thomsen on INSIGHT clinical logistics. In an article in the Journal for Danish Health Care, he points out,” The efficient hospital is characterised by stringent logistics and coordination”. As Jørgen Schøler Kristensen puts it “this is one – if not the - essential key to securing fast and efficient high quality patient flows. Add to this that the working environment of the staff is improved at the same time.”

According to Jørgen Schøler Kristensen, logistics is an important lever in the development of future healthcare because we need to treat ever more patients in a shorter time span. At the same time more patient flows are growing ever more complex and the organisations handling the patient flows are getting larger.

This demands efficient and well coordinated workflows alongside maintaining – preferably improving patient safety and overall quality.

IT for better logistics Jørgen Schøler Kristensen is of the view that 'the efficient hospital' demands tools and processes, which both support and contributes to the further development of good communication, coordination and overview during the execution of daily clinical work. In his experience, INSIGHT Clinical Logistics is that kind of tool.

The system has two main user interfaces: ◗ Firstly the large interactive screens places strategically in the departments ◗ Secondly the browser based interface 'Anywhere' which is accessible on all PCs, laptops and so on. The 'Anywhere' is also available for mobile

devices.

On the interactive large screens, the clinical staff is at any given time presented with a full overview of patients, staff, treatment activities, surgeries, test results and so on - in real time. The staff is at any given time able to edit informations and changes are instantly (in under one second) visible to all staff on both interactive large screens and anywere. Jørgen Schøler Kristensen points out that this is key to enhancing cooperation among staff as well as between departments and the systems’ incorporated webcams and chat functionality supports communications.

Finally, tracking is used making it possible to know where one's colleagues are at present.

And Ole Thomsen wants clinical logistics to go further.

He explains, “The vision is that the overview that clinical logistics provides today on large touch screens will ultimately be in the pockets of the healthcare professionals, where it is constantly within reach”.

Logistics is of great value One of the departments where INSIGHT Clinical Logistics has had a tremendous impact on the execution of the daily operations is the surgical ward.

Jørgen Schøler Kristensen explains that the work flow in the surgical ward consists of a vast number of serial actions involving staff from a number of different departments. The serial nature of the workflow

has the distinct consequence, that delays and errors propagates on to the subsequent actions of the surgical flow.

And Ole Thomsen adds, “Whenever a patient is in surgery, the doctors are easily and efficiently able to communicate with the staff outside the operating theatre by updating an electronic touch-screen.

This is relevant in many cases, for instance if a member of the surgical team is running late or an additional specialist is needed for surgical assistance.

The staff outside the operating theatre stays updated and able to effectively plan the next activities via the status changes conveyed to them from the operating theatre. “This makes sure that the patient has a good

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and safe course of treatment all the way from layering to anaesthesia, surgery and recovery”.

Ole Thomsen explains how clinical logistics is also of high value in the emergency departments where there is a large flow of patients. “We get an overview of the incoming patients and are able to prioritise the patients who are in the greatest need of acute care. At the same time we are able to see which doctors and nurses are attending to each patient and make sure that the right staff are assigned to the particular patient,” Thomsen says.

“Furthermore the system provides us with a detailed overview of the individual patients’ flow. This makes us able to stay ahead and be prepared for the next step”.

Jørgen Schøler Kristensen points out the differences from before to after implementation

Jørgen Schøler Kristensen opines that 'efficient hospital' demands tools and processes, which support and contribute to the development of good communication, coordination and overview during daily clinical work. In his experience, INSIGHT clinical logistics is that kind of tool of an IT-system for clinical logistics, “Before the implementation of an IT-system for clinical logistics, the overview of the surgery programme for the day only existed on a large piece of paper, which was manually updated with acute surgeries and other changes during the day. Changes and other new information had to be communicated by phone and only the staff in the OR theatre had knowledge on how far along the ongoing surgery

was. Today, the complete real time overview of the programme for the day is available on the interactive large screens and staff are able to edit infomation during the day which is instantly available in all screens all over the hospital.”

The results in short Jørgen Schøler Kristensen points out, that several actions have been taken to describe and measure the gains from

implementing a joint IT-system for clinical logistics in the Central Denmark Region.

“Both qualitative and quantitative studies show that clinical logistics provides better overview, improves communication and supports efficient coordination and in effect optimises the collective workflows.

At the same time all users of the system say that the system has resulted in a higher quality of treatment and has improved patient safety,” he says.

The same conclusions were reached in a Medical Technology Assessment carried out by the Centre for Public Health. Finally the one evaluation done of the system in an emergency department was carried out by Regional Hospital Horsens. The evaluation showed an increase of production of 19 per cent in the course of 18 months from the system implementation.

Ole Thomsen sums up the reason for Central Denmark Region to implement a joint IT-system for clinical logistics, ”This way the healthcare regions are constantly working on improving work flows in hospitals and making them more flexible. Because we do not believe that time heals all wounds”.

For further information: bhavesh.bhatt@maquet.com

Carestream launches premium Laser Imager Offers fast output, excellent image resolution for all imaging modalities; printer also supports output of FFDM and CR mammography images CARESTREAM HAS announced the availability for its new CARESTREAM DRYVIEW 6950 Laser Imager, which is designed to produce rapid output of high-resolution images for all imaging modalities including mammography.

The new imager was showcased at the recently concluded 68th Annual Conference of Indian Radiological & Imaging Association (IRIA) in Kochi.

In addition to CT, MR, CR, DR and other modalities, this new laser imager also will support output of full-field digital mammography (FFDM) and CR mammography images.

It can deliver a maximum film density of 4.0, which is preferred for mammography.

Key test patterns are included to assist with mammography quality assurance

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procedures and regulatory requirements. A built-in densitometer measures and displays key film density values, which can eliminate the need for manual density measurements from test films.

The laser imaging system delivers from 160 to 250 films per hour with 650 pixels-perinch resolution on every film size. Three film supplies come standard with the DRYVIEW 6950 Laser Imager, and film size changes are made easy by simply exchanging the film cartridge.

The intuitive user interface includes a multilingual touchscreen user panel with a builtin ‘help interface’ to simplify instruction, operation and user training. Each cartridge holds 125 film sheets to minimise loading frequency. An

The new laser imager was showcased at the recently concluded IRIA in Kochi optional five-bin, top-mounted sorter provides quick access to desired patient films by modality for greater efficiency and control.

CARESTREAM Smart Link remote management services provide technical support with remote monitoring and diagnostic solutions that can continuously track the status of each laser imager.

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Carestream delivers a full portfolio of laser imagers to support small to large volume applications. The portfolio also includes the CARESTREAM DRYVIEW Chroma Imaging System, which outputs diagnostic images on film and referral prints on paper in high-quality grayscale or full color. This imaging system, which is available in most countries, addresses multiple applications that include: PACS, CR, DR, CT, MR, PET/CT, dental, ultrasound, nuclear medicine and radiation therapy.

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TRADE & TRENDS

Transasia Bio-Medicals launches advanced diagnostic solutions Every year, Transasia expands its product portfolio to include the latest cutting edge technology for prevention and precise disease detection

TRANSASIA BIO-MEDICALS, a leader in the Indian diagnostic industry, expands its product portfolio every year to include the latest cutting edge technology for prevention and precise disease detection.

The various annual medical conventions attract a genus of professionals from all over country and the world, thereby offering Transasia a platform to showcase its latest offerings.

The 55th Annual Conference of Indian Society of Haematology & Blood Transfusion Haematocon 2014 was held at Ramoji Film City in Hyderabad, between November 6-8, 2014.

Transasia launched its latest Coagulation Series – ECL 105 (Single Channel Coagulation Analyzer) and ECL 412 (Four Channel Coagulation Analyzer) at the event through the hands of Dr Tejinder Singh (Prof and HOD-Pathology, Maulana Azad Medical College, New Delhi).

Both the instruments received a phenomenal response from the attending doctors and technicians.

Pune played host to 63rd Annual Conference of IAPM and Annual Conference of IAPID (APCON 2014) between 4-7 December, 2014. Transasia was an active participant at the conference with the launch of following instruments, at the hands of Lt Gen JR Bharadwaj, Dr (Maj Gen) SK Nema (Prof and HOD - Pathology, Index Medical College & Research Centre, Indore) and Brig V Srinivas (HOD- Pathology, AFMC and Organizing Secretary, APCON 2014): ◗ ECL 105 and ECL 412- latest coagulation series ◗ HbVario- HbA1c and HbA2/F Analyzer for diabetes management

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Dr Jayashree Bhattacharjee inaugurating EBG Stat at ACBICON

Lt Gen JR Bharadwaj and Brig PDS Dhoot with the Transasia team at APP-IMA pathcon

Lt Gen JR Bharadwaj at APCON

Dr Tejinder Singh inaugurating the ECL series at Hematocon

◗ EBG Stat 820/1020 –Critical care analyzers.

Transasia’s Global Product Managers Dr Suchan Pavel from Czech Republic and Corinne Robbe from France addressed the audiences through scientific sessions on ‘Newer trends in urine sedimentation’ and ‘Advancement in semi-automated coagulation analyzers’ respectively.

The 41st National Conference of Association of Clinical Biochemists of India (ACBICON 2014) was held from 10-13 December in Jodhpur. Dr Pravin Sharma (Prof & HOD – Biochemistry, AIIMS, Jodhpur and Organising Secretary, ACBICON 2014) and Dr Jayashree Bhattacharjee (Principal- Vardhman Mahavir Medical College & Safdarjung Hospital) & Prof Rajendra Prasad (Prof. & HOD- Biochemistry, PGI, Chandigarh) launched HbVario, EBG Stat 820/1020 and the newest ERBA System Packs (Enzy-

matic Creatinine, Bilirubin Total and Direct and Lipase).

Here again, Dr. Suchan Pavel addressed the gathering on the topic ‘New trends and technology in urine sediment analysis’.

The team from Transasia then travelled to the heart of the country- New Delhi to launch the products at APPIMA Pathcon & Lab Expo held on 14th December, 2014. The entire new product basket including the ECL series, EBG Stat 820/1020, HbVario and the system pack reagents were launched through the hands of Brig Gen Rajan Malhotra (Dy Gen – Armed Forces and Medical Services), Dr Vinay Aggarwal (CMD, Pushpanjali Crosslay Hospital and Past President, IMA) and Dr Rakesh Sharma (Founder – New Delhi Path Lab). In addition, Dr Pavel and Dr Sushrut Pownikar (HOD-Hematology & Sp Immunology, Dr Lal Path Labs), spoke on the topics,

Dr SC Ganeshprabhu at tha Transasia stall at ISACON

‘New trends and technology in urine sediment analysis’ and ‘Newer Parameters in Hematology’ respectively. The event was a grand success, with active participation of doctors from all across India.

Transasia also participated in the 62nd Annual National Conference of Indian Society of Anaesthesiologists, held from 25-29 December, 2014. Dr SC Ganesh Prabhu (Director,

Anesthesia Dept, Vellamal Medical College, Madurai & President, ISA, Madurai) inaugurated EBG Stat 820 w.

Transasia continues its efforts to bring in state-of-theart technology in diagnostics to the medical fraternity in India and world alike.

Contact Tel: 022-4030 9000 transasia@transasia.co.in

REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2013-15, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE.