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Coming Soon North India Special & Hospital Infra Special
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Criticare Special Trauma: an untamed evil Page 39
IT@Healthcare Medical Big Data - big problem or big opportunity? Page 52
Life A man of old world ideals and modern ideas Page 87
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VOL 6. NO 8, AUGUST, 2012
Chairman of the Board Viveck Goenka
Market
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Editor Viveka Roychowdhury* Assistant Editor Neelam M Kachhap Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das MARKETING Deputy General Manager Harit Mohanty Senior Manager Tushar Kanchan
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DESIGN Asst Art Director Surajit Patro
The Delhi High Court grants a stay on the Gazzete Notification
Chief Designer
to the PNDT Act ..................................................................25
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UK and Indian universities join hands for polio research ......26
Rushikesh Konka
State of health of Mumbai raises several red flags:
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Praja Foundation ................................................................27
Rajesh Jadhav CIRCULATION
Critical Care Special
Radiology
Circulation Team Mohan Varadkar
Lean Six Sigma is here! And How! ..............................55
Trauma: an untamed evil ............................39
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Critical care in disaster management ..45
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Letters .........................................................................................................................................................12 AUGUST 2012
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Editorial
Many promises to keep ... r Srinath Reddy, President, Public Health Foundation of India was giving the keynote address at the Organisation of Pharmaceutical Producers of India (OPPI)'s recent Conclave on improving access, innovation and reach of healthcare in India, when he quoted Gunnar Myrdal, the Swedish economist and Nobel Laureate: Health leaps out of science and draws nourishment from the society around it This quote underlines the connection between health, science and society, a connection that sadly seems missing in India. While the country's founding fathers had a vision for Universal Health Care (UHC) way back in 1947, where are we today, as we mark our 66th Independence Day? With a current infant mortality rate (IMR) of 47 per 1000 live births and a maternal mortality ratio (MMR) of 212 per 100 000 live births, Dr Reddy rightly predicts that it will be a challenge to meet national goals of 27 per 1000 (IMR) or 100 per 100 000 (MMR) by 2017. Recognising that the Government needs a major re-think on its health policy, the Planning Commission put together a High Level Expert Group (HLEG) on UHC, chaired by Dr Reddy, to prepare a roadmap. The HLEG’s report was released last November and has since been forwarded to all state governments. Sources suspect that state governments could drag their feet when it comes to actually implementing or even discussing the recommendations. For example, the HLEG report suggests a review of existing schemes and bringing them under a central umbrella. Politicians, with their eye on the 2014 election, will predictably see red at this recommendation, as these schemes have come in handy to woo vote banks. But given today's economic realities, government-funded healthcare sounds like Utopia. Indeed, Dr Reddy points out that many developed countries, most notably the US and UK, are cutting back or rationalising healthcare schemes that have become debt traps. The Rashtriya Swasthya Bima Yojana (RSYB), Rajiv Arogyasri of Andhra Pradesh and Tamil Nadu Health Insurance Schemes, which were indeed pioneering efforts at the time they were launched, are running out of steam (as well as funds). For example, the RSBY has become nonviable as claims have outstripped premia and the public sector insurer is reportedly threatening to walk out of the scheme if premia are not increased. Moreover, there is solid evidence that these schemes do not do what they were supposed to do; i.e. reduce health spend. Studies have proved that health expenditure of poorer sections of households under these government-promoted schemes has actually risen, because these schemes do not cover outpatient care, medicines or lab tests, all of which form a larger slice of the out-of-pocket spend on healthcare. Thus while implementing the HLEG report’s recommendations will need political will as well as fiscal heft, at both the central and state levels, there can be no doubt that the healthcare industry in India is possibly at its most important crossroads post-independence. The HLEG dedicated its report to the 'people of India, whose health is our most precious asset and whose care is our most sacred duty'. The 2014 elections could actually work in favour of realising UHC. Will Dr Reddy and his ilk be able to 'season' the ambitions of our political masters with a dose of 'healthcare' sense?
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While India's founding fathers had a vision for Universal Health Care way back in 1947, where are we today, as we mark the country's 66th Independence Day?
Viveka Roychowdhury viveka.r@expressindia.com
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AUGUST 2012
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Letters QUOTE UNQUOTE
Where is the evidence? his is with reference to the interview with Sairaman published in your magazine, Express Healthcare. He claims, 'Indian healthcare was never involved in preventive health care correctly'. The response by Sairaman printed in the 2nd paragraph that Indian sector is gradually moving towards prevention healthcare makes greater sense. However there is no evidence to substantiate this claim.
T
“Access to healthcare comprises not just of medicines, but more importantly a robust healthcare infrastructure including, doctors, paramedics, diagnostics, health centres and hospitals. In India, the demand for these services has outstripped supply. However, the key focus of the government has still remained primarily on access to medicines. There is an urgent need to have a holistic approach in developing adequate healthcare infrastructure, efficient delivery system for medical supplies and creation of a talent pool of healthcare professionals and paramedics to ensure adequate access to healthcare for all the citizens of the country�
Dr Nagraj G Huilgol Chief Radiation Oncologist, Dr Balabhai Nanavati Hospital, Mumbai - 400 056
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AUGUST 2012
UPFRONT New guidelines for National Leprosy Eradication Programme in India
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he Central Leprosy Division of Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India in association with Novartis Comprehensive Leprosy Care Association (NCLCA) and Tata Department of Plastic Surgery, JJ Hospital recently released new guidelines on disability, prevention and medical rehabilitation (DPMR) for National Leprosy Eradication Programme in India. The new guidelines include proper management of leprosy cases and the complication developed before, during and after treatment. It also envisages involvement of medical colleges as tertiary care centres in order to provide the constructive surgery and physical aids and appliances required for proper management of leprosy related complication. Dr CM Agarwal, Deputy Director General, Leprosy, Government of India said,“the aim was to modify the existing operational guidelines meant for primary, secondary and tertiary levels and bring out a comprehensive volumes of guidance, for better coordination at all levels and reduce visible disability due to leprosy in the coming years.” The DPMR activities are scheduled to be carried out in a three-tier system i.e. the primary level care (first level), secondary level care (second level) and the tertiary level care institutions (third level). The primary level care will start from village or community level to community health centre (CHC) level in rural areas, sub-divisional hospitals and urban leprosy centres/dispensaries in the urban areas. DPMR OPD clinic will be established at CHC and sub-divisional hospitals by trained leprosy paramedical worker under the guidance of MO in charge. Secondary level care centres will include district hospitals and district nucleus teams. At some places, secondary level care can be availed in the NGO supported leprosy units. The tertiary level will look after complicated cases referred from primary or secondary level.
Market Quality healthcare products for a healthier India
‘India’s wheelchair market is a nascent market with double digit growth rate’
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EH News Bureau AUGUST 2012
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M|A|R|K|E|T he illustrious journey of Singapura- the Malay name for 'Lion City' to Singapore is known to all. History speaks of the nation's valour which was clearly reflected in its battle for independence. The country gained freedom in 1965 and then on, in one generation metamorphosed itself into a phenomenally successful economy. One can call it the causatum of a constant quest to self-actualisation or the country’s outstanding futuristic trajectory. From a malarial swamp island, Singapore has transformed into a high-tech power house with muchadmired world class infrastructure, internationally talked about economic policies and academic circles as well as incredible security systems. Another feather in Singapore's cap is its highlyeffective and efficient healthcare system. Holding internationally acclaimed medical standards, Singapore's healthcare sector scores a 10/10, both for its primary healthcare services and specialised care facilities. This charismatic nation is also known for providing unbiased care to all patients, be it a poor Singaporean or an elite class citizen, or people who flock to Singapore from countries such as Indonesia, Malaysia, Brunei, Cambodia, Vietnam, Middle East, Indochina, Greater China, as well as the US to seek medical care. Here is a sneak peek into its healthcare sector, to analyse why winds of success are blowing towards the Lion City.
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Singapore's healthcare structure Being a small island country that sprawls over 137 kilometres (85 miles), all healthcare institutions here are evenly spread and are widely accessible. However, most primary care providers are located in housing estates and tertiary medical care centres in more central areas of Orchard and Novena. Kamaljeet Singh Gill, Chief Marketing Officer, Parkway
Health, Singapore, states, “Novena, located in the heart of Singapore, has grown to become a premier medical hub with a cluster of medical services and institutions, such as Mount Elizabeth Novena Hospital, Tan Tock Seng Hospital, Novena Medical Centre, and Singapore’s upcoming third medical school, Lee Kong Chian School of Medicine. Mount Elizabeth Novena Hospital (MNH), Parkway Pantai Group’s new flagship hospital is the latest addition to this area this year.” The well-established healthcare system within Singapore comprises close to 13 private hospitals, 10 public (government) hospitals and several specialist clinics, each specialising in and catering to different patient needs, at varying costs. “Singapore is considered a benchmark of healthcare delivery in Asia with an overall healthcare expenditure in excess of $8 billion. The industry comprises both public and private healthcare systems wherein the key components of healthcare i.e. primary care services are undertaken largely by the private practitioners (approximately 2,000) and hospital services are dominated by the public system. The Joint Commission International (JCI) has accredited 11 hospitals and three medical centres in Singapore,” informs Anurag Dubey, Associate Director, Health IT & Healthcare Delivery Practice, Frost & Sullivan, South Asia & Middle East. Healthcare in Singapore is mainly under the responsibility of the Singapore Government's Ministry of Health. The ministry primarily focusses on ensuring that favourable and affordable basic medical services are available to all Singaporeans. All efforts by the Ministry of Health are directed towards following this principle. That is why the healthcare sector here has received much praise, both locally as well as internationally. According to the Ministry
Singapore healthcare sector at a glimpse ●
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Singapore is considered a benchmark of healthcare delivery in Asia with an overall healthcare expenditure in excess of $8 billion Singapore’s world class healthcare infrastructure treated more than 600,000 foreign patients in 2009 and is expected to reach one million mark by 2012 Currently, there are more than 4,000 Indian enterprises in Singapore The government of Singapore has introduced innovative medical financing frameworks such as Medisave, Medishield, ElderShield and Medifund
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The sector is strongly backed by the government which contributes approximately five per cent of its GDP to the healthcare sector Dr Rana Mehta, EXECUTIVE DIRECTOR-LEADER HEALTHCARE PRACTICE, PWC INDIA
of Health, Singapore, the country's healthcare begins with building a healthy population through preventive healthcare programmes and promoting a healthy lifestyle. Good, affordable basic healthcare is available to Singaporeans through subsidised medical services at public hospitals and clinics. All hospitals and healthcare system within the country never refrain from offering help to a Singaporean because of financial limitations. The Ministry's philosophy also promotes individual responsibility towards healthy living and medical expenses. Government healthcare facilities are fundamentally designed to provide subsidised healthcare services to Singaporeans. These facilities consist of a number of government hospitals namely: Singapore General Hospital, National University Hospital, Tan Tock Seng Hospital, Changi General Hospital, Khoo Teck Puat Hospital and so on. Additionally, the public healthcare facilities in Singapore are further divided into two clusters, which are the National Health Care Group (NHG) and Singapore Health Services (SingHealth). These clusters were made to foster vertical integration of services, enhance synergy and economies of scale inline with the government’s aim to spur innovation and improve the quality of healthcare while keeping medical costs affordable. NHG and SingHealth, although wholly-owned by the government, are public sector hospitals operated as private limited companies in order to compete with the private sector on service and quality. A very progressive market indeed!
EDB supports healthcare organisations' meet their objectives by supporting their presence in Singapore Vishal Bali GROUP CEO, FORTIS HEALTHCARE
Market watch It is said to be one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes. Giving an observer's view, Dr Rana Mehta, Executive DirectorLeader Healthcare Practice, PwC India, says, “Healthcare services in Singapore are one of the best services in the world. The sector is strongly backed by the government which contributes approximately five per cent of its GDP to the healthcare sector. The healthcare system here is mainly dominated by the public sector. However, the private sector in Singapore has also played a significant role in boasting the healthcare system.” Acknowledging the same, Vishal Bali, Group CEO, Fortis Healthcare, opines, “Home to world-class medical talent, cutting-edge healthcare technology, and modern patient-centric facilities, Singapore is widely recognised as a benchmark in healthcare delivery in Asia, and a trusted leading regional medical hub. Singapore has a very well developed public and private healthcare delivery system. It is one of the few countries globally where the two systems exist with an equally competent technology and clinical acumen.” Bali adds, “With a per capita GDP of $ 43,867, in 2010, among the highest in the region, Singapore has a highly developed, marketbased economy and demand for quality healthcare is on the high. The pool of highly well-informed patients also signals an increasing need for healthcare providers to focus not only on surgical outAUGUST 2012
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comes, but also a comprehensive and holistic patient experience for anyone receiving medical treatment.”
Financing for the better As mentioned above, Singapore has a very interesting healthcare financing system as well. This system consists of the innovative medical financing frameworks such as Medisave, Medishield, ElderShield and Medifund. Introduced by the government, these schemes have grabbed global attention. These are mainly administered by the Central Provident Fund (CPF) board for its smooth functioning. Medisave: This is a national healthcare savings scheme, wherein every month a portion of the citizens' CPF savings goes into their Medisave Account to help them build it up for healthcare purposes. According to this scheme, one can use their Medisave to pay for their own and their immediate family members’ hospitalisation, day surgery and certain outpatient treatment expenses. This fund can also be used to pay the premiums of MediShield and Medisave-approved Integrated Shield Plans. MediShield: This is a medical insurance scheme introduced by the government to help economic class patients to meet the cost of medical treatment for serious illnesses or for prolonged hospitalisation. An added advantage to this scheme is that the premiums for MediShield are kept low and affordable to encourage participation of citizens in this scheme. Medifund: This is an endowment fund set up by the government as a safety net to help needy people of Singapore who are unable to pay their medical expenses. This scheme helps those who are unable to afford the subsidised charges at restructured hospitals, even with their Medisave and MediShield schemes. Apart from these innovative healthcare financing schemes, many Singaporeans also have supplementary private health insurance (often provided by employers) for services not covered by the government programmes. On the same lines, Dubey, elaborates, AUGUST 2012
“A larger proportion of healthcare expenditure in Singapore is out of pocket and accounts for approximately 55 per cent of the total healthcare spend (2010). The healthcare financing system for Singaporeans is ably supported by government funding and has gained momentum post liberalisation of the medical insurance sector for private players.” With all these healthcare
financing frameworks in place, it isn't a tall task for the country to maintain a regular healthcare surplus while reducing taxes.
A haven for private players too Looking at the efforts taken by the Singapore government in fostering the healthcare system, it may seem that the private sector here has hardly any role to
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play. This isn't true! Private players such as Parkway Group consisting of Gleneagles Hospital and Medical Centre, Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital and the Raffle Medical Group having its Raffles hospitals are the star performers of the sector. These players with their high-tech and luxurious medical service with minimum
waiting time are like magnets for medical tourists from all around the world. This environment provides an attractive opportunity for private healthcare service providers to initiate or expand their presence in the marketplace. Adding to the list of opportunities that stimulate growth for the private healthcare service providers, Dubey highlights that the Ministry of Health is also beginning to
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look at how it could engage the private sector further. It has initiated programmes such as the Community Health Assist Scheme (CHAS), which provides subsidised treatment at private General Practitioners (GP) clinics for needy, elderly and the disabled. The Singapore Tourism Board is also promoting the country as a regional centre of medical excellence to strengthen its image as a world class healthcare destination. He further informs that as per government statistics, Singapore’s world class healthcare infrastructure treated more than 600,000 foreign patients in 2009 and is expected to reach one million mark by 2012.
overseas operations. These include Fortis Healthcare, Tata Consultancy Services and Punj Lloyd. As a global hub in Asia, Singapore is an excellent platform from which Indian enterprises can launch their expansion into global markets. Indian companies can also tap the strong pool of multi-disciplinary talent, business friendly policies and taxation regime in Singapore to drive their growth. For example, Fortis Healthcare, India's second largest healthcare company has established its international headquarters in Singapore. Manufacturing: Singapore is a trusted location with proven manufacturing track record for speed
The healthcare financing system for Singaporeans is ably supported by government funding Anurag Dubey ASSOCIATE DIRECTOR, HEALTH IT & HEALTHCARE DELIVERY PRACTICE, FROST & SULLIVAN, SOUTH ASIA & MIDDLE EAST
The India connect While Singapore hooks medical tourists with its world class medical services, does it open doors for countries to do healthy business? Yes of course! Singapore has strategic business partnerships with many countries around the world and India is one of the major business partners for the country. Says Kevin Lai, Director, Biomedical Sciences, Singapore Economic Development Board, “Singapore can be a strategic and trusted location for Indian companies to access regional and global markets, manufacture for global markets as well as improved R&D productivity.” He further elaborates it as: Commercial: Currently, there are more than 4,000 Indian enterprises in Singapore. Of these, a growing number have leveraged on Singapore as their regional and international headquarters to coordinate their
Singapore can be a strategic and trusted location for Indian companies to access regional and global markets, manufacture for global markets as well as improved R&D productivity and quality, where companies can manufacture high quality drugs across various modalities. To date, there has been zero negative observations from international regulators like the FDA and EMEA for seven leading pharmaceutical companies having their global manufacturing plants located in Singapore. Various options for ready infrastructure and access to contract manufacturing partners help to provide flexibility and ensure quick ramp up of operations. Beyond chemical drugs, Singapore has also built up strong capabilities in the manufacturing of biologic
drugs and vaccines. Companies like Roche, Lonza and GSK Biologicals have established large scale manufacturing facilities in Singapore. Lonza is also establishing its first Asia cell therapy facility in Singapore. R&D: Singapore is a location that attracts top global scientific talent. The country has built up a strong scientific foundation with seven biomedical research institutes and five research consortia in key fields that include genomics, molecular and cellular biology, bioprocessing technologies, immunology, and bio-imaging. It has a
Singapore has strategic business partnerships with many countries around the world and India is one of the major business partners for the country
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Novena, located in the heart of Singapore, has grown to become a premier medical hub with a cluster of medical services and institutions Kamaljeet Singh Gill CHIEF MARKETING OFFICER, PARKWAY HEALTH, SINGAPORE
growing base of clinician scientists, with deep knowledge of clinical needs and disease biology, as well as key infrastructure such as the investigative medicine units in hospitals that are dedicated to complex early phase trials. Indian companies can improve R&D productivity and cost efficiency by establishing new models of collaboration with Singapore public research institutes, hospitals and CROs. Opportunities are galore but are there any alliances in the healthcare space between the two countries? Well, the answer is an obvious yes. Fortis Healthcare, Singapore is one of the most successful Indo-Singapore business alliances that one can confidently quote. The leading healthcare group from India, in the last one year, has firmly ensconced itself in the Singapore healthcare space. Giving further information on the business plans between Fortis and Singapore's Ministry of Health, Bali reveals that the group is currently in the midst of discussions with the Ministry of Health to explore how the company can be a part of the National E-Health Record System (NEHR). Besides the NEHR, Fortis is also actively exploring how the group can also integrate the CMIS, particularly for patient drug allergies and medical alerts. This isn't just a one-way traffic lane with just Indian healthcare groups entering the Singapore market. On the contrary, Singapore's giant healthcare group, Parkway Pantai in a joint venture with Apollo Group, has already established the Apollo Gleneagles Hospitals, Kolkata, a 425-licensed bed AUGUST 2012
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multi-speciality tertiary hospital, which is currently in the process of increasing its licensed beds to 510, with a focus on cardiology, general surgery, orthopaedics and transplants. “Parkway has been targetting the Indian market for the past few years as there is an increasing group of high net worth individuals in India due to its fast economic growth. Indian patients are willing to travel for high quality healthcare and there is an increasing demand for high end medical services and complex procedures such as transplants (kidney, liver and bone marrow transplants) and complicated neurosurgical and spine disorders. Privacy is also a big factor why these high net worth individuals choose to fly to Singapore for treatment. We provide additional security so that they can relax and recover in peace without public attention”, adds Gill. The Parkway Group will soon be launching their Gleneagles Khubchandani Hospital in Mumbai which is a joint-venture between Parkway Pantai and Koncentric Investments. The hospital will have 450 beds, of which the majority are single suites. The hospital is set to commence its operations by the end of this year. It will provide specialities in heart and vascular, general surgery, orthopaedics, neurosurgery and transplants.
objectives in Asia and globally. In this respect EDB supports healthcare organisations' meet their objectives by supporting their presence in Singapore,” updates Bali.
Lessons to learn After understanding the potential of the Singapore market, the question that arises is - Can similar healthcare policies work in the Indian system? Well, only
time can tell. Comparing the two healthcare systems would be inappropriate at this point, as the Indian healthcare system works on a complete different level. With a population exceeding that of Singapore by several times, it becomes very difficult for the Indian government to organise its healthcare structure. Moreover, red tapism and bureaucratic impedance
hampers the progress of healthcare in the country. But, like the light that shines at the end of the dark tunnel, India too will override these obstacles. But how?... Picking up good things from others is always considered as a smart move. Singapore's healthcare system definitely sets a good precedent for us. Its healthcare financing policies is something that India should
draw inspiration from. Gathering lessons from these polices will help us to formulate an uniform insurance policy for Indian citizens that can be backed by the government. Furthermore, it will also help us organise our public sector offerings in the healthcare space, which currently seems to be the need of the hour. raelene.kambli@expressindia.com
The trade pillar These successful business engagements are possible because of the strong support from the Singapore Economic Development Board (EDB). The EDB plays a pivotal role in identifying and pioneering economic opportunities for Singapore. “The Singapore EDB is the leading government agency for planning and executing strategies to enhance Singapore's position as a global business centre. EDB dreams, designs and delivers solutions that create value for companies in Singapore. Their mission is to create sustainable economic growth for Singapore with vibrant business and good job opportunities. It is about extending Singapore's value proposition to help organisation’s meet their innovation and talent AUGUST 2012
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M|A|R|K|E|T 30 MINUTE INTERVIEW
Quality healthcare products for a healthier India Krishna Kumar PRESIDENT, PHILIPS HEALTHCARE INDIA
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n line with its strategy to expand the company’s industrial footprint in India, Royal Philips Electronics recently announced commencement of operations at its first greenfield manufacturing facility for imaging systems in the country. Located in Chakan, near Pune, the Philips Development and Manufacturing Center will play an essential role in Philips’ commitment to locally develop and produce meaningful products and solutions that help improve access to healthcare for people in India and other growth geographies. Krishna Kumar, President, Philips Healthcare India shares Phillips vision for the facility and future plans with M Neelam Kachhap
What is the rationale for setting up of a greenfield manufacturing facility in India? The Philips Development and Manufacturing Centre (DMC) in Chakan has been set up to provide relevant healthcare solutions for India and other growth geographies. This facility is our seventh global
centre of excellence and it will play an essential role in Philips’ commitment to locally develop and produce meaningful products and solutions that help improve access to healthcare. Let me give you a brief background on this. We conducted in-depth research to understand the onthe-ground requirements in India and worked closely with healthcare partners to gain better insight into their ‘Made in India’ needs. This research indicated that several factors, including low operating costs, energy-efficiency, easy serviceability and support for high patient volumes, are critical to increasing healthcare access in India and thereby improving patient outcomes. The Chakan facility will deliver this type of ‘designed for India’ products that are robust, reliable and can take maximum patient load. The key innovation challenge that we have been able to address is providing high quality care at affordable costs.
What was the total investment incurred on this facility and what are your revenue expectations from this facility?
It is a significant multimillion euro investment. As a company policy, we do not specify any growth/revenue forecasts. Let me reiterate that this is an extremely important long term investment for Philips. We are investing in India to manufacture quality healthcare products for a healthier India. The DMC at Chakan allows us to ramp up “In India For India”. This facility will deliver ‘Designed for India’ products, thus enabling healthcare providers in the country to provide care to those communities who did not have access to high-quality healthcare in the past. With this facility, Philips has reinforced and optimised its production capacity in diagnostic and interventional imaging solutions.
Which markets will this facility serve? While this facility will chiefly serve India’s healthcare needs, it will also play a critical role in expanding the footprint of Philips in emerging markets as well. Many of the products and components developed in Pune can also
serve the needs of mature markets looking to replace or upgrade entry-level diagnostic devices.
How will this set up change the market dynamics for Philips Healthcare's existing market in India? The plant at Chakan will operate as Philips Centre of manufacturing excellence for imaging systems. In growing markets like India, healthcare professionals demand features like durability, dealing with interrupted power supplies, limited radiology technician time per patient, fast and easyto-read diagnostic output, and affordability. To share an example with you, India needs to address about 45-60 million heart patients every year, whereas with the existing facilities in the country, only two million of these patients get treated annually. So there is tremendous scope to provide entry level and value added diagnostic healthcare solutions for emerging markets that will swiftly address the needs of a large volume of patients. mneelamkachhap@expressindia.com
30 MINUTE INTERVIEW
'We aim to make high-end medical facilities accessible to a large number of people TR Pachamoothoo CHAIRMAN, SRM INSTITUTE FOR MEDICAL SCIENCES, VADAPALANI
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RM Group's is set to foray into corporate hospitals, after being a leading player in the education sector for for 27 years offering a wide range of undergraduate, postgraduate and doctoral programmes in engineering, management, medicine and health sciences, etc. TR Pachamoothoo, Chairman, SRM Institute for Medical Sciences, Vadapalani, reveals the motive behind this move and the future plans of the
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group to expand its presence in the healthcare vertical to Express Healthcare
SRM University has been in the field of education for the past 27 years. What have been the achievements of the group in medical education? Set up in 2004, the SRM Medical College at Kattankulathur is today a recognised medical institution. Post graduate courses have
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also been introduced. More important is our service to the society. Our 1122-bed multispeciality hospital supports over 100 villages in the neighbourhood. On an average day 1200 patients are seen, five to six children delivered, and a wide range of services provided, both simple and complex. We have approximately 80 per cent occupancy and provide 40 per cent of our services free of cost. Moreover, we have repeated
this success story in Trichy where we serve a further 100 neighbouring villages.
What is the rationale behind the Group's decision to set up a super-speciality hospital and foray into the competitive corporate hospital space? Following the success of Kattankulathur and Trichy, it is only logical that we expand our horizon and extend the best of medical facilities to
AUGUST 2012
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suit the needs of the city of Chennai.
How did the group prepare to take this plunge? Despite all the players in the field, standardised quality care at affordable costs is hard to find, and there is a huge gap between demand and supply. We aim to bring experienced doctors and patients together, thereby bridging this gap.
What will be unique about this project, given that the corporate hospital space is very competitive? We will have a dedicated Neurological Rehabilitation Centre in close collaboration with an international institution.
What are the SRM Group's future plans? Accessibility and affordability are our watchwords. We aim to make the best of
medical facilities available to all strata of society, and to achieve this, we will be establishing several centres across the country.
How is the group planning to address the affordability and accessibility problem in healthcare? We have the infrastructure, facilities and expert manpower, and an evergrowing post graduate medical
community. We will channel these inputs to address the issue.
India has a shortage of hospital beds as well as doctors and nurses. The problem is magnified in the rural areas. What, in your opinion, are the solutions to this problem? Our experiments in the neighbourhood of Kattankulathur and Trichy
have given us a success model. We just need to replicate this to other areas, thereby reducing the shortages in rural areas.
What should be the Government's role in healthcare in India? The central government should encourage and liberalise medical insurance policies to benefit larger number of people.
What is the capital outlay /expenses incurred on this project? What are the sources of funds for this foray? The expenses would be Rs 150 crores. We intend to get these fund through banks and financial institutions.
Which patient segment is the group planning to tap? Are medical tourists also a target audience? We aim to make highend medical facilities accessible to a large number of people within the city and India. It is quite likely that we will attract some amount of medical tourism.
What are the challenges that the group's implementation team faced and how were these overcome? None, I can say with confidence. We have most of the basic facilities, and had to just put a business plan together and execute it.
When will the first corporate hospital from the SRM Group be operational? And when is it projected to break even in terms of revenues? Tentatively, by the end of August 2012. We should break even within three years’ time.
Why did the group choose Vadapalani as the site for its first corporate hospital? The complex is coming up in five acres of our own land in a prime central location. Chennai is growing in a westerly direction, and the hospital will service a huge population within an eight kilometre radius. The hospital is well serviced as it has access to the metro rail, bus terminus, railway station and airport. AUGUST 2012
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M|A|R|K|E|T 30 MINUTE INTERVIEW
‘India’s wheelchair market is a nascent market with double digit growth rate’ Ankit Suri ASSOCIATE VICE PRESIDENT, PHARMACEUTICAL AND HEALTHCARE PRACTICE TECNOVA INDIA
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ith the growing number of disabled people within the country, the demand for wheelchairs is also increasing, thereby augmenting growth for the wheelchair market. But the problem of healthcare access, unfavourable public infrastructure as well as less awareness among people acts as roadblocks to its progress. Ankit Suri, Associate Vice President, Pharmaceutical and Healthcare Practice, Tecnova India, talks about the bouquets and brickbats of the wheelchair market in India in conversation with Raelene Kambli
Give us an overview of the wheelchair market in India? When was first the Indian wheelchair manufactured? What is the market growth rate? India has about 20 million people with disabilities. Among the different types of disabilities, 11 million are locomotor disabled.The prevalence of locomotive disability is highest in the country –at 1,046 per 100,000 people in the rural areas and 901 per 100,000 people in the urban population. Low literacy, unemployment and widespread social stigma are making disabled people among the most excluded in India. There is a need to effectively overcome stigma and integrate people with disabilities into the society. The best way to empower them is through
Wheelchair market in India ●
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The market for wheelchairs in India is estimated to be 120,000 units worth US $ 15 million, growing at rate of 10 per cent over last three years. Organised market is $ 6 million, growing at a rate of 10 per cent annually Currently in India both manual wheelchairs and motorised wheelchairs are sold. Customisation is the key to usability of wheelchairs by the patients. However, there are few players which do customisation in India. Future demand of manual wheelchair in organised segment is expected to clock a CAGR of 10 per cent to reach $ 5 million by 2015. Future demand of motorised wheel chair in organised segment is expected to clock a CAGR of five per cent to reach Euro 4 million by 2015. There are around 10 such major wholesale markets in India, located in Mumbai, Delhi, Chennai, Indore, Agra and other cities, which control the trading of all wheel chairs in India. The market is highly fragmented into unorganised and organised segment.
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imparting employable skills. Government agencies and NGO’s are working towards progressive policy frameworks for the disabled. Government support/subsidies alone are not enough to cater to the healthcare needs of this segment of the population. There is an inherent need towards getting the basics right. India’s wheelchair market is a nascent market with double digit growth rate.
Who are the major market players in this sector? The wheelchair market in India is currently dominated by wholesalers. These players usually buy their products from China. There are around 10 such major wholesale markets in India, located in Mumbai, Delhi, Chennai, Indore, Agra and other cities, which control the trading of all wheel chairs in India. The market is highly fragmented into unorganised and organised segment.
You say that the wheelchair market in India is fragmented. So can you elaborate this further? The unorganised segment consists of the following : ●
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Domestic manufacturers, estimated to be between 80-100 players sells 100150 wheel chairs in a year. Wholesalers – They are based in wholesale markets and are involved in importing wheelchairs from China.
The organised segment consists of handful of players. These players can be segmented as: ●
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Indian manufacturers e.g. Vissco, Janak, Sage and others Indian distributors of foreign companies e.g. Vin Grace Subsidiaries of foreign companies importing and selling in India e.g. Otto bock, Karma Healthcare. The Government segment i.e. Alimco sold approximately 26,000 wheelchairs in 2010 Private players sold approximately 12,000 units in 2010
Who are the domestic www.expresshealthcare.in
players and what is their market share within the wheelchair market? The domestic players are mainly in the unorganised segment which consists of domestic manufacturers, which are estimated to be around 80-100 players selling 100-150 wheel chairs in a year and unorganised segment players usually cater to demands of local and regional markets – wholesalers are involved in importing wheelchairs from China, and are currently dominating the wheelchair market in India.
What are the characteristics of the manual and motorised wheelchair market in India? Manual wheelchairs are mainly used by low income group disabled persons. These are also used by institutions like hospitals, airports, railways stations etc to transport elderly and locomotors disabled people. This market is becoming more competitive since lot of companies are importing parts from China and assembling in India – which is the hindrance to the growth across the value chain of the market As far as the motorised wheelchairs are concerned, these kind of wheelchair are mainly used by individuals – those who can afford it. However, the usage is still limited due to poor access in India. The roads and pavements are also not well built and there may be chances of accidents due to bumps etc. The market is certainly interesting, since now with more dispensable income, support from NGO’s, it is now possible to afford these wheel chairs. It largely remains a metro or Tier-I market and it will take time when we see its usage in rural parts of India as well.
Since the usage of motorised wheelchair is still limited, is the manual wheelchair market more dominant in India? Manual wheelchair market is more dominant as compared to motorised market. Despite technological advancements and the emergence of powered wheelchairs, manual wheel-
chairs are still witnessing a growth in demand. The reason for less usage of motorised wheelchairs are due to lack of awareness; limited only to the high class patients as cost of the products are high; Indian terrain is less suitable for motorised wheelchairs; lack of customisation – very few players have this capability; lack of support in terms of availability of spare parts and after sales service people and no medical insurance by the private insurers.
What are your future projections for this sector? In future demand of manual wheelchair in the organised segment is expected to clock a CAGR of 10 per cent to reach $5 million by 2015. Whereas, the demand for motorised wheelchair is expected to clock a CAGR of five per cent to reach euro four million by 2015.
What are the roadblocks to the progress of this market? And what are your suggestions for overriding them? Access remains a roadblock for wheelchair users. Even if the market for the wheel chairs is growing, but it is not true indicative of the utility for most of the users. Healthcare access for disabled is the biggest challenge in the India.Currently most of the buildings, toilets, hospitals and other places are not locomotor disabled person friendly. People with wheelchair feel bounded to their homes. Sidewalks that are unpaved, poorly maintained, or crowded by vendors are common across the cities in India which hinder the movement of wheel chaired person. Scenario is changing e.g. some malls in India have taken initiative by building washrooms which are friendly for people with disabilities. Delhi Metro has made provisions for access to the disabled. Few seats are also reserved for the disabled people etc., but we need to go a long way before we actually make our disabled people live a regular life. raelene.kambli@expressindia.com
AUGUST 2012
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Product Update
Design IPR for heart device used in bypass surgery
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heart device that helps in construction of grafts for bypass surgery has been granted Intellectual Patent Rights for novel design. The device, known as mammary artery surgical platform (MASP) has been designed and developed by Dr Lokeswara Rao Sajja of Star Hospitals and Naga Srinivasa Sravan Kumar Manchikanti of 8C Healthcare. Currently, bypass graft surgery is done using a (left) internal mammary artery and leg vein grafts. The standard technique is known as coronary bypass surgery. But, recent studies have revealed that use of both right and left internal mammary arteries (artery of the chest wall) in bypass increases the longevity of heart patients. Technical difficulties in constructing the ‘Y’ graft and other associated problems after use of both mammary arteries have limited the use to 4-5 per cent globally. To overcome this difficulty, the novel device called MASP was designed by Dr Lokeswara Rao, a cardiothoracic surgeon and Sravan Kumar. It helps surgeons to construct both ‘Y’ and ‘T’ grafts faster using both mammary arteries. Since Indian are more prone to coronary artery diseases, the potential to implement the device is enormous. The use of both mammary arteries offers long-term survival of heart patients, Dr Lokeswara Rao, said. Dr Rao said the design IPR granted by the Indian Patent Office confers rights for 10 years. It gives exclusivity to use, make sell and market the design. The Andhra Pradesh Technology Development & Promotion Centre facilitated the design registration. EH News Bureau
AUGUST 2012
MEDICOLEGAL
The Delhi High Court grants a stay on the Gazzete Notification to the PNDT Act Radiologists rejoice as the initial judgment goes in their favour Raelene Kambli, EH News Bureau he double judge bench of the Delhi High Court, on July, 23, 2012, passed a stay order on the Ministry of Health and Welfare's Gazzete Notification of June 4, 2012 and brought a new twist to the ensuing battle between the Central Government and IRIA. After hearing the arguments from both sides, the court disapproved the Government’s stand that ra d i o l o g i s t s / s o n o l o g i s t s should visit no more than two clinics within a district to perform ultrasound and that they should compulsorily specify their consulting hours at each clinic. As per the Gazette Notification, the registration rates for ultrasound centres has also been arbitrarily hiked from Rs 3,000 to Rs 25,000 and from Rs 4,000 to Rs 35,000. During the court proceedings, the government was represented by the Additional Solicitor General of India. He took an emotional angle and pleaded that the move was an attempt to curb female foeticide within the country. The government counsel also pointed out that the sex ratio
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is declining day by day in the country. The IRIA counsel was Vikas Singh, Sr Advocate and former Additional Solicitor General of India who convinced the learned judges that the new notification would adversely affect India’s healthcare delivery system, especially those who form the poorer sections of the society. He further pointed out that this move will also result in an artificial shortage of radiologists in the country which in turn would be very detrimental to the entire healthcare system. Singh, in his argument, also said that IRIA is equally concerned with the rising numbers of sex-selective abortions but the measures taken by the government are misdirected. These measures will not affect the declining sex ratio in any way, on the contrary it would lead to the denial of ultrasound facility to the general public, even during emergency situations. IRIA's argument also highlighted that pregnancy ultrasounds form only about 2-5 per cent of the total number of ultrasounds done by radiologists, and that the other areas of usage would also be affected by this notification. Commenting on the first
achievement of the IRIA in this case, Dr Harsh Mahajan, Honorary Radiologist to the President of India, Padma Shri Awardee President, Indian Radiological & Imaging Association informed, “On July 9, 2012, we first filed a writ petition and pleaded to bring in a stay on the Gazzete Notification. Since it was an important issue the Delhi High Court had its first hearing on the July 10 itself. The Government counsel at that time was asked to file their petition which they couldn’t do in a short period of time. Therefore, the hearing was fixed for July 23, 2012.” Speaking on the verdict passed, he further said,“We are happy that the judgment came in our favour. We did not really raise the issue of increased charges in this hearing which was exclusively for grant of stay, though it does form part of our writ petition. We will take it up on the next hearing which is in September.” He also informed that this case is an eye-opener for the nation and will further dig deep into this issue. Dr Mahajan further commented, “IRIA would lend their full support towards eliminating this
social stigma within our country. I am sure that with the unity of our members we will be able to engage with the government and other interested parties to rid our great nation of sex determination tests and sex selective abortions. IRIA and its members are law abiding and are equally interested to catch the culprits who perpetrate this heinous crime.” The officials from the Ministry of Health and Family Welfare were not available for comment. While investigating on this case, Express Healthcare also spoke to several obstetricians, gynaecologists and radiologists across India who were of the opinion that this case, in its future proceedings will direct the Government to alter the PNDT Act, 1996 that permits any registered medical practitioner (RMP) to conduct ultrasound examinations with just six months’ training in the field. The first round of this battle goes to the radiologists. We will have to wait until September to see how this case pans out further and who has the final laugh. raelene.kambli@expressindia.com
TRAINING
‘First Annual Bariatric Master Class’ conducted by Nova Specialty Surgery Over 100 bariatric surgeons and general surgeons from across the country participated in the Bariatric surgery training programme ova Specialty Surgery organised the ‘1st Annual Nova Bariatric Master Class’ at Tardeo, Mumbai on June 30 and July 01 to train bariatric surgeons and general surgeons in bariatric surgical techniques. This one-of-its-kind training programme on sleeve gastrectomy and gastric bypass was conducted under the supervision of Dr Ramen Goel, Bariatric Surgeon, Nova Specialty Surgery and was attended by around 100 bariatric surgeons and general surgeons from across the country. The ‘Nova Bariatric Master Class’ is a dedicated
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bariatric surgical training programme for surgeons and their teams to help them understand and practice bariatric surgery effectively. This two-day workshop showcased live surgeries viz. gastric sleeve and gastric bypass surgeries at Nova’s ‘Center for Metabolic Surgery’, Tardeo. The live feeds of these surgeries were telecast to the surgeons present at Ethicon Institute of Surgical Education (EISE), Mahim, Mumbai. The workshop included ‘animal lab and endo-trainer sessions’ and comprehensive pre and post-surgery management training with an emphasis on ambulatory bariatric care. www.expresshealthcare.in
Speaking on the need and importance of such workshops in India, Dr Ramen Goel, Bariatric Surgeon, Nova Specialty Surgery said, “Obesity is assuming epidemic proportion all over the world because of changing lifestyle habits, and India is no exception to this trend. Studies suggest that a large subsection of the Indian population fulfills the criteria of obesity, which has increased the need for safe medical procedures to overcome the problems. In the last one decade, bariatric surgery has emerged as a ray of hope for millions of obese Indians. Understanding this growing need, we
designed the entire workshop to help surgeons learn the A to Z of Bariatric Surgery by following standardised surgical steps and follow-up protocols.” Speaking on similar lines, Dr MG Bhat, Medical Director, Nova Specialty Surgery, said, “This workshop is the first step towards creating more awareness among the medical fraternity about the latest technology and surgical procedures to treat obesity. Nova takes immense pride in organising this workshop and we are committed to conduct similar workshops in the coming future also.” EH News Bureau
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Medical Technique
Beneficial advancement of 3D laparoscopic surgery
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aparoscopic surgeon Dr Prakash Trivedi recently performed 3D laparoscopic surgery on two patients at his clinic, the Total Women’s Health Care Center, Ghatkopar, Mumbai. Parineeta Seth, 40, had been suffering from menstrual migraine, cramps, vomiting, nausea for over a year and was mistakenly diagnosed as suffering from fibroids. The specialised surgery enabled the patients to walk home the very next day. With an experience garnered from performing over 25,000 laparoscopic surgeries in the last 20 years, Dr Trivedi hails 3D laparoscopy as a greatly beneficial advancement in the field of surgery. “It could be a boon, particularly for patients who have had a previous C-section, have a big size fibroid or are high risk patients suffering from obesity, diabetes, blood pressure, where you want to do the surgery faster,” he says. Dr Trivedi added, “3D laparoscopy makes the procedure so easy—its just like doing an open surgery, but with the benefits of minimal invasion. Even suturing with 3D laprascopy is so clear and simple, any suturing like rejoining tubes or important structures precisely is done simply. We’ve been doing these surgeries for more than 20 years. But with 3D camera, the job is a lot simpler. There is no need for extra instruments or expensive equipment like the robotic arm. The camera we use, of German make, is directly attached to the telescope and is lighter than the normal 2D camera,” he explains. During a regular surgery, the surgeon has a two-way vision--horizontal and vertical. However, 3D laparoscopic surgery gives the surgeon depth perception. “The addition of this 3rd axis of vision enables us to do meticulous dissection. It is almost like your eye is just inches away—it is better than performing open surgery,” says Dr Trivedi. EH News Bureau
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STUDY
UK and Indian universities join hands for polio research The study aims to explore attitudes to polio immunisation in India K's University of Birmingham is working with Orissa's Ravenshaw University on a new research project looking that is focussed on the ethics, policy and practice concerning polio vaccination in the state. Though India has strived and conquered polio, misconceptions continue to exist around polio vaccination. It is a two-year project which will garner pertinent empirical evidence about attitudes to polio vaccination campaigns in Orissa from three major groups namely
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parents, community workers and government officials who are involved in planning and implementing the campaign. The research team will also study more remote tribal areas where facilities are less developed. The research will outline and explore the ethical issues related to vaccination in general, as well as the issues revealed by the evidence gathered through the project. The project aims to lay the foundations for a longstanding collaboration between the University of Birmingham and Ravenshaw in terms of
both teaching and research in ethics and history relating to health. The first of a series of interdisciplinary research workshops will be conducted in Bhubaneswar in early December, this year. Angus Dawson, Professor of Public Health Ethics from the College of Medical and Dental Sciences at the University of Birmingham, said: “A lot of people in India do not opt for mass vaccination programmes for a number of reasons. We want to explore these reasons and bring about an attitudinal change. It's very exciting to
be working in Orissa with Ravenshaw University on this kind of project. My background is in philosophy and ethics, but I have to engage with the real world of vaccination policy and practice. We expect to learn a lot about the historical, social and cultural context of public health work, and think this will result in new depth in terms of our own understanding, and further research questions to be explored in the future”. EH News Bureau
COMPANY WATCH
Carl Zeiss India starts new campus and production facility Carl Zeiss is active in the fields of semiconductor manufacturing technology, industrial metrology, microscopy, medical technology, vision care and consumer optics/optronics arl Zeiss India inaugrated its new campus and production facility in Electronic City, Bengaluru, on July 11, 2012. The new campus was inaugurated by the President and CEO of Carl Zeiss Group, Dr Michael Kaschke. Speaking on this occasion Dr Kashcke said, "The new facility at Bengaluru adds greater focus to our pursuit of excellence in all spheres of our operations. Built on an area of 240,000 sq ft in the heart of Bengaluru’ s Electronic City, the new Carl Zeiss Head Office for India has 120,000
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sq ft of built-up area which will accommodate close to 300 staff, a warehouse and production facilities for coordinate measuring machines from the Industrial Metrology Business Group and prescription lenses from the Vision Care Business Group. The investment in a modern facility in India signifies Carl Zeiss' commitment to the Indian market. "Strategic investments such as these are only possible because we have a long-term plan," he further added. "Overall we are very pleased with the development of our business in India so far and we are
confident that we will continue to grow rapidly over the next years. It is important to maintain our high growth in the Indian market in order to sustain continued investments at a rapid pace". The Indian subsidiary of Carl Zeiss was originally setup in 1998 with the objective of getting closer to its customers, to take advantage of the high quality talent-pool that India offers and to take advantage of opportunities to globalise value creation at Carl Zeiss. Carl Zeiss is expanding its operations in India to embrace the opportunities and challenges of the
Indian market. The new facility, equipped with modern office space and excellent communication and training facilities, will house all of the Group's business units and activities in Bengaluru under one roof, including CARIn (Center for Applications & Research in India) the R&D centre of the Medical Technology Business Group of Carl Zeiss. It will also house the new prescription lens manufacturing facility in Bangalore, a high-tech laboratory set-up run as per the global standards of Carl Zeiss. EH News Bureau
Growing cancer rates to boost radiation therapy Radiation therapy market to reach $3.6 billion by 2018 report by GlobalData, pharma industry analysts claim that the radiation therapy devices market is growing with the increasing global number of cancer patients. The report states that the increasing number of cancer patients are due to a rising elderly population and the increased consumption of tobacco, espe-
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cially in developing nations like China. Therefore, there is a larger demand for cancer treatments which in turn would cause the worldwide radiation therapy market to grow from a value of under $2 billion in 2011, to $3.6 billion in 2018, at a CAGR of 9.1 per cent. The penetration of linear accelerator machines and www.expresshealthcare.in
other radiation therapy devices is very less in countries such as China and India, but as awareness and purchasing power increase with the number of cancer patients, this is expected to change. Equipment sales in traditional markets like the US and Europe, however, are expected to be propelled
by replacement orders as people expect better and more efficient cancer treatments. In the global external beams therapy systems market, California-based Varian Medical Systems, Elekta AB, Accuray/ Tomotherapy and Siemens Healthcare are some of the major players. EH News Bureau AUGUST 2012
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State of health of Mumbai raises several red flags: Praja Foundation The report is based on a survey conducted among over 15,000 households in Mumbai raja Foundation, an NGO involved with civic governance, in its recently released report has raised several red flags on the state of health of Mumbai. The incidence of sensitive diseases in the city within the past four years has almost doubled in all nine diseases. Malaria has gone up by 171 per cent; Diarrhoea by 123 per cent; Hypertension by 90 per cent; TB by 95 per cent; Diabetes by 89 per cent; Typhoid by 91 per cent; Hepatitis B by 94 per cent; Dengue by 276 per cent and Cholera by 185 per cent. The report is based on a survey conducted among over 15,000 households in Mumbai along with data procured through RTI from BMC. Praja has done a systemic study of municipal health services of all the civic wards of Mumbai to reveal these startling facts. The figures presented by Praja are after a slight improvement in 2011-12 from previous year that had shown exceptional hike in almost all diseases, not just in Mumbai but across the country. So while BMC needs to be commended in curtailing the growth rate of diseases from last year, it clearly is not enough. Identification of health objectives and targets is one of the more visible strategies to direct the activities of the health sector. Nitai Mehta, Founder Trustee of Praja Foundation says, “Our report on the state of health of Mumbai raises several red flags. The survey revealed that more than 30 per cent of households spend 11 per cent or more of their annual income on hospitals and medical costs. Almost 80 per cent Mumbaikars did not have a medical insurance. Also, 75 per cent of Mumbaikars use private sources like private clinics and private hospital, hence, there is a need for a strong mechanism to collect data from them.” Dr Mangesh Pednekar, Director (Research & Development), Healis Sekhsaria Institute for Public Health who has monitored and endorsed
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Praja Foundation’s report, says, “Surveillance systems (health information system) play an important role here. They can provide accurate
understanding of the problem. Hence, setting up strong surveillance system should be priority of the administrator and the data process for cap-
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turing should be scientific, upto-date and sacrosanct. Equally importantly, the data captured should be disseminated at all levels to all stake-
holders periodically and suggestions should be actively sought through a more institutionalised manner from all.” EH News Bureau
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Product launch
NephroPlus launches first dialysis unit at ESIC hospital in Hyderabad
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idney care specialist NephroPlus has launched its first unit under the Public Private Partnership (PPP) model at the ESIC Super Specialty Government Hospital located at Sanath Nagar in Hyderabad. Kondru Murali Mohan, Minster for Medical Education, Arogyasree, and Health Insurance inaugurates the new 10-bed unit which has the capacity to expand up to 25 beds. Developed under the PPP model with the ESIC department of the Government, the unit will address the growing need for highest quality kidney care for patients, especially from the economically weaker sections of the society. Following the world class standard, the unit will have a capacity to dialyse up to 50 cases of chronic renal failure per day. Announcing the launch of the new centre, Sandeep Gudibanda, Co-Founder & Director, NephroPlus said “We are thankful to the Andhra Pradesh government and the management of ESIC Hospital who have lent their full support and cooperation. We hereby state our willingness to offer high quality dialysis at ESI prices across the state in all ESI hospitals. We request ESI authorities to facilitate to this end.” Vikram Vuppala, Founder and CEO, NephroPlus added, “Kidney care in India currently is wanting due to the nonaccessibility of quality treatment. The opening of this new centre is an extension of our vision to provide high quality kidney care to patients from all income groups.” Speaking at the launch, Mohan said, “It gives me immense pleasure to open the world class NephroPlus centre at the ESIC Government Hospital. I am confident that the opening of the NephroPlus centre will be a great relief to patients suffering from chronic kidney failure. Highest quality kidney care at affordable cost is now a reality in Hyderabad.” EH News Bureau
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RARE SURGERY
Yashoda Hospital performs rare surgery, implants first heart assist device in AP The device, when implanted, takes over the function of the heart partially and keeps the patient alive until either heart recovers or patient goes for heart transplantation ashoda Group of Hospitals performed a rare surgery and implanted the first heart assist device in Andhra Pradesh, to save a 63-year old heart patient's life. P Kasturi, a home maker from Secunderabad received the first heart assist device, also called left ventricular assist device (LVAD), under the new ventricular assist device programme at Yashoda Hospital, Secunderabad. This complicated surgery was performed by a team of doctors headed by Dr AGK Gokhale, Chief Cardiothoracic, Transplant and Minimal Access Heart Surgeon. The anaesthetists’ team was headed by Dr GM Subramanyam. The patient had a heart valve problem on the left side
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with an extremely poor heart function. She was suffering from severe narrowing of aortic valve (valve on left side of the heart) and her pumping chamber on left side was very weak (severe left ventricular dysfunction). The patient developed severe breathing difficulty 10 days back and had to be put on ventilator. Dr Gokhale performed this rare surgery and replaced the aortic valve and implanted the LVAD. This was done for the first time in Andhra Pradesh. So far, only four such implantations were done in India. LVAD, used as a ‘bridge to recovery or as a ‘bridge to transplantation,’ is a batteryoperated device that helps keep a patient alive when heart can not effectively work on its own. While the dam-
aged heart pumps part of the blood needed for the body, the remaining blood is pumped by the device taking the burden off from the damaged heart. This will buy time to help the heart to recover or till a donor heart is found for heart transplantation. Speaking on the occasion, Dr Gokhale said, "The patient was on ventilator with breathing difficulty and was suffering from severe left ventricular dysfunction. As her breathing and blood pressure were not improving, her cardiologist, Dr T Sasi kanth performed balloon dilatation of the valve. Despite this, her condition remained critical and she could not be taken off the ventilator. After discussion with the immediate kith and kin of the patient,
we decided that she immediately requires a open heart surgery at a very high risk.” “Without surgery, her chances to survive were meager. A few months back, a new device ‘CentriMag heart assist device’ was approved for use in India. The device will perform the work of left heart chambers giving time for the left ventricle to recover. It was used for this lady after open heart surgery. This operation took six hours. Patient is taken off the ventilator within 24 hours after surgery and she is breathing on her own and recovering well. Depending on the need this device can be left for 30 days to help the heart recover.” he further added. EH News Bureau
E-HEALTH
Fortis Healthcare and GE Healthcare launch eICU facility It is Asia’s first eICU facility called CritiNext for 24/7 remote monitoring of critically ill patients ortis Healthcare and GE Healthcare have launched Asia’s first electronic intensive care unit (eICU) facility—CritiNext. The eICU services being offered by CritiNext makes speciality critical care accessible and affordable to critically ill patients in small towns of India. It is powered by GE’s Centricity High Acuity Care Solutions and operationalised by critical care experts from Fortis Healthcare. It has gone live in two small hospitals based in Raipur and Dehradun and covers 34 ICU beds. The CritiNext eICU enables a remote hospital to provide advanced consultation, care and monitoring to their critically ill in-patients without having to physically transfer them to super-speciality hospitals. CritiNext eICU helps to provide expert care to the patient at the local hospital and to avoid inter-hospital transfer and risks. ICU care at local hospital allows patient
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get better support from family as well as help reduce costs by shortening the stay in ICU. CritiNext addresses the shortage of critical care staff in remote areas and enables physicians in remote units to manage ICUs more efficiently. Remote ICU monitoring technology combined with expert set of eyes can help reduce medical errors and infection within ICUs leading to reduction in patient mortality by upto 60 per cent. With GE’s Centricity High Acuity Care and Critinext command centre in Delhi, intensivist scan monitor real time parameters of critically ill patients from remote ICUs/hospitals on a 24/7, 365 days basis. The Critinext team can also assist in timely treatment and monitoring of patients in collaboration with local physicians over audio/video capability provided by GE Solution. Smart alerts built into Centricity can flag trends in patient’s condition like picking up a www.expresshealthcare.in
(L-R) Dr Amit Verma, Executive Director CritiNext, Fortis Group of Hospitals; Terri Bresenham, President & CEO, GE Healthcare South Asia and Aditya Vij, CEO, Fortis Healthcare
spike in a white blood cell count, the start of a low grade fever, and maybe a little bit of a drop in urine output etc. When an Intensivist at Critinext Command centre puts all those together, they are able to conclude if a serious infection is setting in. Using state-of-the-art rules based engine, clinical parameters are tracked and used to generate clinical notifications
which can be overseen in a paper based workflow. It helps in providing pro-active care to save the patient’s life. As part of a national roll out of this technology, Fortis Healthcare and GE Healthcare aim to deploy the solution connecting a minimum of 500 ICU beds in 20 hospitals by 2014. EH News Bureau AUGUST 2012
A new vision for healthcare In healthcare, every patient is unique yet many of the challenges facing their healthcare systems are similar. KPMG practitioners spanning 150 countries in our global network help clients see their biggest issues clearly, delivering solutions that help change the face of health. Take a closer look at kpmg.com/in
© 2012 KPMG International Cooperative (“KPMG International”). KPMG International provides no client services and is a Swiss entity with which the independent member firms of the KPMG network are affiliated. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG.
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Investment
International Oncology to get Rs 20 crores from RVCF
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ajasthan Venture Capital Fund (RVCF) has invested Rs 20 crores in International Oncology Services Pvt Ltd (IOSPL), a super speciality cancer care company for an undisclosed equity stake. International Oncology has established comprehensive cancer care centres (known as International Oncology Centre) equipped with modern technology at Fortis Hospital, Noida and Dr L H Hiranandani Hospital, Mumbai. The company has marked several cities in India to set up cancer care centres to make cancer care more accessible to the masses. The next two centres are expected to open in Rajasthan and Punjab shortly. "The oncology sector is currently witnessing a huge gap in terms of incidence of cancer in the country and limited quality cancer care facilities to treat the same. While the incidence of cancer is increasing at an alarming rate in India; the country faces large limitations in terms of lack of technical specialisation and trained personnel. India has few public sector cancer centres, some central establishment and limited private sector participation. IOSPL, through its specialised cancer care centres, is set to address this burgeoning demand in India" said Rajendra Bhanawat, Chairman of RVCF. Pradeep K Jaisingh, CEO and MD of IOSPL said, "After setting up comprehensive cancer centres in NCR and Mumbai, we are in the process of taking world class cancer care to several other states of India and Rajasthan is a special focus area for us. This investment by RVCF will help IOSPL carry out its immediate expansion plans and we are delighted to have their support." . EH News Bureau
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TRAINING
Vasan Eye Care conducts CME training programme on oculoplasty Over 150 doctors and eye care practitioners participated in the CME Programme asan Eye Care Hospitals, in association with Bangalore Opthalmic Society (BOS), conducted a continuing medical education (CME) programme on 'Current Concept in Oculoplasty Procedures' under the guidance of National Faculty and BOS Faculty at the Vasan Eye Care Hospital, Bangalore. More than 150 eye care practitioners from various hospitals in and around Bangalore participated in the CME Programme. Dr Roshmi Gupta who established the first exclusive oculoplasty practice in
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Bangalore in 2004 hosted the CME. The programme featured sessions by 'Padmasree' Dr Ashok Grover, former President, All India Ophthalmic Society, Dr Santosh Honavar, “Bhatnagar” award winner for his work on eye cancers and Dr Milind Naik, Vice-President Asia-Pacific Society for Ophthalmic Plastic and Reconstructive Surgery. Together, the doctors covered a range of topics including eyelid reconstructions, managing a contracted socket, current approach to thyroid eye disease, the rational approach to ptosis and much more.
Dr AM Arun, Chairman, Vasan Healthcare said, “Oculoplasty is one of the fastest evolving sub-specialities in opthalmology. New understanding of the ocular adnexal tissues leads to the shift is towards functional procedures, performed with attention to aesthetics, and aesthetics procedures, done with attention to function. We all want the best care for our patients; and increasingly, our patients know the best of what is available worldwide, and expect the best. We are happy to conduct the continued medical education programme on the ever-
DR ASHOK GROVER
widening scope of oculoplastic procedures.” Oculoplasty is a complex and rare case that needs super-specialised treatment. Oculoplasty deals with disease around the eye – the socket, eyelids and tear drainage. The defects can be by birth, caused by injury or by eye tumour. EH News Bureau
RESEARCH
Asian Heart Institute to research benefits of walking for corporate employees Stepathlon Lifestyle to partner AHI in this research sian Heart Institute (AHI), alongwith Stepathlon Lifestyle plans to conduct a research to understand the positive effects of walking and incidental activity on the risks of diabetes, heart disease, obesity and metabolic syndrome on corporate employees in India. Known as Stepathlon, the research would be an initiative which will provide a solution that transforms the sedentary into active and the active into more active, irrespective of age, gender, des-
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ignation, location and fitness levels through a pedometerbased, mass participation programme conducted over 100 consecutive days. The first edition of Stepathlon will commence from September 10, 2012. Dr Ramakanta Panda, Vice Chairman and Managing Director, Asian Heart Institute said, “We are glad to associate with Stepathlon to bring out research which will track and study the positive effects of walking and physical activity on heart diseases
and Type-2 diabetes. Stepathlon is a simple activity which will help employees to work towards an activityfilled life, thus enabling them to live healthy and reduce their risks of life-threatening diseases.” As part of this research, Stepathlon participants from select corporations in India will be tested pre- and postStepathlon for changes in common risk factors for ailments such as heart-related diseases and Type-2 diabetes. These risk factors include cholesterol, triglycerides,
weight, waist circumference and fasting blood glucose. The research aims to correlate the number of steps taken in a day with changes in these risk factors. Stepathlon’s Wellness Grant Programme will support programmes that build awareness or education in these areas. The Grant will also fund research and development programs for prevention and cure of diseases related to sedentary lifestyles. EH News Bureau
Centre for Sight forays into Indore, MP It has a network of 41 super specialised eye hospitals across India entre for Sight, India’s leading eye hospital network now expands to Indore. With state-of-theart infrastructure and a team of distinguished doctors, Centre for Sight has now made world class eye care accessible to people of Indore. Eminent ophthalmologist of the town, Dr Prateep Vyas, has joined it as Medical
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Director, Centre for Sight Indore, along with leading Cornea & Refractive Surgeon, Dr Sharadini Vyas. On the expansion plan Dr Mahipal Sachdev, Chairman & Medical Director, Centre for Sight informed, “This is our maiden venture in Madhya Pradesh and by 2012 we plan to expand to six centres in Bhopal, Jabalpur, Gwalior, www.expresshealthcare.in
Ujjain and Rewa.” In its new facility of Indore, Centre for Sight has introduced technology like micro incision cataract surgery (MICS) and femtosecond bladefree LASIK surgery for refractive surgery (vision correction procedure to remove spectacles). In addition, Centre for Sight, Indore has a state-of-the-art Retina
Institute headed by Dr Teena Agarwal, eminent retina specialist trained at Sankara Nethralaya, Chennai. Equipped with the latest technology it provides comprehensive management of both medical and surgical diseases that affect the retina and vitreous. EH News Bureau AUGUST 2012
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Company Watch
NABCB awards ISO 17020:1998 accreditation to TÜV SÜD South Asia
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he National Accreditation Board for Certification Bodies (NABCB), a constituent of the Quality Council of India (QCI), has awarded TÜV SÜD South Asia with ISO 17020:1998 accreditation, which specifies requirements for the competence of bodies performing inspection and for the impartiality and consistency of their inspection activities. Under the new accreditation,TÜV SÜD South Asia would be commissioning inspections across the food (sea food), textile, leather, gas pipeline and infrastructure sectors. The company would also be issuing related inspection reports and/ or certificates that would reflect if products / project activities are meeting the various customer and/or legal requirements. The Mumbai, Delhi, Tirupur, Bangalore and Ahmedabad offices of TÜV SÜD South Asia have been covered under this accreditation. The Type A accreditation of ISO 17020:1998 signifies accreditation to third party inspection service providers. This accreditation would be valid for a period of three years starting from July 2012 until July 2015. “We are delighted to have been awarded the ISO 17020:1998 accreditation by the NABCB. The accreditation is a clear indication of the fact that our inspectors across India are technically competent to inspect products made by various manufacturers and projects carried in infrastructure industry,” said Niranjan Nadkarni, CEO, TÜV SÜD South Asia. The ISO 17020:1998 is the general criteria for the operation of various types of bodies performing inspection and is an internationally recognised standard. The standard is specific to a large variety of systems beyond quality management systems and requires thorough evaluation of technical competence of the inspecting body. EH News Bureau
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INITIATIVE
Lawrence & Mayo, Virag’s Artist Trust to start eye donation awareness campaign Roshni Zindagi Mein aims to increase awareness on eye donation since around two lakh cornea donations are needed every year awrence & Mayo (L&M) has announced their association with Virag Wankhede’s ‘Roshni Zindagi Mein,’ a pan India campaign to increase awareness on the noble cause of eye donation – with two lakh cornea donations needed every year as against 20,000 cornea donations at present. It will also communicate that one call to universal number 1919 can help people contact the nearest eye bank and transform a life. On the occasion, Vivek Mendonsa, Founder & Marketing Director, L&M and Virag Wankhede of Virag’s Artist Trust unveiled a video promo of the forthcoming album ‘Kaash’ focussed towards spreading the message in favour of eye donation. 'Roshni Zindagi Mein’ is an initiative by Viraag’s Artist Trust, an NGO working towards educating, entertain-
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ing and engaging with audiences on social causes, through the medium of music and art. Commencing from mid July 2012, the ‘Roshni Zindagi Mein’ team including leading doctors from National Programme for the Control of Blindness (NPCB), a Ministry of Health and Family Welfare, Govt. of India body, will travel across all the key districts in Pune and rest of Maharashtra, to spread the message on the urgent need for corneas in India as a mere 10 per cent of applications being met through current resources. As part of the campaign, schools and colleges will be roped in to participate in drawing contests centred around the ‘Eye Donation and Blindness theme.’ National Rural Health Mission (NRHM), National Programme for the Control of Blindness (NPCB), Navi
Mumbai Municipal Corporation (NMMC) and National Service Scheme (NSS) have extended their support to this campaign. Speaking on the occasion, Mendonsa of Lawrence & Mayo, said, “Responsible citizenship and Lawrence & Mayo have always gone hand-in-hand. As part of our community welfare programmes, we conduct multiple activities to raise awareness on prevention and treatment of loss of vision. We felt an instant connect with Guinness Record Holder Virag Wankhede’s noble objective behind the ‘Roshni Zindagi Mein’ campaign - to draw more cornea donations and bring light into lakhs of lives languishing without sight. Starting with Maharashtra, we plan to take this humble effort to the national level and bring
about a sea change in people’s attitude to donating their eyes.” Wankhede added, “At Virag’s Artist Trust, our endeavour has been to reach out to people through music and art, which have a universal appeal. Through the ‘Roshni Zindagi Mein’ initiative, our prime endeavour is to break existing myths and increase response levels at the grassroot levels to the appeal for eye donation. Against an existing demand of 2,00,000 corneas, only 20,000 are being donated. Relying on music as the story telling medium, we want to highlight the helplessness and agony of the sightless, and convey the message that with one simple call to universal number 1919, one can contact the nearest eye bank and transform a life.” EH News Bureau
EXPANSION
Fortis Healthcare launches first speciality hospital in Singapore To offer patients the latest treatments and technological innovations in colorectal disorders ortis Healthcare launched the Fortis Colorectal Hospital (FCH) in Singapore. The speciality hospital is the first in Singapore and Southeast Asia to focus on colorectal disorders. The facility is dedicated to the management of the full spectrum of colorectal conditions including colorectal cancer which is among the highest occurring cancers afflicting patients in this part of the world. FCH’s focus on colorectal diseases allows it to offer patients the latest treatments and technological innovations that have been developed specifically for colorectal conditions. Many of these are minimally invasive procedures that enable faster recovery and require a considerably shorter length of stay at the hospital. Speaking at the official opening of the hospital, Dr Amy Khor, Minister of State for Health, Singapore, said,
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“Fortis’ investment in the treatment of colorectal disease exemplified in this hospital, is very timely. I look forward to your contributions in improving healthcare outcomes for Singaporeans. Fortis has significant experience in delivering quality and affordable healthcare in India. I encourage you to apply the same expertise and experience to bring about new and innovative means of providing cost-effective and high quality healthcare services in Singapore.” Vishal Bali, Group CEO, Fortis Healthcare, said, “The Fortis Colorectal Hospital in Singapore is an important step in our journey to be a leading provider of healthcare delivery in Asia Pacific. This is our first greenfield hospital internationally and the 76th in our global network. The hospital also signifies our speciality approach to patientcentric healthcare delivery.” FCH will also focus on education and research to www.expresshealthcare.in
improve the quality of colorectal disease treatment in the region. This combination of expertise and innovation tie into its focus on offering quality care to colorectal patients. It specialises in the complete spectrum of colorectal surgery including the new generation of robotic surgery. The hospital will offer laparoscopic surgery as well as a 24-hour Colorectal Care Clinic, providing round-theclock consultations and follow-up care for colorectal conditions. Also housed within the hospital is the Fortis Wellness Centre that offers a comprehensive range of screening options including those specific to colorectal health. Cutting edge treatments for colorectal cancer and related diseases are delivered at the hospital with care and compassion. “We are delighted with the launch of FCH, and we remain committed to the best patient care delivered by
FCH’s experienced surgeons. The surgical team is supported by a group of dedicated nursing and allied health staff, all trained in the management of colorectal conditions. Patients expect more from their healthcare providers—better doctors, more treatment options, and a better hospital experience. At FCH, we believe that our speciality focus on colorectal conditions - and only colorectal conditions - allows us to deliver the high quality and differentiated care expected by patients today,” said Dr Jeremy Lim, CEO, Fortis Colorectal Hospital. The hospital brings together four leading and influential surgeons in Singapore — Dr Francis Seow-Choen, Dr Ho Kok Sun, Dr Koh Poh Koon, and Dr Lim Jit Fong — committed to deliver the highest standards of colorectal treatment to patients. EH News Bureau AUGUST 2012
M|A|R|K|E|T INSIGHT
Realising the 'Universal Healthcare' dream Shobha Mishra Ghosh, Director, and Sidharth Sonawat, Assistant Director, FICCI reviews the state of Indian healthcare, recommends ways to reform it and outlines FICCI's initiatives towards achieving this objective
he 12th five year plan document once again pitched for Universal Healthcare on the national agenda. Though, India embraced this vision at its independence it has never had the political will, due to other pressing priorities like poverty eradication, food and shelter etc., to make committed allocation of planned funds towards achieving this end. The economic advancement in the country has enabled the government to clearly articulate its intent to increase the public financing of health to 2.5 per cent of India's GDP in the 12th plan to ensure affordable, accessible quality healthcare. However, chances of a quantum increase in funding are bleak, even in the 12th plan period, with the fiscal deficit hitting 5.9 per cent of GDP, levels not seen since 1991. A welfare state should ideally ensure adequate quality healthcare provisions to every citizen. However, if we do a reality check in India, then we find that private outof-pocket (OOP) expenditure forms 71 per cent of the total expenditure on health. 78 per cent of outpatient and 60 per cent of inpatients are being serviced by private providers. What is more interesting is the fact that private providers have only 20 per cent of the existing health infrastructure. India spent only 5.2 per cent of the GDP on healthcare where more than 80 per cent (4.3 per cent of GDP) of it
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came from the private sector alone and was valued at around Rs one lakh crore. Even where public health facilities are available, nearly 70 per cent of the population do not use them as they perceive that these deliver low quality care, while 47 per cent of people do not use these facilities as they are not located nearby. This is despite the fact that private healthcare can be very expensive compared to treatment at public facilities. Clearly, other than select exceptions, the people at large have little faith in the existing state healthcare delivery. In the rural public healthcare infrastructure, primary healthcare facilities lack appropriate health infrastructure, trained health workers, availability of diagnostic facilities, drugs and proper management structure. At the same time, the district hospitals providing secondary facilities provide low quality of care due to high www.expresshealthcare.in
patient footfall and overworked staff. Low accountability and poor governance further compound the challenges. They are also inconveniently located, leading to poor access. A person in rural India has to travel an average distance of 19 km to reach an in-patient healthcare facility which is arduous due to poor infrastructure. This is three times the distance a person would need to travel to a facility in urban India. There are limited numbers of tertiary care facilities in the public system which are also concentrated mostly in the five southern states of India. Although government is under the process of setting up about 10 AIIMS-like institutions across India, these alone will not be sufficient to meet the demand for tertiary level healthcare. The inadequate public healthcare delivery has over the years led to burgeoning of private healthcare providers which by estimates constitute 15-20 lakh
providers spread across the country in an unregulated environment. Majority of the providers are less than 30bed facilities that are not even registered, giving rise to lack of standardisation in the quality of healthcare delivery. In the last decade, large private and corporate sector super-speciality hospitals have come up in metros, and some expansion of secondary care hospitals have been done in the tier II cities. The practice of visiting a general practitioner for primary care is disappearing from the Indian healthcare scenario, thereby burdening the tertiary care hospitals with primary care cases. For optimal utilisation of existing healthcare facilities in the public and the private sector, there is an urgent need to develop a referral mechanism so that the issue of over-congestion of urban tertiary care centers is effectively tackled. The implementation of Clinical Establishment Act 2010 can facilitate this. EXPRESS HEALTHCARE
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While the country has to undoubtedly aspire towards universal healthcare in a defined time-frame, the roadmap needs to be created after taking into consideration various aspects such as communicable and non-communicable disease burden, infrastructure availability, healthcare financing, human resource gaps, quality improvement mechanisms and reforms in institutional and policy framework. This would, in the long run, lead to a fair and robust mix of public-private delivery system with the public system geared towards preventive and primary healthcare, immunisation programmes, NRHM, URHM and disease control programmes. The private providers, including the corporate chains, would have a greater role in secondary and tertiary care. With 80 per cent of infrastructure in public sector and 80 per cent of doctors in private sector, there is immense scope for public-private partnerships to be leveraged for healthcare delivery provision. FICCI Health Services Committee comprising multi stakeholders from the health services domain has been diligently working on the areas highlighted below to suggest collaborative actions that will positively impact the quality of healthcare system and delivery in the country. Skill development: FICCI’s taskforce on skill gaps is collaborating with AICTE to develop 12 vocational courses in the allied healthcare domain. These training programmes are tailored according to the seven
levels under its national vocational education qualification framework (NVEQF) starting from Grade IX of CBSE. The framework allows lateral entry and exit as well as vertical mobility for the students. At the same time, it promotes an all-inclusive approach to vocational education. It also draws on skill
and discharge summary format, payer provider contracts, quality indicators and essential criteria for hospital empanelment. Awareness on accreditation: FICCI’s initiative in increasing awareness towards accreditation and the benefits associated with the same is also showing results.
With 80 per cent of infrastructure in public sector and 80 per cent of doctors in private sector, there is immense scope for public-private partnerships to be leveraged for healthcare delivery provision
development as a potent tool for empowerment of the economically weaker sections. Standardisation: With standardisation of delivery as the aim, FICCI coordinated the development of national standard treatment guidelines for twenty specialities which covered nearly 250 conditions under its ambit. This single standardisation measure would lead to standardisation in clinical practice and ensure more predictable quality outcomes. The final guidelines are in process of being completed and would be released soon by MoH&FW. Similarly, a number of initiatives were taken in the health insurance domain viz. standard billing
While NABH has existed for more than five years and NABL for about two decade now, movement towards accreditation in hospitals and labs has been painfully slow. Through a series of awareness campaigns in collaboration with NABL across the country, attempts are being made to create awareness amongst physicians and smaller labs about the benefits of accreditation. NCDs: With the country still grappling with the burden of communicable diseases, the rising trend in noncommunicable diseases, is presenting a difficult challenge to the health system. Comprehensive awareness, screening and management
strategies to tackle the growing menace of NCDs is the way forward. FICCI’s taskforce on NCDs prevention and management has taken up the task to make attempts in this regard. Innovation: The FICCI Health Services Innovation Task Force has initiated efforts to build an enabling ecosystem for innovators and provide a platform for the Industry which include Institutions in the Public Health Sector, to bridge and promote innovative practices in health and share knowledge through a structured approach. The need of the hour is a collaborative approach between the public and the private sector to collectively face the challenges and build on each other’s strengths. Government should leverage and build on the industry initiatives while planning for the nation. The private sector should self regulate and work in sync with the government to create a synergy with the aim to provide quality healthcare delivery affordable to all segments of societies. The path towards universal healthcare should be a path of small incremental steps of purpose rather than abrupt change and resultant disorientation. There is no reason to believe that private healthcare system cannot co-exist and flourish along with a public healthcare system. All these issues and more will be deliberated in FICCIHEAL 2012 to be held on Aug 27-29, 2012 in New Delhi. The theme of the Conference is “Universal Healthcare: Dream or Reality?”
PRE EVENT
FICCI Heal 2012: Lobbying for universal healthcare FICCI Heal 2012 revolves around the theme “Universal Healthcare: Dream or Reality?" ederation of Indian Chambers of Commerce & Industry (FICCI) is organising sixth FICCI HEAL, its annual healthcare conference from August, 27-29, 2012 at FICCI, New Delhi. The central theme of the conference is “Universal Healthcare: Dream or Reality?” The main features of the event are conference, master classes, B2Bs and poster presentation. India aims towards achieving universal healthcare by 2020. In spite of the increased public spending proposed in the 12th Plan, private out-of-pocket expenditures on health will remain high as compared to other countries in the
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world. Global experience shows that universal health care is feasible provided there is sustained public finance. The government has proposed to provide universal health care in the 12th Plan by taking steps to provide free generic drugs at all public health facilities. But, will India be able to live its dream of ‘Quality Healthcare for All’ in the present context, is a question we need to ponder upon. The conference would be a conglomeration of policy makers and national and international leaders from healthcare and associated industries with participation of about 350-400 del-
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egates from India and abroad. This conference endeavours to keep universal healthcare as the core theme of the conference and deliberate on the emerging opportunities, challenges and solutions. For more details contact Shilpa Sharma Assistant Director FICCI Health Services Division FICCI Federation House, Tansen Marg Tel: 011 23487438, 011 2373 8760– 70 (Extn. 438 / 513) Fax: 011 2332 0714, 011 2372 1504 E-mail: healthservices@ficci.com www.ficci-heal.com AUGUST 2012
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Assessing Health Technology First international fellowship in Health Technology Assessment (HTA) to be held at AIMS from December 10-17, 2012 mrita Institute of Medical Sciences (AIMS) is organising the 1st International fellowship programme in health technology assessment (HTA) in association with University of Montreal; University of Toronto from December 10-17, 2012 at Amrita Institute of Medical Sciences & Research Centre, Kochi. The cost of health care products and medical devices continues to rise consistently. Appropriate and adequate selection of health technology thus remains an area of continuous debate. The Health Technology Assessment programme will equip participants to understand the role various factors play in this analysis and help them make their decision making evidence based. Thus, HTA is a practice
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for conceptualisation, recommendation, selection and use of health technologies for aiding patient care or in selection of interven-
tial to guide decisions and planning. The participants will learn the basics of impact assessment (IA) in selection
HTA is a practice for conceptualisation, recommendation, selection and use of health technologies for aiding patient care or in selection of interventions to improve healthcare delivery tions to improve health care delivery. Guided by techniques that bring evidencebased medicine, cost–effectiveness and patient safety, HTA continues to be a subject with tremendous poten-
and use of health technologies, by methodological approach. Key learning areas would include learning to conduct systematic reviews to measure clinical effectiveness, economic modelling
by understanding basics of health economics and harm–benefit assessment through an integrated patient safety approach. Hence, the programme is suited for hospital and healthcare administrators, decision makers, finance officers, medical professionals, clinical staff and will open the doors of clearer understanding for fresh graduates in medical/bio-medical/pharmaceutical/hospital management sciences. For more information contact Dr Sanjeev K Singh, Medical Superintendent, AIMS Kochi Tel: 0484-2801234 Email: htafellowship@aims.amrita. edu/hospitaladministration@aims.amrita.edu Website: www.aimshospital.org
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Kolkata to host ASICON 2012 ASICON 2012, to be hosted in Kolkata, promises to be an interesting event with an eclectic mix of interesting segments he 72nd annual national conference of the Association of Surgeons of India (ASICON 2012) will be conducted in West Bengal this year. The Science City-Milan Mela Complex in Kolkata is the venue decided for the conference to be held from December 25-30, 2012. Kolkata has hosted the annual national conference of the ASI, thrice earlier i.e. in 1982, 1992 and 2002. The Association of Surgeons of India (ASI) was founded in 1938, with its headquarters presently based in Chennai. The principal objective of the Association has been the advancement of the science and art of surgery. The Association organises its annual national conference every year and it hosted by one of its state chapters. This year, the members of ASI’s West Bengal Charter are hosting the event. In an effort to promote academic standards in late sixties and early seventies, the renowned surgical personalities used to meet occasionally in different medical colleges, where they would demonstrate interesting clini-
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cal cases, specimens and problems of surgical entity followed by interactions of the surgical fraternity. Those were the initial sowing of seeds which gradually ushered the birth of the West Bengal State Chapter of the Association of Surgeons of India in 1978. According to Prof Tamonas Chaudhuri, Organising Secretary, ASICON 2012, “More than 6000 delegates, distinguished faculties and post graduates are expected to assemble for sharing knowledge and exploring the latest advancements in the field of surgery.” Exchange of ideas among the medical fraternity and discussions on every aspect of development in the world of surgery makes this conference a storehouse of information and knowledge. The Conference is going to feature many exciting academic and scientific programmes. There would be numerous paper presentations by reputed surgeons and post graduates from across the country. Scientific exhibition, continuous medical education (CME) programmes, skill course workwww.expresshealthcare.in
shop and scientific programmess would be the key features of this conference, informed Prof Chaudhuri. Live workshops with interactive sessions would be organised with state-of-the-art technology. Live workshops of basic and advanced laparoscopic surgery, onco-surgery and uro-surgery by experienced and reputed surgeons would be an interesting feature of this conference. Besides, lending updated information in the field of surgery, the conference would also help the surgeons to hone their knowledge and skills. Eminent speakers like Dr Ramakant, Former Professor and HOD of Surgery CSM Medical University, and Gandhi Memorial and Associated Hospitals, Dr Barun K Sinha, reputed uro-surgeon from Patna, Dr Chintamani, reputed onco-surgeon, Professor Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, Dr Ratnaswami, eminent gastro-surgeon from Chennai, Dr NK Pandey, Chairman & MD, Asian Institute of Medical Sciences, Faridabad, Dr C Palanivelu,
internationally reputed laparoscopic and GI Surgeon, Gem Hospital, Coimbatore would be present to share their knowledge and experience with the delegates. 'Col Pandalai Oration' will be delivered by internationally reputed onco-surgeon Dr Rajan Badwe. There would be discussions among the stalwarts in the field of surgery, focussing on the subject of “Innovative Indian Solutions to Indian Problems.” This is an important facet of the conference through which innovative ideas would be brought forth to extend the facilities of surgery, which is acceptable and at the same time affordable, to the poorer sections of the people of our country. Thus the organisers of the conference intend to create an academic atmosphere by arranging plenary session, distinguished guest lectures, workshop, symposia, paper presentations and posters, which would provide a platform where eminent surgeons would meet to share their knowledge, discuss and explore the latest advancements in the world of surgery. EXPRESS HEALTHCARE
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Distributor Search India 2012 Distributor Search India announces business meet for device manufactures targetting new medical dealers istributor Search India (DSI), India’s only website catering exclusively to the medical device fraternity that serves as a platform for sourcing distributors and dealers of medical device and disposables has announced a medical, surgical and hospital equipment dealer meet at Pune on September 4, 2012 Called as Distributor Search India 2012 it will be India’s first of its kind customised and highly targetted one-on-one business event in India. The one day event will see medical equipment manufacturers from across the country meeting with dealers servicing the Pune market. Through pre-fixed one-onone meeting the manufactures will not only aim to find a dealer for their products but also understand the Pune market. According to the organiser Distributor Search India, this focussed meet is designed keeping in mind the challenges faced by established as well as new device manufacturers. Due to the complexities of the Indian medical channel network, manufacturers
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often have a tough time identifying the right dealer for distributing their products. Newly launched medical companies face a much bigger challenge, as it is very important for new companies to not only get recognition by consumers but also to get a foothold and tackle the competition in the market. Distributor Search India 2012 will provide a platform for the medical companies to interact with these dealers who form an integral part of the selling process.
Who should attend? ●
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Any principal importer or medical device manufacturer looking to expand their products reach and have an effective distribution set-up for their products. Entrepreneurs who want to set up new dealership business. The meet will be ideal for existing dealers who wish to expand their product portfolio. And also for dealers who wish to identify the progress happening in
the medical market.
device
Why Pune? As published in many reports, there is clear shift with healthcare markets moving to the tier 2 and tier 3 cities. And Pune is no exception with Pune Municipal Corporation (PMC) having about 650 hospitals, maternity and nursing homes and growing. Several market report indicates that new hospitals and medical setups are more open and inclined in adopting new medical technologies for better patient care. This is essential for them to differentiate themselves in their own business. The increasing demand for quality healthcare is putting immense pressure of new healthcare entities to deliver the best in healthcare service. Speaking about the event, Ali, GM Marketing, Distributor Search India (DSI) said, “The role of a dealer is absolutely critical as they help in ensuring that the product is widely distributed. The key benefit of
these entities is in ensuring that the distribution costs are lower for the manufacturer and simultaneously the products are available for the end consumer. The aim of our meet is to link the manufacturers with right channel partner by cutting the clutter. We encourage a pre screening processes for the dealer by which we are able the filter candidates not meeting the manufacturer’s criteria. This process of due diligence allows manufactures to have fruitful discussions.” “We at Distributor Search India realise the importance of a dealer in the medical sales function and precisely for this reason we are organising a dealer meet in Pune”. He further added, “Tier II and Tier III cities in India will see more such events taking place in the future, since the metros have their fair share of events and they are already saturated”. According to Ali this event is designed not only sell to sell dealership but also to build relationships, which are very crucial in the medical business.
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Transforming healthcare with IT Technology and quality to provide twin fillip to the Indian healthcare sector yderabad is set play host to the third edition of International Conference on Transforming Healthcare with IT-2012 on August 31 – September 1, 2012 at the Hyderabad International Convention Center, Madhapur, Hyderabad. The Healthcare IT awards instituted by NASSCOM will be announced at the conference on ‘Transforming Healthcare with IT’. The 2nd International Congress on Patient Safety will be held on September 1-2, 2012 at the same venue. International Conference on Transforming Healthcare with IT 2012 is expected to bring together policy makers, healthcare providers and technologists from across the globe, combining the synergies of Healthcare IT. The focus of this year’s conference will be on cloud computing in healthcare, impact of hand-held devices in delivering healthcare, analytics and mHealth. Noted speakers at the conference include over 60 national and international speakers. The Second International Congress
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on Patient Safety will address critical issues in patient safety from patient safety experts across the world. The conference offers sustainable initiatives and ideas focusing on real time examples and best practices across the globe through presentations, panel discussions, patient safety awards and display of the most widely accepted patient safety tools. The Indian healthcare industry was estimated at $40 billion in 2010, and is expected to reach $280 billion by 2020. According to Frost and Sullivan reports, spending on IT by Indian healthcare players was estimated at $244 million in 2010 and is expected to grow at 22 per cent a year over the next 10 years. For further information contact:
Background Leading players from the healthcare and IT got together to create a platform to exchange and interact on issues related to these sectors. This resulted in the first International Conference on Transforming Healthcare with IT-2010
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which was held in New Delhi. The second International Conference on Transforming Healthcare with IT- 2011 was held in April 2011 in Hyderabad. It was attended by600 delegates, 66 national and international speakers and over 40 exhibitors. The first Patient Safety Congress was held in April 2011 and was attended by over 750 delegates, 66 speakers and 50 exhibitors. The main focus of the congress was on the four essentials of patient safety at all times - medication safety, infection control, surgical site safety and patient falls. For more details contact Transforming Healthcare with IT 2012 Suresh Kochattil, Organizing Secretariat Mobile: +91 98490 11006/ +91 9818109181 Email: mail@transformhealth-it.org Second International Congress on Patient Safety 2012 Gaurav Loria, Organizing Secretariat Mobile: +91 9866072433 Email: patientsft@gmail.com AUGUST 2012
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EVENTS UPDATE Medicall 2012, 9th edition Date: August 3-6, 2012 Venue: Chennai Trade Centre, Chennai Participant profile: Professionals from various verticals of the healthcare sector Contact: Sundararajan, Project Director Email: sundararajan@medicall.in Yogita R Panchal, Manager - Corporate Marketing Mob: 09840326020, | 09360707022 | +91 9360727424 Email: panchal@medicall.in,info@medicall.in
HospiArch 2012, Bangalore Dates: August 18 and 19, 2012 Venue: API Bhavan, Bangalore Organiser: AMEN & Hospaccx India Systems, Bangalore, India Participant profile: Hospital/healthcare promoters, CEOs/COOs, administrators/managers, executives, healthcare mgmt consultants, designers and architects, healthcare management students Contact: Email: hospiarch2012@gmail.com/ amen.paniel@gmail.com Phone: 09035189824/25 Web: www.amen-hospiarch2012.blogspot.in
PeopleHosp 2012, Mumbai Date: August 29, 2012 Venue: The Orchid Hotel, Mumbai
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Phone: 09035189824 / 25 Web: www.amen-peoplehosp.blogspot.in
3rd International Conference on Transforming Healthcare with Information Technology Date: August 31 to September 1, 2012 Venue: Hyderabad International Convention Center, Hyderabad Participant profile: Professionals from various verticals of the healthcare sector Contact: Conference Secretariat Apollo Health Street, Apollo Health City Jubilee Hills, Hyderabad, Andhra Pradesh, India - 500 096 Mob: 98490 11006, 99633 60002 Email: mail@transformhealth-it.org
HospINVentory 2012, Chennai Date: September 5, 2012 Venue: Hotel Marina Towers, Chennai
HospiArch 2012, Kochi Dates: September 29, 2012 Venue: Hotel Presidency, Kochi Organiser: AMEN & Hospaccx India Systems, Bangalore, India Participant profile: Hospital/healthcare promoters, CEOs/COOs, administrators/managers, executives, healthcare mgmt. consultants, designers & architects, healthcare management students Contact: Email: hospiarch2012@gmail.com/ amen.paniel@gmail.com Phone: 09035189824/25 Web: www.amen-hospiarch2012.blogspot.in
Organiser: AMEN, Bangalore, India Participant profile: Hospital/healthcare promoters, CEOs /COOs, administrators/managers, executives, hospital operations managers, inventory managers, stores managers/ incharge, healthcare management students
To tie up with
Last date to register: August 15, 2012 Contact: Email: hospinventory@gmail.com/ amen.paniel@gmail.com Phone: 09035189824/25
3rd Healthex 2012 International
Organiser: AMEN & Hospaccx Human Resources Consultancy Participant profile: Hospital/healthcare promoters, CEOs/COOs, administrators/managers, executives, healthcare mgmt consultants, HR managers/executives, healthcare management students
Date: September 7-9, 2012
Contact: Email: peoplehosp.amen@gmail.com/ amen.paniel@gmail.com
Participant profile: Professionals from various verticals of the healthcare sector
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Contact: Suresh Babu P Bangalore International Exhibition Services Pvt. Ltd. Entry Plaza, BIEC, 10th Mile, Tumkur Road, Madavara Post, Bangalore-562 123. Mob: +91 80 6583 3234, Mob: +91 99729 29976 Fax: +91 80 6624 6661 Email: suresh@bies.co.in Web: www.bies.co.in
Venue: Bangalore International Exhibition Centre
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for Media Partnerships Contact tushar.kanchan@expressindia.com
AUGUST 2012
C|R|I|T|I|C|A|R|E rauma or injury known to cause thousands of deaths every year around the world has seen an upward trend; thanks to our urbanised lifestyle and quest for commodities leading to unplanned industrialisation. It is ironic that the irresistible temptation to make our lives easy and hassle free is also resulting in accidental deaths, crime and violence around us but the irony deepens when you consider the facts of trauma fatality. In India, a total 3,90,884 accidental deaths were reported during the year 2011. During the same time, a total of 6,94,390 cases of ‘unnatural accidents’ caused 3,67,194 deaths and rendered 5,06,348 people injured says the latest National Crime Records Bureau. According to a WHO publication by Dr G Gururaj, Professor and Head, Department of Epidemiology, NIMHANS, Bangalore, “Every year in India, nearly a million deaths occur due to road traffic injuries, falls, burns, poisoning, drowning, suicide, workplace or occupational injury, natural disasters, violence, etc.”
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Trauma - a major epidemic
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Trauma facts in India 1) India loses approx 2-2.5 per cent of its GDP to only road traffic injuries 2) All trauma is not road traffic injuries 3) 22.8 per cent of all trauma is transport related injuries 4) Majority 77.2 per cent is other trauma like: i) Falls (paediatric age group) ii) Agricultural related trauma iii) Fire Arms, Intentional self harm iv) Assault, Fall of objects v) Burns, Drowning vi) Natural Disasters vii) Terrorist Attacks viii)Possibility of “NBC” events
Ref: traumaindia.org Traumatic injuries have been described as the largest epidemic of the 20th century. In view of the number of victims and the associated costs, they have been also been called the most severe and longest war of the contemporary world. According to WHO, injury will be the third leading cause of death in India by the year 2020. Some experts opine that trauma is the third leading killer in India, next only to heart disease and cancer. In the developed world, it is the leading killer of young persons in their productive years, from
1-44 years of age. According to a report by Dr MK Joshipura, Orthopaedic and Trauma surgeon, Ahmedabad, “Every 1.9 minutes a trauma-related death occurs in India.” Trauma not only results in tremendous human tragedy where invaluable human life is lost but also causes loss of limbs and permanent disability. WHO directive explains that the goals of good trauma care are to prevent deaths among those surviving the initial impact, reduce complications and disabilities among those hospitalised and return the
Trauma care - a joint effort Co-ordination and planning are the pillars on which trauma care stands. “The key components of a trauma care system include efficient pre-hospital care, appropriate hospital care (encompasses efficient acute care facilities, functioning trauma care centres, planned and coordinated responses for injured patients and collaboration within and outside healthcare systems) and adequate disability reduction activities. Hence, a trauma care system includes coordinated activities at all levels and is performed by individual members of the team to cover pre-hospital and emergency care, acute hospital care and rehabilitation services,” points out Dr Gururaj. “As soon as a patient comes to us, we treat the patient as per the advanced trauma life support (ATLS) protocols. Firstly, a primary survey is done. During this primary survey, we check whether the patient is stable or has a life threatening disorder. If there is any life
The tsunami that hit the Indian coasts in 2004 caused heavy losses to life and property
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threatening problem, the same is addressed immediately. Urgent investigations are done at the bedside, if possible, to assess the severity. If the patient is unstable, he is shifted to the intensive care unit (ICU) or the operation theatre (OT) for immediate surgery. If the patient is found to be stable during the primary survey, the secondary survey is then conducted which is a ‘head to toe thorough examination’ of the patient with investigations,” offers Dr Mabel Vasnaik – Head and Consultant, Department of Adult Emergency, Manipal Hospitals. “We do have set protocols for both triage as well as intra hospital transfers. We use the standard ATLS assessment and guidelines to establish triage category and examine the patient accordingly. Same holds good for intra hospital transfers,” she further adds.
“Very few hospitals in India have a dedicated trauma-care centre. In fact, pre-hospital trauma care is absent. Additionally, primary trauma care is available but secondary and tertiary level trauma care is missing.” Dr Joshipura states that private and corporate hospitals, located mostly in large cities, are equipped with modern diagnostic and imaging facilities, good operating environ-
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Loopholes in trauma care ● ● ● ● ● ● ● ● ●
Time-delay in seeking care Delay in reaching designated hospital due to referral Medicolegal issues Refusal to attend by hospitals Cost of care and affordability Lack of uniform protocol Lack of facilities at the hospital Absence of evidence based care Absence of research and trauma audits
ments and intensive-care units. Some of them also run dedicated trauma services. However, there are no norms to govern their standards and their relations with the public trauma system. Compounding the problem is the lack of trained staff and lack of awareness in general public about the ‘golden hour’. “Patients transferred by relatives/friends/onlookers and those transferred by
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VIVO Healthcare, Gurgaon, is a one-of-its-kind training centre, offering Emergency Medical Services (EMS) and skill enhancement courses needed to succeed in the healthcare industry. Who can benefit : Students, Healthcare Professionals, Community Workers, Ambulance Staff, Gym Instructors, Corporate Offices and Hotels. Very few hospitals in India have a dedicated trauma-care centre. In fact, pre-hospital trauma care is absent. Additionally, primary trauma care is available but secondary and tertiary level trauma care is missing Dr Narendra Vaidya Director and Trustee, Lokmanya Hospital, Pune
Trauma care in India is elusive Despite trauma being a major health problem, India does not have a strong trauma-care system in place. At the best trauma-care in India can be described as elementary. Having one or two highly specialised units in private hospitals in metro cities hardly addresses the problem at large. Says Dr Narendra Vaidya, Orthopaedic and Joints Replacement Surgeon, Director and Trustee, Lokmanya Hospital, Pune, AUGUST 2012
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untrained ambulance personnel don't handle trauma victims with care and do not take necessary precaution,” says Dr Thavapalani, Head, Trauma care, Apollo Hospitals, Chennai. “Lack of knowledgeable personnel and appropriately equipped hospitals in all areas is a major issue. In addition, lack of proper prioritisation and early recognition of life threatening and time critical injuries is an issue with clinical set ups in India,” he adds. Not having access to patient records for consulting and having the relative of the patients around to take immediate decisions on treatment provided also adds to trauma-care woes. “One of the problems faced by the doctors while treating a trauma patient is lack of previous medical records,” explains Rekha Dubey, COO, Aditya Birla Memorial Hospital, Pune. According to Dr Joshipura existing traumacare systems are predomi-
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Reality Bites 54 per cent hospitals have set protocol for triage In 30 per cent hospitals, casualty medical officer is the only physician available to provide resuscitation 36 per cent facilities follow NTMC or local protocols In 50 per cent facilities, orthopaedic surgeons lead trauma response One of the problems faced by the doctors while treating a trauma patient is lack of previous medical records Rekha Dubey Chief Operating Officer, Aditya Birla Memorial Hospital
nantly restricted to cities and semi-urban areas, without integration of region or statewide systems. He says that no such systems exist in rural and remote areas to offer prompt life-saving treatment and safe transfer to an appropriate facility. Most government hospitals
Ref: Joshipura MK, Shah HS, Patel PR, Divatia PA. Trauma care systems in India - An overview. Indian J Crit Care Med 2004;8:93-7
Trauma care in various hospitals No of hospitals
Average number of trauma patients treated per year
Lokmanya Hospital, Pune
10,000-12000
Apollo Hospitals, Chennai
400-500
Manipal Hospitals, Bangalore
3,500-4,000
Aditya Birla Memorial Hospital, Pune
500-600
Education of medical personnel about the golden hour in trauma and exposing more medical personnel to trauma workshops, are among many such steps to improve trauma care Dr Mabel Vasnaik Head and Consultant, Department of Adult Emergency, Manipal Hospitals
Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva, World Health Organization, 2002
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offer free care, but the quality of that care differs from one centre to another. Most university hospitals provide a reasonable level of care; these hospitals are able to fulfill the role of tertiary trauma centres but critical care continues to remain the weak link in such settings for a variety of reasons. On the other hand, the district hospitals often lack trained staff, adequate infrastructure for management of polytrauma and supply of consumables. Small hospitals and clinics mushrooming across India are simply unable to cope with AUGUST 2012
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Hospitals were flooded with patients after the multiple train blasts in Mumbai on July 11, 2008 polytrauma, due to lack of multidisciplinary support, particularly the critical care units. Such small establish-
ments struggle to manage severely injured patients, resulting in substandard care and high mortality.
Case Study Supreme Court decision (dt. 23/8/1989) Pt Parmanand v/s Union of India and others ●
The Supreme Court has ruled that all injured persons especially in the case of road traffic accidents, assaults, etc., when brought to a hospital/medical centre, have to be offered first aid, stabilised and shifted to a higher centre/government centre if required
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It is only after this that the hospital can demand payment or complete police formalities
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In case you are a bystander and wish to help someone in an accident, please go ahead and do so
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Your responsibility ends as soon as you leave the person at the hospital. The hospital bears the responsibility of informing the police, first aid, etc
Policy-paralysis here too
The terrorist attack on Taj Hotel, Mumbai, on November 26, 2008 plunged the entire nation into mourning
AUGUST 2012
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It is sad to note that our country does not recognise injury as a major public health problem. Although, road traffic accidents receive maximum attention, recent spats of fire incidents in hospital and prominent government buildings like Mantralaya, have compelled the government to think about this growing health problem. Yet, injuries from fall and poisoning remain neglected. Dr Joshipura laments that despite trauma being a major public-health problem with high morbidity and mortality, the Ministry of Health does not have a designated unit to deal with issues related to trauma.
There is no central government agency to integrate policy-making, planning, financing, drafting legislation or establishment of minimum standards for the performance of a traumacare system. “No law exists to ensure prompt access to life-saving treatment for trauma victims. Statutory provisions to aid national, state, or interstate planning and implementation of trauma-care systems, regardless of jurisdictional boundaries, are yet to evolve. Issues such as the accreditation of trauma centres and critical care units, specialist licensing of health personnel and mandatory training of physicians lack national guidelines,” he further adds. EXPRESS HEALTHCARE
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Way forward Problem of this magnitude requires giant steps to prevent mortality and morbidity. Often, it is difficult to garner support from all the parties involved to take any concrete steps. However, it is the right time now for India to think about developing minimum standards and guidelines for trauma-care across the country. “The accidents rate at different levels emphasises the need for accident and injury prevention modalities to be initiated so as to reduce the injury rate. It needs integrated approach with systematic comprehensive strategies that can change conditions to bring down accident rates,” suggests Dr Vaidya. “Injury prevention and safety measures, still the key. Hospitals should be labelled as level 1, level 2 and level 3 facilities by a central agency based on an objective assessment of the infrastructure, personnel and equipments available. Ongoing training for the healthcare teams involved is a must.” avers Dr Thavapalani. Dr Gururaj writes “Improving trauma care rests on identifying pathways of care for trauma patients and
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Mumbai’s citizens dread a repeat of the harrowing experiences they had during the floods of 2008 recognising various bottlenecks in the system, and this can only be done by good research. It should not be done to find faults with people, but in recognising areas, that if improved, will lead to more positive outcomes. This requires building a system which constantly identifies areas for further improvement
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and is important in both rural and urban areas.” Echoing this opinion Dr Vasnaik says, “Education of medical personnel about the golden hour in trauma and exposing more medical personnel to trauma workshops, are among many such steps to improve trauma care.” However, a lot more needs
to be done and concentrated efforts in epic proportions need to be taken for India to fare well in the arena of trauma care. Who will initiate these steps, how and when will this be achieved are the questions we need to answer and soon. mneelam.kachhap@expressindia.com
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Critical care in disaster management Dr Saurabh Kole provides an outlook on the roles played by critical care professionals and stresses on the need to have an efficient critical care system in place to deal with diasaters effectively
AUGUST 2012
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they need to do. The element of preparedness comes here. Unless a team of critical care professionals are prepared how to face the horrible
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critical care gives a feeling of emergency response. But in highly demanding situations, the response team must be very clear about what exactly
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A large number of people gets affected if disaster strikes. Apart from experiencing trauma, loss of near and dear ones, neighbours, home, possessions, usual way of living etc., shatter their confidence and leaves behind a scar in the mind of affected people. In all
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Country/state specific details, like identification of disaster prone areas, previous history of disaster, geography and topography, distance between capital city and the areas, response and management capacity on national and local disaster, security, maps, early-warning and other alarm systems, relief agencies and disaster management capacity of sister agencies as well as local custom/norms and other information about common and possible natural hazards can be obtained to focus on efficient disaster prevention and to form strong disaster management programmes.
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Disaster preparedness
psychological trauma. And this is where the role of health specialists come into the picture. In a disaster scenario,
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disasters, feeling of safety and security are challenged. But the most critical situation after a disaster is physical injury, spread of diseases and
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rauma is one of the leading causes of death worldwide. It may happen after a major, public disaster like war, earthquake or tsunami that affects many people and loss of life. In case of an outbreak of such events, the affected people need critical care attention. Disaster management, critical care and medical professionals are closely interlinked. Many pathbreaking medical procedures, inventions and protocols came into light in trauma and critical care management during or after-disaster like situation. Involvement of medical professionals in disaster management has benefited not only the victims but also enriched science and its practitioners with valuable experience. Even in today’s world of superspecialisation and niche practice, medical professionals must be in the forefront when disaster strikes.
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ground realities that may warrant imminent variety of medical and surgical actions, the outcome of interventions may not yield desired goals. In this perspective, disaster preparedness is equally important for critical care professionals though slightly different from preparedness activities prescribed for professionals from other fields. As a discipline, critical care personnel are used to rapid response, teamwork, working against odds, working round the clock and doing all these almost by reflex, thereby saving crucial time and preventing delay. Various medical problems and complications can be encountered in a disaster affected area. Not only that, a trivial illness or injury tends to aggravate rapidly in an already stressed person in a disaster-affected area. This is precisely why a critical care specialist’s role is so important in such a situation. As a critical care professional, I have faced various aspects of rendering medical services to affected people. After the massive earthquake in Bhuj, Gujarat (2001), the entire health system collapsed. A team of doctors and paramedics from Kolkata went to the affected area. The experience varied from multifarious fractures inflicted by the earthquake to delivery of a baby in a makeshift medical camp. A doctor from the local hospital was also admitted in that camp following an acute myocardial infarction and
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Critical care personnel are used to rapid response, teamwork, working against odds, working round the clock and doing all these almost by reflex, thereby saving crucial time and preventing delay
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treated by our critical care team within limitations of infrastructure. Thankfully, he was cured to a possible extent. I have worked with Rotary Club Dist. 3290; Society for Disaster preparedness along with Critical Care Society, Kolkata. Together, we have tried our best to provide utmost possible services
to the affected people after the devastating tsunami at Nagapattinam, which was the worst hit, Kadalur in coastal Tamil Nadu, in Port Blair, Andaman (2004), in flood-hit Mumbai (2005), in Bangladesh after the devastating cyclone (Sidr 2007) and in ravaged Myanmar after the cyclone (Nargis 2008).
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Every hospital must develop QRMTs and train them with state-of-the-art facilities of quick and coordinated response in emergency situations QRMTs must be supported by minimum facilities of emergency management QRMTs of different hospitals at city level must be networked to come to each others assistance Critical care societies from each region should have a Rapid Response Team ready for action Makeshift hospitals with proper equipment and facilities to provide adequate service should be planned and be ready on demand Proper training of doctors and health workers to tackle disaster efficiently
Conclusion Critical care teams, in different parts of the world, have played crucial role in emergencies arising out of disasters. A network among them would help to coordinate activities and exchange of expertise. It is high time that critical care should move out of the limited range of intensive care to broader horizons where scores of traumatised people are in need of medical attention following a disaster. The author of the article is ITU in-charge and Medical Coordinator (Academic Wing) Belle Vue Clinic, Kolkata; Secretary, Society for Disaster Preparedness; Past Secretary, Indian Society of Critical Care Medicine; Past Vice President, Society of Emergency Medicine, India
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AUGUST 2012
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EMS courses from VIVO Healthcare Institute With enhanced emergency medical services emerging as the need of the hour in India, VIVO Healthcare Institute offers several EMS courses and life support training programmes to create more paramedics in the healthcare segment
f you fall very sick or get hurt and need help right away what do you do? Call emergency medical services. Emergency medical services is a branch of emergency medicine which provides treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to the next point of definitive care. It is delivered in two forms – prehospital care and treatment in the emergency room within the platinum 10 minutes and golden one hour. Healthcare is one of the fastest growing sectors in India. It is a chain reaction delivered in forms of pre-hospital, definite or hospital care and rehabilitation. In India the pre-hospital care is the weakest link of this value chain and needs huge investment.
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EMS in India – a prime concern EMS care in India currently is suboptimal and requires upgradation. There is an accident happening every minute and a death every four minutes in India – one of the highest rates in the world. Two third of the victims are young between 15- 44 years. They are the breadwinner of their fami-
lies. Many of them die for the want of timely EMS. Every individual has the right to best medical care according to the state of art and not according to the location, severity of injury or ability to pay. Time matters and every second counts in an emergency. A patient in cardiac arrest whose heart has stopped working needs cardiac massage/CPR within four minutes. The golden hour concept in emergency care is a continuous process, beginning with the care that is given in ambulance enroute by trained EMS/ambulance personnel to hospital this protection is vital for survival rates. Trained EMS personnel, manning professional ambulance services make a world of difference between life and death. In India, we lack an awareness of the most important and basic service i.e. pre- hospital care. There is a dearth of qualified paramedical personnel who can assess or assist a victim. There is a strong need for integrated and institutionalised approach for emergency response.
VIVO Healthcare VIVO Healthcare Institute is a one-of-its-kind state of art paramedic institute in Gurgaon, providing AUGUST 2012
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emergency medical services (EMS) courses and life support training programme. Our academic and practical training programme is designed for the students to become effective paramedics for the growing healthcare sector. VIVO Healthcare Institute aims to breathe life into this sector by transforming students into saviours, offering a wide array of paramedical and EMS courses. Job-oriented courses like EMT Basic (two months), EMT Intermediate (six months) and Emergency Medical Technician – Paramedic (two years) are just some of the courses being conducted by VIVO Healthcare Institute. Emergency medical technician (EMT) paramedics work in hospitals as well as in pre-hospital setting and are instrumental in saving lives. An EMT deals with precious lives everyday, including emotional and psychological aspects of trauma, fire, assault and life threatening medical situations. They provide the highest level of prehospital care and are the leader of the pre-hospital care team. Becoming a paramedic requires a great deal of drive and dedication. It is a very honourable job, and one that people often refer to as heroic. People never forget those that helped them when they most needed it, and being a paramedic is all
about helping those in need. With so many hospitals coming up – big and small and their numbers likely to grow in the next 10 years, the need for well qualified and trained EMT staff providing emergency care is increasing and the prospects for EMT paramedic are very bright. They are important members of the teams in a hospital’s emergency rooms, ICUs, trauma units, may work for an ambulance service as well as be part of team working on-site in disaster situations. A good EMT paramedic is a an asset for any good emergency team. Starting salary around Rs 10,000Rs 15,000 per month and sky is the limit. Every month VIVO Healthcare organises mass awareness workshops for the masses. In the month of August, VIVO is organising internationally-recognised American Heart Association (AHA) Heartsaver programme on August 12, 2012. Healthcare providers like doctors, nurses, medical technicians, paramedics/ EMTs can benefit in a big way if they enroll for AHA BLS ACLS programme. For registration and enquiries, get in touch at 9910144233/9910102432, or email at vhi@vivohealthcare.com, visit www.vivohealthcare.com EXPRESS HEALTHCARE
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Knowledge Hepatitis B virus in India: an overview Dr R N Kalra Medical Director & CEO, Kalra Hospital gives an insight about Hepatitis B and suggests ways and means to tackle this 'silent epidemic'
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Doctors! Pause & Prescribe US-based Dr Kunal Saha outlines a case of medical negligence which resulted in the patient’s death and stresses on the need for detailed study of any case before deciding the line of treatment
ward of a few crores as compensation for medical negligence in India is unheard of but times have changed. The disease suffered by the wife of the complainant, a medical Doctor with Ph.D; was also rare – TEN (Toxic Epidermal Necrolyesis) which affects one or 1.3 person out of 10 lakh is also rare. A lawyer’s notice to 26 persons and a criminal complaint against three medical professors which was fought up to the Supreme Court of India – is very rare. Another complaint to cancel the names of three medical professionals from the Professional Register of West Bengal Medical Council and consequently, a final award of Rs 1,55,60,000, a whopping amount in the legal history of India, which was very conservative hitherto in awarding pecuniary and non-pecuniary damages against the opposite parties – makes this a rarest of rare cases!
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Facts of the case Anuradha Saha (36), wife of Dr Kunal Saha (complainant) became the unfortunate victim of TEN when she along with the complainant was in India for a holiday during April – May 1998. The complainant and Anuradha are medical doctors of Indian origin in the US. The complainant having a doctorate in medicine was doing research in HIV/AIDS whereas Anuradha was a child psychologist. Both arrived in Kolkata on April 1, 1998, where Dr Saha found that Anuradha had developed a low grade temperature, sore throat, with some palpable neck glands on April 3, 1998. She was treated by him, as he is a trained medical man. On April 17, 1998, Anuradha developed high grade fever with upper
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respiratory tract infection. On April 25, 1998, her fever increased with skin rash and enlarged neck glands (lymph nodes). On April 26, 1998, the complainant contacted Dr Sukumar Mukherjee (Opposite Party No:1) and requested him to examine the patient at his residence. After examination, Dr Mukherjee suggested a host of pathologwww.expresshealthcare.in
ical tests including blood tests. ● Bio-chemistry tests including liver and kidney functions, immunology i.e., determination of anti-bodies and other relevant examinations; and ● b)Virology i.e., determining the presence of viruses for ascertaining the causes of the fever. No other treatment was
prescribed on the said date. Dr Mukherjee informed Dr Saha that he would be leaving India on May 12,1998 for the US where he was to participate in an international medical conference. In between Dr Saha contacted Dr Mukherjee on May 7,1998 as her condition deteriorated. He advised him to bring Anuradha to his chambers. Anuradha walked into the AUGUST 2012
K|N|O|W|L|E|D|G|E clinic late in the evening on May 7,1998 When Dr Mukherjee examined Anuradha, the complainant informed him that on May 6, 1998, they had Chinese food after which the skin rashes worsened. After examining her, Dr Mukherjee’s diagnosis was that she was suffering from angio-neurotic oedema with allergic vasculitis – the challenge to Chinese food positive. He advised administration of depomedrol injection 80mg IM twice a day for a period of three days. This was based on blood reports with eosinepohilia and mild bucocycosin. Undisputedly between May 7-11, 1998, the complainant consulted two dermatologists, Dr AG Ghoshal and Dr S Ghosh. Both of them diagnosed Anuradha a case of vasculitis. On May 11, 1998, the patient was admitted in the Advanced Medical Research Institute (AMRI), Kolkata. In the hospital, she was under the care of Dr Balram Prasad, a consultant physician (a class mate of the complainant). On May 11, 1988, Dr Mukherjee examined the patient on a reference made by Dr Prasad. He again prescribed Wysolone: ●
number of days, prescribed by 80 mg injections. I would not give more than 40 mg per day -1mg/kg body weight.” Anuradha died on May 28, 1998.
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This case highlights the fact that doctors should use drugs that they are familiar with, in relation to the dose and indications. The dose they are prescribing should be as per the recommendations of US FDA or BNF or Indian drug controller
50 mg once daily for one week
● 40 mg daily for 1 week ● 30mg daily for 1 week
Depomedrol: ● 80 mg IM twice daily for two days then 40 mg IM twice for two days On the evening of May 11, 1998, Dr AK Ghoshal – a consultant dermatologist examined Anuradha and diagnosed that the patient was affected by TEN. It is to be recorded that Dr Ghoshal also recommended to continue the same medicine as prescribed by Dr Mukherjee. On May 12, 1998, Dr Baidyanath Halder – a consultant dermatologists examined the patient and opined that the patient was suffering from Stevens and Johnson Syndrome and recommended confirmation of treatment recommended by Dr Mukherjee. On May 17, 1998, the complainant removed the patient from AMRI hospital to Breach Candy Hospital in Mumbai. On examination Dr Farokh E Udwadia recorded that “...there is no skin left. In any case, first basic management is the same. I do feel that the dose of steroids used in Kolkata is either excessive 120 mg daily for a AUGUST 2012
A short recital of legal proceedings against the doctors may explain the situations easily. On September 30,1998, the complainant issued legal notice to 26 persons which included doctors, hospital management in Kolkata and Breach Candy Hospital, Mumbai. On November 19, 1998 a criminal complaint was filed against Dr Sukumar Mukherjee, Dr Baidyanath Halder and Dr Abani Roy U/S 304 A IPC On 09.03.1998 a complaint of deficiency of service against 19 doctors, claiming Rs 77,76,73,500 as compensation before National Consumer Disputes Redressal
appeal in favour of the doctors against the complainant. But it has held that there is a degree of negligence – by prescribing excess dosage of Depomedrol and hence the commission should calculate pecuniary and non-pecuniary damage and ordered to be paid to the complainant by the opposite parties. Accordingly, the commission ordered the following quantum of compensation against the opposite parties. i) Dr Sukumar Mukherjee – opposite party No 1: Rs 40,00,000 ii) Dr Baidyanath Halder opposite party No 2: Rs 26,93,000 iii) AMRI hospital – opposite party No 3: Rs 40,40,000. iv) Dr Balram Prasad opposite party No 4: Rs 26,93,000. v) The opposite parties were directed to pay the aforesaid amounts to the complainant within eight weeks from the date of order, failing which the amount shall carry an interest of 12 per cent per annum with effect from first date of
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Commission (NCDRC), New Delhi was filed On July 17, 1999, a complaint was filed against Dr Sukumar Mukherjee and three others before the West Bengal Medical Council to cancel the registration for medical practice
Consequence The criminal complaint was dismissed by the Chief Judicial Magistrate, Alipore; subsequently an appeal preferred before the High Court of Calcutta which was also dismissed. A Criminal appeal was filed before the Supreme Court of India. The complaint for awarding a compensation of Rs 77 crore was dismissed by NCDR commission New Delhi. But a civil appeal was filed before the Supreme Court. The Supreme Court considered both the appeals. It dismissed the criminal www.expresshealthcare.in
default. The emerging legal conclusions from this case ● Gone are the days, that the Indian courts are conservative in awarding compensation. ● Doctors should be very careful in prescribing the quantum of medicine. The deposition of Dr Farokh E Udwadia and the manufacturers of Drug Depomedrol went against the opposite parties to enable the judiciary to hold that the quantum is excessive. Dr George Goris, Managing Director Medical and Drug Information of Pharmacia expressed that ‘DEPO’ dosage of more than the approved indication, that too 80 mg, twice daily, was not correct. ● The contributory negligence of the complainant, frequent intervention in the administration of
drugs; not allowing the doctors to examine the patient; not allowing to take biopsy from the patient; administration of a drug Qurisalone antibiotic by the brother – in – law of the complainant, consumption of sea food by the patient when she had skin rashes; being a doctor she should have known that it would be a challenge to allergic vasculitis. ● The shifting of the patient from Kolkata to Mumbai thereby completely exposed for infection. Therefore, the compensation is limited to this quantum or otherwise, the same would be more, amounting to few crores. Though the matter has not attained the finality – open to challenge by both the parties, there is a lot to be studied, understood and followed by the treating specialists and hospitals for future course of action such as: while maintaining the medical records to note the contributory negligence; to prescribe the medicine by taking independent decisions and not carried away by the prescriptions already followed; to offer more degree of professional skill while treating a particular patient. Deep knowledge about the maximum dosage as per drug – literature coupled with the physical stature and condition of the patient at that particular time. In summary, this case highlights the fact that doctors should use drugs that they are familiar with, in relation to the dose and indications. The dose they are prescribing should be as per the recommendation, of the US FDA or British National Formulary (BNF) or Indian drug controller’s recommendations. As and where the doctor feels he/she needs to give drug doses beyond the approved/ indicated dose, they should document in the case sheet the reasons for the same and it is preferable to get the consent from the patient. Gone are the days where a doctor could claim that a particular drug “in his opinion” is good. Doctors should practice “evidence-based medicine”. Their prescriptions should be supported by evidence that they are useful and not harmful. *Source: Dr Kunal Saha Vs Dr Sukumar Mukherjee and others {2012 (1) C PR 154 (NC)} EXPRESS HEALTHCARE
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Hepatitis B virus in India: An overview Dr R N Kalra, Medical Director & CEO , Kalra Hospital gives an insight about Hepatitis B and suggests ways and means to tackle this 'silent epidemic'
DR R N KALRA
Medical Director & CEO, Kalra Hospital
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has occurred. Treatment for acute Hepatitis B is focussed on dealing with any symptoms or complications that may occur as a result of the infection. This is known as supportive care. Even without specialised treatment for acute hepatitis B, most people recover completely within a few months. For people with chronic Hepatitis B, specific medicines are available to help slow down liver damage.
"This is hepatitis… It’s closer than you think" - World Hepatitis Day 2012 theme he World Hepatitis Day logo is the global symbol for encouraging better awareness, action, and support to prevent and treat viral hepatitis. This year will be the fourth annual World Hepatitis Day - taking place on July 28, the birthday of Nobel Laureate Professor Blumberg who discovered Hepatitis B. The whole point is to encourage people to find out the facts about Hepatitis B and to help decrease the stigmas attached to the virus. Hepatitis has been referred to as the 'silent epidemic. That's because while some people will have symptoms straight away others could go upto 10 years without knowing anything is wrong. In Hepatitis B, the infection is transferred through the blood to damage the liver and its ability to carry out essential functions for the body. It can also affect other parts of the body including the immune system, digestive system and the brain. Around 130-170 million people on the planet have it. Thankfully, drug treatments have been successful: 50 per cent success for genotype 1 and an even better 80 per cent for genotype 2. But there is still no vaccine and it's important that people are more in the know about exactly how dangerous hepatitis is and what it does. WHO World Hepatitis Day is marked to increase awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as: strengthening prevention, screening and control of viral hepatitis and its related diseases; increasing Hepatitis B vaccine coverage and integrating it into national immunisation programmes; and coordinating a global response to hepatitis. These viruses constitute a major global health risk with around 350 million people being chronically infected with Hepatitis B World Hepatitis Day, observed on July 28 every year, aims to raise global awareness of Hepatitis B and encourage prevention, diag-
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Cure for Hepatitis B
World Hepatitis Day Logo nosis and treatment. World Hepatitis Day was launched by the World Hepatitis Alliance in 2008 in response to the concern that chronic viral hepatitis did not have the level of awareness, nor
more about contracting AIDS than Hepatitis, the reality is that every year 1.5 million people worldwide die from either Hepatitis B or C, faster than they would have from HIV/AIDS.
The best Hepatitis B "cure" is preventing infection in the first place. Among the ways you can prevent the disease are by getting vaccinated and avoiding high-risk situations (such as unprotected sex and coming into contact with infected blood). However, if infection with the Hepatitis B virus has already occurred, the only cure for the condition is time -eventually, the body is usually able to effectively kill the virus.
Treatment
Hepatitis viruses constitute a major global health risk with around 350 million people being chronically infected with Hepatitis B the political momentum, seen with other communicable diseases such as HIV/AIDS, tuberculosis (TB) and malaria. This is despite the fact that the number of people chronically infected with, and the number of deaths caused by, Hepatitis B and C is on the same scale as these conditions. World Hepatitis Day has generated massive public and media interest, as well as support from governments. Approximately 500 million people worldwide are living with either Hepatitis B or C. This represents 1 in 12 people, and this was the basis for the 2008 World Hepatitis Day’s ‘Am I Number 12?’ campaign. If left untreated and unmanaged, Hepatitis B or C can lead to advanced liver scarring (cirrhosis) and other complications, including liver cancer or liver failure. While many people worry www.expresshealthcare.in
Hepatitis B is caused by the Hepatitis B virus (HBV). Most people who get hepatitis B can get rid of the virus on their own; however, unlike Hepatitis A, which eventually goes away, some people with Hepatitis B develop a lifelong infection known as chronic Hepatitis B. This may lead to a scarring of the liver (cirrhosis), liver failure, and can also lead to liver cancer. The Hepatitis B virus is spread through contact with infected bodily fluids. Among the bodily fluids that can transmit the virus are infected blood and blood products. It is also spread through contact with other infected bodily fluids, such as semen, vaginal fluids, or saliva.
Symptoms Symptoms can vary, although a number of people will not have any symptoms until significant liver damage
There are two types of Hepatitis B -- acute (recently acquired) Hepatitis B and chronic (lifelong) Hepatitis B. Treatment differs for each type. For acute hepatitis B, there are no specific medicines that can cure the disease . Therefore, treatment is focussed on dealing with any symptoms or complications that may occur. This is known as supportive care. Even without specialised treatment for acute hepatitis B, however, most people recover completely within a few months
Indian scenerio An average estimated carrier rate of Hepatitis B virus (HBV) in India is four per cent with a total pool of approximately 36 million carriers among the 400 million Hepatitis B surface antigen carriers worldwide. Therefore India alone constitutes nine per cent of the total. Wide variations in social, economic and health factors of different regions may explain variations in carrier rates from one part of the country to another. Professional blood donors constitute the major high-risk group for HBV infection in India, with a hepatitis surface antigen B positivity rate of 14 per cent. Blood transfuAUGUST 2012
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Hepatitis B virus sions represent the most important route of HBV transmission among adults. However, most of India’s carrier pool is established in early childhood, predominantly by horizontal spread due to crowded living conditions and poor hygiene. HBV is reported to be responsible for 70 per cent of chronic hepatitis cases and 80 per cent of cirrhosis of liver cases. About 60 per cent of those cases with hepatocellular carcinoma are HBV marker positive. Most authorities believe that India falls in the intermediate zone of HBV prevalence i.e., prevalence between two per cent and seven per cent. This figure is based on studies contributed mainly by blood bank screening programmes and screening of healthy pregnant women attending antenatal clinics. Universal immunisation is usually recommended for any disease that causes significant morbidity; both in terms of numbers as well as in terms of the severity of the consequences of the infection including mortality, provided a safe and effective vaccine is available. Hepatitis B is believed to satisfy both these criteria with an estimated prevalence in India between three per cent to seven per cent and its sequelae of chronic hepatitis, cirrhosis and hepatic carcinoma. The goal of immunisation programme against Hepatitis B is to reduce the incidence of, and possibly eliminate hepatocellular carcinoma and chronic liver disease, by reducing the number of HBV carriers in the population. AUGUST 2012
World Hepatitis Day has been led by the World Hepatitis Alliance since 2007 and on May 2010, it got global endorsement from the World Health Organization as one of only four mandated health awareness programmes that increased understanding among the
policy change, both at an international and national level. The ‘12 Asks’ to governments are a central element of the campaign and set out key elements that should be incorporated into national strategies to ensure improvements in health outcomes for patients. All governments are
Programmes for the prevention and control of Hepatitis B should be a priority of the government and health services in India general public. The theme aims to encouraging patients to speak out about their own experiences and to play a role in educating and supporting others (‘This is hepatitis...’); challenging individuals to become better aware and involved in tackling hepatitis (‘Know it. Confront it’); reinforcing the prevalence and global impact of hepatitis and reducing the stigma associated with these diseases (‘Hepatitis affects everyone, everywhere’). The World Hepatitis Alliance had developed several campaign materials to support local organisations in their communications around the 2011 theme. Although raising awareness is vitally important, the scope of World Hepatitis Day goes even further. The World Hepatitis Alliance has developed a wide-ranging integrated campaign, including initiatives focussed on driving www.expresshealthcare.in
being asked to sign up for the ‘12 Asks’. The World Hepatitis Alliance recognises that one day will not change the world. World Hepatitis Day is a stepping stone that focusses first on raising global awareness and then on securing international and national support for improvements in prevention, diagnosis, treatment, care and support for people living with chronic viral Hepatitis B . Hepatitis B remains a significant public health problem in India and will continue to be so as long as commercial blood banks remain operational and until appropriate nationwide vaccination programmes and other control measures are established. Unfortunately, the shortfall between blood collected (1.5 million units per year) and blood needed (three million units per year) in India means that commercial blood banks will remain
profitable unless the number of voluntary donors increases dramatically. Furthermore, programmes for the prevention and control of Hepatitis B should be a priority of the government and health services in India To judge the impact and cost benefit ratio for Hepatitis B immunisation in India, analysis should be performed based on ‘true prevalence’ data. Further, in order to identify the correct strategy for such an immunisation programme, the relative importance of perinatal and horizontal transmission has to be defined for the population. If perinatal transmission is an important contributor to the carrier burden, then early immunisation schedule starting at the earliest after birth has to be implemented. Otherwise it may be acceptable to defer the first dose till one and a half months of age, which is more feasible, as one could merge it with existing schedule. There is an urgent need for proper epidemiologic determination of the prevalence of HBV infection and associated morbidity/mortality in India. This should be done taking into account the diversity in the country and the need for representation of all the sections of the population. The World Hepatitis Day is completely a patient led campaign and also aims to secure political support for its activities to minimise new infections and improve health care for people already suffering from the infection. It aims to emphasise the need for “Increasing the protection for the silent infection” EXPRESS HEALTHCARE
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IT@Healthcare IT solutions for SME hospitals Kishore Shinde, Vice President, IndiSoft HMS, outlines how operational efficiency can be improved by implementing IT solutions in hospitals
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Medical Big Data - big problem or big opportunity? Srinivas Rao, Director, Pre-sales and Solutions, India, Hitachi Data Systems, shares his views about Big Data and its utility in the healthcare industry
SRINIVAS RAO Director, Pre-sales and Solutions, India, Hitachi Data Systems
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ver the past few years, data has seen exponential growth. This growth has been so dramatic that petabytes are now normal, exabytes are on the horizon and we are now beginning to grasp what a zettabyte is. To put this data explosion into perspective, one needs to only look at the proliferation of the Internet, social media, and e-commerce in India. Social media is growing at 100 per cent and is likely to touch 45 million users by 2012; 30 million Indians who are online consumers are members of social networking sites, and 80 per cent of India’s 65 million Internet users are searching or transacting online. These
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Many of the reports on Big Data would refer to the healthcare industry as being one of the biggest contributors to this trend numbers have undoubtedly fuelled the growth of unstructured data. If one were to go through any of the numerous forecasts and IT predictions for 2012, there is one common issue that finds mention at the top of everyone’s list: ‘Big Data’. So, what exactly is ‘Big Data’, and why is everybody talking about it all of a www.expresshealthcare.in
sudden? According to Wikipedia, “Big Data are datasets that grow so large that they become awkward to work with using on-hand data management tools. Many of the reports on Big Data would also refer to the healthcare industry as being one of the biggest contributors to this trend. This does not mean that patient
numbers have dramatically increased overnight, or that healthcare organisations have suddenly doubled their business. The fact is that the Big Data phenomenon is not merely about the volume of data or the trajectory of its growth, but rather, about the untapped potential of already existing data sets which have so far not been stored, managed and analysed in an optimal fashion. Today, given the advancement of technology and the reduction in storage costs, we now have increased access to the information available in non-traditional forms. This, in turn, has given rise to the Big Data phenomenon. The healthcare industry AUGUST 2012
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does in fact account for the proliferation of a large amount of unstructured data. Increasing interest by healthcare organisations in collecting, storing and processing patient data, medical records and information to determine trends and carry out research, has led to its own set of storage, security, and management challenges, with significant implications for the sector. This is because the proper management, storage, sharing and analysis of data is imperative for saving lives, improving the way healthcare is delivered, and making healthcare more reliable, affordable and accessible. Yet the latest studies also show that Big Data can generate big value and create new business opportunities if mined wisely. In a report by McKinsey Global Institute (MGI) published in early 2011, MGI found that if healthcare providers were to use Big Data creatively and effectively to drive efficiency and quality, the sector could create more than $300 billion in new value every year. However, managing, preserving and manipulating Big Data is no easy task, especially with today’s rapid growth of medical technologies, mobile devices and network connectivity, all of which significantly accelerate the volume of medical Big Data and add to its complexity. In fact, in Gartner’s 'Top Predictions for IT Organisations and Users for 2012 and Beyond', Gartner forecasts that more than 85 per cent of Fortune 500 organisations will fail to effectively exploit Big Data AUGUST 2012
for competitive advantage between now and 2015. Fortunately, this prediction need not apply to everyone. That’s because the right storage infrastructure, namely an infrastructure that simplifies the management and retention of data can go a long way towards reducing the complexity of Big Data management.
being compounded by the Big Data challenge is that of business and operational continuity, which is crucial to the healthcare sector. Protecting invaluable medical records and maintaining business continuity is the bottom line of all healthcare organisations. However, these goals have been complicated by today’s
Healthcare organisations can create big value from medical Big Data by collecting, accessing and protecting it in a timely manner that enhances efficiency, productivity and service quality Irrespective of whether the medical Big Data is structured or unstructured, investing in the right storage infrastructure that enables everything to be centrally managed and consolidated with high levels of availability, scalability and compliance is the need of the hour. With this level of storage, healthcare organisations can create big value from medical Big Data by collecting, accessing and protecting it in a timely manner that enhances efficiency, productivity and service quality. In other words, the answer to whether your medical Big Data will become a big problem or a big value is entirely dependent on the competence and intelligence of your storage infrastructure. Another important aspect www.expresshealthcare.in
fast-evolving technology and the rapid proliferation of medical Big Data.
An indestructible DR solution – the need of the hour As organisations begin working on an IT plan for 2012, an area of growing concern is that of operational continuity even under extreme circumstances. The spate of natural disasters that we have seen in the recent past such as the Japan catastrophe and the more recent floods in Thailand, have once again underlined the need for organisations to ensure that they have an effective disaster recovery plan in place. Closer to home, the recent fire at the Columbia Asia Hospital in Bangalore, and at Kolkata’s AMRI Hospital, have demonstrated that apart
from the risks to patients and the tragic loss of lives, there is the added risk of losing valuable, and confidential medical data, patient records and information which could have far reaching implications for all those affected. The first step for organisations looking to adapt to the Big Data challenge therefore, is to begin doing things a little differently. Organisations need to change their perspective on unstructured data from being unwanted to being an asset they can mine to create new value. On a more practical level, organisations now need to move away from investing in backup as part of their strategic direction. Adding storage layers only increases complexity, and organisations need to adopt the latest technologies that will help them move to a backup-free approach to unstructured content or Big Data. Today, given the possibilities that come from infrastructure compression (e.g. smaller cluster systems, storage, and analytics) that is less costly, more and more organisations can now take advantage of Big Data architecture and tools. Big Data is not just another passing trend that has technologists salivating at a new gold rush, but is about the promise of everyday people interacting with confidence in technologies to answer questions that may require analysing enormous quantities of data to make their work more efficient, secure, and of far greater value to customers, patients, and stakeholders. EXPRESS HEALTHCARE
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IT solutions for SME hospitals I Kishore Shinde, Vice President, IndiSoft HMS, outlines how operational efficiency can be improved by implementing IT solutions in hospitals
KISHORE SHINDE
Vice President Indisoft HMS
n the current healthcare setup in India, small and medium-sized hospitals face tremendous challenges in optimising their operations. Tighter and more intricate regulations, insurance reimbursement necessities, ongoing staff shortages, rising HR costs etc. affect operations and the bottom line of the hospital. With limited resources, these hospitals are particularly challenged to optimise their operations for improving revenue cycle management and reimbursements. The operational efficiency can be improved by implementing IT solutions in the hospitals. Small and medium-sized hospitals face a number of challenges in competing with the quality of larger hospitals. Providing similar facilities with the same infrastructure and without increasing cost is one of the major challenges. Smaller budgets have typically made it difficult for them to afford certain technologies and some areas have limited technology resources too. Common challenges
faced by the smaller hospitals are: maintaining medical records; maintaining MLC & TPA records for future references (not-to-do); experiences and learnings of the hospital gets lost if not introduced in the system; nonuniform discharge summary causing crucial data to go missing; track patient outstanding; insurance claims and payment; missing automated discharge summary; incorrect/less/high billing to patient; malpractices in concessions; correct payments to the visiting doctors for hospital image management; creating a one page review of hospital health and duplication of work due to entry in Tally etc. Solutions provided by Rx Office HMS to these problems are: RxOffice HMS is well-equipped to keep track of old patients and avoids repetition of work. It also maintains error free OPD/IPD billing process within a reduced amount of time and fewer manual interventions. Discharge summary is prepared when the patient gets discharged, which in turn
Two hospitals where operational efficiencies were improved using IT
Dr Godbole’s Heart Care Hospital r Godbole’s Heart Care Hospital is one of the oldest private cardiac hospitals in Thane district, Mumbai. It was started by Dr CG Godbole and Dr SC Godbole in 1968 as a one stop solution for all heart ailments and is the only ISO certified hospital in Thane. The 50-bed hospital is the only standalone hospital in Thane where both non-invasive cardiology and invasive cath lab procedures like angiography, angioplasty, open heart surgeries (CABG) etc are conducted. The hospital is fully equipped with advanced ICCU/MICU units,. state-of-the-art operation theatres, dialysis unit and emergency care units which are well supported through 24hour diagnostic services like pathology, radiology, echo, ECG etc. The hospital has a dedicated team of consultants along with specialists as well as trained and experienced nursing and paramedical staff.
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“RxOffice HMS software is simple to use and addresses the true requirements of the medium-sized hospitals. The process of registration to billing and patient discharge is simple and our staff find it easy to use” Dr Rajeev Godbole MS, MCH (Cardiothoracic & Vascular Surgery), Dr Godbole's Heart Care Centre
Dr Milind Patil’s Revival Bone & Joint Hospital r Milind Patil’s Revival Bone & Joint Hospital is a 25bed superspeciality hospital located in Thane, Mumbai. Its major thrust is on orthopedic and trauma surgeries. It has a modern state-of-the-art joint replacement operation theatre equipped with pulse separators, multipara monitors and ventilators. It also has a state-of-the-art navigation system for computer assisted joint replacement surgery. Dr Milind Patil is a leading orthopedic surgeon who has performed over 2,000 surgeries in field of knee replacement. IndiSoft HMS has seamlessly integrated all their complications and provided solutions for stressfree day-to-day operations.
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“RxOffice HMS software is stable and trouble free. Our staff found the software very user-friendly and easyto-use. It has streamlined the processes in our hospital” Dr Milind Patil MS, FRCS, FRCS(Ortho), M.Ch.(Liverpool) saves the time of the staff and patients. RxOffice HMS also generates a report termed ‘Day Summary’, where the user is able to view the hospital activities of the day in a single window. This has proved to be a time saver for the administrators. it also helps to create a one page review of hospital health. The tally integration utility manages the accounts department’s work by transferring the daily entries or date wise activities directly into Tally thereby avoiding duplication of work. Rx Office HMS also generates the patient outstanding report on a daily basis. Presently, both Dr Godbole’s Heart Care
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Hospital and Dr Milind Patil’s Revival Bone & Joint Hospital can track the patient outstanding in a single click and the patients are easily updated on their due payments. The concession report help the hospitals to keep track of the concession given to each patient. Similarly, the services charges report gives details of the services provided by the doctor within a specific period as well as keeps track of the deduction of TDS if the limit is reached. This will ensure correct payments to the visiting doctor. Thus, RxOffice HMS can resolve most of the challenges faced by small and medium-sized hospitals AUGUST 2012
Hospital Infra Ask a Question.... with Tarun Tarun Katiyar, Principal Consultant, Hospaccx India Systems, shares insights and provides practical solutions to questions on hospital planning and management
Page 57 MAIN STORY
Lean Six Sigma is here! And How! Meeta Ruparel, Director, AUM MEDITEC elaborates on the concept of Six Sigma and its learnings which when used appropriately and adaptively, can result in a positive impact on the process performance in consideration
MEETA RUPAREL
Director, AUM MEDITEC
AUGUST 2012
The “Lean Six Sigma” Brigade at work! Data on the Gemba floor,gaily dancing away… Up came a fervent sigma score,Requesting; “lead my way…” “Oh sure!” said, Chance data,“I don’t mind…” “Aw!” minced, Assignable data,“Time to grind…” Loud was an invoke, for the process in line “Do a Pokayoke!”was voiced, to perform in fine Spruced is now, the sigma score,daily, in the process bay… “Cheers!” said the MBB galore,“Celebrate all, we must today!” he reason to start this article on a lighter note; with a small fun intended ode that I wrote after completing my Lean Six Sigma Master Black Belt (MBB) certification exam, is to highlight that no matter how intensely knowledge or skill-oriented an activity could be, we can have fun doing sincere business and enjoy work too! Also to debate on the tag; “Six Sigma is an activity only for statisticians.” I believe that one can deploy these methodologies with little knowledge and clear understanding of quality management concepts, a bit deeper than a novice and a conscious recognition of our important customers as to what would delight these customers. Using the lean Six Sigma learnings and tools appropriately and adaptively with whatever limited knowledge gained about the concept can also result in a positive impact on process performance in consideration. But of course one must remember that half knowledge is dangerous, so whatever bit of tools and methodologies one learns in a Six Sigma training sessions, be it at white belt level/yellow belt/green belt or black belt level, one must know the utility and applications of whatever limited concepts and tools learnt, completely to ensure an effective professional practice in the role play that one is empowered with. The more intense part like project selection, type of data and statistical definitions and statistical solutions can be trusted on to the Six Sigma black belts and Master black belts designated with the team, others need to only be conscious of customer requirements, be alert of possible flaws, in the process and responsible and accountable to report such possible mistakes occurring in the process. Not long ago, in 2006 when I was talking of Six Sigma ini-
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tiatives in Indian hospitals, I had observed a raw and laid back attitude towards “Six Sigma”. Remarks like “Six Sigma is for manufacturing, not applicable in healthcare”; “Six Sigma is a fad!”; “Let’s talk of TQM, Accreditation, ISO 9000:2000, instead”; “Sounds expensive!” were frequent answers to a proposition of Six Sigma deployment. Let’s not blame any industry personnel, let us understand that importance of quality and the necessity of quality management/accreditation systems in the Indian healthcare setups have gained pace in these past few years and this accelerated recognition is such that it would not loose its momentum. It is now obvious that Six Sigma is not intended to replace any traditional quality initiatives; however, the key differences in the methodologies have enabled Six Sigma methodologies to overcome the challenges that may have not been sufficiently addressed with the existing techniques. Organisations that implement Six Sigma methodologies do not necessarily dispense with their existing quality assurance functions. On the contrary, the QA department if existing is trained in the Six Sigma techniques to ensure smooth functioning and an integrated synchrony with the organisation and the Six Sigma consultants/trainers. Healthcare today is highly dynamic and offers creative advances in technology and treatment. It is a complex web, overburdened by resource limitations, other constraints, inefficiencies, negligence, errors and other issues that threaten the safety of patient care and service delivery. Quality care and quality service delivery becomes the prime focus in this race. If we consider the efficacy of a six sigma initiative in hospitals, it is observed that: ● Even if some processes cannot achieve some ambitious goals as implied, it does not diminish the importance of the Six Sigma methodologies. These techniques improve the performance of most processes substantially. ● Highlighted fact is that when a Six Sigma project moves from ‘2 sigma’ level to a ‘3 sigma’ level the project will have an improved accuracy from 69.15 per cent to 93.32 per cent. ● Six Sigma methodologies assist in minimising errors, achieving set quality benchmarks, optimal utilisation of EXPRESS HEALTHCARE
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resources, elimination of wastes and guides as to how a set goal is achieved in terms of tangible results (facts and data). ● Cost implications to implement Six Sigma methodologies are very minimal compared to the losses/wastes occurring in any process variations, without any quality initiative. ● When compared in terms of cost for quality and in financial language, on a cost benefit analysis, it is observed that the results are cost savings and resource savings, directly/indirectly; tangible profits annually. Having said this much on significance and benefits of Six Sigma deployment in healthcare delivery systems, I would like to elaborate on the approach that we need to follow for an effective interpretation of success and benefits of six sigma initiatives in hospitals. I would like to stress on this point that healthcare service delivery is a complex process in itself, the variance in customer satisfaction due to individual specific uniqueness in every delivery process, makes it all the more complex. The demands and requirements of internal customer also varies with different work levels and is again at times unique and process/case specific, not to forget the tantrums of some customers (unions/consultant demands based on authorities/non cooperative customers/political influences/regulations/media, etc) and stress thereof. One needs to be aware of the thin invisible line between care delivery, safety, quality and optimal resource management to impact costs. A slight ignorance or leniency on any of these factors can result in a possible damage or harm to a life, care process outcome or brand image. It is therefore very important for the master black belt to hold some knowledge and experience in the healthcare service delivery field. Allow me to suggest here; just because Six Sigma was pioneered by manufacturing industry and accepted first by these industries, hiring/ appointing a Six Sigma BB/ MBB from such non-healthcare industry for a senior work profile in a hospital, is a possible mistake in its own self. What an irony! We follow accreditation standards that talk of and insist on credentialing and privileging a personnel before recruiting a
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position in hospitals and we overlook or ignore this fact that; an important role/ process enabler of quality care delivery practice system is having no knowledge of the healthcare system! I do not intend to offend my non – healthcare peer group, I am just stressing on the importance and the value addition that results like magic with a Six Sigma professional with some healthcare background when working in a healthcare delivery system. (Even one/two successful project executions in a hospital by a non-healthcare Six Sigma professional can be notable and makes a difference in practice in a hospital). Let’s understand this fact that a Six Sigma black belt is certified only after at least one successful Six Sigma process improvement project submission and evaluation thereof, so the certificate itself indicates an experience of at least one successful project. Some training panels that I know of insist on two project submissions along with passing of a theory exam and some mandate training hours before certification, so the candidate is not a “fresher”! A sincere suggestion to our hospital human resource team recruiting Six Sigma expertise on a payroll is to kindly evaluate the score continuum of credentialing and privileging for this too and then make the decision. Technically, Six Sigma is a set of problem solving and statistical tools that aims at reducing errors/ defects to 3.4 or less per million opportunities. In other words it is a measure of quality that demands data and lots of data; I mean evidence. Any solution is derived from decisions based on facts and not some assumption. So it is most important, in fact necessary to collect data. Understanding the high stress levels for all in the healthcare service delivery chain, we cannot and shouldn’t burden the roles in the chain with additional duty hours, for data collection, monitoring, etc. A hospital must inculcate a strategy that evolves as a culture in practice! Let all understand the concept of Six Sigma methodologies and enlighten on the methodology that the hospital intends to follow to achieve quality care delivery system. I am not saying that all should be sensitised on statistics and its tools, but all should at least be aware of the nuances of possible defects and be able www.expresshealthcare.in
to identify opportunities to improve. This will not only help alert a practice in service delivery but also make all in the chain accountable. I reiterate; leave the statistics for the process owner/team leader, the Six Sigma black belts and the Master black belts! Further, all those who go through Six Sigma training do not require to rigorously learn and master statistics. No doubt; Six Sigma means six standard deviations and relates to statistics but there is a lot more to this methodology, which not only enables us to define a process in a correct fashion but also equips us with a skill to introspect and improve the process appropriately, in advance, much before a probable defect. So let us focus on this aspect of Six Sigma and sensitise our work population on simple practices that can be followed to ensure customer (patient) satisfaction, safety and cost effective systems that not only delights our customers but also our hospital stakeholders (management, employees, doctors, regulatory bodies, vendors, etc). At this point, allow me to share one of my experiences with you on Six Sigma deployment in hospitals. A couple of years ago, one of our known hospitals in India and an esteemed and recognised healthcare management leader encouraged this initiative in the hospital that he led as a CEO. I was welcomed by the staff being identified as a respectable guest introduced by their leader. But when it dawned on them why I was there, I faced all sorts of reluctance; things like “I have my duty”, “Very heavy patient load”, “I don’t understand statistics so leave me out of this”, “I am scared, because any input on some error can lead to acceptance of that negligence and thereby litigation” and so on, the music continued. After extensive convincing discussions that the data is not going to be shared outside and that the exercise would benefit all in the process, I finally started with one process improvement project. It took about five months for the completion of project and on evaluating the performance of the project; it was observed that the project had successfully achieved a direct indicative financial gain in terms of cost savings. The management was pleased and declared a reward, a bonus for each and
every person involved in this project. This not only pleased the staff that was so reluctant in the beginning but also enhanced their understanding on the benefits of a process improvement activity. All those who were trained were more aware of where there was a possible mistake that was occurring and were more efficient in identifying probable defects in the process. This gained knowledge excited them and gave value to their motivation, they all were enthusiastic for the next project and to my delight were even suggesting possible processes that could be explored for improvement! This experience made me realise that a lot of sensitisation was required. Here, I had a hospital leader who believed in this concept and was supporting the initiative so a good part of journey is traveled but what with a management that is apprehensive and has doubts? There was a long path and I did travel those miles to be where I am now, to see what I see now. I am happy; the industry now, recognises the need and importance of Six Sigma quality in Healthcare. After initiating Lean Six Sigma deployment as a consultancy, my next step was training; I started with a small batch of six participants for my first Six Sigma training in healthcare and now the batches go full and my email box is flooded with queries as to when is the next schedule! This indicates that our Indian healthcare industry realises the significant benefits of Six Sigma implementation in hospitals and is now also spacing vacancies and job profiles with such roles. Thanks to our healthcare management fraternity that continues to recommend their candidates for training and recognise ‘AUM MEDITEC’ for Lean Six Sigma training black belt. Today, I herewith have shared with you my experience on Lean Six Sigma deployment in healthcare systems, when lean Six Sigma initiative in hospitals was in its nascent stage. This is an attempt to nurture a culture of safe and quality healthcare delivery service practices and to guide the lean Six Sigma aspirants and assist them in successful implementation of relevant projects. (The author can be contacted at meeta@meditecindia.com) AUGUST 2012
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What green building concepts should a nursing home follow, given the cost and time constraint that such Q projects have? Hospitals that have introduced the green building concepts have shown and proved how much money can A be saved by implementing these initiatives.
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
The green initiatives not only help in saving money, but also in creating a more sustainable environment. The savings in money come in the form of reduced energy (30-40 per cent) use.Iit facilitates reduced consumption of electricity and water and creates an environment that allows for reuse of material, thereby reducing wastage. You can also go for optimal use of sewage treatment plant wherein recycled water is used for flushing, irrigation, HVAC cooling towers etc. Rainwater harvesting, ringwells, low flow plumbing fixtures, automatic sensors for urinals etc. also helps to reduce water usage by around 20-30 per cent. Window to wall ratio should not be more than 25-30 per cent of the room area. Use of UPVC windows result in reduction of room temperature by allowing diffused light and not the heat. Use of solar power will take care of general lighting in the hospital etc. Dr Mohan, Bellary
What are the land requirements for a 50-bed in a small town like Hosur? Q hospital Any hospital needs to be built on a non-agricultural land, the most important criteria for running a commerA cial activity. You also need to highlight important points of your healthcare set up after studying the requirements of the society, facilities provided by the neighbouring hospitals etc. Kindly describe how your healthcare facility would be different from the competitors. Seek advice from an architect to verify the construction price.This will help in recognising the range and ability of your hospital along with the construction rates. Give a brief idea about your marketing plan, operating methods, rivals, projected balance sheet and other monetary information. Most importantly, your hospital's SWOT analysis should be a part of your plan. The land should be bought considering the following things in mind: select the site as per Vastushastra, accessibility, closeness to the catchment area you are targeting, connectivity, SWOT analysis of the location and the cost. Dr Rajiv, Hosur
We want to start a 200-bed hospital and are on the lookout for funds. Could you please tell us the Q different options for borrowing investment from investors? Fund arrangement for multi-speciality hospital is a tedious task for the reason that the investors need to be A very sure about the success of the project.There are a number of instances where without proper planning and huge unplanned investments, projects have failed to deliver.This has resulted in either projects duration getting prolonged or the revenue sharing issue crops up between the promoter and investors. The different options one can have while raising funds are: joint venture (JV) options, term loans from banks, DIH model
(Department in Hospital), private equity etc. JV is the preferred option as there is minimisation of risk, the marketing/finance is taken care of by both the parties thereby reducing burden on the single owner. A market feasibility report will tell you whether it is feasible to start with 200 beds at once or should you go phasewise (100+100). Also, it is usually done along with financial feasibility which is also a bankable document if you are going for any loans or financial support to bankers or investors. A detailed project report should be prepared which ideally will include the following: market research, profile of the locality, existing players, demand and supply of the services and financial details of the project such as total cost of the project, ROI, break even, debt-equity etc. With this detailed report, investors can be approached on various business models and this is the first step towards fund raising. Dr Krishna, Trichy
I am an OBG consultant with private practice in Ahmedabad since 19 years. I want to start a new Q hospital for women along with few colleagues but do not know how to go about it. First, I want to know the feasibility of the project but have no idea on how to put it on paper. Can you guide me regarding the initial planning process, and what to do if we want your professional help? As with any project, a detailed market and financial feasibility is the first step to determine the success of A the project. This is more so if you are thinking of a specialised centre such as a ‘Mother & Child’ centre. Any single speciality centre is like a standalone business model which does not have multiple sources of income. Hence, in order to understand the viability of the business model, a detailed feasibility in terms of both market research and financial study needs to be carried out. Dr Jayashree, Ahmedabad
We are planning to open a diagnostic centre in Chennai. Do we need to do a market survey and feasiQ bility study? Kindly advice. A diagnostic centre requires in-depth survey of the regions wherein the patients can come from. This is A because most of the times it is the physicians who refer the cases to the centre and not much of walk-in happens. Conducting a market feasibility/marketing research early in the project stage can provide a 'reality check' on your idea as well as help define your hospital services to ensure its appeal for the patients. The market survey involves detailed feasibility in terms of the primary and secondary catchment area, number of hospitals and clinics nearby, availability of doctors, facility mix and service mix of the hospitals/polyclinics/nursing homes, existing corporate companies in the vicinity, total population of different zones/localities of the city (if land is not identified yet) etc. As the entire project's success is based on the outcome of the report, we strongly believe that a detailed survey is of prime importance for any project. It is better to have a business forecast than to suffer a loss. Chandrasekhar, Chennai
Readers can send in their questions or feedback to us at email: tarun.faq@gmail.com AUGUST 2012
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Premier Clinical interior solutions from Prime Medical Systems Prime Medical Systems provides intelligent interior design solutions for India's burgeoning healthcare industry. A brief outlook about its products
rime Medical Systems specialises in the supply and implementation of clinical interior solutions such as modular furniture for specialised areas like laboratories and pharmacies, nurse stations, metal ceiling systems, homogeneous vinyl flooring solutions, anti-microbial coating for walls and pneumatic tube systems. Prime has partnered with world renowned healthcare furniture manufacturer Herman Miller, US, Chicago Metallic Corporation, Mannington Commercial, and Hanter IT, Sweden for pneumatic tube systems. Prime has been consulting and creating clinical and administrative applications in healthcare for the last few years. Their staff and designers work with hospital professionals to create environment that supports the delivery of quality patient care and function flawlessly now and in the future. Prime Medical, with support from principals like Herman Miller, takes research-based problem solving approach to the needs of healthcare professionals and the facilities in which they work. The goal is to solve their customer problems better than anyone else.
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Products Prime Medical Systems reorient examination rooms, laboratories, pharmacies, consultation rooms, nurse stations, cafeterias, administrative areas and waiting areas. Thier turn-key projects include operating theatres and intensive care units created in strict compliance with
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international accreditation requirements. Hygiene and sanitation list high on their priorities. Their diligently planned solutions include durable furnishings-finishings designed to facilitate easy cleaning. They only use non-organic materials that discourage bacterial growth and infestations. With an eye on every small detail, the company even provides safety, anti-static and non-antistatic flooring to safeguard people as well as sensitive and expensive medical equipment. Herman Miller’s scope of supply includes furniture for laboratories, pharmacies, nurse stations, carts and storages, consulting room solutions, administrative work stations and seating solutions. All Herman Miller furniture are made of highly durable impact resistant plastic, powder coated steel structures
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and are known for its durability. These products keep up their appearance and there is no chance of colour chipping or scratching. These products go through rigorous tests, simulating the conditions of a fast paced hospital environment and making sure that they will stand upto realworld use. All accessories and components can be removed, making every surface accessible for floor cleaning. All corners are rounded and a softer surface material than metal adds upto a user-friendly design. All Herman Miller products are warranted for 12 years. Chicago Metallic is known for their metal false ceiling solutions for clinical areas. Chicago Metallic has led the way in research, innovative technology and understands the architectural needs of clinical area false ceilings. They offer comprehensive range of metal ceiling solutions from
the most complete programme of lay in panels to air tight clip-in systems. These systems are ideal for operation theatres, ICUs, wards, corridors and lobbies, as well as other administrative areas. Mannington Commercials, US has the full range of vinyl flooring solutions for the most demanding clinical areas. They are reinforced with aluminum oxide making it real tough and durable. They have a protective wear layer providing ease in maintenance and significally reducing the need for polishing and maintenance. Hanter IT , Sweden manufactures feature-rich and durable pneumatic tube systems. Hanter with their experience and on going research, have developed a durable and fool proof pneumatic tube system. Prime Medical Systems has the expertise to provide design, implementation and backup support for their entire range of products and solutions. They have a very impressive list of happy and satisfied customers and they include Kerala Institute of Medical Sciences, Thiruvananthapuram; Medical Trust Hospital, Cochin; SUT Hospital Thiruvananthapuram; MIOT Hospital, Chennai; Continental Hospital, Hyderabad; PGIMS, Rothak; Jayadeva Institute of Cardiology, Bangalore; Shanthi Hospital, Bangalore and many more.
AUGUST 2012
Radiology MAIN STORY
Onco-Imaging: Tapping its potential M Dr Priya Chudgar, Consultant Radiologist, Kohinoor Hospital outlines how imaging has evolved to play a pivotal role in oncology
DR PRIYA CHUDGAR
edical imaging has become an essential component in many fields of clinical practice; and oncology is not an exception. Varied imaging modalities with newer techniques and software not only help in early diagnosis, but also in treatment planning and follow ups. Newer advances with MDCT applications and PET has brought a paradigm shift in oncology. Accurate detection and pre-operative evaluation helps in surgical planning. Regular monitoring helps to follow up during treatment and post-treatment. Thus, imaging plays an important and integral role in oncology. Here we discuss newer imaging techniques and advances vis-a-vis their role in oncology.
Ultrasound Consultant Radiologist, Kohinoor Hospital
Recent improvements in ultrasound such as tissue harmonic imaging, non-linear signal processing and 2D matrix array transducers have introduced newer possibilities and paved the way for useful 3D imaging, while fast computing has allowed the production of real-time 3D scans
(so-called 4D US imaging). Volumes can be displayed as series of multiplanar reformats or rendered 3D images, which improve appreciation of the relative position of structures, including flowing blood. Currently, the main clinical applications are in obstetrics but the approach shows promise in breast and prostate cancer and reveals the complexity of tumour vascularity in a thorough manner. In interventional procedures, 4D ultrasounds are promising for needle biopsy guidance while 3D ultrasounds are used to guide radioactive seed implants in the prostate and for the breasts.
MDCT and its advanced applications The advent of multidetector CT scanners has brought a new era in field of radiology. This produces faster and better scans with shorter breath hold and less amount of iodinated contrast. It proves a blessing for morbid patients with poor renal function who require repeated scans. Newer machines also produce lesser radiation hazards.
3D sonogram of breast accurately depicts size and morpholgy of lesion
MDCT with excellent angiography views serve as a guideline for oncosurgeons, while hepatic volumetric helps to predict tumour volume. Lymph node detection undoubtedly helps in tumour staging, while CT with stereotactic guidance helps in radiotherapy planning. Image-processing softwares help to localise the tumour regions; image measurements help to quantify the tumour properties; image visualisations provide intuitive ways to present the
tumour; image registrations help to fuse two images so that different tumour properties can be combined in one view; finally, CAD could be used in the clinical diagnosis/detection of tumours. Medical image processing has evolved into an established discipline. It is a very active and fast-growing field. Image processing techniques have already shown great potential in detecting and analysing tumours in clinical images and this trend will undoubtedly continue into the future.
MRI with spectroscopy and other applications
Newer generation CT scan machine has revolutionised onco-imaging
AUGUST 2012
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High performance MRI systems with newer sequences using diffusion, perfusion and dynamic contrast has furthered onco imaging. MRIs, with increasingly sophisticated imaging capabilities serve as problemsolving tools in most of the cases. Neuroradiology and imaging of brain tumours is not complete without MRI and spectroscopy. Brain tissue is complex and is composed of many metabolites, some of which have unique magnetic resonance frequencies. However, most conventional MRI scans depend only on water and fat peaks to generate sufficient signal to generate an image. By EXPRESS HEALTHCARE
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R|A|D|I|O|L|O|G|Y selectively measuring the peaks of other metabolites relative to water, a spectrum that contains important clinical information can be generated. Two metabolites of particular importance in the brain are N-acetyl acetate (NAA) and choline (Ch) (31). NAA is a structural component of intact neural tissue. Choline is a membrane component of cells. In tumours, NAA would be expected to decrease in concentration whereas choline would increase in concentration. Thus, the ratio of NAA/Ch decreases in tumours compared to normal brain tissue, and this ratio appears to have prognostic information. Tumours with low NAA/Ch ratio have poorer prognosis.
PET technology with combined PET/CT systems These systems are especially helpful for detailed morphological and functional evaluation of disease. PET-CT has revolutionised onco imaging by adding precision of anatomic localisation to functional imaging. Surgical planning, radiation therapy and cancer staging have been changing rapidly under the influence of PET-CT. A PET/CT system significantly decreases the number of equivocal findings.
Mammography and related newer techniques Discussion about oncoimaging cannot be complete without mammography.
Mammography screening programmes helps for early detection of breast cancer, thus reducing death from breast cancer. Computer aided detection helps to pick up cancer, missed on mammography. Elastography uses principle of the tissue’s distortion (strain) under an applied stress (e.g., compression via the transducer), known as elasticity imaging or elastography. The images produced have very high contrast and may significantly improve lesion detection within the breast, prostate and liver.
HIFU HIFU or high-intensity focused ultrasound surgery, as a therapeutic technique is not a new concept but recent advances in probe design and alternate ultrasonic imaging methods make it likely to become a realistic clinical tool in the near future. HIFU uses a highly focused ultrasound beam to coagulate a well-defined volume of tissue by heating it to above 50 degree celcius. Maintenance of this temperature for one to seconds results in cell death, and a single ultrasound exposure destroys a cigar-shaped volume of tissue of 0.5 ml. The surrounding tissue is not damaged and there is a very sharp line of demarcation between coagulated and viable tissue. This completely non-invasive technique has been used to treat malignant tumours of the liver, prostate and kidney and benign breast
MR spectroscopy helps to predict tumour metabolites
Newer advances with MDCT applications and PET has brought a paradigm shift in oncology. Accurate detection and preoperative evaluation helps in surgical planning via a percutaneous or transrectal approach without the need for general anaesthesia. Currently, HIFU tissue ablation damage is best observed using MRI, however, it often renders the treatment cumbersome and expensive. Since B-mode ultrasound cannot distinguish between coagulated and normal tissue, alternate ultrasonic imaging methods such as elastography, reflex transmission imaging and thermal imaging are likely candidates to depict the tissue damage. HIFU could also be deployed intraoperatively, e.g., in the treatment of liver metastases.
Ultrasound drug and gene delivery
PET/CT picks up disease activity and reduces false positive findings
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Exposure to ultrasound causes a transient increase in cell membrane permeability, an effect known as sonoporation. Using this technique, tissues can be targetted to stimulate cellular uptake of a drug (e.g., a chemotherapeutic agent) or a gene. Sonoporation requires high acoustic powers (higher than that used in diagnosis and equivalent to those used in physiotherapy) but the power needed is markedly reduced when micro bubbles are also present. A drug or gene can be incorporated in or on the surface of the micro bubbles
and tracked in the circulation with an imaging beam; when they are exposed to high power US, the micro bubbles rupture, releasing the agent near the target tissue. In the case of oncological drugs, this has the advantage of decreasing the dose of the drug needed, so reducing systemic side effects. Encouraging initial in vitro studies have demonstrated sonoporation without inducing cell death.
Conclusion This topic of newer advances in onco imaging is unending. Though the list may look elaborate, it is only like tip of the iceberg. Still newer and better applications are emerging. Be it contrast enhanced ultrasound or MR lymphangiography, ongoing research will throw light into clinical and advanced applications of many such techniques. No cancer patient can do without digital radiograph, mammogram, periodic ultrasound or cross-sectional imaging. Evolving role of PET CT will help for accurate staging and hence further management. Future developments with advent of molecular imaging and many more advances will eventually help to increase overall life expectancy. AUGUST 2012
TECHNOLOGY FOR HEALTHIER LIVES
Control: the new buzzword in anaesthesia Dr Laxmi Kamat feels that Aisys, a fully digital and automated anaesthesia machine from GE Healthcare, with its myriad features offers several tangible benefits to anaesthetists
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TECHNOLOGY FOR HEALTHIER LIVES
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naesthesia! It is a branch of medicine which has a very unique role to fulfill. Simply put, it is the support system in the healthcare cycle without which a cardiac surgeon or a neuro surgeon cannot work their miracle and save lives.
Accuracy in anaesthesia – a huge challenge Yet, anaesthetists are often deprived of their share of glory; their contributions in making these miracles go unseen. Nevertheless, it is a mammoth responsibility that they are expected to shoulder. As we all know, anaesthesia refers to taking away sensation, so that otherwise painful procedures or surgery can be performed. However, its implications are enormous. It falls on the anaesthetist to ensure that the patients’ vital functions are kept running through the operation until their reflexes can be restored to them post-surgery. Thus, it is a daunting and often stressful task which can be successfully accomplished only with a great deal of expertise and understanding of the patients’ physiology. It had become imperative to find a solution to the relieve anaesthetists from the uncertainties of their job and give them more control and freedom to administer their responsibilities in a more effective manner.
A much needed solution Dr Laxmi Kamat, a veteran anaesthetist with around three and half decades of experience behind her, is fully cognizant of the responsibility
and the stress that goes with her chosen vocation, even though it also offers moments of intense self satisfaction. However, now she believes that finally she has found a way to share her responsibilities and halve her worries, a new-founded friend in Aisys, a fully-digital carestation for anaesthesia from GE Healthcare. She was introduced to Aisys a couple of years back, when it was installed at the LH Hiranandani Hospital, Powai where she works as the HOD of the anaesthesia department. Since then she has been using this digital and automated anaesthesia machine regularly and is quite impressed by its capabilities. The features that she found quite invaluable in the machine are as follows: Safety: This is one of the features that she is most impressed with. She informs that the machine offers greater safety to both patients and doctors because the machine has a very effective safety net in place which is known as the ‘End Tidal Control (ETC) for volatile anaesthetic agents and hypoxic guard’ in scientific terms. This helps in ensuring that there is no over-delivery of agents used in the anesthetic procedure. Aisys automatically compensates for metabolic rate changes, ensuring the set agent and oxygen end-tidal values at all times thereby giving additional safety for the patient and the caregiver. She also informs that the air exhaled by the patient goes back into the machine and is recycled, unlike other conventional machines where the air exhaled by the patients is often let out in the atmosphere and results in being inhaled by doctors and nurses. Dr Kamat says, “Earlier, we used to feel drowsy and tired by the end of the day due to inhalation of anaesthetic agents. However now, with Aisys, we remain fresh throughout the day and our productivity remains
unhampered.” Improved efficiency: Dr Kamat also points out that the machine is equipped with ETC technology which enables her to tailor the dose for each person precisely. “Earlier, anaesthesia machines were not very sophisticated. However, Aisys has made the whole process of delivering anaesthesia very efficient.” She elaborates on its user-friendliness and informs how once the required data about a patient is fed into the machine, then Aisys itself would ensure that the prerequisite agents are administered accurately to the patient. Thus, the dosage would never fall or rise above the needed dosage. Dr Kamat is of the opinion that this feature takes away a lot of distraction and worry from the doctors, leaving them free to concentrate on the getting the patients well. Affordable: Costing is a very important factor to look into where technology is concerned. However Dr Kamat feels that the anaesthesia machine helps on that count
EARLIER, ANAESTHESIA MACHINES WERE NOT VERY SOPHISTICATED. HOWEVER, AISYS HAS MADE THE WHOLE PROCESS OF DELIVERING ANAESTHESIA VERY EFFICIENT Dr Laxmi Kamat
ANAESTHESIOLOGIST, DR LH HIRANANDANI HOSPITAL
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as well since the machine can provide exact doses required for each patient, and hence it is possible to charge the patient for the exact dose of anaesthesia used. Therefore any kind of wastage of agents can be avoided. She also informs that the lowflow/minimal flow feature of the machine is a safer method of administering anaesthesia and more affordable too since it minimises the fresh gas and anaesthetic agent usage, thereby saving money for both patients and the hospital. Environment friendly: Another benefit that appeals to Dr Kamat about the anaesthesia machine from GE Healthcare is its environmentfriendliness. Aisys recycles the agents used for anaesthesia and hence they are not released into the atmosphere which in turn, preserves the environment since these gases are often green-house gases, which when released into the air can pollute the environment.
The path ahead Overall, Dr Kamat has a very good opinion about Aisys. She informs, “It (Aisys) has made my life stress-free. I don’t have to keep agonising whether the patient has been administered the right dose of anaesthesia and this relieves me from lot of anxiety.” Now, what remains to be seen is whether it would go on to become ‘the’ tool that every anaesthetist would want to have around them. EXPRESS HEALTHCARE
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Trade & Trends ‘We have supplied equipment to almost each corner of the country’ Zoru Bathena, Founder, Periclave shares details about his company, its products and its future plans Page 65
Carestream Dental launches CS 1200 A It is an affordable, easy-to-share camera that provides enhanced imaging, supporting diagnosis and enhanced patient care
s the most recent addition to the company’s full range of intraoral cameras, Carestream Dental has launched the CS 1200 intraoral camera, which provides high image quality at an affordable price. The affordable CS 1200 captures crisp, clear images that reveal even the smallest cracks, caries and other anomalies with the best-in-class image resolution of 1024 x 768. The CS 1200’s 6LED illumination system automatically adjusts to ensure perfectly and uniformly lit images in any lighting condition, and the camera’s wide focus range captures a variety of images including macro, single teeth, arches and smiles. “Dental professionals want to obtain the highest quality images for optimal diagnosis, treatment planning, patient communication and case documentation,” said Edward Shellard, DMD, Chief Marketing Officer and
Director of Business Development for Carestream Health, Inc. “Providing practitioners with an affordable entry point into digital imaging, the CS 1200 puts high quality intraoral images within reach of almost any practice.” The CS 1200 also features a USB 2.0 high speed connection, enabling easy sharing between operators. Additionally, the CS 1200 can store up to 300 images within the camera itself. With a touch of a button, the images can be viewed on a PC, eliminating the need for docking stations or memory cards and improving practice efficiency. Fully TWAIN-compliant, images can be stored and archived in
Carestream Dental’s Imaging Software, as well as other leading imaging software. “The CS 1200’s unique ability to store up to 300 images within the camera streamlines practice workflow with no memory cards or extra storage devices required,” said Pinkesh Garg, General Manager, Carestream Dental – India. The compact CS 1200 is comfortable during use for both the operator and the patient. The camera’s ergonomic, lightweight design fits in hands of any size, ensuring easy handling and reducing operator fatigue. Built with a round head and tapered shape, the camera offers improved patient comfort during exams. The CS 1200 is also easy to install and use, minimising training time and improving practice productivity. The camera is fully backed by expert support and extended warranty programmes.
Cleaning solutions from Getinge F Getinge's detergent range sets the standard for safety and performance in healthcare, pharmaceutical production and life science laboratory applications
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or over 100 years, Getinge has been delivered high-performance processing and sterility assurance products that always meet the most demanding industry standards and which can be trusted to consistently give a reliable result. As a complete solution provider and onestop shop, one can trust Getinge to provide the products that can be relied on to guarantee cleanliness. What does the word “clean” say to you? That your medical equipment is free from soil, such as blood, fat, pollutants or harmful micro organisms? Good, but are you really sure that even beyond the naked eye, every-
thing you wash, disinfect or sterilise is really clean? Using Getinge Clean guarantees that you don’t have to worry www.expresshealthcare.in
anymore. Getinge's class, leading detergent range sets the standard for safety and performance in healthcare, pharmaceutical production and life science laboratory applications. Getinge Clean can be used in automated washerdisinfectors as they are programmed to run a number of different cycles depending on the goods being processed, quality of water and the type and degree of soiling. Most commonly
used cycles include a prewash, main wash and rinsing, finishing with thermal disinfection. Getinge Clean can be optimally used in the prewash and main wash phases with a choice of Getinge Clean detergents and concentrations. They can be added depending on the cycle selected. Getinge Clean is a complete and comprehensive range of cleansing detergents, providing efficient and economical throughput along with maximum performance. The Getinge Clean range includes detergents for heavy soiled, universal, enzymatic, neutraliser, rinse aid, instrument lubricant and pre treatment foam. AUGUST 2012
T|R|A|D|E & T|R|E|N|D|S 30 MINUTE INTERVIEW
‘We have supplied equipment to almost each corner of the country’ Zoru Bathena FOUNDER, PERICLAVE
Z
oru Bathena, Founder, Periclave shares details about his company, its products and its future plans
What are the new developments and latest innovations at Periclave? We have standardised the entire process of manufacturing over the last 65 years and already have a good portfolio of products to serve the unique needs of not only small hospital setups but also huge medical institutions, pharma industries, medical colleges and research institutes, etc. We, at Periclave, are very proud to give full range of CSSD, biomedical waste equipment, and laundry equipment as per the national and international norms. Our products are designed to give continuous performance in the Indian environmental conditions which our foreign competitors are unable to provide. We are using high speed ethernet communication based PLC for process control of our CSSD and laundry equipment which is the best available technology. Because of this the process control is at a higher speed resulting in better performance from the equipment. This technology also helps in saving time and utility. For manual machines, there is a long standing issue all over India of sterilisation cycle documentation. For this we have developed special logger which can transfer sterilisation cycle data to a pendrive or a computer, for storage and monitoring. With this technology the hospital administrators can easily supervise the sterilisation operation, thus eliminating any human errors, which was not practically possible for manual machines previously.
How aware are Indian hospitals about bio medical waste management? How can this stream evolve? Although, there is an increased global awareness among health professionals about the hazards of bio medical waste and also appropriate management techniques are available, but the level of awareness in India is found to be unsatisfactory. It is AUGUST 2012
estimated that annually about 0.33 million tonne of hospital waste is generated in India and, the waste generation rate ranges from 0.5 to 2.0 kg per bed per day. Wherever, generated, a safe and reliable method for handling of biomedical waste is essential. Effective management of biomedical waste is not only a legal necessity but also a social responsibility. Though legal provisions [Biomedical Waste (management and handling) Rules 1998] exist to mitigate the impact of hazardous and infectious hospital waste on the community, still these provisions are yet to be fully implemented and need to be updated. In order to evolve this stream, adequate knowledge about the health hazard of hospital waste, proper technique and methods of handling the waste, and practice of safety measures can go a long way towards the safe disposal of hazardous hospital waste and protect the community from various adverse effects of the hazardous waste. Also we feel that choice of bio medical waste management equipment and infection control equipment should not be 'price centric' but 'performance centric'. For this, specific standardisation norms like using horizontal double door autoclaves in place of vertical autoclaves, should be strictly adhered to in order to achieve optimum sterilisation and complete infection control. Moreover the Rule 1998 made over a decade back, only talks about autoclaves, but if they specify double door autoclaves, then the waste treatment will be more effective, as in a single door autoclave the treated waste is again unloaded in the area where contaminated waste is kept, because of which recontamination of the biomedical waste is possible. However, if double door autoclaves are used then the treated waste is unloaded in a clean area because of which re-contamination of the waste is not possible. For this the State Pollution Control Board and the Central Pollution Control Board should take initiative www.expresshealthcare.in
involving the experts from the environmental field, hospitals and biomedical waste equipment manufacturing companies to upgrade the norms of treatment and handling of bio medical waste.
What is Periclave’s USP? Customers buy from us because of a distinct technological advantage we bring to the table over our competitors. This is reflected by our exhaustive customer list on all India basis. We have supplied equipments to almost each corner of the country. We give our customers 100 per cent satisfaction because, we have over 100 employees and each employee is having over a decade of experience in handling their departments. Further, on all India basis we have over 25 experienced engineers to provide after sales support, some of whom have expertise of over 40 years in this field. We guarantee availability of all spares for the equipment sold by us for at least 10 years. We always aim to communicate effectively with our customers and if need arises, we are definitely open to introducing custom made equipment in the marketbased on individual customer requirements.
How do you meet stringent quality standards for your sterilisation products? Periclave is an ISO 90012008 certified company, because of which we are able to give repeatable performance continuously, due to documentation procedure, monitoring and audits by certified auditors.The products are CE certified, which shows that our product quality is not only acceptable in India, but also throughout the world. We regularly develop technologies to meet stringent quality standards which not only help us to maintain quality standards but also help our customers to comply with any validation or audit requirement which has become a must for meeting NABH and JCI norms. These technologies are also supported by documents like design qualification (DQ), factory acceptance test (FAT), installation qualification (IQ), operation qualification (OQ) and per-
formance qualification (PQ).
What challenges do you foresee for your growth in the Indian market? How are you addressing it? The challenge would be penetration into tier II and III cities and cost competition from unorganised and substandard equipment manufacturers. High excise duty adds to challenge in this highly price conscious market which has a very large potential.
What are the market opportunities for business growth in India? India is one of the largest emerging medical equipment markets in the world.The Indian healthcare industry is estimated at $35 billion and is expected to reach over $75 billion by 2013. The medical equipment market is growing at a rate of 15 per cent and the demand for equipment is expected to reach $5 billion by 2013. The medical infrastructure in India is far from adequate. Demand, for hospitals and beds, far surpasses availability. The World Health Organization projected that India needs to create at least 80,000 hospital beds per year for the next five years to meet the expanding local demand. In the medical equipment segment, competition is from the imports from European companies and Japan. The growing demand for quality healthcare and the absence of matching delivery mechanisms pose a challenge and certainly a great opportunity.
How do you plan to emerge as a dominant player in your segment? At Periclave, we only strive for customer satisfaction using the best available technologies and manpower.The promptness in attending to customer needs and availability of the spare parts and cost of after sales services are critical success factors for any vendor and we surpass our competitors with flying colours. Our goal is to utilise the results of intensive dialogue with our customers to further develop our products and to incorporate relevant innovations so that we set our products as a benchmark on international platform. EXPRESS HEALTHCARE
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Express Healthcare Business Avenues BASIC OPTIMA & LIFE LINE HOPE
BASIC OPTIMA
LIFE LINE HOPE ANAESTHESIA MACHINE
Manufactured by
G S Health Care Products Pvt Ltd
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A subsidiary of Omega Diagnostics Group Plc.
80 MICROPLATES ON A SLIDE!!! 速
Genarrayt Microarray
II microarray technology II IgG response to 200+ foods II quantitative results II II small sample volume II standards included in each test pad II
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Express Healthcare Business Avenues To Advertise in
Business Avenues Please Contact: ■ Mumbai: Tushar Kanchan 022-67440519 / 502, 09821459592 ■ Delhi: Ambuj / Dinesh 09999070900 / 098102 64368 ■ Chennai: Samuel Dhanraj 044-28543031, 09841457936 ■ Bangalore: Khaja Ali 080-22231923, 09741100008 ■ Hyderabad: A K Shukla 040-23418672, 09849297724 ■ Kolkata: Ajanta / Prasenjit 033-22138586, 09831182580, 09830130965
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CENTRALIZED MEDICAL GAS PIPELINE SYSTEM
Main Activities z Execute turnkey project of centralized medical gas pipeline system (CMGPS) for hospitals z Undertake annual maintenance contract of CMGPS for Hospitals z Undertake complete design and manufacture and installation of single / double arm O.T. Pendants and single arm ICU pendants z Manufacturer of Hospital Furniture z Conducts safety audit of CMGPS in Hospitals z Render consultancy services on CMGPS Hospital Furniture
ICU BED
Stretcher Trolley
ICU BED
Having Strength of Qualified Highly Experienced Personnel & Having own well equipped workshop
B. S. MEDICAL INTERNATIONAL An ISO 9001 : 2008 Certified Company
21/3, Central Park, Jadavpur, Kolkata 700 032Tel : 033 2425 0036 M : 98319 46352 Email : info@bsmedicalinternational.com Website :www.bsmedicalinternational.com
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Anti -SlipDesign /Antistatic insert Machine Washable / Autoclavable Breathable / Shock absorption
MEGA HEALTHCARE SERVICES P-11, Chitpur Spur, 3rd Floor. Kolkata - 700 007, India Phone : + 91 33 2270 0669, 4061 2071. Fax : + 91 33 2270 0559, 2461 2072 E-Mail : uniformkariwala@gmail.com Website : www.megahealthcareservices.com
To Advertise in
Business Avenues Please Contact:
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■ Mumbai: Tushar Kanchan
■ Bangalore: Khaja Ali
022-67440519 / 502, 09821459592
080-22231923, 09741100008
■ Delhi: Ambuj / Dinesh
■ Hyderabad: A K Shukla
09999070900 / 098102 64368
040-23418672, 09849297724
■ Chennai: Samuel Dhanraj
■ Kolkata: Ajanta / Prasenjit
044-28543031, 09841457936
033-22138586, 09831182580, 09830130965
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>-
->
-> Automatic Haematology Analyser
->
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Satyamev Jayate and medical ethics: A reality check Gp Capt (Dr) Sanjeev Sood, Hospital and Health Systems Administrator, Air Force Hospital, Chandigarh, speaks on the need for serious introspection and development of a strong self regulatory mechanism among medical professionals
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MAIN STORY
A man of old world ideals and modern ideas An attempt to find what makes Dr BA Krishna tick takes Lakshmipriya Nair on a journey through his life experiences which shaped him into what he is – a man with several layers and facets to his personality physician’s job to find new approaches to medicine and find cures for various ailments.” Thus began his lifelong search for new forms and means of diagnosis and treatment of varied ailments. He was the first to introduce several path breaking technologies in India of which a few are: radioimmunoscanning in colon cancer in collaboration with the University of Frankfurt, Germany; the first PET scan in the country in 2003 using gamma PET machine, glucose PET scan for infection introduced in 2006 and the first Lu-DOTATATE therapy in 2009 using an isotope developed in India, produced by BARC.
is verve or vitality is the first thing that is noticeable about Dr BA Krishna. Even at 62, his energy and enthusiasm have the power to invigorate those around him. The fact that he has been able to sustain them in a world where people half his age are jaded and filled with cynicism makes it all the more special. The HOD of the Nuclear Medicine Department at Bombay Hospital is an intriguing mix of ideals from a bygone era and ideas of the modern world.
H
The child who became the man It is essential to know a person’s childhood to understand his psyche. A person’s character or persona is often formed from his childhood experiences. Dr Krishna’s personality too shows glimpses of the early stages of his life. Born in Gulbarga, a town in Karnataka, in the year 1951, he had a judge for his father and a homemaker for his mother. His strict albeit secure upbringing could account for his disciplined yet confident approach to life. However his father passed way quite early and his family had to go through some difficult times. Recalling those days, he says that it was his mother who kept the family glued together. He admits that his mother’s strength and ideals have always been an inspiration to him and calls her ‘a phenomenal motivator’. Years later, as a doctor, again it was his mother who guided him to choose the path of excellence and satisfaction over monetary benefits. Thus, his childhood indeed laid the foundations for the man he was to become, provAUGUST 2012
Discovering a passion for teaching
ing the truth in William Wordsworth’s words, “Child is the father of man”.
Finding his life’s calling It is said that blessed is the man who finds his life’s work and gets to do it each day. Dr Krishna is one of the blessed ones. He found his calling as a doctor. He has dedicated over 30 years of his life in his bid to relieve suffering in others. Yet, the beginning of his career was quite innocuous. As a child he was quite inspired by his family doctor, who was a jovial, humorous person with a great bedside manner and a spirited attitude towards life. Thus, when he went to college, he took up medicine and became a doctor himself. After completing his www.expresshealthcare.in
MBBS in 1975 from the Government Medical College, Bellary, Karnataka and went on to become the first person to become a post graduate in Nuclear Medicine from Radiation Medicine Centre, BARC Mumbai. He was also the first person to become the Member of National Academy of Medical Sciences (MNAMS), from the National Board of Examination, New Delhi – a degree equivalent to those of MD, MRCP in London. He chose to become a physician rather than a surgeon since he believes that a physician gets to approach medicine in a manner which is ‘thought-provoking, far reaching and more satisfactory’. He feels, “Physicians think, surgeons act. It is a
He spent around 13 years at Tata Memorial Hospital's Radiation Medicine Centre. It was during these days that he discovered a penchant for teaching. Soon, it became a passion as it allowed him to mould young minds and lead them on their paths to success and progress. He went on to teach several batches, and the pride is very evident on his face when he informs that several of his student occupy or have occupied positions at reputed medical institutions like AIIMS, Jaslok and Dhirubhai Ambani Hospital. His efforts in the field of education have been dotted with several notable contributions. It includes setting up the Indo-European Education Forum in 2010 and conducting post-graduate teaching courses for students. He has also conducted PG training course for MD/MS students in 40 medical colleges across EXPRESS HEALTHCARE
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the country. A small pocket book published in 2004 serves as guide for resident doctors in their wards. He has also mentored several students in their theses. His skills as a teacher received international acclaim when the American Biographical Institute awarded him as the ‘Best Teacher’ in 1992.
His eternal quest for knowledge A successful doctor always has to be inquisitive by nature. Only then would he be able to probe deep and find the ailment and root it out completely to ensure the well-being of his patients. Being a good doctor, it was not surprising that before long Dr Krishna’s sphere of interest extended to research as well. His beginning as a researcher was during his days at the Tata Cancer Centre. His work over there involved dealing with cancer patients regularly. This, in turn, led him to study cancer closely and to initiate a fight against this invidious disease. He often travelled to different parts of the world to study new ways and techniques to treat cancer, and on his return to India put the newly gained knowledge to good use. His respect and fascination for the great Indian scientist, Homi Bhabha and his call ‘Radiation for the purpose of human health and peaceful purposes’ also inspired Dr Krishna to study and unravel further benefits of radiation than what is known to the world today. At around the same time he realised that nuclear medi-
Dr Krishna's career at a glance ●
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13 years at Radiation Medicine Centre (1978-1991), Tata Memorial Hospital, Mumbai. Worked as RMO and then Scientific Officer – participated as Postgraduate teacher – conducted five theses for postgraduate students of Nuclear Medicine (DRM) of Bombay University 20 years as Chief of Nuclear Medicine at PD Hinduja National Hospital and MRC, Mumbai (1991- to September 2011) Honarary Professor of Nuclear Medicine at BYL Nair Hospital since 1998 Currently heads the depatment of Nuclear Medicine at the Bombay Hospital
Achievements & awards ● ● ● ● ● ● ● ●
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“Thinking Minds of 21st Century” Award by American Biographical Institute Award for international distinguished leadership in teaching in 1992 by American Bibliography Institute Homi Bhabha Memorial Oration Award, 2002 Kinariwala Cancer Research Award, Gujarat Cancer Research Institute, Ahmedabad Kundu Memorial Cardiology Oration Award, Calcutta 1999 Dayalu Memorial Oration Award, Banglore 2003 Dr KP Mangalwede Memorial Oration Award, 2005 Dr SK Sharma oration at Kolkata 2010
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cine can be effectively channelised as a weapon against cancer since it had the ability to detect the possibility of getting cancer and preventing its onset. Even today, a lot of his research is centred on cancer; however he has also branched out his study on nuclear medicine to expand its applications to other areas of treatment. After his stint at the Tata Cancer Centre, Dr Krishna moved on PD Hinduja Hospital in 1991. Over here he found a new area of interest for his research. Even as he continued his studies on cancer, he started researching on infection scanning and the various techniques to do it. Presently at Bombay Hospital, the focus of his research is on brain diseases and how isotopes help in understanding the functions of the brain better. He is researching on the ways to treat cancer, Parkinson's disease and depression through the means of isotopes. Thus, his quest for knowledge continues and it seems to be a life-long journey.
Finding religion It is interesting to note that Dr Krishna, the scientist is also a person who is deeply interested in theology and religion, maybe as a result of having a very devout lady for his mother. Yet, his view of religion and god is a very broad and enlightened. He says that there is no cause for any antipathy between science and religion since they are extremely complementary to each other. Science is a way of learning what religion has already taught us. His example to prove it is that while doctors today stress on the need to exercise regularly, religion already told us that hard work is a must in one's life. He is highly influenced by the philosophy and teachings of Vivekananda and Aurobindo. Having read the Bhagvad Gita as well, he says that Lord Krishna is the greatest psychologist in the world ever because he understands the motives and inspirations of a human mind better than anyone else.
On being a true Indian Dr Krishna has very strong views on giving back to the country in which you were born. He says that it is time that we, as Indians propelled our country to achieve the greatness and glory that it deserves and is capable of. He teaches us by example since all his studies, learnwww.expresshealthcare.in
ings and knowledge are directed towards achieving this goal. His advice to his students is the same. He urges them to learn from other nations and put it to use in our own country for the betterment of our fellow citizens. He says that we should take the discipline of the West and merge it with the ancient knowledge of the East as this is 'the' way to progress. He aims to make India a hub for nuclear medicine by creating a young group of scientists and doctors in India itself and spreading a nationalistic approach to medicine
Pursuing philanthropy with a vengeance His roles as a dedicated doctor, an educationist and a serious scientist are not sufficient to appease his soul that he has given back enough to the society. He, and his wife Dr Smriti, have adopted a school in Juhu called 'Balkanchi Bari' where he devotes his time and efforts to resensitise street children about the importance of hygiene, health and education. He also contributes through regular health checkups for these children and by sending uniforms and special biscuits enriched with iron for these children.
The lighter side of his persona Given the seriousness towards his work and his
deep-felt convictions about issues and things, it is often easy to believe that his entire life is devoted to serious pursuits. However, taking a cue from the twinkle in his eyes, a further probe into the personal side of his life reveals him as a man of varied interests. He comes forth as an avid reader who loves reading philosophy and medical thrillers alike, a pet lover who has two dogs named Ginger and Pepper and a person who loves travelling and takes time out of his busy schedules to grow different types of roses. Indulging in sports like tennis and cricket as well as watching plays are some of his leisure time activities. His interests, both in work and leisure is shared by his wife Dr Smriti, a cancer specialist working at the Leelavati Hospital, Mumbai.
Learning lessons Dr Krishna, by example has demonstrated how each person should strive to achieve their full-potential in every sphere of their life. He shows how passion, be it during work or play, can enrich life for the better. Thus, he is one of those people who have lived life fully and enjoyed every moment of it to prove that “It's not what the world holds for you, it's what you bring to it”. lakshmipriya.nair@expressindia.com
AUGUST 2012
L|I|F|E OPINION
Satyamev Jayate and medical ethics: A reality check Gp Capt (Dr) Sanjeev Sood, Hospital and Health Systems Administrator Air Force Hospital, Chandigarh, speaks on the need for serious introspection and development of a strong self regulatory mechanism among medical professionals
GP CAPT (DR) SANJEEV SOOD
Hospital and Health Systems Administrator Air Force Hospital, Chandigarh
his year, a popular TV talk show ‘Satyamev Jayate’ hosted by actor Aamir Khan cast some serious aspersions against medical profession on the issue of ethics in its fourth episode; and female foeticide in the first episode. The show had participation of some industry leaders, aggrieved patients and the selected audience who highlighted some critical issues that hit at the very core values, further eroding public faith in medical profession. The show stirred a hornet’s nest and evoked intense reactions from the medical community. The controversy generated by the show and its aftershock is still being felt in the medical circles and public. The response varied from demand for an outright apology from the actor from bodies like Indian Medical Association (IMA) and Medscape to more sober voices of need for some serious soul searching and having a strong self regulatory mechanism. Another programme, telecast on NDTV on June 10, 2012, ‘We the People-Brain Drain-Bond-ed to India’, dwelt on issues like brain drain of healthcare professionals. Given this backdrop, there is a need to take a reality check on these sensitive issues related to healthcare and also offer possible solutions.
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MCI: The sentinel of medical ethics When patient comes to a doctor, he is in no position to judge the quality of care due to inherent complexity of healthcare and his lack of requisite information. There exists a tremendous information asymmetry between the provider and patient. Further, the entity providing the advice is also providing the services, leading to a possibility of provider-induced demand for services. The code of ethics, as laid down under The Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, serves as an institutional response to safeguard the interest of patients and to enforce a social obligation on providera to live up to a set of values and standards voluntarily adopted by the fraternity. Medical Council of India AUGUST 2012
(MCI) is the regulatory body for upholding this code and ensuring its enforcement. But unfortunately, this august body itself is mired in controversies and is in an ad hoc state of affairs; and to say the least, in the absence of any effective implementation, is also perceived to be a toothless and spineless body. There is a need to reinstate autonomy and restore democracy in the current structure of MCI so as to represent national consensus and improve quality of medical education.
Privatisation of medical education The Government faces a formidable task of overcoming the shortage of skilled workforce by opening up more medical colleges to meet WHO norms of medical personnel for our ever increasing population. The Government is getting seized of this matter and has initiated a slew of measures like relaxing land requirement norms. Seeing the enormity of this task, it is not possible without the participation of corporate entities and private sector. There is nothing flawed in this policy, since higher education is privatised and unsubsidised in most countries. Deprived students too can study at these institutes by availing soft education loans. But unfortunately, education loans are more expensive than car loans in our country. However, what is lacking in this policy is the enforcement of good education standards, which is the responsibility of MCI. Charging capitation fees is legally banned. Yet seats for certain lucrative specialities are sold for huge sums of money. Such money machines produce ‘EMI doctors’, whose sole aim is to recover this investment. Obviously, such colleges and corrupt practices cannot flourish without the nexus of MCI and politicians, who actually own these colleges. To ensure quality of education and prevent mushrooming of fake colleges, MCI can certainly conduct surprise visits and blind inspections (where neither the college nor the inspector knows where he is going to inspect) to these institutes. It doesn’t www.expresshealthcare.in
take a Sherlock Holmes to make out if the physicians and admitted patients are fake and the arrangements are makeshift. If the MCI chooses to turn a blind eye to such practices and still recognise these money machines, it is unfair to blame medical professionals for these maladies.
Female foeticide: A horrendous crime Female foeticide is essentially a socio-cultural problem for which our Government has a taken a stringent legislative approach through PCPNDT Act 2003. This is one abominable crime where few black sheep in the profession have brought disrepute to the entire community. The adverse sex ratio is higher in affluent sections of the society since they have access to ultrasonography. Though the law blames the doctors and ultrasound machines for this situation, the sex ratio was adverse even before the advent of this technology, till late 80s. This Act comes down heavily on the medical profession for not only any violations but also for any procedural lapses. On the flip side, with raids being done and machines sealed, operators to be registered and this entire legal maze to be navigated, this Act has become the nemesis for any well meaning physician. In fact, it has dampened the effective utilisation of this diagnostic procedure in diverse clinical settings. Whatever may be the odds; the medical profession must come clean on this issue and do everything possible to stop this evil practice. Some initiatives, like Doctors Against Sex Selection (DASS) have set an award for anyone who helps in nabbing doctors violating this Act, need to be scaled up. Government could have been more ingenuous by offering free education and other incentives to a girl child, using technology like ‘Silent Observer’ embedded in to ultasound machines and operationalising state-wide pregnancy tracking systems like eMamta, to remedy the problem which is essentially socio-cultural.
Cuts and commissions: It hurts! Another malady afflicting the medical profession is rampant practice of soliciting cuts and commissions on referral to other physicians, diagnostic labs or chemists. In such cases, the advice offered to the patient is not always unbiased and in the best interest of the patient. Cut practice is a menace that leads to escalation of healthcare cost, overuse of investigations and overmedication. Such a malpractice can only be sustained if members of the fraternity tolerate and support it. Since a physician is a service provider and not a businessman/trader, soliciting commission is unethical. Therefore, medical fraternity itself is to be blamed for this malpractice and cannot pass the buck to politicians or State.
Generic vs branded drugs: It is all about efficacy It is alleged that doctors prefer to prescribe branded drugs, newer vaccines and imported devices to receive up to 30 per cent commission from pharma companies, rather than prescribing cheaper generic medicine or indigenous devices, such as Raju-Kalam stent, contrary to WHO recommendations. But this is a partial truth and is as blatant as saying that software companies selling antivirus programme are themselves infecting computers with virus. The prices of the drugs are regulated by the DPCO, NPPA, and DCGI under MoC&F. The State run ‘Jan Aushadhi stores’, meant to provide generic medicine have been non starters in last three years and have most of drugs out of stock. Further, in critical conditions, doctors prefer to prescribe reliable drugs with proven efficacy to achieve better clinical outcomes irrespective of the price tag. MNCs have also outsourced manufacturing generic drugs under doubtful quality control. With high percentage of counterfeit drugs being sold in the market, there is no guarantee that generic drugs have the desired bioequivalence. Further, in spite of all the brouhaha by pharma compaEXPRESS HEALTHCARE
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L|I|F|E nies, their promotional activities may not translate into higher bottom lines; that may just remain a marketing exercise. So, if they sponsor a CME or gift a pen; such an innocuous promotional activity should not raise suspicion, as long as it’s within limits.
Misuse of certain procedures The fact that the clinical decisions are not always based on evidence under most situations is not a revelation. There is a wide inconsistency in performance of procedures like caesarean sections, tonsillectomies, joint replacements, coronary angiographies and CABG; and underuse of other proven therapies. Such procedures certainly need to be subjected to clinical audit to curb their overuse. What is more glaring is the misuse of procedures like hysterectomies when unwarranted. Such cases of mass hysterectomies, as reported in Kowdipally village in Medak, AP and earlier in Ajmer, Rajasthan are appalling. The SMCs should suo moto investigate such cases and take action against those found guilty. In view of the need to practice evidencebased medicine, there is a need to develop standard treatment guidelines and clinical protocols, such as, mandatory pap smear and ultrasound before contemplating hysterectomy.
Getting doctors to rural areas The state has initiated a slew of coercive measures to post doctors in rural areas, like proposal to increase the duration of MBBS, linking with PG seats, obligatory rural postings, banning immigration to the US and more recently imposing heavy penalty on students who do not comply with this diktat. But these irrational measures have not met with success, since the Government has failed to visualise the big picture and reality of free market economy. Before taking such drastic measures, there is a need to provide adequate infrastructure in villages and resources in PHCs for providing better care and living conditions. A person who becomes a doctor does so to lead a better quality and standard of living which each citizen is entitled to. And why selectively target doctors alone and not other cadres who have an equal role to play in rural development. To overcome this problem, Government can upgrade district hospitals in resource poor areas to medical institutes, so that the native stu-
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dents who graduate from there are inclined to settle there. Such a measure shall go a long way in overcoming the shortage of doctors in rural areas.
The fair view: treat us like human beings While putting doctors in the dock may fetch good TRPs, one must adhere to journalistic norms and present complete facts before drawing conclusions. One must not belittle the sacrifices made and hardships faced in the course of becoming a doctor, besides poor working conditions and 24*7*365 emergencies, the need for specialisation and competition to keep oneself updated, COPRA hanging like sword of Damocles; the occupational hazards of acquiring infection and the brunt of mob violence. Becoming a doctor demands great struggle during prime years of one’s youth for not so commensurate rewards in the end. Exasperated, doctors say, ‘don’t treat us like a God, just treat us like a human being’. The fact that the number of students taking the medical exam has declined recently bears testimony to this harsh reality. Coming back to Satyamev Jayate, while all may not be well with medical profession, but such a doctored talk show with a one sided version, putting words into a guest’s mouth to get selective opinion and audience with exaggerated expressions only plays to the gallery. Besides factual inaccuracies, the show took unnecessary potshots and was scornful in its overall tone and tenor towards the profession. The show gave an impression that an honest and good doctor cannot survive in India, which is fundamentally incorrect. Rather he is likely to be more successful and sought after by his patients in comparison to his dishonest colleagues. If a few doctors leave Indian shores because of the corrupt system, what about the scores of doctors who return back to be successful medical entrepreneurs and thousands who choose to stay back and serve in India? If the Indian healthcare system is so sick, how come it has emerged as the preferred destination for medical tourism and more importantly, relieves sufferings and pain of thousands of patients every day with unparallel commitment? However, what has hurt the medical community most is that the show did not unequivocally highlight at any stage that inspite of some wrong doers in the profession, www.expresshealthcare.in
the majority are still ethical and conscientious and such a percentage is higher than that in any other cadre or profession. A sermon so harsh without offering a solution does no justice to a complex issue like medical ethics, especially after pocketing a whooping sum by the host for just creating awareness! In the meanwhile in another show, the actor has refused to apologise to the IMA and said he is ready to face any legal action. He expressed his highest regard for the profession and added that if the medical profession has been defamed by anybody, it is by those who are indulging in unethical practices.
Identifying the root cause Irrespective of this dose of pontification, apology or no apology; the fact remains that healthcare needs healing; the medical profession needs serious introspection and develop a strong self regulatory mechanism. The entire fraternity must come clean on certain maladies ailing the profession as a whole. Part of the problem is that the Government and society still continues to see healthcare through the prism of socialism caught in the time warp of the 60s. The prejudice that doctors are under oath and receive subsidised education and should be ever willing to serve humanity is so passé and unpragmatic. Doctors are obliged to serve by choice, not by compulsion. In the recent past, cost of all inputs into healthcare, like land, equipment, medical education and staff salaries have gone very high; electricity and water tariffs have to be paid at commercial tariffs by most healthcare equipment manufacturers, yet the system expects healthcare to be inexpensive. For a society worshipping Lord Mammon so deeply, isn’t it too virtuous to expect physicians to abide by 2400 years old Hippocrates oath, which is no more than an anachronistic document? The healthcare sector is most regulated and medical ethics encompass many issues and values. However, while MCI may lay down guidelines and define ethics, such principles are not always easy to uphold. For example, informed consent is far from being informed in most situations, since the content of all forms is standardised and each patient is unique and interprets it differently. Trainees regularly see patients in most institutes which is not always in the best interest of
patient and hence unethical. These ethical transgressions are universal and not unique to India. Some of the legal statutes are like a minefield and tricky to navigate. Today, doctors are caught in a moral dilemma of taking purely an ethical approach or charting a commercial path in their careers. In a rush to chase top and bottom lines, some easily forget that there is a patient in between who deserves an ethical care.
The way forward The Government on its part needs to play a pivotal role by taking certain policy decisions and allocating sufficient budget for healthcare. It needs to strengthen public healthcare system, check rampant corruption in cases like NRHM scam, curb the sale of counterfeit drugs and promote health microinsurance so as to provide enabling environment and achieve universal healthcare. A large part of unethical practices are attributable to quacks, the neighbourhood chemist, pharma companies, entities like hospitals and even IMA, who are a strong force in the healthcare ecosystem and are beyond the purview of MCI Act. Therefore any solution to the problem has to be found in the entire ecosystem of healthcare, not just allopathic doctors. The MCI and IMA have failed miserably to curb rampant quackery, improve quality of medical education, and effectively enforce medical ethics. Certainly, professional bodies like MCI and IMA need to get their act together, rather than being at loggerheads; and work effectively towards restoring public faith into the system. Another solution is to educate and empower patients as an equal partner and important stakeholder towards delivery of patient centric care.
Conclusion Though the talk show might have ruffled some feathers, the collective conscious of the community is always there to enlighten and inspire the medical profession in such turbulent times. it is time we rededicated ourselves to professional ethics and earn more bouquets than brickbats from the society. Otherwise, the nation’s dream to achieve healthy India may remain elusive forever. The author is a NABH empanelled assessor and prolific writer on healthcare matters. He can be contacted at doc_ssood@yahoo.com AUGUST 2012
REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2010-12, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, AT IND.EXP.PSO.