Modern Medicare March 2011

Vol 7 No 4

MODERN MEDICARE

March 2011

Editorial

Service, when it matters most

I

n the event of a medical emergency, the cliché every second Delhi and surrounding towns such as Gurgaon, Faridabad, Noida, counts holds true. During these situations, availability of Ghaziabad etc) can be correlated with high economic growth and required services stands on the thin line between life and rising migratory population witnessed here in the recent years. death. This brings us to the topic of emergency healthcare, In fact, NCR has emerged as one of the top 10 contributors in which has evolved from a basic transport van to state-of-the-art India’s healthcare infrastructure spending.

Simultaneously, the focus of healthcare providers seems to medically assisted air transportation and monitoring system.

However, today’s healthcare system in the country reflects a be shifting towards neighbouring Tier II towns such as Jaipur, glaring gap in the quality of emergency healthcare offered by Chandigarh, Jalandhar, Ludhiana, Dehradun Lucknow, among private hospitals in cities vis-à-vis public hospitals in rural areas. others. Hence, these cities are experiencing enhanced activities Some of the challenges before emergency medical services in in infrastructure development and have become the preferred India include improper distribution of resources, shortcomings of destinations for several healthcare projects. medical education, high patient volume as well as affordability and The key challenge faced is the urban-rural divide, which is accessibility to emergency care. quite visible here as most private healthcare projects are in Suffice to say that there exists a pressing need for continual metros and Tier I cities. Besides, there is a dearth of trained upgradation, training, implementation, support, review and hospital staff, doctors in North India, and although financing reformation of the Indian emergency healthcare services in both and government approvals are relatively easy to obtain, public and private sectors. For further insights into this arena, turn providers have to tackle numerous ground-level operational to the ‘Sector Watch’. roadblocks. The ‘Region Focus’ on North India offers glimpses Going by the latest advances in diagnostics and therapeutics in of these facets. Read on… oncology, there are greater survival rates in children and reproductiveaged adults with malignancies. Also, the emergence of oncofertility presents high hopes for cancer survivors to lead healthy and fulfilled lives. Turn to the ‘Specialty Scope’ for a detailed perspective.

Manas R Bastia The surge in healthcare facilities in North India, especially the Editor National Capital Region (NCR, including Union Territory of manas@infomedia18.in

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Contents

22 Roundtable Doctor’s prescription: Do patients understand the handwriting?

28 Sector Watch Emergency healthcare: Taking off to the next level

18 Experts Speak Manpreet Singh Sohal Facility Director, Fortis Hiranandani, Vashi (Navi Mumbai)

REGULAR SECTIONS 4 8 14 58

Editorial National News World News

34 Specialty Scope Oncology: Treating the unmet needs

Health Chip Semiconductors in healthcare: Revolutionising medical imaging Rakesh Joshi, Business Development Manager – Medical Business, Texas Instruments India

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Policy Matters Prohibiting sex determination: Regulating misuse of technology Dr Sanjay Gupte, MD, DGO, FICOG, FRCOG, LLB, President, FOGSI 2010

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39 North India: Healthcare on the growth radar

40 Spotlight

Curtain Raiser Medical Fair India 2011: A one-stop portal for med world

68 70

Region Focus

44 Interface

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Events Calendar

Snapshot

Report Medicall 2011, Kolkata: Connecting industry with innovations

72 84 87 88

Product Update

Highlights of Next Issue

Rx

Sector Watch: Health Insurance

Product Index

Specialty Scope: Ophthalmology

Advertiser’s List Note: ` stands for Indian rupee, $ stands for US dollar and £ stands for UK pound, unless mentioned otherwise

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National News

In Brief Cashless healthcare services restored at Max Healthcare Max Super Specialty Hospitals, Saket, has recently announced the restoration of cashless treatment services for all individual mediclaim customers and Third Party Administrators (TPA) card holders after reaching an agreement on the package rate structures with the Public Sector Undertaking (PSU) insurers.

Dr Pervez Ahmed, CEO & MD, Max Healthcare, said, “We have reached an agreement with the TPAs and the services have been restored with immediate effect. We have given our suggestions on package rates for treatment under mediclaim policies to the TPAs, who are facilitators between the insured and the insurer. Under the structure that is being worked out, the hospital would be categorised on the basis of super specialty medical centres and premiums could vary accordingly.”

At present, 166 hospitals are covered under the cashless network, called Preferred Provider Network (PPN), of the four public insurance companies.

Shalby Hospitals signs MoU with Gujarat Government Shalby Hospitals has recently signed an MoU with Government of Gujarat for setting up hospitals & education institutes in the state. Among its many endeavours the hospitals has initiated in setting up of 200-450 bed multispecialty tertiary care hospital in Ahmedabad and Surat respectively, establishing 100 bedded multispecialty tertiary care hospital each in both Vadodara and Rajkot.

Education and training is essential for any industry to cope up with the latest trends and the upgradation.

It has taken initiative in establishing in College of Nursing-BSc Nursing in association with Nursing Council of India, Delhi, Gujarat Nursing Council, Government of Gujarat.

Further, it is also ready to offer paramedical sciences training through certificate course in radiology and diploma course in Medical Laboratory Technology (MLT) in association with Department of Technical Education, Gujarat Government. Again, Shalby Hospitals is also taking initiative in Diplomate of the National Board of Medical Examinations (DNB) programmes in several broad and super specialty in association with National Board of Examinations, New Delhi.

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Smiths Medical sets up subsidiary in Mumbai Smiths Medical, a global medical device manufacturer, has recently announced that it has set up its wholly owned subsidiary in Mumbai, which is opened to help grow its business in this part of the world.

Srini Seshadri, President, Smiths Medical, said, “India is one of the most dynamic healthcare markets in the world. By creating an Indian subsidiary, we are committing to invest in this market, growing our business and becoming a part of the fabric of the regional healthcare community.”

Further, Stuart Morris Hopkins, Vice President, Global Sales & Marketing, Smiths Medical, said, “We intend to invest in sales, marketing, R&D and product development geared towards the Indian market. We want to be recognised as both a global and a local company, which is focussed on addressing the Indian customer needs. We have had a presence of over 20 years in India through our strong distributor network. Our aim in establishing Smiths Medical India is to continue to leverage that network while also growing our direct-to-customer business.”

Vasan Healthcare aims to establish 28 eye care centres in India Vasan Healthcare (VHC) recently announced that it is planning expand its operations.

The Vasan Eye Care Hospital is planning to establish 28 eye care centres in East, West and North India. Currently, it has over 80 eye care hospitals, 15 dental clinics spread across Tamil Nadu, Karnataka, Andhra Pradesh, Kerala and Pondicherry.

Dr A M Arun, Chairman and Managing Director, Vasan Healthcare, said, “Vasan Healthcare has been progressing towards bringing world-class healthcare within the reach of every Indian citizen. We are proud to achieve the feat of becoming the world’s largest eye care network. By June 2011, we will be launching 28 eye care hospitals in the cities of Delhi (4), Kolkata (5), Mumbai (4), Surat, Ahmedabad, Vadodara, Rajkot, Nagpur, Pune, Kolhapur, Nashik, Amritsar, Jalandhar, Ludhiana, Chandigarh, Indore, Bhopal and Bhubaneshwar. The network also plans to start operations in Dubai and Colombo by April 2011 and later in Africa, Oman, Abu Dhabi, Sharjah and Doha.”

Dr Sudarshan K Aggarwal gets Lifetime Achievement Award

by IRIA Dr Sudarshan K Aggarwal of DCA Imaging & Research Centre, New Delhi, has been recently conferred with Shri K R Gupta Lifetime Achievement Award by the Indian Radiological and Imaging Association (IRIA), New Delhi.

The award was presented to Dr Aggarwal at the 64th annual conference of IRIA. He was felicitated for his contribution to the growth of radiology and for introducing diagnostic technologies in India.

National News

In Brief Carl Zeiss Meditec opens CARIn in Bengaluru Carl Zeiss Meditec has opened its Center for Applications and Research, India (CARIn).

Carl Zeiss Meditec is strengthening its presence in high growth markets like India and targeting its investments at R&D projects.

Dr Michael Kaschke, President and CEO of Carl Zeiss AG (Asia) said, “Carl Zeiss has been active in India for more than ten years.

However, for our company the country is more than a sales market; our customer base, as well as the industrial and research landscapes, have a lot more to offer. Therefore, in India we are investing not only in the expansion of our sales and service network, but also in product and application development.” Dr Ludwin Monz, President and CEO of Carl Zeiss Meditec AG, said, “With CARIn and a team of highly motivated staff, we can work even more closely with customers on site and integrate their needs even more effectively into our product developments.”

Fortis in action in Australia and Singapore Fortis Global Healthcare Holdings Pte Ltd, has entered into a Takeover Bid Implementation Deed with Dental Corporation Holdings Ltd, Australia under which Fortis Global will make a proportional offer to acquire up to 30 per cent of each Dental Corporation’s existing shareholding. In addition, Fortis has also agreed to offer to acquire 30 per cent of the employee options held by each Dental Corporation option holder.

Malvinder Singh, Executive Chairman of Fortis Global, and a Director of Dental Corporation said, “We will continue to support the Dental Corporation management team to deliver the company’s growth forecasts in Australia, New Zealand and potentially take this unique model to new geographies in Asia.” In another venture Fortis has made its first foray in Singapore by acquiring an under construction specialised Cancer Hospital in the prime Adam Road area from First Real Estate Investment Trust, a Singapore listed healthcare real estate company. “Through this hospital, we are making a beginning in the highly recognised and competent healthcare delivery system of Singapore” said Singh.

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Jaslok Hospital introduces new therapy for Parkinsons With over ten years of experience of successfully performing Deep Brain Stimulation (DBS) surgery, Dr Paresh Doshi, In-charge, Department of Stereotactic and Functional Neurosurgery at Jaslok Hospital Mumbai, has developed a new surgical therapy called SubThalamic Nucleaus (STN) lesioning. In this surgery, a small lesion is created to permanently control the symptoms of Parkinsons Disease (PD). This is a thermal lesion Purshottam Dadhania, that is created by sophisticated radio frequency patient who underwent lesion generator machine. The entire surgery is the surgery performed under local anaesthesia with the help of stereotactic system.

Commenting on the new surgery, Dr Doshi, said, “STN lesioning is even more challenging than DBS as it involves an irreversible lesion. Centres with a high level of expertise in performing Parkinson’s disease surgery can and should attempt this.”

Lilavati Hospital gets NABH accreditation Lilavati Hospital, Mumbai recently announced that it has received the National Accreditation Board for Hospitals and Healthcare Providers (NABH). Lilavati Hospital is now the sixth hospital in the city to receive this accreditation.

Receiving the accreditation, Dr Narendra Trivedi, COO, Lilavati Hospital, said, “We are honoured and delighted at this prestigious recognition. Ours has been a remarkable journey from a 10-bed hospital to a hospital now on the national and international map focussing on several specialities. We will now take steps to set newer standards of excellence for ourselves.”

Bombay Hospital organises NCTTC symposium Bombay Hospital recently organised the National Counter Terrorism Trauma Care (NCTTC) at S P Jain Auditorium. This antiterror forum aims to help the government policy create a doctor’s protocol for handling terror attacks, provide training to paramedical staff, pre and post trauma L-R: Dr M M Begani, Consultant counselling to patients and create public Surgeon, Bombay Hospital; Dr D education and awareness, thus increasing P Vyas, Medical Director, Bombay awareness about medical services provided Hospital; Dr B K Goyal, Padma during such attacks.

Vibhushan; Rajendra Shekhavat, During the 26/11 attacks, 84 patients MLA, Maharashtra were treated by 20 doctors, 400 plus nurses and numerous ward boys at the Bombay Hospital. During the conference, a suggestion was proposed regarding setting up a Joint Civil military trauma and terror control centre for the entire country.

Mental trauma was also a subject of discussion at the symposium.

Dr Maya Parihar, In-charge, Blood Bank, Bombay Hospital, said, “To provide the right blood group as and when required, we need to have a blood bank registry.”

MMC (March 2011) 1Tab-11

MMC (March 2011) 1Tab-12

World News

In Brief Cancer breakthrough to prevent heart failure A breakthrough by scientists at Queen’s University Belfast aims to reduce heart failure in cancer patients around the world, and consequently increase survival rates.

Scientists at Queen’s Centre for Vision and Vascular Science have discovered the role of an enzyme, which a patient receives in chemotherapy, can cause life-threatening damage to the heart. This has, until now, restricted the amount of chemotherapy doses a patient can receive; but while protecting the heart, this dilutes the chemotherapy’s effectiveness in destroying cancerous tumours.

Dr David Grieve, jointly leading the research at Queen’s School of Medicine, Dentistry and Biomedical Sciences said, “Although we have known about the NADPH oxidase enzyme for many years, until now, we were not aware of its crucial role in causing heart damage associated with chemotherapy. Our research findings hold clear potential for the creation of new drugs to block the action of the enzyme, which could significantly reduce heart damage in cancer patients.”

Long- and short-sleeved physician workwear are prone to receive similar bacterial contamination Governmental agencies in the United Kingdom recently instituted guidelines banning physicians’ white coats and the wearing of long-sleeved garments to decrease the transmission of bacteria within hospitals due to the belief that cuffs of long-sleeved shirts carry more bacteria. However, a new study published in the Journal of Hospital Medicine observed that after an eight-hour day, there is no difference in contamination of long- and short-sleeved wear, or on the skin at the wearers’ wrists. A group of researchers from the University of Colorado, USA, decided to assess the accuracy of the assumption that that longer sleeves lead to more contamination by testing the uniforms of 100 physicians at Denver Health.

They found that although the newly laundered uniforms were nearly sterile prior to putting them on, by three hours of wear nearly 50 per cent of the bacteria counted at eight hours were already present.

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Gene fuelled transporter causes breast cancer cells to self-destruct According to a research recently published in the International Journal of Pharmaceutics, scientists at Queen’s University Belfast have shown that by using an innovative, miniscule gene transport system they can deliver a gene directly into breast cancer cells causing them to self-destruct. Dr Helen McCarthy from Queen’s School of Pharmacy, funded by Breast Cancer Campaign, packaged a gene into a nanoparticle allowing it to be delivered straight into breast cancer cells in the laboratory. This is accomplished by using a transport system called a Designer Biomimetic Vector (DBV). The gene called iNOS, is targeted specifically to breast cancer cells using the DBV where it forces the cells to produce poisonous nitric oxide; either killing the cells outright or making them more vulnerable to being destroyed by chemotherapy and radiotherapy. Dr McCarthy’s next step is to turn the nanoparticles into a dried powder that could be easily transported and reconstituted before being given to patients. Commenting in this regard, Dr McCarthy said “The major challenge of using gene therapy in the past has been the lack of an effective delivery system.”

Medical travel market to see a boost With the global medical travel market expected to reach at least $60 billion by 2012, the first Annual Global Medical Travel Forum at the 2011 World Health Care Congress hopes to gather global thought leaders for sharing insights on the future of the rapidly growing industry. The forum is scheduled for April 4-5, 2011 in Washington D C. More than 1,800 delegates from 40 countries around the globe will be present at the conference, including over 200 CEOs from major health plans and Third Party Administrators (TPAs).

Diabetes pipeline cannot reverse the cardiovascular market According to Datamonitor, strong growth in diabetes will not be enough to stop the cardiovascular and metabolic market from declining. Datamonitor forecasts that the cardiovascular and metabolic market across US, Japan, France, Germany, Italy, Spain and the UK is expected to reach its peak in 2011 and then begin to decline, with total sales falling from $105 billion in 2009 to $101 billion in 2019.

Further, in contrast, the volume of sales will continue to increase, driven by aging population and higher rates of obesity. Christine Henry, Healthcare Analyst, Datamonitor, said, “The proportion of the market composed of branded therapies is forecast to fall and by 2019, generics and biosimilars will contribute 68 per cent of volume sales across the mentioned seven major markets.” In this context, Henry continued, “Anti-diabetics will provide the key growth market in cardiovascular and metabolic disease, and by 2019, seven of the top 10 brands will be anti-diabetics. At this point, diabetes will contribute 35 per cent of all sales in the seven major markets, and anti-diabetics will generate 50 per cent of cardiovascular and metabolic sales in the US market.”

World News

In Brief A new era of healthcare assistance ‘HealthSearch’ An innovative website ‘HealthSearch’ has been launched in Otago, New Zealand that would provide patients with information about health practitioners from all fields, including alternative therapies, their qualifications, and the treatments they offer.

‘HealthSearch’ is the brainchild of the Integrative Health Trust Otago (IHTO), a group of general practitioners (GP), specialists, complementary health practitioners, academics and members of the public, who began working together after a GP conference held in Dunedin in 2003.

People today want to use a variety of healthcare approaches, including both conventional medical treatments and complimentary & alternative therapies. The website is established keeping this group of people in mind. Dr Monika Clark-Grill, group spokesperson and lecturer in General Practice, informed, “The unique thing about the website is that it is a one-stop-shop, which provides information about practitioners who are both conventional and complementary/ alternative healthcare providers.”

Safety of biologic treatment for arthritis is drug dependent According to a recent systematic review by Cochrane researchers, safety of biologic drugs varies from drug to drug. Although biologics are FDA-approved, it is thought that some may have rare but serious side effects related to their immune-suppressing activities.

Some side effects associated are increased risk of infections, reactivation of Tuberculosis (TB), cancer and congestive heart failure. This review was based on 163 studies focused on nine different biologics used to treat arthritis and other conditions. 50,010 patients participated.

Adverse events and TB reactivation were more likely among those taking biologics compared to controls. Serious side effects, lymphoma and congestive heart failure were not likely.

Jasvinder Singh of the Birmingham VA Medical Center in Birmingham, Alabama, said “The data provides some guidance for clinicians and patients as regards the safety of different biologic drugs, but we should remember that these are not head-to-head trials. There is an urgent need for more research into the safety of these drugs.”

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Promoting collaboration in research and medical education Bilateral relations between Malaysia and Bangladesh received a boost as the health ministers of these countries have pledged to work together.

Manpower development and joint research along with academic exchange are a few areas that will establish collaboration and co-operation between these countries. While inaugurating the two-day Malaysian healthcare expo the ministers committed to work jointly.

Further, a Memorandum of Understanding (MoU) was also signed between a Dhaka-based healthcare facilitator Guardian Network and University of Malay at the function to promote collaboration in the field of research and medical education. Liow Tiong Lai, health minister of Malaysia, said that the Malaysian delegation was in Bangladesh not only to promote healthcare but also to pave way for future ‘win-win’ collaboration for both countries.

Bangladesh’s health minister AFM Ruhal Haque welcomed Malaysian healthcare in the country and said “It will boost our long-standing brotherly relationship. We have plenty of things to do together.”

He emphasised support in developing the nursing sector as Bangladesh grapples with a skeleton number of nurses. The nurse and population ratio in Bangladesh is 1:5,782, while it is 1:600 in Malaysia. In this regard, he added, “Our nursing sector is still very weak. I know Malaysia is doing very well.”

maxIT Healthcare launches novel business unit in Canada maxIT Healthcare, a Westfield, Indiana-based professional consulting services company for healthcare providers in the US, declared the launch of a new business unit in Canada. maxIT Healthcare is a privately owned US healthcare IT consulting firm with over 550 full-time consultants. The company provides experience and expertise in a variety of strategic areas, including Electronic Health Record (EHR) systems, Health Information Systems (HIS), Enterprise Resource Planning (ERP) systems, Clinical Imaging and Informatics systems and Management Consulting. The company supports most of the leading software vendors, including Cerner, McKesson, Allscripts, GE, Siemens, NextGen, Epic and many others. maxIT Healthcare has named Bob Betts, (formerly a Business Manager with eHealth Ontario), as the Regional Vice President of Canada. Further, Betts will primarily concentrate on new business development in Canada.

Wales becoming a name in digital healthcare Wales is establishing itself as a world leader in the use of digital technologies to better patient safety and the quality of health and social care, commented Edwina Hart, the Welsh Health Minister. Significant investment has been made for delivering an integrated digital healthcare service that puts the needs of patients at the centre of service delivery. £4.7m has been invested in creating the Individual Health Record (IHR) system.

Experts Speak

ple have always been th conscious but today evel of awareness is nitely increasing’ ...says Manpreet Singh Sohal, Facility Director, Fortis Hirananadani Hospital, Navi Mumbai. A law graduate from Panjab University, Chandigarh, he has more than 8 years of healthcare experience. Sohal has been a part of the team for all the M&As including Escorts Healthcare group and Fortis Hospitals (erstwhile Wockhardt), and been a key member for completion of IPO. Further, he has an expertise in formulation and implementation of systems for managing legal risks and exposures on statutory and contractual obligation. Sohal was also a key member of the Clinical Engagement Group.

He was also the Director at Fortis Jessa Ram Hospital, New Delhi, and was awarded the Turnaround story award. He had started various initiatives for patient care.

Chandreyee Bhaumik

Please discuss the oft-noticed trends in healthcare.

With time, there is an increasing awareness among people regarding their healthcare requirements. They have always been health conscious, but today this level of awareness is definitely increasing. As a result, we see more people securing their lives with insurance policies. Further, there is a difference in the attitude of the people.

Hence, when people visit doctors, they

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are very much aware of the information that they receive from these doctors.

In this regard, Internet has a dominant role to play. As most of them have gained the required knowledge merely by surfing Google.

Besides, people now have discarded the attitude of curbing healthcare expenses.

This has resulted in the mushrooming of large corporate hospitals with multispecialty facilities. This also eventually leads to doctors keeping themselves

updated with the latest technology.

However, what is actually marking a difference is the fairly competitive relation that has been established between health providers, doctors and patients.

Kindly elaborate on the disease patterns in India.

One of the most dominating disorders is obesity. Nowadays, diabetes is observed in children at a very young age; this

Experts Speak FORM IV Statement about ownership and other particulars about Modern Medicare, as required to be published in the first issue every year after the last day of February.

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makes even cardiac diseases common. Furthermore, lifestyle diseases now occur at an age as early as 30 years. Due to the lifestyle pattern, working parents, children tend to eat a lot of junk food. The calorie-rich food consumption by children brings about hormonal changes in them. Puberty comes as early as 8 years. In this scenario, it is not just the government’s initiative that can take care of this situation but even private players can help. Therefore, the government and the private players should employ their combined efforts to tackle this situation.

What is the education and awareness level in this regard.

Several educational institutes exist; however, on a broader scale they are not up-to-date. The coursework does not include specific sections on lifestyle diseases. There should be specified sections in the course that would throw light on such diseases. Further, the current education system does not encompass practical training. Thus, in order to tackle this environment more institutes should be established.

Also, the existing syllabus should be revamped on a yearly basis.

Discuss the contribution of technology in this arena.

As far as technology at our hospital is concerned, we are updated on a daily basis. At Fortis, we have always wanted to bring the latest technological innovation. A recent national oncology data reveals that there are many people suffering from cancer. Therefore, we are planning to tie-up with a lot of high-end oncology centres to bring in the latest technological innovations for treating this disease.

Tell us about the investment pattern at Fortis.

Healthcare is all about complete investment. And the major investments at hospitals is generally for the infrastructure and technological upgradation. For example, the cost of setting up one bed is ` 80 lakh. Sometimes in this industry the gestation period is comparatively more. In that case, healthcare becomes a loss, and therefore, there might be a dropdown in the revenue. So investments at Fortis are planned keeping this in mind.

What are the key challenges faced by the healthcare sector?

At present, lifestyle diseases are one of the primary concerns.

In this regard, Indian doctors are the best but we need more doctors in this field. On a darker side, we are far behind with regard to technological advancement/progress. Further, there is a system for well-planned total knee replacement. For full recovery the patient takes approximately 12–15 months.

Our main motto is that we pledge an early patients’ mobility, considering the current recovery period is long. (chandreyee.bhaumik@infomedia18.in)

Roundtable

Doctor’s prescription

Do patients understand the handwriting?

Is a doctor’s illegible writing a result of indifference, less time, busy schedule or just a routine practice? Let us have a look at the plausible explanations given by some medical experts.

Dr Asma Mohd Yousuf

D

octor’s handwriting has always been a subject of discussion.

Most of the time one tries to decipher it instead of reading, and yet is not successful. There have been studies conducted that proved the illegibility of doctor’s writing and the disturbing results it could produce.

There are many people who write badly, but the consequence of a doctor’s poor writing skills could be grave. It can harm patients by wrong administration of medicines by pharmacists or nursing staff, who have difficulty in reading the prescription. This could also get a doctor into legal hassles.

In 1999, a ground-breaking lawsuit drew attention to the implications of doctors’ handwriting when a cardiologist was fined $225,000 by a Texas jury. A prescription he had scrawled for Isordil, a drug for heart pain, was misread by the pharmacist as Plendil, used for high blood pressure. The patient took an overdose of the wrong medication and died of a heart attack. The total judgment of $450,000 included an equal fine against the dispensing pharmacist.

Since then, six American states have subsequently passed legislation making doctors` illegible handwriting a fineable offence. Even in India the court had directed that doctors should write legibly.

Dr Ajay Sharma Senior Consultant Dental Surgeon, Prosthodontist and Oral Implantologist, Max Healthcare, New Delhi All doctors do not have bad handwriting and some have writing which is clear enough to be read even by a school-going kid.

However, some doctors have very bad handwriting. The reason for this could be preparing notes in medical college that have to be written hastily. As a result most of the budding doctors spoil their handwriting. Your repeated act becomes your habit, and thus many doctors start writing badly.

However, the illegibility of a doctor’s writing is not intentional and has no association with the myth that doctor’s prescription is only for the pharmacists to understand and for the patient. If asked to

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write a piece, still doctors will write in the same way as prescriptions.

Well yes, there is a possibility of giving wrong medicine if it is difficult for the pharmacist to comprehend the prescription. Whenever a pharmacist is not clear about the prescription, he/she should always cross check with the concerned doctor. All prescriptions should have clear instruction in bold for the pharmacists stating ‘Incase of doubt, please consult the prescribing doctor.’

Besides, electronic record is another solution for documentation of medical data. However, all clinical set ups do not have computers or software for preparing prescriptions, especially in healthcare set-ups beyond the metro cities.

Roundtable Dr Amit B Upasham Consultant Psychiatrist and Psychotherapist, Godrej Memorial Hospital, Mumbai It is unfortunate that doctors are the only professionals whose handwriting is exposed and is subjected to others’ judgement unlike other professions. However, the reason for a badly written prescription could be heavy OPD with many patients to be examined in less time.

It is not just badly written prescriptions that mislead pharmacists. In recent times, at how many pharmacy stores do we get to see the main pharmacist on the counter? It is mostly his/her unqualified family members and their support groups. Maximum mistakes that occur over the pharmacy counters are due to these unqualified staff over the counters who keep substituting the medicines according to their so-called pharmacy knowledge without even consulting the prescribing doctor. Therefore, this is not a one-sided problem. Efforts should be taken from

both sides; doctors should make sure of the legibility of the handwritten prescriptions and the licensed pharmacist should only dispense the prescribed medicines. Also, the pharmacist should not try to give substitute medicines on his own without consulting the concerned physician.

Today, IT plays an important role, however due to lack of proper infrastructure, adequate manpower and heavy patient load on the doctor leads to inadequate documentation. To tackle this problem in a populated country like India, it is important to develop the right infrastructure.

At the same time it is crucial to form and strictly implement health policies. Last but not the least, every individual in the healthcare system should make an effort to put in their best keeping patient benefit as a priority.

Dr Anshuman Agarwal Senior Consultant Urologist, Fortis Hospital, New Delhi Many, but not all the doctors have bad handwriting. Largely, it is because of the pressure to write too much in very less time, as a medical student or as a medical practitioner.

Nonetheless, the poor writing skill is purely unintentional. Even some pharmacists are unable to understand what is written, which at times could be dangerous. However, there can be misunderstandings not solely due to doctor’s badly written prescription, but also due to a less experience chemist attending the patient. If the chemist does not understand what is written, then he/she should avoid giving medicines at all cost when in doubt.

Prescriptions should be preferably written in capital letters in order to avoid confusion. Further, Information Technology (IT) is playing a crucial role in developing softwares for managing patients’ clinical records.

However they constantly need to be modified tomake them user friendly.

In a country like India where there are too many patients, especially in the government run hospitals with over crowded OPDs, it is really difficult for the doctor to maintain a good handwriting. Perhaps, doctors working here should be given enough secretarial help to overcome the problem of writing many prescriptions in a short time span.

Dr Lavkesh Bansal Director and Chief Dental Surgeon, Durga Dental Care & Research Centre, Mumbai The words and vocabulary used in medical field are different, which are not taught in school.

We humans are generally good in reading and pronouncing familiar words, the words we use in day-to-day life. However, a new word is always difficult to read, whether it is on a prescription or any other document. Human eyes generally look at the first & last letters of a word and the brain registers a complete word. It is really difficult for our brain to read a word that is new, and the same is the case with medical prescription.

For every complication and tragedy, everyone justifies himself, and badly written prescription is the easiest excuse for a pharmacist to place the responsibility on the doctor. If a pharmacist does not understand what is

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written in the prescription then he/she should call the treating physician to clarify what has been prescribed.

However, the best would be a printed prescription, but it involves a lot of additional infrastructure, manpower, expertise in IT and most importantly, time. Have you ever thought why medical transcription is such a big business in America, where every patient or lawyer is ready to sue the doctor? In India, it means addition in doctor’s consultation fees, which is a least appreciable act in people’s view.

The best would be ensuring a qualified pharmacist at every medical store, who has sound knowledge of the medicines prescribed for each disease. For doubtful cases, he/she should consult the prescribing doctor for verbal or written correction of any unreadable word.

Roundtable Dr Rasika G Bhat Medical Genticist & Lecturer – Medical Genetics, Institute of Nursing Education, J J Hospital; and Bombay Hospital College of Nursing, Mumbai A doctor’s prescription could spell the difference between success and failure of therapy he/she has advised. Illegible prescriptions have been held responsible for more than 7,000 deaths in United States annually according to a July 2006 report from the National Academies of Science’s Institute of Medicine (IOM). However, in India, apart from a physician’s sloppy writing there are more than few reasons that hinder good prescription practices. The ones that have a profound effect are physician practice of prescribing brand names, peer influence over junior physicians, huge array of drug formulations, vast number of brands in the market and underqualified staff at chemist shops. A study assessing prescription errors revealed that out of almost

1,000 prescriptions reviewed, 7 per cent omitted the patient’s name, 8 per cent had no hospital number, 5 per cent did not state the dosage, 11 per cent left out the frequency of the dose, and 8 per cent were missing the date on which medication should start. Only 9 per cent recorded the patient’s weight and 17 per cent mentioned the allergy status. In 2 per cent of cases there was no doctor’s signature.

A prescription should be complete while at the same time legible. Undeniably, some time and effort needs to be spent in framing a proper prescription. Taking a shortcut at the patient’s expense is not a good practice.

Physicians should take the initiative on their own rather than being forced by a legal instrument, such as the Consumer Protection Act.

Dr Samir Parikh Chief Psychiatrist, Department of Mental Health and Behavioural Sciences, Max Healthcare, New Delhi ‘All doctors have bad handwriting’ is a generic statement, which is not true. One of the reasons behind poor writing skills could be time constraint faced by medical practitioners due to their busy schedule, which involves a lot of writing while preparing medical records as well as prescriptions. This has to be done alongside analysing the patient’s case, and therefore, at times doctors may lose attention while writing.

However, the illegibility of the writing has nothing do with not the patient but only the pharmacist understanding what medicines are prescribed. If one individual can read, so can the other. More so, when a doctor writes a prescription, it can go to any chemist store and not to a specific one. There are reports that say

badly written prescriptions have mislead pharmacists, resulting in patients taking wrong medicines or wrong doses that have caused various complications and even death in some cases. That is why it is advisable to write prescription using capital letters only.

Also, prescriptions can be typed and computer print outs can be used to avoid any misunderstandings. Digital medical records management is an excellent tool, and it is advisable that all doctors must try and use the same.

These softwares besides writing, also solves the complex medical record management.

In India, only qualified physicians and nurses are allowed to write prescriptions. Very strict laws and safety guards are in place to prevent the forging of prescriptions.

Maj Gen Vijay Krishna CEO, Breach Candy Hospital, Mumbai It is not right that all the doctors have bad handwriting. There are doctors, who have handwriting which is not only legible but also very neat. Handwriting should not have any connection with a person’s profession. In all professions, there are people with very good and very bad handwriting.

However, when the pharmacist cannot understand the prescription, he/she should not sell the drugs without consulting the doctor who has written the prescription. Further, no assumptions should be made and no substitute medicine should be dispensed.

Also, the patient/relative should get the medicine checked by the treating doctor incase of any doubt

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prior to commencement of the treatment. Moreover, many doctors have now begun to handover typed prescriptions. Further, a medical transcriptionist can help the busy doctor in documentation of medical records. In addition, with the help of IT, medical records can be scanned and kept for longer period, which proves to be very beneficial.

In a vast country like India where high-ended technology is yet to reach the interiors of the country, facilities like IT and medical transcription are hardly available. therefore, all three players - doctor, patient & pharmacist - must be in sync while prescribing, dispensing & consuming medicine. To conclude, is it not said that it is better to be safe than sorry?

Sector Watch

Emergency healthcare

Taking off to the next level Emergency Medical Services (EMS) is an essential part of the overall healthcare system; however, the state of EMS varies significantly from developed to developing countries like India. Although there has been tremendous development in the healthcare sector over the past decade, India is yet to create a single, comprehensive EMS that can be accessed throughout the country.

Dr Asma Mohd Yousuf

E

MS constitutes an extension of emergency medical care into the community. It means taking medical care to every door step in emergency conditions. As per the World Health Organization (WHO) survey, there are around 30 per cent of people who die due to lack of adequate EMS. Therefore, developing strong EMS is crucial as without proper EMS, people will not be able to utilise state-of-the-art facilities despite having modern hospitals and technologies in the country.

EMS system “Emergency healthcare consists of two broad areas, EMS and Emergency Departments (ED). EMS is responsible

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for delivery of emergency care in the prehospital or out-of-hospital environment, like ambulance and on-scene care. EMS includes ambulance vehicles, ambulance drivers and emergency medical technicians (EMTs),” describes Dr Hari Prasad, CEO, Apollo Hospitals, Hyderabad.

Past to present The history of EMS dates back to ancient time when wounded soldiers were managed on field. The first communitybased ambulance service was started in London in the year 1887. However, it was not until 1960 when EMS became more organised and defined. The state of Maryland was the first to have a state-based community ambulance service

pioneered by Dr R Adam Cowley. Over the last few decades, the EMS system has had a multifold development in terms of ambulance design, patient care strategies and research.

Dr Vanita Mittal, Head Emergency Services, Max Super Speciality Hospital, Patparganj, New Delhi, elaborates, “Indian EMS is still in its infancy. The first hospital-based EMS started a decade ago when individual hospitals had their own ambulances as per requirement.

Community-based statewide EMS was started in Delhi with the launch of Centralised Accident and Trauma Services (CATS), an initiative by the Delhi Government in later 1990s. In spite of having a centralised number ‘102’ and a nation wide expansion, it failed to gain the acceptance equal to western EMS. In 2005, another community-based statewide EMS was launched by GVK EMRI (Emergency Management and Research Institute) in association with the Andhra Pradesh Government and with a common number ‘108’ for medical, police and fire emergencies. Today, many states have a community EMS system providing free pre-hospital care, police and fire services to the community through the number 108. India also has hospital-based air ambulance services at a few corporate facilities. Boat/water rescue ambulances are functional in the state of Assam in association with the 108 system.”

EMS in India Indian EMS is superior compared to other developing nations, but far from ideal when compared to the system existent

Sector Watch in Western countries. India needs lot of paramedics, ambulance privileges and more integrated systems. Moreover, 70 per cent of the Indian population lives in rural areas that do not have access to EMS. Dr N K Venkataramana, Vice-Chairman and Chief Neurosurgeon, BGS Global Hospitals, Bengaluru, agrees, “Globally, the systems are getting refined in terms of communication, documentation and care. The guidelines for rescue have been advanced to integration of EMS into the hospital services. In India, it is still at a very primitive stage. The concept of EMS has just started here. Comprehensive Trauma Consortium was the first to initiate this concept in Bengaluru.”

EMS should be unique and standardised across the country so that everyone gets identical benefits irrespective of the location. India with its vast and varied geography has a risk potential for all types of medical emergencies. The most unfortunate aspect of the current healthcare system is the huge variation in the quality of emergency health care between private hospitals in big cities and public hospitals in rural area.

In agreement Dr Mittal avers, “The conditions in most of the public hospitals are bad due to overcrowding and neglect.

The patient load is too much as compared to the available facilities. Also, there is lack of dedicated & trained doctors and nurses for providing emergency care. A lot of private hospitals also do not give too much importance to emergency departments and are lacking basic technical equipment.”

Organised pre-hospital care (ambulance services) is scanty. In cities, ambulances are owned by private businesses and operate on a strictly fee-for-service basis that are usually little more than transport vehicles and may include just a bed and an oxygen tank. They may or may not be staffed by personnel with little or no medical training. Even today, in India, pre-hospital care, including patient transport, is usually performed by bystanders without using ambulances. Dr Mittal states one study that found only two per cent of the patients were transported to the ED by ambulance. Transport of an injured

Emergency healthcare consists of two broad areas, EMS and Emergency Departments (ED). EMS is responsible for delivery of emergency care in the prehospital or out-of-hospital environment.

Dr Hari Prasad CEO, Apollo Hospitals, Hyderabad

patient to a hospital may take up to an hour, and the most convenient form of transportation may be a taxi.

Dr Mittal adds, “Challenges to the development of emergency medical services within India include improper distribution of resources, shortcomings of medical education, high patient volume and overcrowding. An additional obstacle is economic and physical access to emergency care. Although there is unrestricted access to government EDs, private EDs reserve the right to see patients based on financial status. There is no ‘911’ or consistent EMS system in India. Urban areas have private ambulances; the fees of such facilities fees are beyond the reach of the average citizen. Governmental support is financially limited.”

Changing scenario The concept of service is changing from a simple transport van to a medically assisted safe transportation and monitoring system.

Sweta Mangal, CEO, Ziqitza Healthcare Ltd, Mumbai, informs, “Worldwide, EMS has evolved over the years. In developed countries, the emergency services are funded by government and are free of cost to the people. There, people have access to emergency services within 8–9 minutes. However, in India this is at a very nascent stage but is developing at a fast pace. There is a huge scope in the next 10 years. Currently, the response time in India is 20 minutes in urban locations and 30 minutes in rural areas. Out of 32 states, presently 108 call services are available in 14 states such as Punjab, Bihar, Rajasthan and Kerala. Our support in these states is very strong and people benefit from the free ambulance services provided in these locations. “ In support, Dr Mittal says, “Max Healthcare is integrating ambulance services that covers Delhi and NCR.

The control of the ambulance fleet is centralised at the ‘Emergency Base Station’ located at Max Heart & Vascular Institute, Saket, having one common emergency telephone number - 011 4055 4055. Ambulances are dispatched from the nearest Max Healthcare facility, thus cutting down the response time taken in reaching the patient.”

Further, while discussing the ambulance services at Apollo Hospitals, Dr Prasad says, “Our ambulance services were started about a decade ago and have evolved over the years. The major changes have been the incorporation of GPS tracking systems and advanced radio communications. We have two types of ambulances - Basic Life Support (BLS) ambulances that are used to transport relatively stable patients and Advanced Life Support (ALS) ambulance that contains all emergency equipment and drugs necessary to manage any kind of patient emergency. Our hospital always provides a qualified paramedic to take care of patients during their transport.”

Need for paramedic staff It is crucial to have paramedics who are trained and certified in rescue, resuscitation, evaluation, monitoring and transportation. Adds Dr Mittal, “None of the Max Healthcare ambulances are dispatched without trained medical/ paramedical staff. Our staff is specially trained to handle ambulance transport.

We are one of the first institutes in India to start academic emergency medicine training for doctors in form of a three year Masters in Emergency Medicine programme in collaboration with Ronald Regan Institute of Emergency Medicine (George Washington University), USA. We also train paramedics in collaboration with Jamia Hamdard University to develop skilled manpower through a three year

March 2011 I

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Sector Watch Indian EMS is still in its infancy. The first hospital-based EMS started a decade ago when individual hospitals had their own ambulances as per requirement.

Dr Vanita Mittal Head Emergency Services, Max Super Speciality Hospital, Patparganj, New Delhi

training programme – B Sc in Emergency Trauma Care Technology. Decision to send a paramedic or nurse or doctor in an ambulance is taken after assessing the condition of the patient on telephone.”

Without a trained person on board, an ambulance will be only as good as any other vehicle. It is crucial to have both the right equipment and trained personnel to have an effective ambulance service.

There are very few ambulance services which have adequately trained paramedics.

Most of them are privately run.

24/7 ambulance services The ‘Dial 1298 for Ambulance’ is an initiative by Ziqitza Healthcare Ltd to provide a network of fully equipped life support ambulances 24/7. Providing details about this service, Mangal says, “In case of a medical emergency, a person can dial 1298 from any phone to access a fully equipped ALS or BLS ambulance within the shortest possible time. ‘Dial 1298 for Ambulance’ service currently covers Greater Mumbai with 52 ambulances and seven districts in Kerala with 30 ambulances. The uniqueness of this service is its multi-level differential pricing strategy making the service accessible to all. Charges for the users of the ambulance to private hospitals are normal and those to government/ municipal hospitals are subsidised. This service is provided free to victims of road

accidents and mass casualty incidents in Mumbai and Kerala.”

Common emergency call number In case of any emergency, a person tends to forget his or her physician’s telephone number. In case of a road traffic accident, the bystander might get confused as to whom to call for help. In these situations, if a simple toll free number is available, it becomes easy for a lay person to call for help at the earliest and be assured that quality patient care will be available.

108 have been considered as the national EMS number for medical, police and fire services.

Dr Venkataramana says, “Ideally it should be a single number across the country and should be incorporated in all communication systems, mobiles and emergency services so that when people travel to different places need not have confusion to access the service. In fact, it is ideal to have a single number globally as the commuting of people to different countries has become so often.”

Saving every second “In the event of a medical emergency call, there is not a minute to be wasted.

The price for time spent could well be a life. Now that being a price nobody wants to pay, whether it is getting a patient to a hospital in time or transporting vital organs across cities. This is where

In India, we are at the beginning phase and are rapidly evolving to state-of-the-art EMS by adopting established systems of the West, which have been in vogue for nearly 50 years.

Dr N K Venkataramana Vice-Chairman and Chief Neurosurgeon, BGS Global Hospitals, Bengaluru

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helicopters and fixed wing aircraft play an important role,” says Clive Lewis, Vice President Marketing, Swajas Air Charters, Chennai.

Expressing his views on air ambulance services in India, Dr Mittal says, “The air ambulance services currently are run by private companies specialised in air transport with trained personnel on board.

On site air evacuation in form of rescue of accident or disaster victims is currently not readily accessible. At Max hospital, air ambulance service is provided by collaborating with other service providers.

We do not own any air ambulances. But we have all the equipment necessary for air transport and our staff is also trained for the same.”

Describing facilities at BGS Hospital, Dr Venkataramana says, “BGS Global Hospitals in association with Deccan Aviation offers an air ambulance facility.

Air ambulance is very useful in all life threatening situations. BGS Global Hospitals has a temporary helipad behind the hospital. Though well equipped state-of-the-art air ambulances are commercially available now, yet the system needs to be refined. We need paramedics and trained doctors for such rescues. An air ambulance is an expensive facility no doubt, but the cost factor has to be overcome by participation of government, NGOs, corporates and insurance companies.”

Indian vs global air ambulance services Globally, EMS is interlinked with hospitals, operator, law enforcement, insurance agencies and the end user.

So, when the hospital receives a call, the process of evacuation starts immediately.

Here, most of the hospitals have their own EMS aircraft and helicopter that have state-of-the-art medical equipment installed in the aircraft. These aircraft are dedicated to EMS and they can land any single engine helicopter on elevated helipad or at crash sites. Most hospitals have a dedicated emergency call number for air ambulance services.

Insurance companies abroad cover the air ambulance cost, so the reaction time

Sector Watch Out of 32 states, presently 108 call services are available in 14 states such as Punjab, Bihar, Rajasthan and Kerala. Our support in these states is very strong.

Sweta Mangal CEO, Ziqitza Healthcare Ltd, Mumbai

to activate the aircraft to the location is reduced drastically.

“However, in India, all agencies, ie, hospitals, operators and end user work separately. Furthermore, aircraft is subject to availability as these aircraft are used for corporate charters. Currently, there are no dedicated aircraft for EMS; when there is an EMS requirement, the client generally calls the charter operator/hospital or the hospital calls the charter operator.

The operator then configures the aeroplane/helicopter from a passenger seating to Medevac requirement where the seats are removed and a portable stretcher is placed. Medical equipment is carried on-board, and the hospital provides the medical team,” informs Lewis. He continues, “Insurance companies do not cover the Medevac cost in India for Indians. So unless the payment is made or Hospital guarantees for the payment, the charter does not take off which results in delay.

Moreover, helicopter cannot land on accident sites, and currently no hospitals have elevated helipads.”

However, the infrastructure of every hospital in India is not designed to support such services. Expressing his opinion on this subject, Lewis says, “The current need for hospital in India is roof top helipads or dedicated helipads close to the hospitals.

Priority should be given to helicopters

by Directorate General of Civil Aviation/ Air Traffic Controllers (DGCA/ ATC) use

these helipads even if they are located in the airport runway funnel. DGCA should also give leverage to operate single engine helicopter on elevated helipads.”

Looking forward to…

In India, due to lack of awareness, even today, ambulances are used more often as a hearse than a life-saving van. It is important to educate people that ambulances are 24/7 services meant to save lives. Their purpose is beyond transporting dead bodies. Besides, the role of government support is of prime importance as then only there will be drop in the charges. Sixty per cent of the Indian population cannot afford the private emergency service costs. The government support has helped in establishing free ambulance services in 14 states. Similar support will hasten emergency facilities in the rest of the country.

With a note of positivity, Mangal says, “As per WHO guidelines, one ambulance can serve a population of one lakh. With the help of Public Private Patnership (PPP), as we have with government for 108 services in 14 states, in the coming 2 to 3 years, we aim to reach all the states in India. We plan to have 20,000 ambulances all over the country. At present, there are 214 ambulances in Rajasthan, which serve about 1200 cases per day. We aim to make it 450 ambulances in Rajasthan as then it will be adequate to help the four crore population residing here.”

Air ambulance segment will change the way India looks at Medevac service currently. Operators have sensed the need to grow this business and have taken steps to make it affordable.

Clive Lewis Vice President Marketing, Swajas Air Charters, Chennai

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However, with rapid industrialisation in India, besides road ambulances, there is also a need for adequate and affordable air ambulance facilities. “Air ambulance segment will change the way India looks at Medevac service currently,” informs Lewis.

Only if the government steps in and ensures insurance agencies work forward to support this segment, then only there will be an increase in the demand along with reduction of the cost. He further adds, “Operators have sensed the need to grow this business and have taken steps to make it as easy and affordable as possible to the end user.”

Emergency healthcare system is an evolving system that needs constant upgradation, training, implementation, software support, review and reformation.

“In India, we are at the beginning phase and are rapidly evolving to state-of-theart EMS by adopting established systems of the West, which have been in vogue for nearly 50 years. We must quickly adopt the good systems and the protocols to suit the local needs to introduce indigenous system and make the whole process cost-effective,” says Dr Venkataramana.

Further, suggesting steps that will help Indian EMS, Dr Mittal says, “Recognising of emergency medicine as a separate specialty

by Medical Council of Indian (MCI) has been the first step in the development of the Indian emergency healthcare. The entire healthcare community needs to accept this as the need of the hour and help in implementing it across the country. Besides, dedicated emergency departments with trained professionals will help to develop the services. Also, funds need to be allocated for the development of emergency services both in public and private sectors.”

For a country like India, focussing on one area of emergency care is not an option.

To make a difference, the entire spectrum of emergency services must be developed together simultaneously. It will be a team work that will demand participation of government, hospitals, policy makers, enforcements systems, safety systems, preventive systems and human resources along with apt utilisation of the funds. Pulling all the strings together will only help in creating an efficient system in the country. (asma.yousuf@infomedia18.in)

Specialty Scope

Oncology

Treating the unmet needs Cancer management involves a combination of many therapies. Chances of infertility are high following the aggressive cancer treatment. However, oncofertility offers hope to all patients who have fears of conceiving post cancer treatment. what is seen in the developed world. It remains to be determined if this is a true difference or a registration artefact.”

Further Dr Niti Raizada Narang, Consultant Medical Oncologist, Vital Diagnostic Clinic, Bengaluru, adds, “Over 70 per cent of the cases report for diagnostic and treatment services in advanced stages of the disease, resulting in poor survival and high mortality rates. The disease is associated with a lot of fear and stigma in the country.

But what is worth emphasising is that now with improving treatment modalities, ‘cancer survivorship’ has increased and so issues like fertility preservation are being brought to the forefront.”

Imaging diagnostics: An oncological risk factor?

Dr Asma Mohd Yousuf

T

he prevalence of cancer in India is rising in quantum leaps. Today, oncology OPDs of every hospital in India are overcrowded. Increased awareness among the masses along with better diagnostic procedures are some of the reasons why more and more people are diagnosed with cancer. “The current prevalence is approximately 30 lakh cases in our country, and in 2010 there were 10 lakh new cases.

The estimated load in our country could exceed that of cardiac-related diseases by 2015. The male to female ratio of cancer in India is almost equal. The common cancers found in Indian men are cancers of the mouth, tongue larynx, lung and upper digestive tract, which are all tobacco-related. In women breast cancers and cervical cancers had the maximum incidence, with breast cancer

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more prevalent in urban areas and cervix cancer more in the rural areas,” points out Dr Dhairyasheel Savant, Consultant Surgical Oncologist, Reconstructive & Microvascular Surgeon at SL Raheja Hospital (a Fortis associate), Mumbai.

Cancer prevalence in India is estimated to be around 2.5 million with over 8,00,000 new cases and 5,50,000 deaths occurring each year, informs Dr Rashmi Yogish, Obstretician and Gynaecologist, The Lady Hospitals, Bengaluru. She further adds, “Overall cancer in childhood is more common among males than females. The reported incidence of childhood cancer in India in males (39-150 per million children per year) is higher than in females (2397 per million children per year), except in North East India, and this gives a male to female ratio that is much higher than

The presence of cancer can be suspected on the basis of symptoms or findings on radiology. Definitive diagnosis of cancer, however, requires microscopic examination of a biopsy specimen. Dr Anita Balakrishna, Consultant Gynaecologist, Motherhood, Bengaluru, says, “Repeated exposure to radiations poses health hazards as these electromagnetic ionising radiation (like X rays) can remove the electrons from the molecules producing free radicals. This is responsible for molecular damage like mutations and chromosomal aberrations causing abnormal reproductive capacity.”

Medical use of ionising radiation is a growing source of radiation-induced cancers.

Ionising radiation may be used to treat other cancers, but this may, in some cases, induce a second form of cancer. It is also used in some kinds of medical imaging. Dr Rakesh Badhe, Onco Surgeon, Kohinoor Hospital, Mumbai, mentions a report that estimates approximately 29,000 future cancers could

Specialty Scope be related to the approximately 70 million CT scans performed in the US in 2007. He further adds, “It is estimated that 0.4 per cent of current cancers in the US are due to CTs performed in the past and this may increase to as high as 1.5-2 per cent considering the 2007 rates of CT usage.”

The current prevalence is approximately 30 lakh cases in our country, and in 2010 there were 10 lakh new cases.

Dr Dhairyasheel Savant Consultant Surgical Oncologist, Reconstructive & Microvascular Surgeon, S L Raheja Hospital (a Fortis associate), Mumbai

Treatment: A hindrance?

Surgery, radiotherapy and chemotherapy are the main stay of treatment in cancer patients. However, all the three modalities can affect the reproductive health of both the males and females. Radical surgery done for most female gynaecological cancers involves the removal of both ovaries along with the uterus. Radiotherapy uses high-energy radiations to kill cancer cells, which can also kill gonadal cells apart from causing fibrosis, stenosis, scarring and permanent sterility.

Chemotherapy kills the fast multiplying cells targeted at the cancer cells. These cytotoxic drugs affect other tissues as well and can cause immediate infertility or premature loss of reproductive function.

Dr Savant explains, “In the female, the ovary is particularly sensitive to the adverse effects of chemotherapy and radiation due to its finite number of unrenewable germ cells. Alkylating agents and pelvic irradiation pose the greatest threat to ovarian function.

In addition, the uterine effects of pelvic irradiation may contribute to infertility and increase the risk of pregnancy loss. Premature ovarian failure not only causes infertility but can lead to long-term health problems such as osteoporosis, cardiovascular disease and sexual problems in women.”

He further adds, “Cancer therapies also affect reproductive function in males. Both chemotherapy, particularly alkylating agents such as cisplatin, and testicular radiation pose a threat to future fertility. In addition, some surgical treatments for cancer can have an effect on transport of sperm and ejaculatory function, eg, surgery for rectal cancers. In both males and females, cranial irradiation can have a profound effect on pubertal development and long-term reproductive function.”

Gene toxicity Many anticancer agents damage DNA and interfere with its replication and repair

Cancer prevalence in India is estimated to be around 2.5 million with over 8,00,000 new cases and 5,50,000 deaths occurring each year.

Dr Rashmi Yogish Obstretician and Gynaecologist, The Lady Hospitals, Bengaluru

Now with improving treatment modalities, ‘cancer survivorship’ has increased and so issues like fertility preservation are being brought to the forefront.

Dr Niti Raizada Narang Consultant Medical Oncologist, Vital Diagnostic Clinic, Bengaluru

and with chromosome segregation in both animal and human cells, which can cause genetic diseases in the offspring.

Agrees Dr Nitin Pai-Dhungat, Consultant Obstetrician and Gynaecologist, Bombay Hospital, Mumbai, “Chemotherapy acts on rapidly dividing cells. Different drugs act at different times in cell division. Therefore, there is a higher risk of genetic abnormalities after someone has received chemotherapy.

However, it also depends on the dosage and the drugs used. Some drugs like the alkylating agents, cyclophosphamide and nitrogen mustard are particularly toxic to the testis and can cause permanent sterility.”

these concerns, using both existing fertility preservation technologies and developing new techniques to accommodate the unique concerns of cancer patients.

Highlighting on this subject, Dr Badhe explains, “The Oncofertility Consortium is a multi-institutional project to assess the impact of cancer and its treatment on reproductive health. The term was coined in 2006 by Dr Teresa Woodruff, at the Feinberg School of Medicine (Northwestern University, Chicago). By aggressively applying new reproduction techniques it can help improve the fertility prospects of cancer patients.”

Preserving fertility What is oncofertility?

The emergent discipline of oncofertility, an intersection between oncology and fertility, recognises that cancer patients and cancer survivors have legitimate concerns about their fertility. Common cancer treatments such as chemotherapy and radiation pose a great threat to reproductive functioning, and infertility is a very common side effect of cancer therapy. Oncofertility addresses

Discussing the methods available for preserving fertility in women, Dr Badhe informs, “The first method is cryopreservation that is generally done in pre-pubertal girls, where the ovarian tissue is taken and preserved in deep freeze. This can be later auto-transplanted. Stimulating the ovary to produce lots of eggs and preserving them in deep freeze to use later for conception is the

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Specialty Scope

Repeated exposure to radiations is responsible for molecular damage like mutations and chromosomal aberrations causing abnormal reproductive capacity.

Dr Anita Balakrishna Consultant Gynaecologist, Motherhood, Bengaluru

The Oncofertility Consortium is a multiinstitutional project to assess the impact of cancer and its treatment on reproductive health.

Dr Rakesh Badhe Consultant Oncologist, Kohinoor Hospital, Mumbai

Different drugs act at different times in cell division. Therefore, there is a higher risk of genetic abnormalities after someone has received chemotherapy.

Dr Nitin Pai-Dhungat Consultant Obstetrician and Gynaecologist, Bombay Hospital, Mumbai

second method applied in female patients.”

He continues,“The third method is removing eggs, mixing them with sperm, creating an embryo and preserving it, and the fourth method includes using Gonadotropinreleasing hormone (GnRH) analogues, which is given before chemotherapy begins.

This injection protects the ovaries from the effects of chemotherapy.”

Further informing on the fertility preservation methods used in male patients, Dr Balakrishna says, “In men, infertility may precede the disease itself. Further, chemotherapy or radiation therapy can cause decrease in the sperm count, motility, morphology and DNA integrity. Due to the advances in fertilisation and sperm banking technologies, all men, even those with extremely low sperm counts and motility, should be considered candidates for sperm cyropreservation. Sperm should be collected before initiation of cancer therapy; however, men with testicular cancer or Hodgkin’s lymphoma may have particularly poor sperm quality. Hormonal therapy has not been successful in preserving fertility or speeding the recovery of spermatogenesis.”

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However, given the potential of cancer therapies to cause reproductive problems, it is important to monitor a patient’s reproductive function after cancer therapy.

Avers Dr Savant, “Cancer survivors at risk for infertility should be counselled about pursuing pregnancy as soon as appropriate because the age-related decline in fertility may occur at an earlier age. In addition, cancer survivors experiencing delayed conception should be evaluated by a fertility specialist sooner than normally recommended (before 12 months of unprotected intercourse) given that such couples may have a shorter fertile window compared to couples without a history of cancer. Post-therapy options for having a family include fertility treatments including IVF, the use of donated gametes or embryos, or adoption.”

The discovery of new and more efficient anti-cancer drugs has increased the survival of the young cancer patients. The aggressive treatment has created new health problems, which were not anticipated at the time of diagnosis. Discussing the measures taken to preserve fertility in kids and teenagers, Dr

Pai-Dhungat says, “Kids and teenagers who have not reached puberty most often do not need measures to preserve fertility. The reason chemotherapy or radiotherapy act more on cancer cells and less on normal cells is because they act at the level of cell division, so obviously those cells which are rapidly dividing are more prone to the action of chemotherapy/radiotherapy. In adults, the testis and the ovaries have some of the most rapidly dividing cells and the drugs have an adverse effect on them as well. However, in kids and teenagers who have not reached puberty, the testis and ovaries have not started function, ie, rapid cell division and hence they are much more resistant to the effects of chemo/radio therapy.”

Facilities in India According to Dr Pai-Dhungat, “Sperm banking is readily available in India.

Embryo freezing is also readily available.

However, storage of ova (eggs) and the ovarian tissue is much more difficult. It is not a problem prevalent only in India but all over the world. However, things are looking up in this respect with the availability of blast freezing.”

Meanwhile, Dr Badhe adds, “The average cost of IVF cycle in the USA is around $7500 to 9000, whereas the discounted cost of IVF cycle in India is around $1500. The facilities are present in many private hospitals in various cities like Mumbai, Chennai, Delhi, Noida, Pune, Banglaru and many other parts of India. These facilities are at par with those in the developed world.”

However, Dr Narang feels, “Facilities like these are rapidly evolving in our country and most big cities have good facilities. But what is important here is that the oncologist needs to be cognisant of the patients’ needs and should be able to discuss fertility and fertility preservation options to their patients in the reproductive age group.

‘Timely intervention’ is probably the bottom line. It is vital to discuss these options before starting cancer-directed treatment so that whatever possible can be done at that juncture. Also, a subset of treated patient can regain ‘natural fertility’ some time later after treatment and so discussion with the oncologist and reproductive medicine specialist may be vital.”

Specialty Scope Legal concerns Providing details on the legal issues involved, Dr Balakrishna says, “Fertility preservation counselling is to be offered to all patients who are under 45 years and also to anyone who expresses an interest regardless of the prognosis of the cancer. Women have the legal rights to decide if they want to parent a child.

Future fertility options following cancer treatment must be considered in the patient’s best interest. The advantages of any fertility preservation must outweigh the disadvantages, both in short and long term. Every attempt is made such that the patient fully understands the risks and the benefits of her treatment plan. Any intervention must be evidence based as well as morally right. It should not give rise to unrealistic expectations nor have longterm adverse effects on the patients or the offspring. She further adds, “There is an increased risk of abnormalities with the use of Intracytoplasmic Sperm Injection (ICSI). There is also the probability of an increased risk of abortion and of genetic

defects in offspring conceived soon after chemotherapy. Informed consent should be given voluntarily by the patient after discussing the complexity of the issues surrounding the fertility preservation.

The consent should first be obtained for the collection and storage of the gametes.

Later, consent is also obtained for the use of collected material for fertilisation or reimplantation. It is important to discuss with the patient and their family, of what could happen to the stored samples in the event of the death of the patient during the course of treatment. Some would seek to discard the samples whereas others may choose to donate for research purposes.”

What future beholds?

Recent diagnostic and therapeutic advances in oncology have led to greater survival rates in children and reproductive aged adults with malignancies. Clinicians must be aware of the reproductive consequences of cancer therapies in order to anticipate and address the needs of cancer survivors so that they can lead healthy, fulfilled lives.

Dr Savant says, “Cancer patients of all age groups and gender who choose to pursue fertility preservation in the face of a cancer diagnosis demonstrate faith and attribute value to their capacity to reproduce at a time when their physical bodies are at risk of not supporting their own lives. Modern science is offering a new option to cancer patients, an option that forces patients to think about creating a new life at a time when their own life is being questioned.” He further adds that understanding the biological, social and psychosocial roots of these parenting desires can hopefully help healthcare practitioners in best counselling their patients during the decision-making period and thereafter.

“A journey of 1000 miles begins with a first step. The first few steps have already been taken but we have a very long way to go. At best it can be summarised that the field is in its infancy and it will require a lot of effort on the part of oncology community, medical fraternity and civil society for the field of oncofertility to reach its logical ends,” concludes Dr Badhe. (asma.yousuf@infomedia18.in)

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Region Snapshot Focus

The Indian healthcare sector is in the process of a paradigm shift. A few years ago, healthcare was the sole responsibility of doctor-run clinics and private practitioners. But today, we have corporate hospitals, private institutes, etc with promising expansion plans. Despite a few geographical disadvantages, the northern region of our country has seen a boom in the rise of hospitals alongwith an increasing medical tourism in the past few years. In this special edition, some key players from North India share their growth and success story.

Inside ......... 40 Spotlight ......... 44 Interface ......... 50 Snapshot

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Spotlight

Healthcare in North India

Need to fill the rural-urban disparity There is an urgent need to address the rural-urban divide in North India and scale up the skilled work force, which will open up opportunities for the healthcare sector. Besides, high project costs and lower incomes have kept the developments in the rural areas at bay. special focus of healthcare providers is now shifting to neighbouring tier II cities like Jaipur, Chandigarh, Jalandhar, Ludhiana, Dehradun and Lucknow. These cities have seen high growth in infrastructure and economic development and have become the preferred destinations for many new healthcare projects.

Heavy disease burden

S

tates of Northern India together comprise around 30 per cent of the country’s total population as well as geographical area. Over the years, the North Indian region has experienced both economic and social development, and prospered because of the Green Revolution particularly in the states of Haryana, Punjab, Rajasthan and Uttaranchal. This region also includes

Anurag Dubey Industry Manager - Health IT and Healthcare Delivery Practice, South Asia and Middle East, Frost & Sullivan

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some of the highest per capita areas like Haryana, Himachal Pradesh, Punjab, Delhi and Chandigarh. With high economic growth and increasing migratory population, the healthcare services sector has prospered in the National Capital Region (NCR, Union Territory of Delhi and a few ring towns around it – Gurgaon, Faridabad, Noida, Ghaziabad etc). Several major healthcare facilities have opened in the last two–three years, and many more are planned. NCR is amongst one of the top 10 contributors of the country’s healthcare infrastructure spending.

As a high concentration of healthcare facilities are established in NCR,

North India suffers from high levels of diseases like malaria, filaria, dengue dever/dengue haemorrhagic fever, kala-zzar and tuberculosis (TB) Celiac disease (Chronic Nutritional Disorder) exists in almost all parts of the world, although it is rare among people of purely African-Caribbean, Japanese and Chinese descents.

Hospital records have revealed an increasing trend of the disease in the predominantly wheat-eating areas of North India According to WHO projections, India needs to develop facilities for another 1.5 million cancer patients, while the same is expected to increase by 1.4 million by 2026 Coronary heart disease (CHD) and risk factors are prevalent in urban and rural populations of Northern India. Cardiovascular diseases and diabetic cases are increasing at a rate of 8 to 11 per cent per annum

Private health insurance Currently, only 8 per cent (90 million beneficiaries) of the Indian policies are under insurance/reimbursement scheme. Driven by increased

Spotlight awareness, rise in income levels and increase in employment in sectors such as IT and financial services, this is expected to increase Boosted by rising number of customers, the premium collection in 2008-09 was ` 3,976 crore and it doubled in 2009-10 to ` 7,803 crore.

Meanwhile, payment towards claim settlements by insurance firms rose by about 82.5 per cent to ` 7,456 crore last year over 2008-09, as per the data released by Insurance Information Bureau (IIB) People in Punjab, Haryana and Chandigarh set aside a huge part of their annual income for health expenses, but spend very little on health insurance. A survey, jointly carried out by Economic Research Institute, National Council of Applied Economic Research and Max New York Life Insurance, found that in Punjab, for an average household income of ` 77,325 the annual health expenses are ` 34,729, which is 44.9 per cent of the total income. Similarly, in Haryana and Chandigarh, the annual expenses on healthcare are 40.9 per cent and 59.4 per cent of their respective annual household incomes Chandigarh ranks third among the 23 states that participated in the survey. Punjab and Haryana stood at 9th and 19th, respectively, in health insurance penetration rankings Health insurance is one of the fastest growing segments with 5-year growth rate of 37 per cent. The same is projected to grow to ` 26,000 crore by 2010-11 and is expected to grow at 25 per cent for the next 5 years Insurance currently pays one-tenth of all hospitalisation expenditures in North India. The same is 30-40 per cent of revenue for hospitals in Delhi and other large towns in North India Health occupies a prominent place in the Insurance Regulatory and Development Authority’s (IRDA) developmental agenda

More state governments (for example, Punjab) are introducing their own schemes

Medical tourism With an increasing number of foreign patients opting for India as their treatment destination, medical

Insurance currently pays one-tenth of all hospitalisation expenditures in North India. The same is 30-40 per cent of revenue for hospitals in Delhi and other large towns in North India. tourism is projected to contribute revenue of ` 9,200 crore in 2012 with a growth rate of 25 per cent per annum Hospitals risk the loss of revenues and talent (ie, physicians) to foreign institutions

Wockhardt, Care, Vasan and Narayana Hrudayalaya. An estimated 150 facilities cater to those seeking topof-the-line medical treatment. About 70–75 per cent of total healthcare is provided by private healthcare.

Income levels and awareness Rapidly rising incomes in middle class; with nearly 60 per cent of population earning between ` 120,000 to ` 700,000 per annum and nearly 10 per cent earning above ` 700,000 per annum, the same is expected to increase health spending by 15 per cent per annum With increasing national literacy rate and readily available information on the Internet, journals and various interactive forums, regional magazines about healthcare there is a rapid increase in awareness about healthcare in all age groups Growing healthcare segment is expected to constitute 6.1 per cent of the country’s GDP and employ around 9 million people in 2012

Privatisation of healthcare Over the past two decades, a number of Indian private sector companies have set up hospital facilities and clinics.

Prominent examples include Apollo, Max, Fortis, Manipal, Columbia Asia,

Demographic profile Old age population projected to be ` 9.5 crore in 2011 in India.

It is projected to reach ` 17.3 crore in 2026.

New hospital projects in North India A list of some of the new hospital projects, which have come up in last two years and are slated for operations within a year: Medanta Medicity - Gurgaon Fortis Hospital – Shalimar Bagh, Jaipur and Alwar Columbia Asia Hospital, Gurgaon and Ghaziabad Pushpanjali Crosslay Hospital, NH 24, Ghaziabad Alchemist Hospital, Gurgaon Noon Hospital, Bhawani mandi Eternal Heart Hospital, Rajasthan Asian Institute of Medical Sciences, Faridabad Mayom Hospital, Gurgaon Rockland Hospital, Panesar

Fortis Healthcity, Gurgaon, Lucknow Panacea Hospital, Gurgaon Metro Hospital, Gurgaon and Faridabad Yashoda Hospital, Ghaziabad Jaypee group Hospital, Noida QRG Hospital, Faridabad Sarvodaya Hospital, Faridabad Rockland Hospital, Dwarka, Delhi Unique Hospital, Delhi NKS Hospital, Faridabad Khanna Hospital, Janakpuri, West Delhi Eye 7 Hospital, South Delhi Nova Medical Center, Kailash Colony, Delhi Action Cancer Hospital, West Delhi Sahara Hospital, Lucknow Source: Frost & Sullivan

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Spotlight

Past FDIs in hospitals in India Date

Indian company

Country of foreign investor

Foreign equity ($ million)

Dec 2002

Sir Edward Dunlop Hospitals, New Delhi

Canada

26.71

Jan 2004

Max Healthcare, New Delhi

Mauritius

6.63

Jan 2000

Dr Ramayya’s Pramila Hospitals Ltd, Hyderabad

UK

0.35

Jan 2003

Duncan Gleneagles (now Apollo Gleneagles)

Singapore

1.29

Aug 2004

Add Life Medical Institute Ltd, Building, Ahmedabad

USA

7.01

Source: Department of Industrial Policy and Promotion (DIPP)

Recent PE investments Most of the big players like Sabre Capital, India Value Fund Advisors and Dr Moopen’s Group with DM Healthcare, Warburg Pincus, IFC, Actis, AIG, Sequoia, JRE Asia Capital — have set up offices and are actively looking out for potential investment opportunities for long term. Medanta Medicity, Gurgaon, has holdings of Punj Lloyd and Avenue Capital; Fortis Medicity, Gurgaon gets equity from Trinity Capital, George Soros and Blue Ridge Capital for its various projects. This project is worth an investment of over ` 1,200 crore. Fortis Medicity, Lucknow is spread over 52 acres with an approximate investment of ` 500 - 800 crore. Apollo Hospital Enterprises received equity from Schroders, Apax Partners, One Equity Partners and IFC; Max Healthcare and Rockland Hospital received equity from IFC for its multispecialty hospitals; Nova Medical Centers from GTI and NEA; the company has opened two centres in Bengaluru, one centre in Mumbai, one centre in Delhi and is planning to open one more centre and one hospital within six months in Delhi.

It is also planning one centre each at Jaipur and Amritsar.

RG Hospital, Delhi, got equity of `50 crore from Iven Medicare (ICICI Venture) for its super-specialty Urology and Laparoscopy Institute.

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Vasan Eye care got equity from Sequoia to ramp up its number of centres all across the country. Centre for Sight, New Delhi, a chain of specialty eye hospitals has raised ` 50 crore from Matrix Partners India. The chain will use the funds to expand its network to over 60 eye hospitals in 3 years and for acquisitions of certain private eye care hospitals in Tier II and Tier III cities.

Max Healthcare and Singapore General Hospital (SGH) have collaborated for medical practice, research, training and education in healthcare services. Steris, a $1.1 billion healthcare equipment company, plans investment of $1, 00,000 to set up a fully owned arm in India to sell its devices and products in the country’s growing medical device market. NSR Direct PE Mauritius, LLC, Mauritius, invested into Capricorn Hospitality Services Pvt Ltd, Uttar Pradesh, for further investments in companies that are engaged in hospitality and healthcare.

In 2010, two projects worth $235 million were approved by Alexandria Real Estate Equities, Inc USA to Alexandria Real Estate Equities Inc New Delhi for setting up of specialised medical centres to operate and manage fully furnished, staffed and equipped facilities.

Proton Health Care, US-based healthcare products major, has a strategic tie-up with the Delhi

based S M Logistics for distributing its products in the Indian market for its range of digital health monitoring devices.

Malaysia-based hospital chain, Columbia Asia Hospitals already has seven facilities in India and plans to set up 15 new multi-specialty hospitals in India in the next 2 years. It plans to invest around ` 4600 crore for the expansion, which will take up the bed strength from the current 570-odd to over 2,000. The company has identified a few locations like Ghaziabad, Meerut, Lucknow, Pune, Ahmedabad, Trivandrum and Hyderabad for the new hospitals.

Columbia Asia Hospitals Pvt Ltd, the Indian subsidiary, has entered into an agreement that forms an alliance for the development of hospitals with DLF Home Developers Ltd (DLFH) to enable it to realise its aim of communal hospital chains. Under the agreement, DLFH would construct Columbia Asia designed hospitals upon lands situated in DLFH townships in India and then lease the lands and hospital buildings to Columbia Asia.

Government support The Government of India has promoted foreign investment in the pharmaceutical and healthcare sectors by allowing 100 per cent FDI through the automatic route. This has encouraged many investments in the past 3 years and it is expected to continue sectoral growth over the next 5 years. In addition, the opening up of real estate has enabled increased investment into the hospital sector as well. With REITs (Real Estate Investment Trusts) also getting approved, the healthcare services sector in India is expected to see rapid growth over the next 10 years.

High growth markets Entering the Indian pharma and healthcare services market gives foreign investors a chance to be part of the growing Indian economy and develop along with it. The

Spotlight Indian pharma industry has been growing steadily at a rate of 12 per cent annually over the past 3 years and is expected to continue its growth over the next 5 years. This is expected to be driven by increased domestic consumption as well as increased exports.

Earlier Tier I cities were the primary focus for private hospitals, today Tier II and Tier III cities have developed into profitable ventures for private institutions. Foreign investments into this sector are also expected to yield high returns in the next 5 years.

Challenges in North India Urban-Rural divide very visible as most private healthcare projects are in metros and Tier I cities Dearth of trained hospital staff, doctors in North India Hospitals in rural areas and Tier II towns are not focused on following healthcare standards and quality care Lack of a widely recognised Indian healthcare accreditation standard Financing and government approvals are relatively easy to obtain, but providers have to face and overcome ground-level operational challenges

Major challenge: Healthcare infrastructure Northern India has a tremendously huge urban-rural disparity. The tertiary care facilities are seen concentrated in the urban areas, whereas rural areas of Punjab, Haryana, Rajasthan, Uttar Pradesh, depend on facilities provided by Government hospitals. Significant numbers of the referral and floating population travel from these places to tier I cities like Delhi, Chandigarh, Jaipur, etc At the same time, skilled work force is found only in the urban conglomerations. Hospital chains like Fortis-Escorts Group, Max Healthcare, Apollo Hospital, Moolchand Medicity - some of the big names in healthcare delivery are high-end facilities - but again located in tier I cities like Delhi and Jaipur. Work force needed for upcoming hospitals is not available in adequate numbers due to lack of educational institutions in the North. Moreover, the Middle East and Southeast Asian countries attract a significant share of the skilled nursing and paramedical staff.

Cities like Varanasi, Kanpur, Lucknow, Manesar, Rohtak, lack the right type of healthcare facilities and trained healthcare workers as well. Roadblocks for healthcare infrastructure development in these areas are inadequate attention from private players, lack of skilled work force, high project cost vs lower incomes, etc.

Hence, private players are now focussing on emerging tier II cities. (anurag.dubey@frost.com)

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Interface

‘Physical infrastructure is inadequate to meet today’s healthcare demands, much less tomorrow’s’ …says Dr Zainab Zaidi, Assistant Director, National Accreditation Board for Hospitals and Healthcare Providers, Quality Council of India, New Delhi. She highlights the importance of accreditation and suggests ways to the government to improve the Indian healthcare scenario.

Anwesh Koley

Please give an overview of the Indian medical sector and the direction it is heading towards.

Indian medical sector comprises healthcare facilities at various levels like Primary Health Centres (PHCs) and Community Health Centers (CHCs) in rural areas, and clinics, day care centres, small healthcare organisations and hospitals in urban areas. These systems are run by the constituent states and

As per the reports on medical tourism, nearly 450,000 foreigners sought medical treatment in India last year with Singapore not too far behind and Thailand in the lead with over a million medical tourists. Medical tourism in the country is enhancing because of the accreditation-standard care and increasing sense of awareness towards quality healthcare. We already have 69 hospitals accredited by NABH.

There are inadequate public health facilities. For instance, India needs 74,150 CHCs per million of people but has less than half that number.

In addition, at least 11 Indian states do not have laboratories for testing drugs, and more than half of the existing laboratories are not properly equipped or staffed.

territories of the country. These facilities are part of a tiered healthcare system set up to provide comprehensive healthcare so as to cater Indian population. In addition, we also have traditional medical practices, which are being practiced throughout the country like Ayurveda, Unani, Homoeopathy, Yoga, etc. There are several institutions offering training in indigenous medical practice.

India is on the path to becoming a hub for medical tourists seeking quality healthcare at affordable costs.

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Accreditation, compliance with quality expectations along with reduced medical expenses and access to the latest medical technology is important since these provide tourists with a confidence that we are offering services of international standards.

What challenges do you think the healthcare system in India faces and how can the same be tackled?

The basic steps towards improved healthcare in India are but not limited to:

Policy makers must strongly pursue progressive health care policies that are practical to the needs of their constituents.

Re-evaluation and reformation of existing policies to match today’s complex and challenging healthcare is the core.

Because of expeditious population growth, the Indian healthcare industry needs to raise the number of licensed medical practitioners, which at present is 4 per 10,000 individuals. In 1991, there were approximately 10 hospital beds per 10,000 individuals, even these figures need to be raised.

Also, according to the data provided by the Ministry of Health and Family Welfare, in 1989, the total number of hospitals for all states and union territories combined was 10,157. In 1991, this number was 811,000. The issue is that the geographical distribution of hospitals varied according to local socioeconomic conditions. Hence, in order to provide consistent health care, the uneven distribution of hospitals needs to be re-examined and rectified wherever possible.

Humanitarian organisations involved in healthcare, such as WHO and UN, must continue supporting local policies and initiatives that are practical to the cultural and social realities of the people.

The government healthcare organisation catering medical needs of poor population at minimum or no cost needs to be upgraded. India’s healthcare infrastructure has not kept pace with the economic growth. The physical infrastructure is inadequate to meet today’s healthcare demands, much less tomorrow’s. While India

MMC (March_2010) 2Tab-45

Meditech Engineers Pvt Ltd

MMC (March_2010) 2Tab-46

Interface has several centres of excellence in healthcare delivery, these facilities are limited in their ability to drive healthcare standards because of the poor conditions of the infrastructure in the vast majority of the country.

Quality system based on national standards shall be incorporated so as to install continuous quality improvement in the facilities.

Also, there are inadequate public health facilities. For instance, India needs 74,150 CHCs per million of people but has less than half that number. In addition, at least 11 Indian states do not have laboratories for testing drugs, and more than half of the existing laboratories are not properly equipped or staffed.

Hospitals going for accreditation, and hence, working for quality improvisation of healthcare delivery system should be rewarded by incentives, so as to promote quality standards in the country and support accreditation structure of the country.

The Indian medical sector is faced with rising cost of medicare coupled with a demand to provide quality healthcare at affordable prices.

How can this be addressed?

In India, new diseases and increasing health risk give rise to the increasing demand of developing and introducing new technology, and development of these techniques and related parameters increases medical cost.

Further, third party administrators (TPAs) and insurance has played a major role in raising the cost. India is a growing economy where the gap between the rich and poor is widening day by day. The government, health providers and insurance companies all pay lot more attention to the preventive and primary health care.

Fair distribution of financial costs, access to cost-related information and well-developed government healthcare institutions can help.

What are your views on the Union Budget?

In the Health Budget 2011, service taxes of certain group of hospitals and diagnostic services have been raised. Hence, it is

difficult to comprehend how this move will help the common man for whom the budget has been prepared as with this the patient will end up paying much more than earlier.

Allocation of infrastructure to healthcare and education sector is however appreciated.

Except for the new tax slabs and home loan benefits the Budget 2011 is definitely not as per our expectations.

Where does the Indian medical sector stand vis-a-vis global standards?

Improvisation in patient safety through standardised system is essential. The most important need of the society is primary healthcare, but it remains the most neglected service. The posted doctors and paramedicals should be extensively trained.

The society must bring increasing pressure on nursing homes to improve their standard and state their charges clearly. Accreditation must become mandatory. The support to the hospitals for accreditation should be provided by Government or other national and international funding agencies. (anwesh.koley@infomedia18.in)

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Interface

‘We are planning to launch a 1,500-bed hospital in Amby Valley’ ‌says Dr H P Kumar, Director, Sahara Hospital, Lucknow. Explaining the services rendered, investments and expansion plans, Dr Kumar elaborates on the various initiatives taken by Sahara Hospital, Lucknow in paving the way for future growth.

Meghna Mukherjee

Kindly state the services rendered by the hospital.

At present, we are running approximately more than 50 departments. The USP of our hospital is that we have all specialties and super specialties division under one roof. From performing neuro to cardiac surgeries using the latest methods, and using the latest equipment for diagnostics, the

Please state the investment made in the hospital till now.

We have spent about ` 300 crore including infrastructure, and we are also looking at more funds in time to come. Apart from this, we have recently added a portable CT scanning system, which assists in performing complicated neurosurgeries. We are also planning to add more equipment in the long

We have recently signed a Memorandum of Understanding (MoU) with Axa Assistance India Pvt Ltd for promoting medical tourism in our hospital. We have already extended our services to London and US and are also planning many similar ventures.

hospital has many reasons to boast.

We have full-fledged laboratories and CT scanning and MRI systems.

All these units are equally important to us. We also have an excellent emergency centre at our hospital and have dedicated an OT completely to it. There are about 106 doctors (part- and full-time) and about 325 nurses. Presently, we are a 250-bed hospital and there are about 116 critical care beds.

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run that will help complicated surgeries.

us

perform

Are you planning to collaborate with any foreign university/college for academic purposes?

Yes, we plan to collaborate with many foreign universities. Recently, we have had talks with the Nebraska Medical University for academic purposes and are also in talks with Alaska University Medical Center and Mayo Clinic, US.

How many foreign patients are treated at Sahara every year?

The number of foreign patients presently visiting Sahara Hospital is not much. But we are planning to expand into medical tourism soon.

We have recently signed a Memorandum of Understanding (MoU) with Axa Assistance India Pvt Ltd for promoting medical tourism in our hospital. We have already extended our services to London and US and are also planning many similar ventures.

What are your future plans with regard to expansion?

Yes, definitely we are planning to expand our services by adding about 100 more beds to our services in another 5-6 months and gradually move onto becoming a 554-bed hospital in another 2-3 years.

Apart from this, we are planning to launch a 220-bed hospital in Gorakhpur and 1,500-bed hospital in Amby Valley. We are also planning to come up with high-end specialty centres in all the Sahara city homes and about 50 cities alone have been shortlisted in Uttar Pradesh.

We also have plans to introduce more services in the rest of the country and mainly in Uttar Pradesh.

Apart from this, we are planning to expand our horizon technologically.

We are planning to introduce the GAMA camera into our services along with PET MRI, linear accelerator and other major equipment, that help in performing complicated surgeries. (mmedit@infomedia18.in)

Snapshot

Sanjeevan Hospital, Mandi, Himachal Pradesh

Taking small steps for big causes Quality healthcare is a must in order to make India a global healthcare hub, especially for states which witness a steady arrival of tourists who in turn contribute to state’s revenue. Hence, Himachal Pradesh, with its wide tourist base, needs to set benchmarks in terms of healthcare quality, and Sanjeevan Hospital is paving path for the same. tourists, adjoining areas like Mandi, which are fast catching up on the tourist radar, are seeing the development of quality hospitals.

Benefits of Sanjeevan

Anwesh Koley

T

he state of Himachal Pradesh holds special importance as far as healthcare is concerned.

While the region has witnessed a flurry of pharmaceutical manufacturers setting up their manufacturing bases, the government has also shown enthusiasm towards developing Himachal as an ideal location for medical services.

While locals of a region will have their own healthcare requirements, for a state which excels in being a tourist destination, availability of medical services assumes high importance. Thus, it becomes important to have hospitals in areas where tourist influx can be witnessed. While the state capital of Shimla has hospitals to cater to domestic as well as international

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Sanjeevan Hospital in the town of Mandi is an apt example. Despite several innate challenges present in the town, the staff and team consists of talented and established doctors, and are further fuelled by increasing awareness and healthcare programmes for masses and underprivileged. The hospital is committed towards ensuring quality healthcare services to its patients who vary in their profile, considering the nature of the state.

Sanjeevan Hospital is one of the most reputed medical institutions in Mandi, being equipped with modern and state-of-the-art facilities for comprehensive care; right from OPD consultations and routine health check-ups, to intensive care and specialised and super-specialised surgeries.

Focus “Our primary focus is to create a healthcare institute which stands up to the expectations of our domestic as well as international patients in terms of service quality, while at the same time not being harsh on their pockets,� says Subhash Paul, Administrator of the hospital. The medical institution was established in 1993.

Cost factor Considering that a large portion of the local population cannot afford services

of a private health institution, the facilities in the hospital have been kept affordable, thereby acknowledging its social obligations.

The hospital has an efficient department of medicine with consultants specialising in different aspects like general medicine, cardiology, neurology and pulmonology. Also, a 24-hour emergency service has been initiated for all patients suffering from cerebrovascular accidents, brain haemorrhage, fever, diabetes, hypertension, heart attacks, epilepsy and headache. The surgical department forms the core competence of the hospital. Supported by a good technological backup and long-term experience, the department is well equipped to handle any type of major and extra major surgeries. Hundreds of successful surgical operations have been performed, ensuring a happy, healthy life of people.

Encouraging future The amount of infrastructural development witnessed in the state of Himachal Pradesh is truly encouraging for the manufacturing sector and in order to attract talent pool from across the country and abroad, and thus, a steady medical structure must be maintained. Hospitals like Sanjeevan are contributing towards this goal and with the passage of time, various other quality medical institutes are expected to come up in Himachal, thereby ensuring that in the near future India becomes a global healthcare hub. (anwesh.koley@infomedia18.in)

Snapshot

Action Healthcare, Delhi

Offering quality with care The Action Medical Institute promises to combine the best of quality medical services and affordability, something which the city of Delhi requires. hospitals decided to make state-of-theart medical facilities available to people in this area. With this aim, it established the Action Medical Hospital. With 400odd beds for patients and world-class medical services at its disposal, it did not take too long for the hospital to become well known for its quality and commitment towards patients.

T

he national capital region has often been applauded for the quality of medical services that are available for people. Many of the country’s finest medical institutes and hospitals are located here, which provides a wide array of medical services to local, outstation as well as international residents. Doctors, with worldwide recognition, practise and teach here that acts as a boon for ailing patients.

However, the area of west Delhi had always suffered a set back with regard to availability of medical services.

Considering the vast expanse of Delhi, commuting often posed a threat for people requiring immediate medical attention.

To address this anomaly, Action group of

Where Action Hospital fits “Our aim is to make available all medical services to our customers under one roof without compromising on quality,” says Dr D P Saraswat, CEO, Action Medical Institute. The hospital received the ISO 9001-2000 accreditation in 2008 and has also been awarded the NABL accreditation.

“We are very strict about quality and ethics here; even finicky to a certain extent.

Once we received these accreditations, we strived to make our quality international,” adds Dr Saraswat. The hospital realises the importance of stringent quality norms in today’s world where patients demand high standards in lieu of the charges they pay.

The total investment for setting up the hospital was in excess of ` 80 crore. The land for the hospital was procured from the Delhi Development Authority (DDA).

Present and future Dr (Prof) D P Saraswat CEO, Action Healthcare

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“Clinical support should be strong if we intend to attain a world-class stature.

Our patients should leave the compound

of our hospital fully satisfied,” airs Dr Saraswat. Further, Delhi has few dedicated cancer treatment facilities.

A need was felt to establish a dedicated cancer treatment facility in the area and this spurred the group to initiate the development of a cancer hospital. Hence, on April 2, 2010, the Action Cancer Hospital was established. With the existing infrastructure and quality assurance, it is currently considered the finest cancer treatment hospitals in Delhi. It was developed with an initial investment of more than ` 60 crore.

Over a period of time, Indian medical services have caught up with international standards. “During the 70s, we were 9-10 years behind the US in terms of technology adoption. Today, we are only 6-7 months behind them,” proclaims Dr Saraswat. This means that three decades ago, a technology launched in the US would take nearly a decade to reach India, whereas today it takes just half a year to be on our shores. This has led to ease of buying equipment on a much faster and larger scale. “Old equipment tend to become obsolete faster, hence our investments must increase, as we cannot continue using such old equipment,” says Dr Saraswat. The hospital has 11 state-ofthe-art Operation Theatres (OTs).

One to reckon With a commitment towards quality and availability of the best medical equipment, the Action Medical Institute is poised to attain cult status among Delhi hospitals. A dedicated team of practitioners, coupled with a no-compromising stand towards medical ethics, the institute is sure to have many more smiling customers leaving its campus with passing days. (anwesh.koley@infomedia18.in)

Snapshot

J P Hospital, Zirakpur, Chandigarh

Combining care with affordability At its infancy now, the hospital which was incepted last year has a clear vision, ie to make healthcare affordable. For this it plans to tie up with the govenment to offer services at a reduced cost to the affluent. of the city find it difficult to travel to Chandigarh because of the traffic.

Thus, this hospital stands as an advantage for them.”

sending doctors to these locations so that the process becomes all the more easy.

In this manner, basic work will be done without any hazards.

Helping the Government schemes: In this context, the hospital is ready to reduce its charges.

Extending help

Chandreyee Bhaumik

J

P Hospital, established in June 2010, is a multi-specialty, 100bed private hospital equipped with state-of-the-art facilities and specialised equipment. It is located at Zirakpur (a suburb of Chandigarh), and is easily accessible from Chandigarh, Panchkula and Mohali. Elaborating on the location of the hospital, Dr Arvind Sharma, Chief Eye Surgeon and Chairman, Medical Advisory Board, says “We are situated at the junction of four states. People who do not live in the heart

Dr Arvind Sharma Chief Eye Surgeon & Chairman Medical Advisory Board, JP Hospital

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The facilities at the hospital span from outpatient consults, general & routine care to those oriented to emergency & critical care, including a host of diagnostic, surgical & rehabilitation services. The hospital has the latest facilities for maternity care round the clock. Further, the hospital provides ambulance services and fully equipped cardiac ambulance services throughout the day.

The emergency department has three emergency and four observation beds equipped with life saving equipments like monitors, ventilators, defibrillators, etc.

Commenting on the USP of the hospital, Dr Sharma reiterates, “We specialise primarily in the trauma section. There is a medical advisory board that deals with the quality assurance.”

Business model The hospital primarily follows three core marketing strategies: Corporate sector: In this arena they take care of the healthcare management of the employees of corporate companies like Larsen & Toubro.

Tying up with primary and smaller hospitals located in the vicinity, and

Investment Discussing the investment pattern of the hospital, Dr Sharma informs, “It is approximately a ` 15-crore project. With regard to the Return on Investment (ROI), if we exclude the land cost, with the running cost alone we can break the target in a month or two.”

Experience so far Inspite of this being a relatively new hospital, it already has some memorable experiences.

Dr Sharma discusses, “Once a driver from West Bengal with several injuries on his head was admitted. The mishap had pierced his eyes too. Multiple surgeries were offered, and at present he is fine. He had nothing on his own, and no money for any surgery. The surgeons of the hospital contributed money and extended extensive help.”

On the journey of the hospital, Dr Sharma says, “Earlier there was hardly any quality healthcare in this region, however, gradually the situation is improving. In general, we receive patients from 15 villages located within a radius of 25 km.” Dr Sharma elaborates, “Usually to establish any hospital and then carve out reputation for itself is a mammoth task. However, we were fortunate enough that from the second month there were about 50-60 patients coming to the hospital per day.

Very soon we are expecting to receive 70-80 patients per day.” (chandreyee.bhaumik@infomedia18.in)

Snapshot

Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand

Providing local healthcare and more Located in the green valleys of Dehradun, the Himalayan Institute of Medical Sciences aims to achieve excellence in education, research and dissemination of knowledge. It offers healthcare and more to the local people alongwith catering to the surrounding regions.

H

IHT University (a deemed to be university) is the first medical university of its kind in the state of Uttarakhand. Spread over 190 acres of land, it is located in the lush green valley of Dehradun on the RishikeshDehradun highway, adjacent to the Dehradun Airport. The University was established under the aegis of the Himalayan Institute Hospital Trust, which is the sponsoring society. The society was founded by H H Dr Swami Rama a great yogi, scientist, philosopher, philanthropist, researcher, writer and humanitarian, who conceived, designed and made this dream project a reality.

Facilities provided The Institute has a 750 bed multi-specialty teaching hospital. The hospital has facilities for outpatients, in patients and emergency healthcare, and caters to the needs of all sections of society. The hospital has a state-of-the-art ICU, CCU and operation theatre complex

Dr Vijendra Chauhan Dean, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand

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equipped with central monitoring systems, ventilators and laminar air flow systems. The hospital also has full-fledged facilities offering homoeopathy, ayurveda, panchakarma and holistic medicine therapies. This is in keeping with the mission of providing cost-effective healthcare by integrating traditional knowledge with modern technologies. The integrated holistic approach allows medical students to gain an appreciation for various alternative and indigenous systems of medicine, in keeping with global trends of exploring new alternatives for health promotion.

Affordable care The hospital provides services at very nominal rates of Rs 70 per day in the general wards inclusive of two meals. The general OPD charges are Rs 10 per day and the patient can take opinion from any number of specialties on that day. “Those patients who cannot even afford this are treated through Sewa-ward where the bed, surgical and diagnostic charges are waived off. He is also provided free medicines worth Rs 4000. The hospital pharmacy (Kalptaru) provides quality drugs to patients at a price lower than the market price,” informs Dr Vijendra Chauhan, Dean, Himalayan Institute of Medical Sciences, Dehradun, Uttaranchal.

Leading the way Unfortunately, until recently, the state of Uttarakhand had no facility for comprehensive cancer treatment.

This void has now been filled with the development of the first-of-its-kind comprehensive cancer research centre in this institution to serve the region.

This centre is equipped with modern facilities for radiotherapy treatment, brachytherapy and nuclear medicine.

More to roll out...

Future plans include facilities for medical tourism, a dedicated trauma centre, a cardiac centre, neurosciences centre, ophthalmic centre, regional cancer centre, enhancing telemedicine services and further integration of modern medicine with Indian systems of medicine.

To sum up, here one finds a beautiful amalgamation of HH Swami Rama’s philosophy of ‘Love, Serve, Remember’, where faculty considers to teach passion, treat patients with compassion and nurture a teaching environment in which students feel happy, secure, stimulated and at the same time, challenged. “We make every effort to reach them, not just teach them, so as to enable them to blossom into beautiful human beings,” concludes Dr Chauhan. (mmedit@infomedia18.in)

Health Chip

Semiconductors in healthcare

Revolutionising medical imaging Healthcare devices enabled by semiconductors have become the first choice for professionals of the industry. This technology is definitely at the verge of a major industrial revolution.

H

ealthcare is one of the largest service sectors in India and the medical devices market is one of its thriving segments. Rise in the number of hospitals and increasing requirement for healthcare facilities is creating a need for sophisticated devices and equipment, which can provide accurate treatment. Further, the rising awareness of healthcare in emerging economies like India has created a rapidly growing need

Rakesh Joshi Business Development Manager – Medical Business, Texas Instruments India

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for innovative medical solutions such as portable and affordable ultrasound equipment for use in doctors’ offices, ambulances, mobile triage situations and remote regions. Semiconductors have always been at the vanguard of technological change, right from driving simple day-to-day consumer applications to helping in advanced industries like defence and aerospace.

Growth track The semiconductors market in the healthcare sector is essentially driven by the medical electronics segment. The Indian medical electronics market is currently valued at ` 3,850 crore (ISA Report, 2010), and is expected to grow at a Compounded Annual Growth

Rate (CAGR) of 17 per cent to reach approximately ` 8,934.03 crore by 2015.

Portability and miniaturisation are two primary attributes driving the medical electronics market, and semiconductors play a critical role in bringing these to home, clinical and imaging endequipment segments. Semiconductors such as sensors, microcontrollers (MCUs), microprocessors, Digital Signal Processors (DSPs) and Analog Front Ends (AFEs) bring high levels of functional integration in the medical equipment they are inserted into, thereby improving the equipments’ efficiency and performance levels and reducing their form factor.

India is a key market for the Medical Devices and Equipment OEMs. The semiconductor industry will play a pivotal role in designing and developing portable and affordable medical devices. The connectivity enabled by semiconductor technology (wired or wireless) will drive applications such as telemedicine, e-health and digital hospitals that will facilitate access to the required level of healthcare.

Power of technology Semiconductors are revolutionising the area of medical imaging. Devices like MRI scanners, CT scanners, Digital X-Ray and Ultrasound Imaging systems are used extensively for medical diagnosis today.

Semiconductors are transforming these into low power machines, which can be made portable to enhance and increase their reach. Semiconductor technology is increasing the accuracy of images captured by these devices, thus leading to early detection of diseases. In addition, new processors are enabling powerful

Health Chip

algorithms that will flag abnormalities at the initial stage of the disease. This can help in curing the ailment with simple medication instead of resorting to a major surgery.

Extending its high-performance analog expertise in the medical imaging market, in 2010, Texas Instruments (TI) launched two new products – AFE5807 and AFE5808, the latest additions to TI’s AFE family. The AFE5807 and AFE5808 address ultrasound designers’ need for superior performance and image quality with the best noise performance. Also, these new devices are 25 per cent smaller than competing solutions and ensure a compact system footprint for higher channel count.

TI’s TX810, integrated transmit/receive switch, speeds up ultrasound design and reduces board space by more than 50 per cent. TI’s TMS320 family of DSPs drive ultrasound into portable and handcarried units where computational efficiency is critical for performance and maximising battery life.

The most important features in monitoring a patient today are mobility, ease and effortless patient data transfer.

Mobility includes portability as well as the ability to interface with other medical devices such as anaesthesia machines or defibrillators. The ever-increasing demand to minimise healthcare costs is driving the healthcare providers to move the patient treatment and monitoring outside the hospital. Further, providing healthcare in highly populated rural and remote areas in emerging economies

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like India is driving the need for remote patient monitoring and telemedicine.

Semiconductors play an essential role in addressing the challenges of cost and mobility in patient monitoring systems. TI’s OMAPTM platform (OMAP3 and OMAP4 processors) perform digital signal processing, measurements and analytics to monitor patient condition.

Detecting abnormal conditions and communicating to a central server is essential in providing timely and ondemand healthcare. This platform offers extensive peripheral sets to support various connectivity options such as Bluetooth, Wi-Fi, Zigbee and other emerging standards.

Semiconductors play an essential role in addressing the challenges of cost and mobility in patient monitoring systems.

Key advantages Semiconductors have brought simple medical tools right to the common man’s doorstep through a number of portable devices like electronic thermometers, blood glucose meters, digital hearing aids, blood pressure monitors, etc. Availability of these tools at home will make regular monitoring easy. Connectivity solutions will enable patient data collection and analysis, which would be accessible to users as well as physicians.

Wearable and implantable devices will enable continuous monitoring.

The wearable devices would be part of a user’s clothes, shoes or wrist watch.

These devices will continuously monitor temperature, blood pressure and other parameters. The wireless connectivity and processing capability of these devices

will again alert the user if there is any condition that needs attention. Ultra-low power semiconductor devices are at the heart of this paradigm shift. Intelligent power management technology is used in these wearable and implantable devices to acquire vital signals and to process, send or store the information. TI’s ultralow power MSP430 MCU family offers high integration levels in the complete signal chain, making it an ideal choice for applications such as personal blood pressure monitors, spirometers, pulse oximeters and heart rate monitors.

Emerging trends Another emerging trend in this field is telemedicine. With ageing populations, increasing incidence of chronic diseases and the need to control healthcare costs as well as connected health technologies are becoming increasingly important. Telemedicine answers these challenges. It enables the patients and physicians to connect instantly and access accurate data in real time, making it an appropriate choice for a country like India where providing healthcare in rural and remote areas is a major challenge. The concepts of e-health and digital hospitals, which involve the optimal use of wireless/IT technologies through the use of a centralised server, enable doctors and patients to remotely monitor diseases and aid in remote prognosis–diagnosis. These concepts are also fast catching up in India. TI offers end-to-end solutions for this technology including connectivity, audio/video solutions, power and battery management.

Future opportunities On a concluding note, the medical electronics market in India is still growing and is set for greater advancements in the future. We believe that there is a tremendous opportunity if semiconductor technology is applied to medical devices so that more efficient systems can be built with lower power, lower cost and introduce it to a broader market, as with the other technologies. (ticontrib-in@ti.com)

Policy Matters

Prohibiting sex determination

Regulating misuse of technology Determing the sex of a foetus is ethically and morally despicable. The current sex ratio in various regions of the country sparks a debate. Formualting a policy may not only help in eliminating the practice but will also send out a strong message that such abortions are atrocious.

T

he Ministry of Health and Family Affairs correctly notes that, “The social, cultural and religious fibre of India is predominantly patriarchal, and this contributes extensively to the secondary status of women. The patrilineal social structure based on the foundation that the family line runs through a male makes man a precious commodity and is given a special status.” Women

Dr Sanjay Gupte MD, DGO, FICOG, FRCOG, LLB, President, FOGSI 2010

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also suffer from having limited, or often, no say in decisions pertaining to marriage, managing their lives or bodies or bodily integrity.

Such is the social fabric and allied tradition that even the birth of a girl child is considered to be an unfortunate event, since it is deemed certain to drain the family of finances (marriage expense, dowry, etc), besides potentially hampering progress (financial set back, social and classbased humiliation).

Whereas, birth of a male is rejoiced considering that they can potentially take charge and lead the family forward (carrying the family name and legacy, performing last rites, etc).

Consequently, female infanticide and foeticide are stark realities that need immediate and decisive action. The current female:male ratio in Haryana is 861:1000, leading to deleterious effects like polygamy. Overall, the current national sex ratio stands at 933: 1000. Rural ratio is at 946:1000 males, whereas urban ratio stands at 900: 1000. (Source: www.censusindia.gov.in) It is noteworthy that the urban sex ratio is more skewed than the rural sex ratio. The development and recent advances in imaging and other diagnostic devices and their

easy availability in urban settings may account for this bias. The Ministry of Health and Family Affairs observes that ‘instead of being a great deterrent in effectively countering female foeticide, the continuous demand and easy money has led medical practitioners to collude with parents and relatives to carry out sex determination’.

The Pre-Conception and Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) (PCPNDT) Act is born out of the urgency to deal with this precarious situation before more harm is done. It is the only Act besides the Medical Termination of Pregnancy (MTP) Act that addresses female foeticide.

Inspite of a few shortcomings, it is a potential intervention, which prescribes criminal punishment for contravention, and aims at checking the rampant sex determination done at various levels – from technicians with mobile ultrasonography units to research institutes with standard ultrasonography protocols.

Understanding the fine print ‘Sex selection’ includes any procedure, technique, test, administration or prescription or provision of anything for the purpose of ensuring or increasing the probability that an embryo will be of a particular sex.

‘Pre-natal diagnostic techniques’ include all pre-natal diagnostic procedures and pre-natal diagnostic tests. Again, ‘Pre-natal diagnostic test’ means ultrasonography or any test or analysis of amniotic fluid, chorionic villi, blood or any tissue

Policy Matters or fluid of a pregnant woman or conceptus conducted to detect genetic or metabolic disorders or chromosomal abnormalities or congenital anomalies or haemoglobinopathies or sex-linked diseases.

3A. Prohibition of sex-selection: No person, including a specialist or a team of specialists in the field of infertility, shall conduct or cause to be conducted or aid in conducting by himself or by any other person, sex selection on a woman or a man or on both or on any tissue, embryo, conceptus, fluid or gametes derived from either or both of them.

3B. Prohibition on sale of ultrasound machines, etc, to persons, laboratories, clinics, etc not registered under the Act. No person shall sell any ultrasound machine or imaging machine or scanner or any other equipment capable of detecting sex of foetus to any genetic counseling centre, genetic laboratory, genetic clinic or any other person not registered under the Act.

The PCPNDT Act The PCPNDT Act is inclusive of imaging and diagnostic services and does not differentiate between a technician’s work and a gynaecologist’s prescription, citing similarities in modus operandi. This necessitates dissemination of knowledge about the Act, its implications, its consequences and penalties for contravention.

The Act also specifies the indications for ultrasound in both pre-conception and pre-natal states and undermines the penalties for contravention.

Registration: It is also imperative by law for every institute, nursing home or any facility with diagnostic techniques to register themselves with the appropriate authorities.

Failure in doing so can lead to sealing of the premises, seizure of equipment, criminal charges and penalties. And failure to register may lead to teh following: The appropriate authority or authorised officer may seal and seize any ultrasound machine, scanner or

PCPNDT Checklist Registration of place (renewal) Registration of the person (qualification and experience) Display boards (size and language important) Bare act (book) PNDT register F forms (with all 19 columns and 2 declarations) Referral chits G form whenever necessary Monthly reports Additional communications (timings, vehicles, locum arrangements, change or upgradation of machines) Scraping of machines Closing down or change of the centre

any other equipment, which is capable of detecting the sex of foetus, and is used by the organisation inspite of not being registered under the Act. These machines of the organisations may be released if they pay penalty equal to five times of the registration fee to the appropriate authority concerned and gives an undertaking that they shall not undertake determination of sex of foetus or selection of sex before or after conception.

Cognisance of offences (I) No court shall take cognizance of an offence under this Act except on a complaint made by: (a) The appropriate authority concerned, or any officer authorised in this behalf by the Central Government or State Government, as the case may be, or the appropriate authority; or (b) A person who has given notice of not less than 15 days in the manner prescribed, to the Appropriate Authority, of the alleged offence and of his intention to make a complaint to the Court Maintenance of records: Person conducting ultrasonography on a pregnant woman shall keep complete record thereof in the clinic/centre in Form F and any deficiency or inaccuracy found therein shall amount contravention of provisions of section 5 or section 6 of the Act, unless

contrary is proved by the person conducting such ultrasonography.

Code of conduct: The Act obligates the society and the medical fraternity in particular to implement it by informing the appropriate authorities about any contraventions.

In a nutshell The aim of the Act is not only about creating awareness and educating society about the immorality of female foeticide, but the larger goal is to preserve the natural equilibrium of societal existence and proactively avoid deleterious impacts of skewed sex ratios.

Empowering the medical fraternity would further expedite measures against female foeticide, which threatens the very fabric of our society.

If severe and immediate measures to check abuse of diagnostic techniques are not implemented, then the status of women and the gains that have been made over the years are at stake. If there are fewer women in society, the violence against women in all its forms would go up and the resultant atmosphere of insecurity would lead women again being confined within the four walls of the home. Thus, it is an absolute need of the hour to come forward, come together and stand united against female foeticide. (mmedit@infomedia18.in)

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Curtain Raiser

Medical Fair India, 2011

A one-stop portal for med world With an aim to cover a wide spectrum of the medical world, the 17th Medical Fair India will be held at Pragati Maidan, New Delhi, during March 25-27, 2011. A preview on how this three-day event hopes to bring together the best in diagnostics, hospital, medical and rehabilitation equipment & supplies and more. categories like medical device technology and electrical medicine, physiotherapeutic processes and medical IT, in particular, captured increasing attention. Some of the major names involved last year were All India Institute of Medical Sciences (AIIMS), Delhi Medical Association, Escorts Heart Institute, Indraprastha Apollo Hospital, Ministry of Health and Family Welfare, Federation of Blood Banks, Association of Hospitals, Mumbai and many others.

Watchout for this year

Chandreyee Bhaumik

M

edical Fair India is all set to showcase the varied medical world ranging from medical furniture to medical software. This is a multi-disciplinary fair in India for diagnostics and medical equipment.

The three-day event will also witness conferences on the first two days.

The event is being organised by Messe Duesseldorf India Pvt Ltd. Suraj Ullal, Project Manager, Medical Fair India, highlights, “This is one of the leading shows as far as the B2B segment is concerned. This exhibition caters to the medical professionals as well as the trade visitors. US Commercial Service Department of the American

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Embassy is helping in promoting the exhibition.”

Looking back Last year’s show was held at Bombay Exhibition Centre, Mumbai.

The 2010 edition had 5,659 registered trade visitors and 234 exhibitors.

Last year, international visitors formed 16 per cent of the total. With prominence, in its last edition, Medical Fair India confirmed its leading position as one of the most successful trade fairs in the medical community.

It presented a complete spectrum of new products, services and processes for use in medical field and hospitals.

Besides, the general interest-garnering

Similar to the previous year, the 17th edition is also looking at the international participation from US, Taiwan, South Africa, Korea, Italy, France, Belgium, Germany, Hong Kong and Malaysia. This year, the event will be witnessing 255 exhibitors, of which 60 per cent are from the international front. In this regard, Ullal avers, “There is an increase in the number of exhibitors from 234 to 255.” Discussing the popularity of this year’s event, he adds, “While the last edition saw one hall, this year two halls are already sold out. This indicates the increasing significance of the expo.”

Further, the conference topics will highlight numerous issues such as innovative and effective models to increase healthcare infrastructure density, delivery of healthcare services to Indians, benchmark and quality standards in India. The conference will also focus on the efficiency of insurance delivery models and the role played by the enablers. (chandreyee.bhaumik@infomedia18.in)

Events Calendar

NATIONAL Medical Fair India 2011

Healthex 2011

An international exhibition and conference featuring diagnostic, medical equipment, devices and medical technology. Doctors, hospital administrators, hospital managers, directors, technicians and other healthcare professionals are expected to visit this exhibition.

Healthex 2011 is an international exhibition on hospital, medical and surgical equipment, materials, supplies and allied services, which aims to showcase the latest innovations in the field of medical technology to the medical experts from all over the country and abroad.

Date: March 25-27, 2011 Venue: Bombay Exhibition Centre, NSE Exhibition Complex, Mumbai Organiser: Messe Düsseldorf GmbH Tel: + 49 211 4560 900 Fax: + 49 211 4560 668 Email: info@messe-duesseldorf.de Website: www.medicalfair-india.com

Date: August 5-7, 2011 Venue: Bangalore International Exhibition Centre, Bengaluru Organiser: Bangalore International Exhibition Services Pvt Ltd Tel: + 91 80 65833234 Email: suresh@bies.co.in Website: www.healthex.co.in

Seventh Medicall Meditec Clinika 2011 Meditec Clinika is the third international trade fair for medical equipment and technology showcasing innovative medical products & systems in India. The event aims to take a firm step forward in revolutionising and effectively contributing to the efficacy & quality of healthcare.

Date: July 2-4, 2011 Venue: Palace Grounds, Bengaluru Organiser: Orbitz Exhibitions Pvt Ltd Tel: + 91 22 2410 2801/02/03/04 Fax: + 91 22 2410 2805 Email: info@meditec-clinika.com Website: www.meditec-clinika.com CHENNAI Tamil Nadu Mar 11-13, 2011 Chennai Trade Centre

The event aims to attract the healthcare industry exhibiting a wide range of products including hospital equipment, surgical equipment, rescue and emergency equipment, facility management and support services, hospital furniture, diagnostic/ laboratory equipment, and dental & ophthalmologic equipment. The event expects participation from more than 400 exhibitors.

Date: August 6-8, 2011 Venue: Chennai Trade and Exhibition Centre, Chennai Organiser: MedExpert Tel: + 91 9840326020 Email: medexpert@medicall.in Website: www.medicall.in om

PUNE Maharastra Oct 14-17, 2011 Auto Cluster Exhibition Centre

AHMEDABAD Gujarat Nov 2011 Gujarat University Exhibition Hall

INDORE Madhya Pradesh Jan 2012 Poddar Plaza, Nr Gandhi Hall

India’s premier industrial trade fair on products and technologies related to Machine Tools, Hydraulics & Pneumactics, Process Machinery & Equipment, Automation Instrumentation, Packaging & Auxiliaries, IT Products, Electrical & Electronics, Material Handling and Safety Equipment.

For details Infomedia 18 Ltd, Ruby House, 1st Floor, J K Sawant Marg, Dadar (W), Mumbai 400 028.

• Tel: 022 3003 4651 • Fax: 022 3003 4499 • Email: engexpo@infomedia18.in

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Second International Conference on Stem Cells and Cancer (ICSCC-2011) The event will discuss basic research on proliferation, differentiation & apoptosis of stem & cancer cells, stem cell therapy, clinical trials on stem cells, monoclonal antibodies, anti-cancer drugs, commercialisation of stem cell technology and biologics.

Date: October 15-18, 2011 Venue: Pune Organiser: School of Biotechnology, International Institute of Information Technology, Pune Tel: +91 20 22933441 Fax: +91 20 22934592 Email: icscc2011@gmail.com Website: www.isquareit.ac.in

Hospital Infrastructure India 2011 Hospital Infrastructure India 2011 is an international exhibition on hospital infrastructure, planning, supplies and healthcare development sector. This exhibition will see investors, planners, builders, contractors, architects and designers.

The wide range of products include building materials, flooring, roofing, cladding, walling, glazing, furniture, hospital supplies, etc. It is expected to be visited by senior managers, commissioners, medical centres, healthcare institutions, hospitals, CEOs, hospital administrators, medical superintendents, medical directors, executive directors, etc from the healthcare industry in the country as well as from overseas.

Date: October 21-23, 2011 Venue: Bombay Exhibition Centre, Mumbai Organiser: IIR Exhibition India Tel: + 91 22 4020 3329 Fax: + 91 22 4020 3300 Email: guru.prasath@informa.in Website: www.hospitalinfra-india.com

Events Calendar

INTERNATIONAL Medtec 2011 A trade fair on medical equipment design and technology. Designers, engineers and decision makers from this field are expected to visit this exhibition.

A concurrent conference would highlight and discuss various trends, quality and regulatory issues surrounding medical devices & equipment. A place to make new contacts and broaden one’s clientele.

Date: March 22-24, 2011 Venue: Stuttgart Trade Fair and Convention Center, Germany Organiser: Canon Communications LLC Tel: +1 310 445 4200 Fax: +1 310 445 4299 Email: info@cancon.com Website: www.medteceurope.com

MED-E-TEL 2011 An international educational and networking forum for e-health, telemedicine and health ICT. The conference will feature over 150 presentations and workshops that will highlight the current applications and future trends in this field and their impact on the healthcare system. It will also provide a great platform for networking and establishing local as well as global contacts.

Date: April 6-8, 2011 Venue: Luxepo Exhibition & Congress Center, Luxembourg, Belgium Organiser: International Society for Telemedicine & eHealth (ISfTeH) Tel: +32 2 269 84 56 Fax: +32 2 269 79 53 Email: info@medetel.eu education@medetel.eu Website: www.medetel.lu

MEDTEC UK 2011 A medical device & technology exhibition & conference showcasing technologies for design and manufacture of medical devices. Conferences will also be organised concurrent with the exhibition. It promises a good base for

building new contacts and broadening one’s clientele.

Date: April 6-7, 2011 Venue: National Exhibition Centre, Birmingham, UK Organiser: Canon Communications LLC Tel: +1 310 445 4200 Fax: +1 310 445 4299 Email: info@cancon.com Website: www.medtecukshow.com

World Vaccine Congress Washington 2011 An international exhibition of the vaccine products industry to showcase modern vaccine technologies. The exhibitor profile would include analytical instruments, labware, excipients, equipment, etc.

Professionals from the pharma and biotech industry, sales and marketing personnel, technology delivery manufacturers and members of the higher management are expected to attend this event.

Tel: + 65 6346 4402 Fax: + 65 6346 4403 Email: info@apc2011.com.sg Website: www.apc2011.com.sg

REHAMEDEXPO 2011 An international specialised exhibition showcasing modern rehabilitation technologies for remedial treatment. An array of diagnostic equipment, medical technology, IT equipment, etc, will be displayed at the exhibition. Professionals and consultants from the healthcare, health insurance, medical sciences, medical software systems, etc, are expected to attend this event.

Date: April 25-28, 2011 Venue: EcoCenter Sokolniki, Russia Organiser: MVK - International Exhibition Company Tel: +7 495 995 05 95 Email: info@mvk.ru Website: www.mvk.ru

Date: April 11-14, 2011

BioProcess International China

Venue: Gaylord National Hotel and Convention Center, Washington DC, USA

BioProcess International China will be organising its 3rd annual event and will focus on topics like Cell culture, cell line engineering, purification and recovery, process charaterisation, process analytics, formulations and disposables technologies which will be presented by top notch scientists and executives from all around the world. The objective of the event is to provide China and the regional countries with high quality presentations, case studies and strategies that will help the region’s burgeoning bioprocessing and manufacturing industries achieve their potential faster and more efficiently.

Organiser: Terrapinn Pte Ltd Tel: +61 2 9005 0700 Fax: +61 2 9281 3950 Email: enquiry.au@terrapinn.com Website: www.terrapinn.com

14th ASEAN Paediatric Congress The 14th ASEAN Paediatric Congress and the 3rd ASIAN Paediatric Otolaryngology meeting will concentrate on topics like trends, issues, priorities in paediatrics and also translate & transmit new knowledge & information to doctors and allied health professionals. The event will also conduct interactive sessions.

Date: April 14-17, 2011 Venue: Suntec, Singapore Organiser: The Meeting Lab, Congress Secretariat

Date: August 22-24, 2011 Venue: Grand Hyatt Hotel, Shanghai, China Organiser: IBC Life Sciences Tel: + 816 472 0701 Fax: + 65 6508 2407 Email: mlangley@ibcusa.com Website: www.ibclifesciences.com/

The information published in this section is as per the details furnished by the respective organiser.

In any case, it does not represent the views of March 2011 I

69

Report

Medicall 2011, Kolkata

Connecting industry with innovations The sixth edition of Medicall provided an excellent platform for exhibitors to showcase their products and services, and an opportunity for visitors to discover India’s competence in the medical equipment arena. A report.

(L) Event inaugration, (R) An overview of the exhibition

Dr Asma Mohd Yousuf

M

edicall 2011, a threeday event organised by Medexpert Business Consultants Pvt Ltd, was held at Netaji Indoor Stadium, Kolkata. The event was inaugurated by Honorable Dr Surjya Kanta Mishra, Ministry of Health and Family Welfare, Government of West Bengal, India on February 11, 2011.

East India calling Medicall was planned for the first time in East India. In a span of three days, from February 11-13, 2011, the show attracted more than 1,500 business visitors. The audience comprised specialised doctors, members of medical fraternity and medical colleges, researchers, pharma professionals, administration heads and medical directors of government, private hospitals & nursing homes, dealers & distributors and biomedical engineers. Around 150 exhibitors from India, the US and Taiwan participated in the show. Dr S Manivannan, CEO, Medicall, informed, “We have sensitised East India about the concept of hospital equipment

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fair and management seminars. Since the industry has started to boom in this region, we expect a wider reach in the coming years.” He further said, “The hospital conferences were new to certain hospital owners. Major hospitals like B M Birla Heart Research Centre, Medica Synergie Pvt Ltd, AMRI Hospitals, and Guwahati Neurological Research Centre (GNRC) and representatives from hospitals in the North East attended Medicall 2011.

Budding hospital owners tied up with a few consultants who gave lectures in the seminar for future projects.”

Medicall 2011, Kolkata, was a comprehensive trade fair for hospital requirements with concurrent medical conferences and seminars on cost control in hospitals, organising a central sterile supply department in hospitals and hospital construction. Equipment manufacturers met their objectives of meeting new clients and seeking agents in East India. In the expo, there were positive strategies towards Return on Investment (ROI) that drew enthusiasts and visitors to do business and network.

Dr Manivannan added, “Visitors felt that this event was a new concept for East India. It helped them acquire a few special products that they were unable to get in any specialists’ conferences. A few of the exhibitors were able to identify dealers for Northeast and Nepal. Around 90 per cent of exhibitors were pleased as they could close some deals, identify potential customers and dealers as well as learn about this new market.”

The aim of Medicall 2011 was fulfilled as medical equipment manufacturers as well as business visitors had an opportunity to network and facilitate informal referrals and exchanges. The event catered to the audience with a proactive pledge to offer the best the customer can desire and more.

Upcoming edition The seventh edition of Medicall is scheduled to be held at Chennai Trade Centre, Chennai from August 12-14, 2011.

Dr Manivannan informed, “Medicall Chennai will have close to 500 exhibitors, of which 100 will be international. We expect a footfall of close to 9,000 from India and many African nations.”

He further shared, “A concurrent show on hospital infrastructure called ‘Archimedis’ will be organised for the first time. This show will help budding hospital owners to find all requirements for building a new hospital. Interesting seminars on hospital management, hospital construction, laboratory medicine and quality will be organised during the event.

With this edition, Medicall will become the third largest hospital equipment expo in Asia next only to China International Medicinal Equipment Fair (CMEF) and Arab Health.” (asma.yousuf@infomedia18.in)

Product Update This section offers an overview of the latest medical/surgical equipment available in the worldwide market. If you wish to have your products featured in this section, send us the details at mmedit@infomedia18.in. Also gain added advantage through our ‘Product index’ and ‘Advertiser’s list’ to facilitate your business.

To facilitate easy and speedy diagnosis of anaemia, Trivitron Healthcare has introduced this technologically advanced, truly portable, haemoglobin (Hb) meter, URIT 12. It is a truly portable point-of-care treatment (POCT), and is user friendly for fast and accurate result. It is just a 3-step operational device, which can be used by healthcare providers. It requires a very small quantity of blood and provides results in just 10~30 seconds. This meter can hold over 250 test results.

options like MIP/MEP, Sniff, Rocc, Rhinomanometry, compliance, etc.

The report documentation generated by the spirometer is supported by MEC PFT Report Server Program. This program has several handy report tools with the help of which clear, structured and tailored reports are generated according to individual needs. The PDI spirometry software allows to perform in real-time a complete spirometry with pre-post bronchodilatator comparison, bronchial challenge test with FEV1 (and ROCC*) dose-response curve, spirometry interpretation with quality control and lung age estimation, etc. The software also includes a series of paediatric incentive animations.

Trivitron Medical Systems Pvt Ltd - Chennai - Tamil Nadu Tel: 044-2498 5050, Mob: 099620 40668 Email: skraman@trivitron.in

Helix Corporation - Bengaluru - Karnataka Tel: 080-2686 0692/0689 Email: mail@helixindia.com

Tracheostomy tube

Respirator

Global Surgimed Industries offers tracheostomy tube.

It is used to provide unobstructed airway to lungs by passing the larynx and upper respiratory tract. It is designed to maintain ventilation and respiration in patients during general anaesthesia. It is manufactured from non-toxic, non-irritant medical grade PVC compound. It readily conforms to body contours. It has soft flexible wing fixed at proximal end, which helps in easy fixation. Its terminal end is provided with 15 mm connecter and is latex free. It is available in sizes of 5.0, 6.0, 7.0, 8.0, and 9.0. The packing is sterile (sterilized by ethylene oxide gas) and is individually packed in medical grade paper pouch.

Venus Safety and Health offer ‘N 95’ particulate respirator range, designed in cup style to suit a wide range of face contours. Approved as per American Standards, it is tested in-house for protection against particle size ranging from 0.35.0 micron. Its light-weight and collapse-resistant shell makes it suitable for long duration wear. This unique design makes communication possible and assures comfortable fit with other PPE’s. These respirators are made of hightechnology filter media of micro-fine fibres and electrostatic charge ensuring over 95 per cent feature filtering efficiency. A soft cushion provided under adjustable nose clip provides leakproof snug fit.

The N 95 range of respirators includes the CN 95 (unvalved respirator), CVN 95 (valved respirator) and CN 95 OV (with impregnated carbon granules for adsorption). These respirators are used in pharmaceutical industries, medical industries, for protection from virus and bacteria, etc.

NATIONAL Haemoglobin meter

Global Surgimed Industries - New Delhi Tel: 011-2748 0250 Email: gulshan1966@hotmail.com

Spirometer Helix Corporation offers ‘MEC Pocket-Spiro Meter’ – a highprecision spirometer and pressure meter that plugs directly into a computer’s USB port. It can be upgraded with many

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Venus Safety & Health Pvt Ltd - Navi Mumbai - Maharashtra Tel: 022-2769 2646, Fax: 022-2769 0126 Email: info@venusohs.com

An invite that rewards as well...

Dear Reader, ‘Modern Medicare’ solicits original, well-written, application-oriented, unpublished articles that reflect your valuable experience and expertise in the pharmaceutical industry.

You can send us Technical Articles, Case Studies and Product Write-ups. The length of the article should not exceed 2000 words, while that of a product write-up should not exceed 200 words.

The articles should preferably reach us in soft copy (either E-mail or a CD). The text should be in MS Word format and images in 300 DPI resolution & JPG format.

The final decision regarding the selection and publication of the articles shall rest solely with ‘Modern Medicare’. Authors whose articles are published will receive a complimentary copy of that particular issue and an honorarium cheque.

Published by Infomedia 18 Ltd, ‘Modern Medicare’ is India’s leading magazine on healthcare, and related equipment & technologies. This monthly magazine was launched in December 2004 and provides the latest and most apt updates exclusively for the medical fraternity. Moreover, ‘Modern Medicare’ acts as a sourcebook that facilitates buying decisions for this key sector - hospitals, specialty clinics, pathology labs, nursing homes and doctors - and brings out highly useful business information on various healthcare facets such as surgeries, procedures, technologies, equipment et al. So get going and rush your articles, write-ups, etc…

Thanking you, Yours sincerely,

Manas Bastia Editor Infomedia 18 Limited ‘A’ Wing, Ruby House, J K Sawant Marg, Dadar (W) Mumbai 400 028 India

D +91 22 3003 4669 T +91 22 3024 5000 F +91 22 3003 4499 E manas@infomedia18.in W www.modernmedicare.in

Product Update Radiopaque thread Global Surgimed Industries offers radiopaque thread for gauge. This thread is widely used inside the surgical dressings of gauze sponges, surgical towels, gauze balls and lapotomy sponges. These threads are non-toxical & non-fluorescent products. It has good radiopacity, high strength and flexibility allowing it to be thermally attached or woven. At temperature of 135 degree centigrade; it does not have phenomena of cracking, aging, melting. This thread will not lose color after being boiled in distilled water for 35 minutes and can be sterilised. It is currently available in blue colour and other colours can be made upon request.

Global Surgimed Industries - New Delhi Tel: 011-2748 0250 Email: gulshan1966@hotmail.com,

Pulse oximeter Zigma Meditech India offers ‘Nellcor N-180’ pulse oximeter. It provides continuous, non-invasive measurement of oxygen saturation and pulse rate. These measurements are updated with each heartbeat. The saturation range is from 0 to 100 per cent and pulse rates from 20 to 250 bpm. The unit can run on AC power as well as on an internal battery. It is compact, light weight, portable, has two 3-digit green and red displays for

oxygen saturation and pulse rate and 16-segment display for pulse amplitude indicator.

It measures functional oxygen saturation of arterial haemoglobin and pulse rate. This pulse oximeter is provided with RS-232 and analog communication ports for interfacing with central monitoring systems, recorders and computers.

Zigma Meditech India Pvt Ltd - Chennai - Tamil Nadu Tel: 044-2644 1285, Mob: 098408 78122 Email: raj@zigmamedical.com

Electrolyte analyser Carewell Biotech offers ‘Carelyte,’ a fully automated ion selective electrolyte analyser for measuring sodium (Na+), potassium (K+), calcium (Ca), chloride (Cl), lithium (Li) and pH in all types of sample like whole blood, serum, plasma or urine, etc. It is available in five different combinations. This easy-to-use analyser, provides results within 40 seconds. It works on two-point calibration, both Cal-A (500 ml) & Cal-B (85 ml), and are available in individual packs. This instrument is designed for use 24x7 and has a built-in thermal printer.

Carewell Biotech Pvt Ltd - New Delhi Tel: 011-41539602/41539626, Fax: 011-66402100 Email: info@carewellindia.com

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Product Update Hospital beds Narang Medical offers seven-function ‘Comfy ICU’ hospital beds with electrically operated back rest tilting 0-80º, knee rest tilting 0-35°, trendelenburg tilting 0-20°, reverse trendelenburg tilting 0-20°, mattress base tilting to the left up to 40° and to the right up to 40°. All functions are controlled with power device (actuator). These beds have four easy lifting guard rails (two on each side), which are safe and reliable, and can be fixed upwards and downwards. The beds are easy to operate and have built-in control panel on both sides of guard rails. The separate movable nurse control panel can lock the buttons of guard rail control panels and foot step control panel. These come with removable and interchangeable ABS engineering plastic head panel and foot panel.

The head and foot panels are equipped with safety lock and roller bumpers. These hospital beds are equipped with 125 mm diameter noiseless castors with simultaneous braking system, which locks/ unlocks two castors with single pedal press.

Narang Medical Ltd - New Delhi Tel: 011-4555 4000 (100 Lines), Fax: 011-4555 4001 Email: NET@narang.com

Laser marking systems Videojet Technologies offers laser marking systems. The Videojet 7210 (10 W) and 7310 (20 W) pulsed fibre lasers are compact, versatile and low-maintenance solid-state marking systems.

These are perfect for direct parts marking (DPM) and unique identification (UID) applications on metals, plastics and other hard-to-mark materials in aerospace, automotive, electronics, medical devices and tools markets. These machines have the smallest available standard & high-resolution scan heads, with straight-out or right angle beam exits. Optional highresolution scan heads offer exceptionally large marking areas, and extra wide mark fields for high speed mark-on-the-fly applications.

No PC is required for stand-alone operation, which saves space and increases reliability & versatility for broad application range. These laser coding systems are clean to operate, have low consumable cost, and are suitable for industries with high processing requirements.

These deliver laser marking on almost any material, giving a wide range of application options.

Videojet Technologies (I) Pvt Ltd - Navi Mumbai Maharashtra Tel: 022-2778 0678, 3298 1209, Fax: 022-2778 0674 Mob: 9920227957 Email: Info.India@videojet.com

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Product Update

INTERNATIONAL Pulse oximeter Smiths Medical International offers rugged design ‘Digit®’finger oximeter, which delivers fast, reliable oximetry in an extremely handy, pocketsize solution by combining the monitor and sensor into one unit.

It provides SpO2, pulse rate and pulse strength measurements on patients from paediatric to adult. It is handyto-use for clinicians in EMS, hospital, clinical environments and at home. Its features include easy-to-use one-button keypad, easy-to-read, large LED display, runs on standard AAA batteries, auto power shutdown after 8 seconds, low battery indicator and high-impact polycarbonate shell.

Smiths Medical International Ltd - Kent - UK Tel: +44-0-1233 722 100, Fax: +44-0-1303 236 899 Email: ics@smiths-medical.com

Chair scale Seca GmbH & Co KG offers ‘Seca 952’ chair scale for weighing, especially for physically disabled or older people. Its fold-up armrests and footrests make sitting easy. Intuitive operating elements simplify the use. This chair scale is provided with brakes on wheels for secure stance. It is also equipped with ‘Seca 952’ with the ‘TARE’ function, which allows every newly added weight to be ascertained separately. The ‘HOLD’ function lets medical personnel take care of the patient first and read out the results later. The display elements are conveniently located in the handle and can be set to show kilograms, pounds or stones. The scale is easy to use because the batteries eliminate the need for connection to an electrical outlet and is capable of handling up to 4,000 weighing.

Seca GmbH & Co KG - Hamburg - Germany Tel: +49-40-2000 000, Fax: 49-40-2000 0050 Email: marketing.de@seca.com

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Product Update CPAP mask Besmed Health Business Corp offers CPAP mask, which is a flexible, one-piece silicone forehead pad.

It conforms to the contour of the forehead to provide comfort and stability during use. Due to its unique and patented adjust forehead design, it increases the flexibility and comfort for different patients. Double-layer cushion optimises seal and minimises pressure on the nose.

It is provided with quick-release clips, which allow for easy removal of the headgear and eliminate the need of adjustment.

The swivel and 360° elbow rotation connector enables easy attachment and disconnection to air tube and provides flexibility of tubing position.

Besmed Health Business Corp - Taipei - Taiwan Tel: +886-2-2290 3959, Fax: +886-2-2299 9076 Email: info@besmed.com

Cardiotest line Seca GmbH & Co offers ‘CT8000L Interpretive’ cardiotest line, which provides paperless ECG options when combined with Seca Achimed Passport Patient Record Software, allowing transmission of ECG traces into all leading clinical record systems, eg, EMIS, Vision, System One. It is equipped with 12-channel interpretive ECG with LCD screen for menu navigation and alpha-numeric keyboard and bundled with adult and paediatric interpretive software. It has easy selection of traces from 12 x 1, 6 x 2 or 4 x 3 plus Rhythm Strip one page report. All parameters including filters are easily programmed through the on-screen menu for a one-touch ECG. The features of the cardiotest line include on-screen lead test and lead-off indication, one-touch automatic or instant real-time operation, digital filters for clear traces, internal memory for up to 45 stored ECG records, etc.

Seca GmbH & Co KG - Hamburg - Germany Tel: +49-40-2000 0000, Fax: 49-40-2000 0050 Email: marketing.de@seca.com The information published in this section is as per the details furnished by the respective manufacturer/distributor. In any case, it does not represent the views of

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Product Index

To know more about the products in this magazine, refer to our ‘Product Index’ or write to us at mmedit@infomedia18.in or call us at +91-22-3003 4684 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better.

Sl No Product

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56

Pg No Sl No Product

Adult/paediatric transport ventilator.......... 25 Analyser.................................................................3 Aspirator .............................................................90 Audio/video mounting system...........................9 Audio-visual auscultation device.....................23 Banking services ............................................. 43 Bariatric/obesomatic OT table.........................83 Biomedical waste solution ................................61 Bipnasic defibrillator .........................................25 Blood glucose monitoring system .....................7 Blood pressure recorder....................................25 Cardiac OT table............................................. 83 Cardiology machine ..........................Back Cover Cardiotest line ....................................................80 Cardiothoracic surgery......................Back Cover Chair scale...........................................................78 Cleanroom design..............................................55 Clearroom equipment.......................................55 Coagulometer.....................................................27 Colour doppler...................................................84 Computed rediography.....................................53 Countersink ........................................................19 Covers..................................................................86 CPAP mask .........................................................80 Custom fabrication..............................................9 Desktop pulse oximeter ................................. 25 Diagnostic equipment.......................................27 Diamond tool.....................................................19 Direct rediography.............................................53 Disinfectant product..........................................21 Doppler ...............................................................23 Drilling tool ........................................................19 Dual syringe infusion pump ............................25 ECG .................................................................. 23 ECG machine .............................................. 84, 85 Electrical & manual needle & syringe destroyer..............................................67 Electrolyte analyser ..................................... 25, 75 Electronic patient recorder ..Front Inside Cover EMR........................................Front Inside Cover Endocrinology....................................Back Cover Endoscope...........................................................86 ERCP / endoscopy OT table.............................83 E-swl ....................................................................49 Exbiition - Healthex 2011.................................79 Exhibition - Conference on public private partnership policy framework .......................74 Exhibition-Meditec Clinika 2011.....................76 Fetal monitor............................................. 25, 85 Financial services ...............................................43 Fingertip pulse oxymeter ..................................84 Foetal monitor....................................................23 Fogging machine................................................84 Fully automatic biochemistry analyser ...........27 Fumigation..........................................................84 Gastroenterology system ................Back Cover General surgery ..................................Back Cover General surgery OT table..................................83

57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112

Pg No Sl No Product

Gun drill..............................................................19 Gynaec examination coach...............................75 Gynaecology system...........................Back Cover Haemoglobin meter ....................................... 72 Halogen lights.....................................................12 Hospital bed ................................................ 77, 90 Hospital curtain ...................................................5 Hospital furniture ..............................................75 Hospital furniture & accessories............................. Back Inside Cover Hospital furniture/OT equipments .................31 Hospital information sytem ..................................... Back Inside Cover ICU bed............................................................ 75 Imported hospital furniture / equipment.......90 Infusion pump ...................................................85 Intensive care unit..............................Back Cover Intensive care ventilator ............................. 25, 51 Kaematology analyser .................................... 27 Laboratory medicine.......................Back Cover Laparoscopy OT table .......................................83 Laser blood cleaner............................................84 Laser marking system........................................77 Layongoscopes & medical devices ...................59 LED lights ...........................................................83 LED lights with multi color..............................12 Medical apron ................................................. 86 Medical equipment............................................46 Metal door ..........................................................55 Milling cutter......................................................19 Mobile cath lab...................................................49 Mobile light ........................................................12 Modular cleanroom...........................................55 Modular tooling system ....................................19 Monitor system ..................................................11 Multi parameter defibrillator ...........................25 Multipera monitor.............................................84 Nebuilser.................................................... 23, 57 Neonantal transport ventilator ........................25 Neonatology system...........................Back Cover Nephrology system ............................Back Cover Neurology operating room...............Back Cover Neurosurgery OT table .....................................83 Nuneb PRO nebuliser .......................................57 Online B2B marketplace.......................... 33, 87 Operation table ..................................................75 Opthamology .....................................Back Cover Orthopaedic OT table .......................................83 Orthopaedic system...........................Back Cover OT / examination light .....................................90 OT light...............................................................83 OT table ....................................................... 12, 90 Oximeter .............................................................85 Oxygen concentrator.................................. 84, 85 Oxygen flowmeter .............................................90 Oxygenator .........................................................23 Pacs ................................................................... 53 Paediatric.............................................Back Cover

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169

Pg No

Paediatric OT table............................................83 Patient monitor........................................... 47, 85 Patient monitoring system................................23 Patient privacy system.........................................9 Patient transfer system ......................................83 Pedal suction ......................................................71 Pendants....................................................... 12, 83 Pocket fetal..........................................................84 Portable colour doppler ....................................84 Portable ventilator..............................................84 Powder coated & stainless steel furniture.......85 Printer..................................................................53 Prosthetic and orthotic services.......................17 Pulse oximeter.......................................75, 78, 84 Pulse oximeter & NIBP monitor .....................84 PW ultrasound scanner ....................................84 Radiopaque thread ......................................... 75 Rapid endotoxin detection system ..................85 Reamer ................................................................19 Recovery bed ......................................................75 Refurbished goods .............................................86 Respirator............................................................72 Respiratory humidifier......................................84 Scandoc DICOM workstation....................... 15 Scopy doc endoscopy IMS................................15 Self adhesive tape...............................................85 Sensor controlled suction sytem......................13 Services - Hospital consultancy........................... Back Inside Cover Shredding machine............................................67 SME finance........................................................43 Sphygmomanometer .........................................90 Spirometer ..........................................................72 Spot light.............................................................12 Stem product......................................................86 Surgical / ICU pendant.....................................90 Surgical diathermy.............................................13 Surgical instrument ...........................................90 Surgical light.......................................................13 Surgical pump ....................................................13 Syringe infusion pump .....................................84 Syringe pump.....................................................85 Taps................................................................... 19 Tourniquet ..........................................................77 Tracheostomy tube ............................................72 Ultrasound scanner............................ 23, 84, 85 Ultrasound system.............................................45 ULV fogging machine .......................................84 Urology................................................Back Cover Urology OT table ...............................................83 Ventilator ................................................... 84, 85 Vital signs monitor ............................................84 Wheelchairs and accessories ......................... 37 X imager C-arm memory .............................. 15 X-ray / C-arms ...................................................49 X-ray film............................................................53 X-ray machine............................................. 23, 84 X-ray viewer .......................................................90

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Advertisers’ List

To know more about the advertisers in this magazine, refer to our ‘Advertiser’s Index’ or write to us at mmedit@infomedia18.in or call us at +91-22-3003 4640 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better.

Advertiser’s Name & Contact Details A R V S Equipments Pvt Ltd

Pg No 61

Advertiser’s Name & Contact Details Charles River

Pg No 85

Advertiser’s Name & Contact Details GMP Technical Solutions Pvt Ltd

T: +91-11-41044444

T: +91-80-25588175

T: +91-22-66083700

E: vishvesh@arvsequipments.com

E: india.customercare@crl.com

E: projects@gmptech.net

W: www.sharpsandwastecontainers.com

W: www.charlsriverindia.com

W: www.gmptech.net

Aavanor Systems Pvt Ltd

FIC

T: +91-44-26208920 E: enquiry@aavanor.com

CII

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Comfort Orthopedic Co Ltd

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19

T: +91-80-40322500

W: www.guhring.in

E: tina.lee@comfort.com.tw

AGFA Healthcare

55

E: info@guhring.in

T: +886-5-289-2093

W: www.aavanor.com

Guhring India Private Limited

Pg No

Hospaccx India System

W: www.comfort.com.tw

T: +91-22-40642908

BIC

T: +91-09845208778 Compamedic Instruments Pvt Ltd

84

E: titus.menezes@agfa.com

E: hospaccx.india@gmail.com T: +91-11-43085193

W: www.agfa.com

W: www.hospaccxindia.org

E: sales@compamedic.com Allengers Medical Systems Ltd

49

India Mart Intermesh Ltd

W: www.compamedic.com

T: +91-172-2725695

33, 87

T: +1800-200-4444 Concept Imaging

E: allengers.marketing@allengers.net

47

T: +91-11-27551433

W: www.allengers.com

E: pr@indiamart.com W: www.indiamart.com

E: sanjeev_concept@yahoo.co.in Anand Medicaids Pvt Ltd

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Industrial Electronic & Allied Prod

W: www.conceptimaging.in

T: +91-11-25225225

77

T: +91-20-24222538 Dispowear Sterite Company

E: sales@anandind.com

86

T: +91-11-28521839

W: www.anandind.com

E: ieap@vsnl.com W: www.diamondbp.com

E: dispowear@rediffmail.com Bangalore International Exhibition Centre

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International Trading Co

85

W: www.dispowear.com T: +91-80-65833234

T: +91-33-22379476

E: suresh@bies.co.in

Endolite India Ltd

W: www.healthex.co.in

T: +91-11-45689955

BPL Limited

23

17

W: www.lifeplusmedical.com

E: endolite@vsnl.com

Kamla Molecular Medicine Pvt Ltd

W: www.endoliteindia.com

T: +91-80-22270134 E: sales.healthcare@bpl.in

Entrepreneur

W: www..bpl.in/healthcare

W: www.entrepreneurindia.in/ibi

Carewell Biotech Pvt Ltd

7

Genuine Medica Pvt Ltd

E: info@lifeplusmedical.com

86

T: +91-130-6451235 38

E: info@kamlabiotech.com W: www.kamlabiotech.com

86

Lonza India Pvt Ltd

T: +91-11-41539602

T: +91-11-40513401

T: +91-22-43424000

E: carebio@gmail.com

E: genuine@ndf.vsnl.net.in

E: prajakta.sonavane@lonza.com

W: www.carewellindia.com

W: www.genuinemedica.com

W: www.lonza.com

21

COMPLETE ENGINEERING UNDER ONE ROOF @ www.engg-expo.com

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Advertisers’ List

Advertiser’s Name & Contact Details M.S.Enterprises

Pg No 90

Advertiser’s Name & Contact Details Narula Udyog (India) Pvt Ltd

Pg No 31

Advertiser’s Name & Contact Details Sonosite

45

T: +91-866-2442786

T: +91-11-42463777

T: +91-124-2881100

E: moinmsent@yahoo.co.in

E: ptn@medikraft.com

E: india@sonosite.com

W: www.accura-healthcare.org

W: www.medikraft.com

Magna Tek Enterprises

12, 83

Orbitz Exhibitions Pvt Ltd

Pg No

W: www.sonosite.com 76

Space Labs Health Care

11

T: +91-40-39803687

T: +91-40-66668036

T: +91-22-39504586

E: sales@magnatekenterprises.com

E: info@spacelabs.com

E: info@meditec-clinika.com

W: www.spacelabshealthcare.com

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