Medgate today march april 2018 by Medgate Today

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Volume VIII || Issue VI || March-April 2018

The Gateway to Health & Medical Worldâ&#x20AC;&#x201A;

Cervical Cancer Kills One Woman The Future of Diagnostics in India How Healthcare media can be part of your Business An Advance Media Publication

Advance Media Group A Health Journalism

MEDICAL TOURISM

EDITOR SPEAK

Global Medical Tourism Trends and Forecast by 2021 Market Research Report 2018 The Global Medical Tourism Market was worth USD 19.7 billion in 2016 and estimated to be growing at a CAGR of 18.8%, to reach USD 46.6 billion by 2021. Medical tourism is defined as to travel across countries with the reason for benefiting medical treatment of some form, which might not be accessible in the travelers’ nation of origin. This treatment may incorporate a wide cluster of therapeutic services. However, the most frequently profited services includes dental care, elective surgery, fertility treatment, and cosmetic surgery. Developed nations like the U.S., Germany, UK, Japan, Canada, and France offers highly advanced treatments. So, patients used to travel to such destinations when the quality care is not available in the local environment. High treatment costs and long waiting time’s circumstances for medical procedures, advancements in technology, and development of market are the major factors driving the growth of the market. Stringent documentation forms, issues related with visa endorsement, and limited protection scope are the restraining the growth of the market. Developing countries with evolving innovation and technology is fueling the market. The Global Medical Tourism Market is broadly segmented into type of treatment. On the basis of the type of treatment, the market is further segmented into Orthopedic Treatment, Cardiovascular Treatment, Dental Treatment Fertility Treatment, Cosmetic Treatment, Neurological Treatment, Cancer Treatment, and Others. On the basis of geography, the global market is analyzed under various regions namely North America, Europe, Asia-Pacific, Latin America, Middle East and Africa. Cosmetic treatment holds the largest share, because cosmetic treatment is not covered under insurance. Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m

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2018

Volume - VIII Issue - VI March-April 2018 Editor Feature Editor Editorial Advisor

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Dr. ma Kamal Razi Ahsan GP Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia Afzal Kamal Dr. Sarika Gupta Deepti Tripathi, Rushda Parveen Hina Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Zyaul Haque Ansari All right reserved by all everts are made to ensure that the information published is correct 'Medgate today’ holds no responsibility any unlikely errors that might occur. Circulation Office:

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Medical tourism in India Volume - VIII Issue - V March-April 2018 Dr. Pravin. K. Nair

Patient Safety & Powdered Gloves Dr. Dipak Shukla

Dr Sushil Shah,

The Future Of Diagnostics In India

QUALITY HEALTHCARE AND BEYOND– PSRI PERSPECTIVE

Dr Sarika Gupta

Medical tourism in India

Dr. V. Mohan

Dr. Santosh Dhage

India’s Most The New, Science-Based Impactful Diabetologist Non-Surgical Treatments for Heart Blockages Afzal Kamal

Dr. Sandeep Nayak

How Healthcare media can be part A guide to healthy living of your Business development for Cancer survivors & Help in Medico Legal

6 SRL Analysis – Kidney Dysfunction most common in Eastern India �� 6 Commemorative postage stamp and book release function on shri b.Nagi reddi – �� 8 Influenza A is a shapeshifter, with new strains emerging each year This condition �� 10 FDA warns duodenoscope manufacturers about failure to comply with required postmarket �� 10 A Rainbow for Delhi NCR Children �� 14 Budget Reaction by Indian Medical Device Industry Budget 2018-19 –Highly Disappointing �� 20 A guide to healthy living for Cancer survivors �� 22 Every 7 Minutes Cervical Cancer Kills One Woman �� 28 SMART Lab CME on Quality Management for Clinical Laboratories @Chennai �� 30 Advisory On How To Cope Up With Stress During Exams �� 38 Akas Medical Leading name in medical device industry in India �� 44 Chasing SDG Goals Interconnectedness of Health, Poverty and Livelihoods �� 46 India Hospital Design & Build Summit 2018 edition �� 48 HITLAB and Unitus Seed Fund Announce Winners of 2018 HITLAB World Cup: �� 50 A game changer for Cervical Cancer �� 52 Why Ayurveda Should be the First Choice for Chronic Kidney Disease �� 54 Curofy Partners with Bajaj Finserv to Provide Financial Aid to Doctors ��

Cover Story Medical Tourism India Emerging As A Top Destination

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NEWS Update

Curofy Partners with Bajaj Finserv to Provide Financial Aid to Doctors

Assists doctors in setting up their clinic, buying medical equipments and expanding business In the quest to build a strong support system for doctors, Curofy, a leading social media networking app, specifically developed for doctors’ community, has recently collaborated with Bajaj Finserv to help its users with easy loans and financial assistance on their app. This strategic collaboration is the outcome of 3 months long pilot between Curofy and Bajaj Finserv which has helped various doctors in breaking the financial barriers to solve clinical problems. Through this initiative, more than 1000 doctors havealready received financial aid in setting up their clinic, starting their practice, expanding their business expansion, purchasing medical devices and buying real estate.All these loans are unsecured loans that do not require any collateral to be given by the doctor, exceptonly few cases, where doctors who want home loan or loan against property needs to provide collateral. On this business collaboration, Nipun Goyal-Founder of Curofy, said, “Being a trusted networking app for doctors, we always want to make the practice of doctors more efficient. Everyday, many doctors on Curofy send us requests seeking assistance in various aspects of their practice like getting collateral-free loans, finding job or staff, buying medical devices, seeking medico-legal advice and insuring their practice. We have partnered with many service providers to help them with the same.”

“Our collaboration with Bajaj Finserv is a big step towards this. They have a strong on ground teamto support doctors whenever needed. The partnership will definitely help us bring a change in doctors’ life. As part of this association, we are aiming to provide loans to more than 10,000 doctors in the next 12 months.”, said Nipun. “We are extremely delighted to partner with Curofy to provide financial assistance to doctors. We believe in the potential of technology and process innovation to disrupt the status quo and build a large scale, sustainable business. Our partnership with Curofy will enable a stronger customer convenience creating a win-win proposition for the all the members in the ecosystem”, said Neeraj Pandey, National Manager, Online Business, Bajaj Finserv With this collaboration, both the companies are looking to digitize doctor loan segment by eliminating paper work in long term. Currently, a loan request can be easily sent by a doctor on the Curofy app. Based on his/her profile and history, the doctorquickly gets to know how much loan is he/she eligible for. Further, the loangets disbursed within 48 hours. Curofy is one of the fastest growing digital healthcare start-up with over 2,20,000 doctorsactively discussing medical cases on the platform. Apart from loans, the app also provides medical practice insurance, medical devices, jobs and medico-legal help to the doctors.

SRL Analysis – Kidney Dysfunction most common in Eastern India • Analysis based on more than 4 lakh samples received for kidney function testing • Observed kidney dysfunction higher in women (average 11.36% prevalence) than in men (9.48%) On the occasion of World Kidney Day, SRL Diagnostics – a leading diagnostic chain in India – revealed that Eastern states might have higher number of undetected kidney related diseases than other parts of India. The analysis test results were gleaned from the two main parameters: Blood Urea Nitrogen (BUN) and Creatinine, used for assessing kidney function. The data is based on more than 400,000 tests done at SRL Labs across India between 2013 and 2017 as part of preventive health checkups for kidney function. Blood Urea Nitrogen is a waste product produced by the liver during processing of protein and is removed from the blood by the kidneys. Similarly, Creatinine is a product from 6

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the normal breakdown of muscles in the body. The kidneys remove both BUN and creatinine from blood. As kidneys start malfunctioning the levels of these markers go up in blood. In India, WHO had projected that the number of deaths due to CHRONIC DISEASES would rise from 3.78 million in 1990 (40.4% of all deaths) to 7.63 million in 2020 (66.7% of all deaths). Traditionally, health programs for prevention of chronic diseases are focused upon hypertension, diabetes mellitus and cardiovascular diseases. However, the increase in the prevalence of chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) and the consequent

financial burden of kidney transplantation is dawning upon us as in India diabetes and hypertension account for 40–60% cases of kidney dysfunction. The approximate prevalence of CKD is 800 per 10,00,000 of the population. Commenting on the same, Dr B.R Das, Advisor and Mentor - R&D and Molecular Pathology, SRL Diagnostics said, “At present 17 in every hundred citizens in India suffer from some form of kidney disease. Approximately 6 lakh women are estimated to die of kidney disease every year. Epidemiological research studies highlight sex-specific differences in the prevalence and outcomes of chronic kidney disease (CKD) with specific issues relating to reproductive health and pregnancy in women with CKD. Owing to this published gender disparity and ignorance of kidney health among women, The 13th World Kidney Day campaign focuses well on Kidney and Women Health: Include Value and Empower. Making women aware of the risks of CKD and implementing the targeted, gender-sensitive prevention measures appears to be need of the hour for combating this silent killer disease.”

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NEWS Update

COMMEMORATIVE POSTAGE STAMP AND BOOK RELEASE FUNCTION ON SHRI B.NAGI REDDI – FOUNDER VIJAYA

MEDICAL & EDUCATIONAL TRUST, CHENNAI Vijaya Group of Hospitals (Unit of Vijaya Medical & Educational Trust) held a grand function at Chennai on the occasion of unveiling of the Commemorative Postage Stamp on Shri B.Nagi Reddi, its Founder. The release of the Stamp was done in the August presence of the Chief Guest – Shri M.Venkaiah Naidu, Hon’ble Vice President of India and Guest of Honour – Thiru Banwarilal Purohit, Hon’ble Governor of Tamil Nadu. The programme was graced by many senior members of the film fraternity and healthcare industry. On this special occasion, a book on Shri B.Nagi Reddi was also released. The Commemorative Postage Stamp was released by Shri M.Venkaiah Naidu, The Hon’ble Vice President of India. Thiru. Banwarilal Purohit; The Hon’ble Governor of Tamil Nadu released the book ‘The Legend - Shri B.Nagi Reddi’ on the same day. This book edited by Late Shri B.Venugopal Reddi (Son of Shri B.Nagi Reddi) and co-edited by Smt.B.Bharathi Reddy (Trustee & CEO – Vijaya Group of Hospitals) is a compilation of the key incidences in the life of a great man – Shri B.Nagi Reddi. The Hon’ble Vice President of India highlighted the contributions of Shri B.Nagi Reddi to the society. In his speech, the Hon’ble Vice President congratulated the Management of Vijaya Group of Hospitals for having carried forward the legacy of the Founder. The Hon’ble Governor of Tamil Nadu spoke about how Shri B.Nagi Reddi’s life in itself would be an inspiration for many given the kind of personality he was. This grand function was held at Hotel Green Park in Chennai. The Dignitaries among many included Shri M.Venkaiah Naidu - Hon’ble Vice President of India, Thiru. Banwarilal – Hon’ble Governor of Tamil Nadu, Thiru. D.Jayakumar - Minister for Fisheries and Personnel and Administrative Reforms, Shri M.Sampath – Chief Post Master General, Tamil Nadu and Shri AV.M.Saravanan – AVM Productions. The other dignitaries from Vijaya Group of Hospitals who graced the diaz included Shri B.Venkatrama Reddy – Managing Trustee (Designate), Smt.B.Bharathi Reddy – Trustee & CEO, Smt.B.Vasundhara – Trustee & Shri B.Viswanatha Reddi – Chief Administrative Officer. The multifaceted personality, Shri B. Nagi Reddi, at once an eminent publisher, successful film producer, philanthropist and a great lover of humanity, was born on 1st December, 1912 as the second child of Bommi Reddy Narasimha Reddy and Erukulamma, in the village Pottipadu, in the Kadapa district of Andhra Pradesh. Initially, he took care of his father’s onion export business, but his elder brother B. N. Reddy was instrumental in getting him involved in the film industry. Taking over from him the management of Vauhini Studios in 1948, he developed it as the largest studio in South East Asia, in less than 10 years. The Telugu film ‘Shavukaru’ was the first film produced by him under the banner of Vijaya Productions. The story for this first film of his was provided by Shri Chakrapani, who became his friend philosopher and guide in later years. This exemplary collaboration 8

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heralded the golden era in the world of Telugu, Tamil, Kannada and Hindi cinema. Starting his career as a letter press printer in 1944, he chose to join hands with Shri Chakrapani and extended his activity into publishing a socio-political monthly, ‘Andhra Jyothi’ in Telugu in 1945. He later established one of India’s largest offset printing presses, Prasad Process, which was then the only plant in India specialising in printing large size 24 sheet integrated hoarding posters. No wonder that Prasad Process was classified as an ‘A’ class printer in South India, winning the maximum number of awards from the Government of India for excellence in printing. Conceptualized by B. Nagi Reddi and his friend Chakrapani, the monthly children’s magazine ‘Chandamama’ was launched in the year 1947, the year our nation won independence, with the idea of making the children of India learn, think and dream together, despite their different mother tongues. Soon it became a household name. Besides English and Sinhalese, Chandamama was published in 14 Indian languages – Telugu, Tamil, Malayalam, Kannada, Sanskrit, Hindi, Marathi, Bengali, Odia, Assamese, Gujarati, Gurumukhi (Punjabi), Sindhi and Santhali (a tribal language). Chandamama also had a Braille edition in four languages for the visually impaired, distributed free. As an emerging entrepreneur he held several high positions. • President, All India Master Printers’ Federation for three terms. • President, South Indian Film Chamber of Commerce for three terms. • President, Film Federation of India for two terms. • Chairman, Tirumala Tirupati Devasthanams Board. B. Nagi Reddi’s dynamism could not be contained in all these achievements and the numerous accolades he received. His great aspiration was to provide “quality medical service at affordable cost to the society’. His vision led to the establishment of Vijaya Hospital in 1972 which was one of the first multispecialty hospitals in Chennai. With initial bed strength of 30, the hospitals have now grown over 600 beds under the banner of Vijaya Medical and Educational Trust. Vijaya Group of Hospitals is now one of the largest healthcare providers in South India and one of the most trusted Medical institutions. The Trust encompasses Vijaya Hospital, Vijaya Health Centre, Vijaya Heart Foundation and Vijaya Eye Foundation.

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NEWS Update

Influenza A is a shapeshifter, with new strains emerging each year This condition can be a huge economic burden and reduce productivity

FDA warns duodenoscope manufacturers about failure to comply with required postmarket surveillance studies to assess contamination risk

Past National President Indian Medical Association (IMA), said, “We need to understand how vaccines work. They mimic an infection, exposing the body to a germ, but in a weakened form. When confronted by another microorganism, the immune system takes a few days to produce an array of antibodies. The antibodies stay even after the microorganism has been vanquished in case it comes back. However, the virus that causes flu has evolved manifold to avoid this detection by antibodies. Called, antigenic drift, minute genetic changes happen as the virus replicates, which make it different every season. Another change is called the antigenic shift in which genetic material is exchanged between Influenza A subtypes to create a brand-new strain to which few people, if any, have immunity.” Influenza or ‘the flu’ is a highly contagious disease caused by infection from influenza type A or B (or rarely C) virus. These viruses infect the upper airways and lungs. Flu is not similar to a common cold and can be a serious illness. It is particularly of harm to the elderly and those with underlying medical conditions. Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Influenza can also bring in other health complications such as bacterial pneumonia, ear infections, sinus infections, and worsening of chronic medical conditions, such as asthma, or diabetes. It is, therefore, important to not ignore symptoms of a flu. Chest pains and shortness of breath might indicate a lot more.” The following tips can help prevent influenza. • Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too. • If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others. • Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. • Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub. • Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. • Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

The U.S. Food and Drug Administration today issued warning letters to all three duodenoscope manufacturers for failing to comply with requirements of federal law under which they were ordered to conduct postmarket surveillance studies to assess the effectiveness of reprocessing the devices. As part of an ongoing effort to prevent patient infections associated with the transmission of bacteria from contaminated duodenoscopes, the FDA in 2015 ordered U.S. duodenoscope manufacturers Olympus, Fujifilm and Pentax to conduct a postmarket surveillance study to determine whether healthcare facilities were able to properly clean and disinfect the devices. Specifically, as part of their approved study plans, all three manufacturers are required to conduct a study to sample and culture reprocessed duodenoscopes that are in clinical use to learn more about issues that contribute to contamination, as well as a human factors study to assess how well trained hospital staff are following the reprocessing instructions. To date, Olympus has failed to commence data collection, and Pentax and Fujifilm have failed to provide sufficient data, as required for their respective studies to sample and culture reprocessed duodenoscopes that are in clinical use. Olympus and Pentax also have not complied with requirements for their respective human factors studies to assess how well hospital staff are following reprocessing instructions; Fujifilm has been meeting its requirements for its human factors study. “The FDA has taken important steps to improve the reprocessing of duodenoscopes, and we’ve seen a reduction in reports of patient infections, but we need the required postmarket studies to determine whether these measures are being properly implemented in real world clinical settings and whether we need to take additional action to further improve the safety of these devices,” said Jeff Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health. “We expect these device manufacturers to meet their study obligations to ensure patient safety.” Duodenoscopes are flexible, lighted tubes that are threaded through the mouth, throat and stomach into the top of the small intestine (duodenum) and are used during endoscopic retrograde cholangiopancreatography, a potentially life-saving procedure to diagnose and treat problems in the pancreas and bile ducts. In 2013, the FDA learned about a potential association between multi-drug resistant bacteria and duodenoscopes. Upon further investigation, it became clear that these cases of infection were occurring despite confirmation that device users were following proper manufacturer cleaning and disinfection or sterilization instructions.

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DOCTOR SPEAK

Tuberculosis The Scourge of India

Dr. Shalu Verma Kumar CORE Diagnostics

uberculosis (TB) is an infectious disease variously named consumption, white plague, phthisis, or scrofula. It has been rampant in India, with the first cases being reported as early as 1500 BCE. As we celebrate the WHO World TB Day on 24 March 2018, we need an up-to-date assessment of our efforts to control TB. In 2016, 10.4 million people worldwide became ill with TB, with ~1.7 million people dying of it. As per the Global TB Report 2017, a whopping 26% of these deaths (4.23 lakhs) were reported from India. The incidence of TB in India remains high—2.790 million patients in 2016. However, the incidence has declined during the 2000-2016 period, such that the rate (2016) stood at 211/100000 population/year. India led the world in notification of new TB cases, with a 37% increase during the 2013–2016 period. The issues of HIV/AIDS, and multi-drugresistant tuberculosis (MDR-TB) further complicate TB control in India. The government of India initiative ‘Revised National Tuberculosis Control Program’ (RNTCP) is tasked with TB control in India. India allocated US$ 525 million for TB prevention, diagnosis, and control in 2017. Plans are afoot to carry out a national TB prevalence study in 2018. Tuberculosis is caused by one of several bacteria belonging to the Mycobacterium tuberculosis complex (MTBC). Of these, Mycobacterium tuberculosis is the most

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important causative agent. One-third of the world's population is infected with this bacterium. Those infected may either carry latent TB (these people do not feel sick, do not have any symptoms, can’t spread TB, and are usually positive in PPD skin test) or show active disease. Symptoms of active TB include coughing that lasts ≥3weeks, chest pain or coughing up of blood and sputum. Early symptoms may include unexplained weight loss, fever, fatigue, weakness, night sweats, chills etc. Infection spreads when you breathe TB bacteria shed into air by a patient with active disease. Such patients can spread disease by coughing, sneezing, or simply talking. Approximately 10% of people with latent TB infection, go on to develop active TB disease. People with compromised immune system (such as HIV/AIDS patients), those who inject illicit drugs, and who have past history of inadequately treated TB have increased risk of progression to active TB disease. Diagnosis starts with a physical examination wherein a doctor examines your lungs with a stethoscope and checks your lymph nodes for swelling. He/she may next order a chest X-ray or a CT scan which may show white spots (granulomas) in your lungs where your immune system has trapped TB bacteria. Should the chest X-ray be suggestive of TB, your doctor may take samples of your sputum (the mucus brought up by coughing). This is examined under the microscope, and also cultured to find out the strain of bacteria, and which antibiotics are effective. The commonest TB test is a simple skin test called the Mantoux test. In this, the physician injects a substance called PPD tuberculin into your arm. A swelling or bump at the site of injection post 48 to 72 hours shows that you are likely to have TB. Nucleic Acid Amplification Tests are routinely used in TB diagnosis. The US Food and Drug Administration (FDA) has approved QuantiFERON-TB Gold Plus (QFT-Plus). Treatment of TB is immensely possible. It requires close cooperation between the

patient and the physician. The treatment lasts at least 6 months in duration but may extend to 12 months. Treatment involves taking one, or several different antibiotics. The most common antibiotics prescribed are Isoniazid (INH), Rifampin (RIF), Ethambutol, and Pyrazinamide. For a person with latent tuberculosis, the doctor might treat you with isoniazid for at least six months. The side-effects of these drugs may include lack of appetite, nausea, vomiting, abdominal pain, skin rashes, joint pain, blurred/changed vision, ringing in ears, hearing loss etc. However, it is dangerous to discontinue your TB drugs, or not take them regularly. The Tb bacteria could continue to proliferate in your body, and even develop resistance to the prescribed drugs. Thus, drug-resistant TB evolves when you are infected with a TB strain that is resistant to one or more of the standard antibiotics. Drug-resistant TB is more frequently encountered in people who do not take their prescription drugs regularly or as prescribed, are in close contact with a patient with drug-resistant TB, have relapsed disease, or hail from areas where drug-resistant TB is common. Patients resistant to isoniazid (INH) and rifampin (RIF) are said to harbour MDRTB. In 2016, there were 147,000 such patients in India, with an incidence rate of 11/100000 population/year. Patients with MDR-TB are treated with several antibiotics each day for up to two years, but mortality rate in such patients remains high. About 6.2% of MDR-TB cases worldwide have extensively drug-resistant TB (XDR-TB). Patients with XDRTB are resistant to at least four anti-TB drugs. Such patients in addition to being resistant to INH and RIF, are resistant to fluoroquinolones (such as levofloxacin or moxifloxacin) and to at least one second-line drug (amikacin, capreomycin or kanamycin). Once treatment of such patients is initiated, isolation is usually neither necessary nor appropriate. Tuberculosis control shall entail a sustained commitment by scientific, political and social authorities in India. It is time to tackle this scourge on a war footing.

INTERVIEW

A Rainbow for Delhi NCR Children TAKING HEALTHCARE FOR CHILDREN TO ANOTHER LEVEL, RAINBOW CHILDREN’S HOSPITAL HAS CREATED ITS MARK IN THE MEDICAL FIELDAS A FIRST-OF-ITS-KIND 24/7 COMPLETE CARE FACILITY FOR CHILDREN provide unmatched medical care. We provide all pediatric care ranging from simple to complex and eventually would like to offer all specialty services under one roof. What inspired you to build an institution for children’s healthcare?

Dr. Ramesh Kancharla

MD Peds., MRCP (UK) Chairman & Managing Director, Rainbow Group of Hospitals

n a heart-to-heart conversation, Dr. Ramesh Kancharla shares the inspiring journey, his experiences and vision for the group. What are the reasons behind Rainbow Hospital’s success? The willingness to take complete responsibility not just for survival, but improving the quality of life for the child is what distinguishes us. Our highly talented team of consultants with global exposure backed by local experience and state of the art infrastructure for children is a key differentiator. The expertise and dedication of our doctors who are available 24/7 while providing the highest quality of care from conception to childbirth to treating all ailments of children has made Rainbow the first choice. We have benchmarked our practices and systems to world class centers. Our clinical care is unparalleled in the Healthcare system in India. Our doctors and paramedical staff are trained to take care of the little one as their needs are different. At Rainbow, we have created an ambience where the child feels at home. That's why we say, "Children First, Always" We desire to add value to all the professionals practicing with us. This is supported by the infrastructure and the latest equipment under one roof, making a difference in the lives of those who come to us either as patients or partners in growth. At Rainbow, we believe in teamwork and

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I was working with world renowned experts and stalwarts at King's College Hospital, London and later at the Great Ormond Street Hospital, UK. Here, all pediatric specialties were available under one roof. The doctors were available 24/7 and all this coupled with the best technology. I returned to India after 9 years to find that we had no dedicated children's hospital. The idea was not to set up a venture for commercial success, but build a "workplace" to practice skills we had acquired and improve the quality of life for children. The emphasis was on creating an ecosystem for the professionals to practice their skills, empower them with professional freedom while making a difference in caring for children. We began the practice of having the pediatrician stay overnight in the hospital to handle any emergency that may arise. How was your initial journey? I returned to India and looked at the Healthcare scenario. The special needs of children were lost in the fast growing multi-specialty hospitals that were present. When I mooted the idea to have a dedicated children's hospital, many were wary of this approach. The interactions with young parents and other seniors gave me the confidence to start the venture. The first Rainbow Children's Hospital at Banjara Hills, Hyderabad started on Children's Day i.e. 14th November 1999. The work was difficult as we had to win the trust of the people. We had world class expertise coupled with best of equipment’s. We use to travel 200-300 km to bring the sick children in specially designed ambulances. We also used to visit different hospitals to treat critically ill children. During this period, we received requests to have all our specialized services under one roof and this propelled us to expand the scope of our services. Our commitment, specialized services, expertise in handling complex cases

in children helped to prove ourselves and eventually win the trust and confidence of the people. Our work started getting the required appreciation and eventually, we became India's popular children's hospital. What is the growth trajectory of Rainbow Hospitals? Today, we are a medically respected children's healthcare group in India.We have dispelled the myth that a children's hospital is not a sustainable model. Currently, we operate out of 10 locations - 6 in Hyderabad, 2 in Vijayawada, 2 in Bengaluru and 1 in Delhi. We shall be shortly opening in Chennai and Visakhapatnam. We are now the largest children's hospital in the country with 1000+ beds, 400+ full time doctors and 3,000+ staff. In my opinion, we should have one dedicated children's hospital for every 15 lakh of population in India. It was a moment of pride for us on the World Prematurity Day, when we had the largest gathering of 445 preterm babies under one roof. It was one of its kind by any hospital and propelled us into the Guinness Book of World Records. What Rainbow has achieved is due to the trust and confidence of the people. Tell us about the new Rainbow venture in Delhi NCR? We identified that Delhi NCR required many more beds for children. We also knew that a dedicated children's hospital will always be the preferred place to maintain high standards of care for children. In Delhi, Rainbow Hospitals is associated with Madhukar trust. The maternal needs would be addressed by the exclusive birthing division- BirthRight - "Your right to a safe delivery." The specialized perinatal center would offer high standards of maternal care and also focus on natural delivery, painless delivery & high risk pregnancies. BirthRight will have services ranging from prepregnancy counselling, fertility treatment and fetal medicine to complete prenatal and postnatal care. Being a children's hospital our neonatal and specialty services would back our perinatal services comprehensively. At Rainbow we believe that the best place to have a child birth is in a children's hospital.

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Patient Safety & Powdered Gloves European standard EN 455-part 3,American standards ASTM D3577 besides ISO standards being followed by Japan,China & others.

Health And Safety Concerns: For Patients : Inflammation, granuloma formation, granulamatous peritonitis, adhesions, allergic responses, delayed wound healing are these enough to alarm us. Cardiac complications such as granulomatoous endocarditis, thrombi have been documented (Truscott 1977) In experiments conducted it was demonstrated that methicillinresistant staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE) may be able to use glove powder as vector in a hospital environment (Newsom & Shaw, 1997). All these contribute to longer hospital patient stay and increased healthcare costs.

For Healthcare Workers:

Dr. Pravin. K. Nair

Consultant Microbiologist & Head Infection Control, Holy Spirit Hospital (Mumbai)

he topic heading looks very absurd. I would have thought the same if i had read this article 10yrs before, but with development of science and more evidence coming in ,the heading of my article is more relevant and in context with the current Patient safety standards. No one in healthcare industry would be remembering William Halstead, Chief Surgeon at Johns Hopkins Hospital city in 1896 as the person who discovered Surgical gloves. He discovered this not to protect patients from infections but to protect his wife's hands from dermatitis caused by mercuric chloride used for cleaning instruments & with the help of tyre company. The discovery & increased incidence of AIDS (HIV) in the early to mid-1980s resulted in a tremendous increase of latex examination gloves. In 2008, more than 12 billion units of medical gloves were sold. Club moss, talcum powder and finally Cornstarch were used as lubricants for the gloves. Today most international standards do not accept the use of talc as a lubricant. Most developed countries have standards for gloves,unlike in India where at least I am unaware of the existence of such standards.

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 Immediate type I response (latex allergy) approximately 17 % of healthcare workers.  Occupational Asthma in 9 % of healthcare workers.

Whats other countries doing Hospitals around the world realizing the dangers of cornstarch on examination & surgical gloves have started moving to powder free alternatives  1997 : Banned in Germany  2000 : UK  2016 : Japan  2017 :USA,Saudi Arabia,South korea,Hong Kong In India still many hospitals are unaware of the potential hazards compounded with no regulations on glove manufacturing or import

Conclusion: The significance of these studies & findings justifies the consideration of switching from powdered to powder-free gloves. We at Holy Spirit Hospital, Mumbai have taken a conscious decision for being a patient centric as well as staff centric hospital hence has introduced powder free gloves from November 2017. And we are thankful to Ansell, Global Leaders in Healthcare Safety Solutions, for providing us superior quality products and also facilitating educational initiatives on hazards of powdered gloves.

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THE FUTURE OF DIAGNOSTICS IN INDIA Wellness diagnostics

As the consumer becomes more aware and health-conscious, various diagnostic tests are being packaged together to serve as a preventive or wellness healthcare plan. These can range from basic hormone and stress tests to cancer monitoring and infertility tests. The wellness approach of diagnostics can transform lives by detecting and predicting issues early on and prompting major lifestyle changes. Smart health solutions

Dr Sushil Shah, Chairman and Founder, Metropolis Healthcare

In a laboratory setting exclusive to medical diagnostics, constant innovation and up-gradation of technology is a must. Technicians need to stay up-to-date with latest research findings as well as technological developments and study them to ensure efficient, automated, and accurate test results. Laboratory technology has been at the forefront of medical advances in the recent times, with newer tests, updated analysis parameters, and sophisticated testing machinery replacing the old. The remarkable growth in the range and complexity of available tests and services is expected to continue. Diagnostic tests are the first step to establish the existence of a certain disease or to filter certain conditions before effective treatment can be decided upon. Continuous evolution of the pathology industry has brought us from curative to preventive healthcare plans. This is the one field of medical science that can single handedly change way healthcare is managed in India. Some of the trends emerging in the diagnostic industry in India are interestingly progressive and transformative. 18 March-April 2018 w w w.m e d e g a te to d a y.co m

The role of smartphones and other wearable technology has become prevalent in today’s time. People are now using these devices to track their physical fitness levels, monitor their diet, and even keep a check on their sleep patterns. This especially, can be largely indicative of health issues like stress, fatigue, insomnia, which may have other serious underlying, causes. Self-testing Consumers are largely taking the selfdiagnosis practice to a self-testing practice by using various home health monitoring devices. A single prick and drop of blood smeared on a stick can tell you if your blood sugar is in control or not. Various other medical devices are being introduced in the market daily, which help people check for a number infectious disease. This evolved diagnostics technology is also making disease diagnosis more accessible for people who are physically challenged or live in remote locations with limited access to quality healthcare.

Molecular diagnostics One of the fastest growing sectors of pathology, molecular diagnostics identifies genetic markers like proteins or nucleic acid at a molecular level. This technology has proven beneficial people with chronic disorders and is being increasingly developed for genetic testing, infectious diseases testing, blood screening, oncology testing, cardiovascular testing and others. The growth of this segment is being supported by rapid turnaround time, low cost, convenient workflow, and high sensitivity. Epigenetic diagnostics Epigenetic changes are inherited changes to the DNA molecules that don't affect the actual sequence of the DNA, and have been described as ‘Post-it Notes’ on genes. Epigenetic changes, including the addition of methyl groups, switch genes on or off. The detection of their presence or absence could help with early diagnosis of sever conditions, or could indicate to diseases that are more likely to progress quickly. Fluid biopsy In the course of cancer treatments, rebiopsies are required many times. Unlike the traditional, painful invasive biopsy methods, fluid biopsy isolates cancer cells from a simple blood sample, making the process commercially feasible, and more comfortable for patients and caregivers. 3D anatomical modwels 3D printing is another area that has excited radiologists and clinicians as an opportunity to bring to life studies previously available in 3D, CT, or MRI modalities, making the diagnosis process multi-dimensional with improved accuracy.

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Budget Reaction by Indian Medical Device Industry

Budget 2018-19 –Highly Disappointing A deathblow to Indian Medical Device Industry

Mr. Rajiv Nath expressed deep disappointment and anguish over the Union Budget 2018-19 giving cold shoulder to the Indian Medical Device Industry. We were expecting the government to move forward on promised reforms and anticipated conducive measures to boost domestic manufacturing of the medical devices. It is frustrating that against our expectations, the government has not included any measures for promoting growth of $10 billion Indian Medical Device market in the Union Budget 2018-19 as has been done for consumer electronics, food processing, footwear, etc. It reeks of step-motherly treatment. The sector was looking forward to clear and specific promotional measures since it was one of the first five sectors included for ‘Make in India’ initiative. Regrettably, nothing has been done to improve domestic manufacturing in the sector. And that too when the Indian medical Device industry has opted for self regulation wherever necessary for 20 March-April 2018 w w w.m e d e g a te to d a y.co m

strengthening the government’s hands in improving affordable healthcare in the country. Though budget’s focus on providing universal healthcare services is a step in the right direction for building a healthy nation, the domestic industry is left in the lurch by not giving it necessary protection against imports, Mr. Nath felt. Nominal tweaking in custom duty applicable to medical devices is urgently needed to address Rs 27300 crore import bill and 70-90% import dependency. Other sectors like automobile and mobile phones are flourishing with custom duty protection while medical devices industry is left to languish, Mr. Nath said. If the government is still serious about ‘Make in India’ it can still include some minor legitimate demands of our industry which will go a long way in making medical device industry internationally competitive and world class and boost ‘Make in India’ program. These include:  The government needs to increase the basic import duty on medical devices in the range of 10-15 per cent to make manufacturing more viable than importing, and give nominal protection to investors.  Withdrawal of Concessional Duty Notification of Basic Duty and Special Additional Duty of Medical Devices

and for reverting of Duty on the items covered under HS 90.27, 30.06 and 38.22  Imposition of 10% Basic Duty on HS 90.27 & HS 30.06 (mainly Diagnostics - equipment & reagents)  Reduction of duty on raw materials to produce these devices and diagnostics to 2.5%. In addition, we also need to think of consumers and Dept. should consider to introduce a Tax Innovation Structure of stalling Artificial Inflation of MRP by imposing a 1% GST Cess on MRP to have a disincentive to Importers from passing on above effect of duty increase to the Consumers and even by indigenous manufacturers . This will make Indian Medical Devices including Diagnostics competitive and safeguard consumers from artificial inflation and exploitatively high MRP. If the government had focused on giving a major boost to medical device manufacturing in the country and also ensured a robust MRP regime, then it would have served many purpose with one shot – i.e. (a) Lower the overall healthcare cost and (b) lead to sharp reduction on import dependency. The additional critical benefit would have been quality job creation within the country.

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Features of 03 GEN - The Magical Air Disinfectant Without Any Chemicals  03 GEN kills all types of bacteria, fungus, virus molds and reduces the biological burden upto 93% with 2.5 ppm concentration within 30 minutes.  Ozone having half life just 10 minutes and its biproduct is Oxygen so very safe to use in unoccupied operation theatres (Rooms).

Features of Infection Control Live Monitoring System (ICLMS)  Actual Temperature Display with control  Actual Humidity (Rh) Display with control  Air Flow From HEPA Filter  Air Cycle Per Hour (ACH)  Air Particle Quality  HEPA Filter working status ‘  Positive Pressure (Pascal) inside the OT  Multiple Gas Sensor detecting CO2, i-butane, Propane, Methane, Alcohol, Hydrogen, Smoke  OT ready for operation indication will get on mobile with display of all parameter with every hour sms alert.  USB to PC (485) connection for recording of Data for Air Quality Parameter for Infection Control medico-legal issue.  SMS Notification & Alert for any type of fault in system and sms will be sent to company and doctors.

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Features of AHU Without Duct Patented Innovative Solution for Air Condition of OT  Ductless Air Handling System needs to start just one hour before the operation starts to get Class ll Air Quality in entire Operation Theatre.  Ducted Air Conditioning System for OT has to keep on round the clock may be with temperature control (with VFD) but our Ductless AHU has to keep on just 1 hour before to get desired air quality (Class ll) in entire OT.  HEPA Filter needs to be replaced once in a 2 year as compared to ducted system required replacement of HEPA thrice in a year so saves maintenance cost.  Ducted laminar air flow system (LAF) required Robotic duct cleaning before changing HEPA Filter and duct insulation and maintenance required periodically and costly.  AHU without duct maintain all NABH requirement by giving 20air cycles / hour, positive pressure2.5 Pascal CLASS II Air Quality and With Laminar Air Flow Class I (0-10) Air Quality Get on of table & Routine Cleaning can be done from Inside OT by any non technical OT staff.

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A guide to healthy living for Cancer survivors

Dr. Sandeep Nayak Consultant Surgical Oncologist, Fortis Hospital, Bangalore

The importance of a healthy and sustainable lifestyle is very well known to us all. While we all take efforts to maintain our health and wellbeing, the same might quite be a tough task for cancer survivors or patients post recovery .The complex therapies and medications performed on a cancer patient is likely to have an impact on his/her physical and psychological wellbeing. The person might feel fatigued or can go through pain post treatment, it takes time to get over the effects of cancer treatment and each person's recovery time is different. However, a little extra care post cancer treatment can improve your sense of well-being and your quality of life. Apart from the basic maintenance steps like timely medications, adequate rest, regular check-ups, avoidance of strenuous activities and a balanced diet, there are a few other lifestyle alterations that is beneficial for a smoother survivorship.

A list of must Do’s would include:  Regular Exercise : In whatever capacity possible, exercise post treatment speeds up the recovery process as it will help in increasing strength and endurance, reduce 22 March-April 2018 w w w.m e d e g a te to d a y.co m

anxiety, fatigue and body stiffness, lift up one's mood, improve sleeping patterns and simply help the person stay active.. A minimum of 30 minutes of exercise at least 5 times a week can go a long way in easing post- treatment stress and weakness.  Balanced Diet: A healthy composition of fruits, vegetables, lean protein, healthy fats and carbohydrates in the diet is highly recommended post treatment as it would help in regaining the lost nutrition during the treatment. Lots of fruits and vegetables, as well as whole grains should be included in the diet as it is needed to cope up with the heavy inducement of medicines.  Regulate body weight: Post treatment, the person either gains or loses weight, both of which is unhealthy. Efforts should be maintain to reach a healthy weight goal. For the ones who need to gain weight, food which is easy to chew and swallow and can be easily digestible should be included in the diet. Also, the cancer survivor can consult the dietician for food supplements. For the ones who need to lose weight, there should be a control on the number of calorie inputs, healthy and low fat diet should be considered for maintain the weight.  Include Yoga and meditation in your daily routine: The recovery time for each patient is different and so is the capacity to indulge in fitness activities. While most people are able to take up exercise slowly, few are not physically stable to take up exercise immediately after treatment. However, yoga can prove as an effective form of physical activity post recovery. It has a larger impact in terms of relieving stress, calming the mind, initiating a process of detoxification, it can help improve concentration and focus, reduce anxiety and thereby fasten the process of restoring physical and mental fitness

alike. Moreover, it boosts the immune system, and produces a much-soughtafter feeling of well-being.  The time post an illness can be emotionally very draining. For this very reason, 20-30 minutes of simple meditation a day if done the right way, will not only mentally recharge you but also helps in improving concentration, enhance clarity and induce a general sense of calm and positivity. S ay NO to tobacco and consume alcohol in moderation, if at all: Afterthe heavy dose of medications and treatment process, it is highly recommended non-consumptionof tobacco and alcohol consumption. In a period of extra physical and mental vulnerability, such intoxications would only worsen revival and wellbeing. Therefore, it is a big no to alcohol and tobacco for a period of time. In a state of physical and emotional turmoil post treatment, all these steps and tips might seem daunting and too stressful. The key however is to take things in one’s own pace and never be too hard on oneself. The pressing need for intensive post-illness care is to basically reduce chances of a recurrence and keep any other kind of health dysfunction at bay. Apart from these steps to be followed, accompanied with a stress relieving hobby, regular vacations, productive use of time and quality personal time, the survivor along with their family and friends must take every possible measure to restore normalcy and positivity. Treatment or illness should never be a barrier to a fruitful life. With adequate care, one must learn to enjoy every little thing and make the most of their time. As they say, surviving an illness is not the end of a gruesome story; it is the beginning of a beautiful one.

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Impactful Diabetologist Dr. Mohan is the first Indian doctor to be conferred with this award by the ADA. This award is given in the memory of Harold Rifkin, an internationally recognized clinician, researcher and educator in diabetes. It is one of the Association’s highest scientific achievement awards given annually to an individual whose efforts have increased the awareness of the burden of diabetes worldwide to improve the care and lives of those with diabetes. The award recognizes Dr. Mohan’s outstanding service to the cause of diabetes in India. The award will be conferred on Dr. Mohan during the 78th Scientific Sessions of the ADA at Orlando during the National Scientific Achievement Awards Presentation Ceremony on June 25th 2018.

Dr. V. Mohan, Chairman and Chief of Diabetology at Dr. Mohan’s Diabetes Specialities Centre and President & Chief of Diabetes Research of the Madras Diabetes Research Foundation has been conferred the prestigious Harold Rifkin Distinguished International Service in the Cause of Diabetes Award by the American Diabetes Association (ADA). 24 March-April 2018 w w w.m e d e g a te to d a y.co m

Deeply interested in research from his undergraduate days, Dr. Mohan has published over 1110 papers in peer reviewed journals and textbooks including 718 original articles, 235 review articles and invited editorials and 150 chapters to textbooks. His work has received over 48,000 citations and has an h-index of 100. Dr. Mohan has received over 160 awards including the prestigious Dr. B.C. Roy National Award by the Medical Council of India and Dr. B.R. Ambedkar Centenary Award from the Indian Council of Medical Research, the highest award for Biomedical research in India. Dr. Mohan also provides lifelong free treatment to thousands of poor patients through the free diabetic clinics established by him. For his extensive contribution in the field of diabetes, Dr. Mohan was awarded the prestigious Padma Shri, one of the highest civilian awards from the Govt. of India.

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The New, Science-Based Non-Surgical Treatments for Heart Blockages The world has moved ahead fast in the last 3 decades. But our bodies have not been able to keep up with accelerating technology. This has affected one of the most delicate parts of the human body — the heart. Heart conditions and ailments are growing at an alarming rate across the world, in developed and developing countries alike. The biggest causes for this are stress and improper eating habits. They lead to uncoordinated pulses reaching the heart chambers, and can cause an abnormal heartbeat. Other reasons include an autoimmune disease which can be passed on from the mother in certain proteins through the umbilical cord, a birth defect, damage from a previous heart attack, and more.

Heart Blockage and Its Symptoms Blockages limit the amount of oxygenated blood to the heart. This condition is known in medical terms as a ‘stable angina’ and makes the heart muscles ‘cry out.’ The results manifest through the below symptoms:

Dr. Santosh Dhage B.A.M.S. P.G.P. (Panchakarma) Director of Dhage Healthcare

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Facing Respiratory problems...??? ...We provide Solution...  Dyspnea on exertion (shortness of breath)  Chest congestion and pain, as if someone sat on it  Palpitation and sweating  Giddiness  Heartburn, pain in the shoulder, back and hand (right or left side) …and more.

Types of Heart Blockages Heart blockages are of three types.  First degree: This involves minor disruptions without are not grave in nature. Hence, they can be corrected without therapy.  Second degree: These occur when some electrical signals don’t reach the heart, leading to dropped or skipped beats. At such times, patients might need a pacemaker.  Third degree: These blockages occur when electric pulses do not travel between the upper and lower chambers. Without proper treatment, this condition can quickly deteriorate into a heart attack. Until recently, angioplasty and bypass surgery were the only known forms of treating heart blockages. However, research from the American Heart Association, the Experimental Department of Cardiology, Germany, and the British Heart Foundation, has presented the medical world with a great gift – natural bypass therapy.

What is Natural Bypass Therapy? “God knows the importance of heart, blood and blood vessels for every human being,” said the medical researchers at the above associations. Thousands of arteries lie on the heart’s surface in two forms — seeds and micro vessels (capillaries). Normally these arteries don’t open up in people. But that doesn’t mean all hope is lost. By creating certain situations, the arteries in seed-form open up, as do those in the micro vessels form. This process immediately improves blood flow towards the heart and is known as natural bypass.

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How to Take Care of Your Heart? Heart blockage doesn’t always need treatment. To avoid or treat first-degree heart blockage, you can take the following steps:  Consistent exercise, especially yoga. This keeps the flow of oxygenated blood to the heart steady.  Maintain a diet. Form good eating habits and avoid junk (and fried) food. Stick to traditional Indian food according to your region because it’s best for your body and is science-based.  Avoid stress. Spend time with your family, laugh with them, and take out time to do relaxing manual work like gardening.

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Every 7 Minutes Cervical Cancer Kills One Woman

Dr Satinder Kaur CORE Diagnostics

Cervical cancer is a slow developing cancer that starts in the lining ofthe cervix which is the lower part of the uterus (womb). Worldwide, there are approximately half a million cases of cervical cancer annually and 85% of cases occur in low- and middleincome countries. It is the second most frequent cancer among Indian women with almost 122,844 new cases diagnosed every year. Every 7 minutes one woman dies of cervical cancer of which every fourth is an Indian. Infection of the uterine cervix with the high-risk types of HPV is necessary for the development of cervical cancer. However, this infection alone is usually not sufficient to cause cancer and additional cofactors are required for progression. There are over 100 types of the virus. The types that cause genital warts are known as low-risk HPV types (most common type 6 and 8). The high-risk types cause cancer (type 16, 18 cause 70% of the cancers). The human papilloma virus is sexually transmitted, and the possibility of contact with it increases with the number of partners a woman or her partner has had. Through 28 March-April 2018 w w w.m e d e g a te to d a y.co m

regular cervical screening, the changes caused by HPV can be picked up early and any treatment needed is simple and effective. Very rarely, these changes can go on to develop into CIN or cervical cancer if they are left untreated. Other risk factors for cervical cancer are genital infections, early onset of sexual activity, multiple sexual partners, cigarette smoking, immuno-compromisedstate and low socioeconomic status. Cancer of the cervix tends to occur during midlife. Half of the women diagnosed with the disease are between 35 and 55 years of age. It rarely affects women under age 20, and approximately 20 percent of diagnoses are made in women older than 65. For this reason, it is important for women to continue cervical cancer screening until at least the age of 70. Precancerous cervical cell changes and early cancers of the cervix generally do not cause symptoms. For this reason, regular screening through Pap and HPV tests can help catch precancerous cell changes early and prevent the development of cervical cancer.

Possible symptoms of more advanced disease include:  Abnormal bleeding, such as  Bleeding between regular menstrual periods  Bleeding after sexual intercourse  Bleeding after douching  Bleeding after a pelvic exam  Bleeding after menopause  Pelvic pain not related to menstrual cycle  Heavy or unusual discharge that may be watery, thick, and possibly have a foul odor  Increased urinary frequency  Pain during urination Once diagnosed with cervical cancer the patient should consult a gynaecologic oncologist to discuss treatment options.

The treatments available are surgery or radiation with chemotherapy. Early stage disease can be treated by surgery. A woman may have the option of preserving her ability to have children and to keep her ovaries if diagnosed in very early stage. For advanced cases chemoradiation is the treatment of choice. When detected at an early stage, the 5-year survival rate for women with invasive cervical cancer is 91%. About 46% of women with cervical cancer are diagnosed at an early stage. If cervical cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 57%. Cancer in cervix is a preventable cancer and to reduce the risk of cervical cancer, the following measures are recommended: V accination against HPV: Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active. P ap test: Pap test can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every three years. H PV test: infection with Human Papilloma virus can be detected directly in place of cervical precancerous changes via pap smear. This test can be used in women over 30 years of age and is more sensitive than Pap smear. The interval of screening can be increased to five years if HPV test is negative. P ractice safe sex. Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer. D on't smoke. T o conclude, cervical cancer is a preventable and treatable condition. Prevention via vaccination, early detection via Pap smear/HPV test and timely treatment can help in controlling the disease.

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SMART Lab CME on Quality Management for Clinical Laboratories @Chennai

Dr. C.N. Srinivas

MD (Path), DNB (Path), IFCAP Head â&#x20AC;&#x201C; Clinical Lab, Head Transplantation Immunology and Consultant Pathologist at MIOT Hospitals, Chennai

The Department of Laboratory Medicine, MIOT HOSPITAL, Chennai, India conducted the Third edition of SMART lab CME on Quality Management for clinical laboratories. MIOT organises and conducts SMART lab CME once a year to mark the World Quality Month celebrated round the globe. SMART is an acronym for Smart, Measurable, Achievable, Relevant and Time bound, which form the objectives of the CME.SMART lab focuses on key Quality essentials including evidence based quality practices with Indian and global perspectives, method verification, risk management, IQCP, error disclosure, laboratory management and leadership etc;. The latest edition of SMART lab attracted more than 150 delegates including laboratory technologists, supervisors, quality managers and doctors spanning all divisions of clinical laboratory medicine from within India and abroad. Panel of faculties for the CME included speakers from prestigious organisations, many of them being stalwarts in the field of laboratory medicine. 30 March-April 2018 w w w.m e d e g a te to d a y.co m

The program started with an opening ceremony followed by felicitation of Dr.A.S.Kanagasabapathy, Former Professor and Head of clinical Chemistry of CMC Vellore for his valuable contributions over 5 decades to the field of Clinical Laboratory Medicine. This was followed with presentations from the faculties. Dr.A.S.Kanagasabapathy delivered the plenary session on error disclosure and risk management in clinical laboratory. His lucid talk was well accepted by delegates. They understood the basics of error disclosure culture with tips on how to handle ''Just culture'' system .He also made everyone understand that QMS according to GCLP AND ISO guiding to do risk assessment and manage the errors accordingly. Dr Satish Ramanathan, Clinical Biochemist and Deputy Quality Manager at MIOT spoke on traceability in Laboratory medicine which took several routes to enlighten the audience on Meteorological traceability and opening up a new arena on discussion of procedural traceability to several guidelines across all phases of testing process. Prof Febe Suman, Former professor, SRMC, Chennai took audience in her journey towards quality in coagulation

lab by her real lab experience including how to trouble shoot IQC and EQA. DR Vidhya, Histopathologist from Anand labs, Bangalore took up the challenge to make everyone understand in a simple way, a tough topic on method verification in Anatomic Pathology including verification of LDT and IHC. She stressed that this area is always neglected by laboratory professionals and need to upkeep global practices Ms. Priya from Eppendorf, took the audience through basics of handling of Pipettes and good clinical laboratory practices in handling and maintaining centrifuges. Dr C.N.Srinivas, Director of Department of Laboratory Medicine at MIOT took a different route to make audience understand the application of principles of Bhagvat gita in Laboratory medicine. He discussed how the eighteen chapters of Gita are translated to policy, procedure and process in QMS leadership trends and personnel attitudes as elaborated in Gita. The program concluded with a Quiz on Quality Management System.

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QUALITY HEALTHCARE AND BEYOND– PSRI PERSPECTIVE defined patient care protocols, institute was accredited by ISO 9001:2008 in the year 2007. Subsequently institute got accredited by NABH for all the clinical disciplines in 2012and NABL Accreditation for the Lab Medicine department in the year 2010. It is quality conscious approach, which enabled the Institute to attain levels to have these prestigious quality accreditations, in due course of time. We understand that an exceptional work culture is equally important for professional excellence in every sphere of the service imparted by the healthcare institutions. PSRI is known for a highly employee centric CEO, PSRI Hospital and patient centric work culture. Not many institutions are sensitive Pushpawati Singhania Hospital & and demanding about a work culture Research Institute (PSRI Hospital) which makes the employees proud and is a Nationally and Internationally helps in inculcating sense of belonging reputed tertiary health care institution while discharging their professional promoted by JK Organization. role through various portfolios. This Institute started in 1996 with the Super approach has given outstanding Specialities of Gastroenterology, GI outcomes to the institutes, across the Surgery, Nephrology and Urology world. Mayo clinic and cleveland clinic including Kidney Transplant are the glaring example of following a Surgeries. well-structured institutional culture. In last one year PSRI Institute PSRI work culture has been aptly has added Cardiac Sciences, reflected in its vision and mission Neurosciences, Orthopaedic & Joint statement which are displayed in Replacement and Liver Transplant various locations of the institute. It Programme as the new four Super ensures patients and visitors about Specialities along withGeneral their safety, security and professional Medicine, General Surgery, handling at PSRI. Institutional work Gynaecology, ENT, Psychiatry & culture is also reflected in the form of Clinical Psychology etc. were added value system. PSRI has a unique value to the Institute. Apart from all these system. To mention few valuesspeciality PSRI Hospital is equipped with World Class State-of-the-Art 42 bedded Critical Care Unit

Dr. Dipak Shukla

Since the inception of the Institute, Quality in healthcare has been Central through the planning and operations of all the clinical disciplines and support services. To ensure quality and well 32 March-April 2018 w w w.m e d e g a te to d a y.co m

Pursuit of service rather than profit  Patient is first in planning and monitoring of all services  Ensuring ethical approach in patient care  Transparency of patient care at every level  Pursuance of education and research for professional excellence and patient care

PSRI is team oriented

This unique value system reflects the work culture at PSRI which has resulted into exceptional employee retention and leadership development at all levels. On one hand quality systems have helped in improving the procedures and flawless patient care at every level and on the other hand in an exceptional work culture has projected PSRI team on the healthcare map of the country, as an institution committed for excellence in healthcare. Research academics and world class teaching and training programmes have further strengthened this culture. Therefore, we firmly believe that it is not only quality healthcare but beyond that which helps to make you different.

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COVER STORY

Medical I

Dr Sarika Gupta

ndia is fast emerging as the leading global healthcare destination for medical value travellers from across the globe. Visitors from over 55 countries come to India for treatment. In the past decade, India has become a medical hub for patients from conflict countries like Afghanistan, Iraq, Yemen, Sudan, the Republic of Congo and Somalia, where years of war have destroyed public medical infrastructure. Patients are also coming from countries like Russia, Uzbekistan, and Kazakhstan where health care infrastructure hasn’t shown robust growth in the past two decades. Patients are also coming in from the United Kingdom, Europe, and North America for quick, efficient, and cheap surgical procedures, sometimes coupled with the incentive of travelling to ‘incredible India’. The total number of foreign patients coming to India every year is reaching close to 400,000. According to an industrywide study, the Indian market is likely to reap $7-8 billion in revenue by 2020, more than double its current level.

Why India?

The total number of foreign patients coming to India every year is reaching close to 400,000. According to an industry-wide study, the Indian market is likely to reap $7-8 billion in revenue by 2020, more than double its current level.

The private healthcare sector in India has shown remarkable growth, beginning with the liberalisation of the economy in 1991. India ranks amongst the top 20 of the world's countries in its private spending, at 4.2% of GDP. India today boasts of some world class tertiary care hospitals in the metro cities like Mumbai, Chennai and New Delhi, offering advanced treatment for cardiac, orthopaedic, neurological and cancer care, with easy accessibility and at a fraction of the cost in the west. A knee replacement in the USA would cost $50,000 and entail several months' wait under the NHS in the UK. In India, the same operation can be done for $5000-8000 and within 10 days of the first email contact. Indian doctors are also highly trained, with their treatment results and surgical capabilities matching international standards of excellence. In order to allay suspicion regarding the quality of care in a developing country, Indian corporate hospitals are also getting certified by international accreditation schemes like JCI. Going a step further, large private hospital chains like Fortis, Apollo, and Max have adopted a holistic approach to providing care to the international patients. The patients are provided with accommodation, round the clock interpreter services, and their dietary and cultural needs are well taken care of. The National Health Policy of 2002 makes it clear that the Indian government supports medical tourism. Since 2006,

34 March-April 2018 w w w.m e d e g a te to d a y.co m

COVER STORY

tourism in India the government has also started issuing M (medical) visas to patients and MX visas to the accompanying spouse.

Key Challenges

Few pertinent issues, however, need to be looked into. While the government has taken several progressive steps concerning medical visas, more can be done to ease the travel of medical tourists to India. Additionally, the market continues to be largely unregulated, with several touts, interpreters and intermediaries connecting prospective patients to health facilities. There also is a considerable lack of awareness in target markets about India’s capabilities, infrastructure and cost advantage in the health and wellness space This is perhaps why India currently accounts for only 2% of the global wellness market.

The Way Forward First, it may be worthwhile to revisit some of the medical visa norms. For instance, the process of registering at the Foreigner Regional Registration Offices could be made easier for patients by setting up helpdesks at major airports and hospitals across the country. The procedure for visitors who come on a tourist visa to switch to a medical visa should also be streamlined. Further, medical visa on arrival could be piloted

for patients from countries like Uzbekistan, Turkmenistan, Kyrgyzstan, Oman, UAE, UK, UK and Canada. Secondly, to enable better regulation of the intermediaries in the market, a system should be put in place for registering these agents. They should also be accredited according to the framework developed by the National Accreditation Board for hospitals.

Future ahead

Healthcare industry is the world’s largest and most rapidly growing industry which can provide huge potential for employment in a young country like India, grappling under a massive burden of unemployment. The industry is currently growing at nearly 30% annually. While this boom seems to be profitable for all stakeholders, we cannot forget the burgeoning demand of healthcare for the Indian poor who are still dependent on the extremely deficient public health care sector on which the Indian govt spends mere 0.9% of gross domestic product (GDP). The healthcare policy thinktank ,therefore, needs to find innovative ways to extend the financial benefit from medical tourism to the country’s poor as well. That will be a true win -win situation.

w w w.medegatetoday.com March-April 2018

COVER STORY

MEDICAL TOURISM INDIA EMERGING AS A TOP DESTINATION

MEDICAL TOURISM: INDIA EMERGING AS A TOP DESTINATION When people move from one country to another to avail medical, dental or surgical care it is defined as medical tourism. It tends to occur when people from countries with less developed medical facilities migrate to countries with better medical facilities to seek treatment in highly specialised medical centres and hospitals. Medical tourism is a popular phenomenon as it ensures better and cheaper access to quality healthcare. Often procedures, which may be very expensive in one’s own country, can be undergone at a subsidized rate in other countries. In addition to this, a common reason for medical tourism is that the patient might have to undergo a quality medical procedure which is not conducted within the boundaries of his or her home country. Sometimes people go abroad for treatment for medical conditions which may not be covered under insurance in their own country. In 2014 a KPMG report placed India among the top three medical tourism destinations in Asia along with Thailand and Singapore. This is because of India’s low cost of treatment, quality healthcare infrastructure and availability of highly skilled doctors. In addition, almost everyone associated with healthcare is well conversant in English and hospital has translators for other languages. According to a study done by FICCI, India’s medical tourism market is expected to grow to 6 billion rupees (seems too little as it is only 600 crores. -fmri alone must be doing more than 100 crores annually from foreign patients) by 2018, and the number of people arriving in the country for medical treatment is set to double over the next four years. 36 March-April 2018 w w w.m e d e g a te to d a y.co m

COVER STORY

There are many factors which have promoted medical tourism in India. These include lower costs of medical procedures, world class treatment solutions, highly qualified doctors, ability to tackle complicated procedures, better technology and wider treatment options, lower logistics and accommodation costs and no waiting list as compared to other countries. Another attractive aspect is the number of alternative medicine techniques such as Ayurveda, Siddha, Unani, Yoga, Acupuncture and Homeopathy. According to the Ministry of Tourism, the number of people entering India on medical visas jumped to 166% in the last three years, from 75,688 in 2014 to 201,333 in 2016 and this is despite the fact that many patients still come on tourist visa. In order for medical tourism to flourish, hospitals need to get accredited internationally by the Joint Commission International. This body is the international affiliate agency of the US based Joint Commission and was launched in 1999. Currently there are 600 such hospitals in India and the rate is growing by 20 percent every year. However there are several risks that are associated with medical tourism as well. For instance, communication may be a problem. If care is received at a facility where there is a language barrier then misunderstandings can occur about the course of treatment. In some countries, there is a chance that medication is counterfeit or of poor quality. Anti-microbial resistance may be more common in some countries and this could pose the threat of infection. One must also plan their travel in a timely manner as flying after surgery can increase the risk for blood clots. There are some things that one must keep in mind while travelling to another country for medical care. One must check the qualifications and credentials of the doctors and the facility in which they will receive treatment. There should be a written agreement with the health care facility defining the parameters of the treatment. If there is language barrier issue then before the treatment begins one should establish a means of communication with the doctor. One should carry copies of their medical records related to the condition for which

they are obtaining care. This should include copies of all the prescriptions and medicines taken. The government of India is quite proactive in helping people obtain medical visas. Most international patients visiting are cash patients and do not have a valid health insurance. In times when the diagnosis post arrival is different from what their reports suggest, there might be financial constraints or additional costs which the patient has to bear. Â Fortis Healthcare Limited is a leading, accredited integrated healthcare delivery service provider in India. The healthcare verticals of the company primarily comprise hospitals, diagnostics and day care specialty facilities. On an average, Fortis receives 15% of its patients in the form of foreign patients, with most coming from Iraq, Yemen, Kenya, Nigeria, Somalia, Angola, Uganda, Uzbekistan, Kazakhstan, Ukraine, Pakistan, Bangladesh Afghanistan and many other countries. While the leading specialties at Fortis healthcare are Neurosurgery and spine surgery, Orthopaedics and joint replacement surgery, Cardiology and cardiac surgery, Nephrology and urology, and Oncology and all forms of cancer treatment, Organ transplant and metabolic surgeries, In vitro fertilization, it has the best treatment solutions available across all major specialties. Customized services for international patients such as visa assistance, interpreter facility, concierge services, dedicated service managers, complimentary airport transfers, accommodation, food assistance and a provision for local sim cards is organised by the hospital. Local site seeing and intercity tours can also be organized. Many patients who come to Delhi like to travel to Agra (which is near Delhi) to see world famous Tajmahal. India is projected as one of the frontrunners in quality healthcare services today, and it is estimated that the number of medical tourists would only increase in the coming years. Even as the healthcare sector in India has off-late been under the scanner by the regulatory authorities, it is one of the fastest growing areas today in India in terms of demand for quality services and offering best possible care by international standards at very low cost and provides employment to thousands of people w w w.medegatetoday.com March-April 2018

DOCTOR SPEAK

ADVISORY ON HOW TO COPE UP WITH STRESS DURING EXAMS

Dr. Mrinmay Das

Senior Consultant, Behavioural Sciences, Jaypee Hospial, Noida Exams are on their way and it’s likely that students might experience more stress and anxiety than usual. Feeling a degree of stress and nervousness about exams is completely a normal reaction. Every person has a different level tolerance for stress and a different way of responding to it. Although exam stress can sometime cast a dark shadow in the lives of teens. Stress, in simpler terms means, body’s way of responding to any kind of threat or demand– be it real or imaginary. When one feels stressed, then the nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, which rouses the body for emergency action. Exam stress is normal and very common. You might experience it because:  You often need to learn and recall a large amount of syllabus  Exams always have an element of uncertainty about them T here is a certain kind of expectations from the students by family and friends  You may need a particular exam result to gain entry into another course or for a successful career path 38 March-April 2018 w w w.m e d e g a te to d a y.co m

Following are some of the symptoms that can help to detect stress in students: P hysical Signs: Increased heart rate, shallow breathing, muscle tension, excess perspiration, heart palpitations, stomach churning, headaches, dry mouth, nausea/upset stomach, faintness/ light-headedness, feeling too hot/cold (shivers), insomnia/nightmares, fatigue, changes in appetite/eating patterns  Behavioural Signs: Procrastination, restlessness, wanting to get away, avoiding others, impatience with others (‘short fuse’), lack of self-care, substance abuse, high-risk and selfdestructive behaviours  Emotional Signs: Wanting to cry/laugh, anger, helplessness, fear, disappointment, depression, irritability, frustration  Cognitive Signs: Negative/selfcritical thinking, confusion, poor concentration and memory, racing thoughts, going blank, difficulties with problem-solving

Managing exam stress Often students get the anxiety of ‘what if I fail’ or ‘what if I go blank during the exam’. To study effectively one needs to focus on the study materials. One can never concentrate on their studies while the mind is occupied with such thoughts of uncertainty. If one is experiencing exam stress, it’s important to try to remind themselves that it is only a small part of their life and it won’t last forever. How to beat the exam stress:  Begin studying NOW – Procrastinating and just thinking about it won’t help you. It won’t get any easier. Just thinking about it will make you more stressed and will yield less result.  Clarify areas you need to study – Be strategic. Ask what areas you should focus on. Give more attention to those areas you are weak in.

 Organise a time plan – Start when you said you’d start, stop when you said you’d stop. Follow your schedule. Take ten minutes break from studies after every hour or so.  Organise a study group – Make it social and productive. If you have any questions or concerns, discuss it among yourselves. Focus on your trouble spots and share notes on that and once you’re ready to start studying, make a schedule that takes into account the different demands of each subject.  Take a break: You may feel like you need to study for as many hours as humanly possible, but at a certain point this all-in approach becomes counterproductive. Schedule in short breaks: chat with friends, grab a coffee or go up and down a flight of stairs.  Get moving: Increasing activity level is something you can do to help relieve the stress and to feel better. Rhythmic exercises such as walking, running, swimming, and dancing are particularly effective, especially if you exercise mindfully (focusing your attention on the physical sensations you experience as you move).  Eat a healthy diet: Healthy diet can help to cope with life’s stressors. Eating a diet full of processed and convenience food, refined carbohydrates, and sugary snacks can worsen symptoms of stress while eating a diet rich in fresh fruit and vegetables, high-quality protein, and omega-3 fatty acids, can help you better cope with life’s ups and downs.  Get your rest: Students often tend to study overnight. This provides them with less sleep which can accelerate stress. It’s extremely important to sleep for 6-8 hours during exam to give rest to your brain.

EXPERT VIEWS

How Healthcare media can be part of your Business development & Help in Medico Legal Healthcare media as assumed a very crucial role in these days of information flood and comprehensive media coverage. A sound media management has capabilities of minimizing the risk of perceptual distortion on one hand and projecting the positive image of hospital on other hand. As there is lack of correct & timely Public Communication among healthcare facilities, there is an urgent communication need to bridge between public & healthcare facilities. This perennial vacuum needs to be filled in to ensure correct connect between public and healthcare facilities. 40 March-April 2018 w w w.m e d e g a te to d a y.co m

EXPERT VIEWS

Print Media

This is most significant media like magazine ,newspapers etc. Despite information explosion in various media, print media still enjoys a lot of seriousness as it engages and focuses the readers on contents. It makes them think , interpret & analyse the contents as per their own comfort levels. Facts remain that Print media by and large still relevant in this age of information revolution.

Electronic Media

This complements the inevitable information void created by print media as live telecast does entrall the audiences .However it runs the risk of hyperboles and rhetoric by increasingly getting louder electronic media. Media bytes are getting more and more driven by personal agenda & interests. Hence objectivity of reporting has been badly hit.

Social Media:

21st century media avatar though instant and unprecedented mass based however proved to be 2 minutes media by any standard. It lacks seriousness of conventional mass media. The social media has enough powers to public however when it comes serious matters, experts with outstanding credibility and experience are required. Unfortunately these experts and thought leaders are not so comfortable in expressing their views in the midst of usual public outcry

Mass Communication of clinical & crucial issues

The best way to project and position a healthcare facilties is to make public aware of prevalent diseses in that catchment areas and clinical solutions thereof . More over if mass communication focuses on preventive approach, it instills confidence in public about caring approach of healthcare facility.

PR Management

Its an exercise which keeps highlighting the achievement of hospitals in treating rare cases and there is no dearth of such cases in any facilities. Even if there are changes in speciality and bed mix , there is the need to share with masses.

Advertising & Promotions

Surrogate advertising as mandated by medical bodies can be used to promote hospitals. The care should be taken to avaoid direct and hard selling. One must remember the basic rule that healthcare is not for consumption and public is not consumer . hence conventional marketing approach and tools must be avoided. A more pragmatic approach is feature and acknowledge GPs of the catchment areas in promotional compaigns. Healthcare needs to have more collaborative & collective than competitive approach. There is still lots of untapped potential in almost all catchment areas so need not be panic and myopic. At the of the end of the day hospitals rooted in basics and ethics win the heart of public not ones which have loudest marketing approach. Publicâ&#x20AC;&#x2122;s sensibilities must be respected and not taken for granted.

Medico legal communication:

This fast growing concerns in whole healthcare eco systems and must be dealt with sensibility. Medical Science is no mathematical science and outcomes can never be guaranteed. any promotional campaign must carry the rider that like mutual funds , outcomes are subjected to various physiological parameters and responses to treatment . In case of any such eventualities , a medico legal press release to be issued and publicized detailing complications of cases.

w w w.medegatetoday.com March-April 2018

EXPERT VIEWS

The Sad Demise of the Sacred Patient-Doctor Relationship

Dr. H Sudarshan Ballal Chairman - MHEPL, Chairman-Medical Advisory Board

NATHEALTH: A conglomerate of Health care Providers, Medical Technology Providers (Devices, Equipments & IT), Diagnostic Service Providers, Health Insurance companies, Health Education Institutions, Medical Journalism companies, Biotech/ Lifesciences related companies, Healthcare Publishers, Healthcare Consultants, Home Healthcare companies, PE & VC companies and other stakeholders, is a thought leadership organization constantly working towards better health care delivery in our country. The topics in the upcoming 5th NATHEALTH event are reflective of the major concerns in health care today and I would like to address the “Sad Demise of the Sacred Patient doctor relationship” and “The Rising Costs of health care

42 March-April 2018 w w w.m e d e g a te to d a y.co m

I have pondered long and hard about the reasons for the intense mistrust between the patients and the care givers and more importantly, about the solutions to correct this In my opinion, the reasons for this are the huge increase in cost of treatment which usually is out of pocket; patient’s misconception of what constitutes negligence; corruption and unethical practice by some healthcare givers; extortion from some interested parties and adverse media coverage. It’s not too late if all of us work together to revive this relationship and only mantra is be compassionate; inculcate soft skills, be honest ,transparent; communicate constantly; financial counselling; clamp down on unethical practices; work on cost reduction; and work with media to mitigate the distrust. Let’s all work together to restore the trust. The Rising Costs of Health care is a huge challenge for our country especially in the rural areas The paradox in our healthcare is that we are expected to deliver healthcare with first world standards at third world costs, Eg: a heart surgery, bone marrow or kidney transplant in India is at 10% or less of the cost in the USA and even this is considered very expensive. Unfortunately, in our country about 80% of healthcare (esp. tertiary) is in the private sector and since the public health sector is in disarray, most citizens including economically weaker sections of the society are forced to avail expensive many a time unaffordablecare in private sector and this is the root cause of the conflict between patients and healthcare givers.

Hence the focus of the govt. health care should be preventive and primary care measures like sanitation, nutrition, clean drinking water, vaccination antenatal and perinatal care and education on life style modifications which will save millions of lives at a fraction of the cost. They also should look at some form of reasonable insurance for secondary and tertiary care as a PPP model. To contain the increasing costs the government has come out with measures like capping prices of consumables like stents, knee implants and and fixing prices for procedures. Though all of us believe that urgent measures are needed to control prices, in a free market economy fixing prices could severely dent private health care which in our country delivers over 70% of tertiary health care. The government should strengthen the public health sector and work with private sector to come out with viable universal health care coverage on a PPP model. The recent introduction of National Health Protection Scheme covering the health care of 10 crore families at 5 lakh coverage for medical expenses will be an interesting model to watch Health care is on the cusp of a giant leap forward and if managed well with a meaningful dialogue between the government and private sector could truly be a giant step in creating a healthy Bharath! This is something NATHEALTH hopes to achieve by getting all stake holders together for an ethical, transparent, quality based reasonably priced health care

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Mr. Arjun Sooraj CEO, Akash Medical

hospital. When Private hospitals do not stress on CE mark from notified body, why should the govt hospitals stress. Are they trying to favour the European manufacturers? CE mark from a notified body is only required for European countries. We can provide the same on some of products, but that adds to the cost. The cost of CE mark from a notified body is an investment of 25 to 30 lakhs rupees for 1 product. Should we add this cost to the government hospital and wrongly use the tax payers money? It is necessary for the government to ensure quality is agreed. They are already enforcing guidelines that x count of quantity should have been installed and should be in marked for x years, etc. This ensure that product is to quality. If there is a government of India guide line then we have to make it mandatory. But what is the need for Govt hospitals in India to make a European CE Mark from notified body as mandatory. So we have come past all this hurdles and hardships to fight against multinationals in our own country.

How you are seeing Medical device Industry and Tell me something about your journey into growth? healthcare since inception? This industry is growing at 12 to 15% is what every one says. We Health Care since inception has always been challenging. This being a small industry but demands high levels of quality, becomes automatically challenging. Quality is high priority. But industry is small. When we make a tooling costing lakhs of Rupees, we cannot even recover the tool cost in 3 years of sales. Hiring a qualified Human resource is a challenge. It is more challenging to retain him/her. Software giants are always there to hunt on the technical resource. We found it difficult to retain quality man power. We do not find vendors who can deliver quality at lower volumes. Every thing has been a challenge. Even the government has kept the import duties for imported machines at around 5% to 7.5%. The Government hospitals do not favour indigenous manufacturers. On the alternative the government hospitals favour imported players at 2 or 3 times the cost. They lock in the specifications. For example they lock in a CE mark with a notified body as the specification. I do not understand how a CE mark from a notified body is stressed by the govt of India 44 March-April 2018 w w w.m e d e g a te to d a y.co m

also see it to be right. But for indigenous manufacturers like it grows faster owing to the fact that we are inching into the imported players share other than enjoying the market growth. Today 85% of the high tech equipment are imported. 10 years down the line we will have only 40% to 50% as imported. Indian manufacturers have proven in many products.

What is the market size of the medical equipment in India and what is your stake? Medical equipment on the whole is 25000 cr market. But we play only in less than 500 to 600 cr market. We enjoy a stake of 5% to 20% in various product segments that we play.

How Akas Medical serving to India through dealer Network? Tell me about dealer support system? This industry sells through relationship. Relationship cannot be maintained with 10000 people. One can hardly maintain a

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Dealer Meet 2018

relationship with say 50 to 100 customers. So Our dealers have a network of hospitals who maintain relationship with customers. We have more than 60 dealers to cater to reaching every hospital.

What is your upcoming product to launch and its features? We have newly launched an innovative product called the Quick Vital Sign used in Out patient deparments (OPDs). This is a product which measures the Height, Weight, BMI, Spo2%, NIBP, Non Contact Temp, Pulse Rate of the patient with in 2 mins. This product is essential for all OPDs. This also gives a print out to the patients. Has computer connectivity for data base. We have another unique product called Drip Sure. This is an infusion controller ( not an infusion pump) which controls the IV fluid at precise rates ( set rates) . We have been in IV pumps segment for more than 22 years and we know what the customer wants. This product delivers the customer needs at close to half the price. This is for every bed. Our patient monitors and drug delivery pumps have wireless connectivity to Central Monitoring Station. So everything can be centrally watched. Reports taken. This is unique. Hospitals cannot imagine taking a print of Drugs delivered to patients over a 7 day period in a graph format. We have it.

Mr. Sudhir

Mr. Irshaad Raza

Mr. Raghuraman

Mr. Pradeep

Mr. Ashish Banshal

Mr. Ashok Parmer

What is your future expansion plans? AKAS has been slow over the last 22 years. Even though our CAGR is more than 26% YoY, we call it slow. We have launched some innovative products recently. In the next 3 years AKAS is all set to take off very well. We are planning for a factory in the outskirts of Chennai in 2018. We have software and applications through mobiles for registering customer complaints and take customer feedback. w w w.medegatetoday.com March-April 2018

DOCTOR SPEAK

Chasing SDG Goals

Interconnectedness of Health, Poverty and Livelihoods

Dr. Monika Choudhary Associate Professor, IIHMR University, Jaipur

Dr. Monika Choudhary is a postgraduate in Economics, MBA in Finance and Ph.D in International Trade and Finance from University of Rajasthan and now serving as Associate professor at IIHMR University, Jaipur. She is a National Scholarship holder and was selected for Rajasthan State Administrative Services, but she found her true call in research and academics. After having taught Capital Markets in a regular business school for six years, she decided to switch to development studies. Her early research work is in capital markets, exchange rates and financial modeling. She has presented research papers in National and International conferences and won awards. She had done Corporate Consultancy in the areas of Capital Financial Restructuring and Profitability Analysis. For the last five years she has been involved in research pertaining to various areas of health economics viz Water Economics, Water Financing, Hospital Finance, Integrated Water Resource Management, Monitoring and Evaluation of health programs, Health Financing and Health economics. She has worked closely with government, funding agencies and NGOs. Her consistent endeavor is to develop sustainable models, particularly in the health sector, which may contribute in the growth and development of the economy. 46 March-April 2018 w w w.m e d e g a te to d a y.co m

eing the second most populous country, India and the efforts it makes would be important for the achievement of overall sustainable development goals (SDG) targets which the world adopted a couple of years ago to end poverty, protect the planet and ensure prosperity for all. The strategies that India adopts to frame and achieve SDG goals and targets would be of relevance for the rest of the world, as best practices, models, and paradigms. However, Indiaâ&#x20AC;&#x2122;s journey towards sustainable, equitable development would be one of the most complicated and unique, given the level of socio-economic diversities in the country. While there are states like Kerala, which are already far ahead and at par with the world on some of the SDG goals and targets, there are states like Bihar, UP, Rajasthan, Chhattisgarh, and Jharkhand, which are far behind. India has fared badly on SDG goals and particularly on goals related to health and poverty.

Interconnection of Goals SDG Goals are interconnected to each other. Universal Health Coverage, becomes a very difficult goal to achieve when about 276 million people (or about 23% of the population) live below poverty line. According to Census 2011, the workers (comprising of main workers and marginal workers) formed 39.79 per cent (481.7 million people) of the total population as against 39.10 per cent in 2001 census. Only a small percentage of the total workforce of the country is employed in the organized sector. Organized sector employment as on March 31, 2011 was 29.00 million of which 60.52 per cent or 17.55 million was in public sector. The population that lives below poverty line falls short on the aspects of accessibility and affordability of healthcare because they are forced to make huge out of pocket expenditures. They work for unorganized sector and cannot resort to health insurance largely. They fall into a vicious cycle of poverty - which results from inadequate source of livelihood, low productivity due to bad health.

Micro Level Data And Planning Must Structuring an optimal â&#x20AC;&#x2DC;big pushâ&#x20AC;&#x2122; is the most critical link to chasing SDG goals. The efforts made at the macro level by

DOCTOR SPEAK

government should be supported by efforts made at the micro level by households. Creating infrastructure and systems should be balanced by creating skills, education and awareness. When there are resource constraints, optimal solutions are reached at by permutations, combinations and an interplay of variables, which would be too many in case of health, poverty, and livelihoods. There are zero sum situations, and a negotiation between various outcomes is hard to make. One of the factors which accounts for an interplay of variables with-in resource constraining situation is an imperative out of pocket expenditures to be made by those belonging to the lowest quintile in terms of disposable income. According to National Health Accounts statistics(2014), all households out of pocket expenditures is 69.1% of the total health expenditure. Households must resort to their own financing resources to seek healthcare. Many studies have indicated that households belonging to lower quintiles of disposable income are pushed back to below poverty line status because of imperative health expenditures. One of the main source of financing is assets and debt, for households. Healthcare expenditures thus account for dis-savings for households having lower disposable incomes. Savings as a percentage of disposable incomes rise when incomes increases. Households that must make healthcare expenditures are not able to save enough to do capital formation, which leads to subsistence existence. Health-Wealth nexus, cannot be broken unless a push in terms of public health and livelihoods is provided.

At the district level, a primary effort should be made to identify these households. District level data related to poverty, unemployment, seasonal and disguised unemployment, nutrition, disease surveillance, health indicators, water and sanitation should be disaggregated at the panchayat and block level. Research related to epidemiology of the district should be collected by district health officer.

Health Expenditure Details Paramount Importance

are

Health expenditure on preventive care is a very small percentage of curative care expenditure in India. As per National Health Accounts estimates general inpatient curative care accounts for 20.5% of the total expenditure while outpatient care accounts for 29.5% of total expenditure, while preventive care is a mere 9.6 % of expenditures. The underserved population with regards to health in India is huge and it is difficult to achieve the goal of universal health coverage or Healthy India through curative way. It will require huge funds, and will cut into other essential developmental expenditure on education, infrastructure, and energy. That is where the interconnectedness of health-poverty-livelihoods variables and the dynamic of interplay of these variables becomes extremely important to understand. Increasing public expenditure on preventive care is one such â&#x20AC;&#x2DC;big pushâ&#x20AC;&#x2122; that could be provided. Government Budgets for all the preventive health programs mentioned above should be increased at the center and the state level. District level Public Health Management cadre of officials, and larger investment in primary health has been mentioned as essential steps to be taken by the government in Health Policy 2017. Department of Statistics and Planning working in close co-ordination with Public Health officials, to generate data, and design localized solutions for health problems in the district would bring results. The District Public Health office will prepare regular reports on epidemiological surveillance studies conducted in the district and combine it with poverty and unemployment data collected by department of statistics and planning to identify vulnerable population groups.

Employment Generation Schemes Linking MNREGA, and other employment generation schemes with health insurance, nutritional programs, awareness programs, disease surveillance and developmental works like infrastructure development, and water conservation would bring about bigger outcomes with cost effective investment. District level planning of comprehensive development schemes for a household which requires assistance in all the three areas of health, employment and poverty is the key to achieving SDG goals in India. w w w.medegatetoday.com March-April 2018

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India Hospital Design & Build Summit 2018 edition, during 22-23 Feb 2018 at Le Meridien, Gurgaon. The India Hospital Design & Build Summit 2018 Edition, with the theme “Transforming Hospitals” provided a platform for industry stake holders to work out a roadmap for unleashing the future of Healthcare Infrastructure Industry in India and Asia region. The exclusive two days summit was organized during 22-23 February 2018 at Hotel Le Méridien in Gurgaon, Delhi NCR. The Day 1 inaugurated with the chief guest address by the Honourable Minister of State for Health & Family Welfare, Government of India, Shri Ashwini Kumar Choubey was read by the Mr Upendra Joshi- Director Conferences. Where the honourable minister expressed his happiness to the organizer, Quest Onthefrontier for organizing the important summit on Healthcare Infrastructure and Facility with national and international experts and audience. He also mentioned how government is going to help the healthcare services and facility. The international expert of health industry, Mr Carson Shearon, Principal, Director of International Client Strategies, CannonDesign, USA welcomed the all industry leaders, eminent speakers and audiences from India, neighbouring countries and Europe. Mr Mehul Shah, Head Healthcare & Turnkey Solutions, Godrej Interio spoke and presented on “Agile and Trusted Healthcare Project Solutions by Godrej Interio”. The first Panel was - CXO Power Discussion: Building Intelligent Hospitals. The panel was moderated by Ms. Tulika Puri Katyal, Architect, Partner & Head, Urbane, with the key industry experts - Mr. Shekar N, Head – Projects & Maintenance, Aster DM Healthcare, Mr. Gaurav Chopra, Principal, Managing Director, HKS India, Dr. Sunil Khetarpal, Secretary, Association of Healthcare Providers India - Delhi NCR Chapter and Mr DN Suresh, Senior Vice President (Infrastructure), Max Healthcare, as panel members. Later on Mr. C. Carson Shearon, Principal, Director of International Client Strategies, CannonDesign presented his keynote presentation on “Transforming Health: Designing Tomorrow’s Care Environments”. The next big panel was on Smart Hospitals – Project Management Aspects. The panel was moderated by Dr Roheet Rao, Head 48 March-April 2018 w w w.m e d e g a te to d a y.co m

– BD, Sales & Marketing, Stasis Labs. Dr. Vivek Desai, Founder & Managing Director, Hosmac India Pvt. Ltd, Dr. Lalit Varma, Vice President Projects, Apollo Hospitals, Mr. Surender Kumar, Head – Projects, Fortis Healthcare, Dr. Chandrashekhar R, Advisor (Architecture), HLL Lifecare Ltd. (A Govt. of India Enterprise), Mr. Gaurav Dewan, Director, Kgd Architecture, Ms. Brinda Sen Gupta, Senior Project Architect, HKS India, and Dr IJS Sekhon, Astron Healthcare were the panel members. The next highlight on the day was very crucial panel on Green field hospitals Vs Brown field hospitals. Mr. Siddhartha Chatterjee, Marketing Manager, Honeywell Building Solutions – India presented on Connected Hospitals. The panel was very well moderated by Mr Rahul Bajpai, COO, HCG Cancer Center and the panel members were - Mr. Rajesh Sivan, Group Head – Projects, Asian Healthcare Holdings, Mr. Shamit Manchanda, Chairman, Indian Institute of Architects, Northern Chapter, Mr. Uday Kumar Alaham, Head, HOSMAC Middle East, Mr. Ritesh Dogra, Managing Partner, Medium Healthcare Consulting and Ms. Shilpa Naik, Associate Vice President & Director of Healthcare, India, CannonDesign. Mr. Antonio Pellicer, CEO, NIBUG and Prof. Ignasi Perez Arnal, Development Coordinator, NIBUG presented on the topic - Pre-industrialized hospital architectural projects is the best health treatment? The presentation was followed by Mr. Naresh Duble, Head – Commercial Excellence & FMD, Armstrong World Industries (India) Pvt. Ltd presented on Hospital are for Patients – Acoustic Solutions for Healing Spaces. The final session of the day was panel on Project Financing in Hospital Sector. The Panel was moderated by subject matter expert Dr. Salil Choudhary, Director, Hosconnn Consulting Services Pvt. Ltd and the panel members were - Dr. Yasha Pandit, Principal Consultant, PwC India, Mr. R. Venkatakrishnan, Founder & Partner, RVKS and Associates, Dr. Shuchin Bajaj, Founder, Cygnus Hospitals and Dr. Saarthak Bakshi, CEO, International Fertility Centre. The Day 2 started with the keynote presentation by Mr. Raghava Rao, CEO, Camomile Healthcare Ventures on

POST EVENT

topic – Healthcare in 2030 –what are the new models of care? What will be the key change drivers, implications for existing hospitals. This was followed by the panel on Achieving optimal costing per bed to enhance the revenues. The panel was moderated by Mr. Ritesh Dogra, Managing Partner, Medium Healthcare Consulting. Mr. Gaurav Malhotra, Managing Director - India, Medicover, Dr. H. P. Singh, Chief of Medical Administration, Indian Spinal Injuries Centre, Dr. Dharam Meena, Hospital Administrator, Institute of Liver and Biliary Sciences (ILBS), Dr. Saarthak Bakshi, CEO, International Fertility Centre and Mr. Raghava Rao, CEO, Camomile Healthcare Ventures were the panel members. The session was followed by the presentation by Mr Manish Kashyap – Head Projects & Specification Business and Laminate & Allied, Greenlam Industries. The next panel on time saving and efficient technologies for construction was on Effective implementation of precast and prefabrication to help reduce the cost of construction

& ensure timely completion. The panel was very well moderated by Mr. Darpan Katyal, Director, Sky Construction. Mr. Surya Prakash, President, Pre Engineered Structure Society of India, Mr. Amit Krishn Gulati, Senior Architect, Incubis Consultants India and Ms Arpita R Ranjan, HoD, IVS School of Design were the panel members. Later on, Mr. Sanjay Joshi, Senior Vice President and Business Head, Everest Industries presented on Rapid Construction for Indian Healthcare. Dr. Thimmaiah Anil Kumar, Professor & HoD Internal Medicine, M. S. Ramaiah Medical College presented on SMART STASIS SAVES LIVES. Mrs. Mala Mohan, Additional Director General (Architecture), MES, Ministry of Defence presented special presentation on Hospital Projects in Defence. Mr. S. Karthikeyan, Principal Counsellor, CII - Indian Green Building Council (IGBC) – Healthcare Rating System presented on Green Healthcare Rating System. Mr. Amarnath CB, Founder, India BIM Association presented on Benefits of adopting BIM for building and managing hospital projects. The summit was ended with the final and crucial panel on Hospital Design & Patient Safety. Prof. Ignasi Perez Arnal, Chair- Sustainable Architecture, International University of Catalonia, Spain was the moderator and Mr. Ajay Bery, Vice President - Operations, Sir H. N. Reliance Foundation Hospital, Ms. Kawaljeet Oberoi, Regional Chief of Nursing Services, Fortis Healthcare, Mrs. Mala Mohan, Additional Director General (Architecture), MES, Ministry of Defence and Ms. Jagruti Bhatia, Senior Advisor - Healthcare Advisory Practice, Godrej Interio.

w w w.medegatetoday.com March-April 2018

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HITLAB and Unitus Seed Fund Announce Winners of 2018 HITLAB World Cup: India With $500,000 in Potential Funding After receiving over 180 applications from digital health innovators around the world, HITLAB and Unitus Seed Fund, through its StartHealth initiative, are pleased to announce that Medi360, a cloud-based telehealth solution, was the winner of the 2018 HITLAB World Cup competition, part of the HITLAB Innovators Summit held on February 10 at the Indian Institute of Technology, Delhi. Medi360 integrates electronic medical records with diagnostic devices and prescription capabilities. "It was a great experience participating in the HITLAB World Cup as one of the finalists and we are extremely thrilled to be recognized as the winner. This provides further fuel to our motivation in the journey of making a meaningful impact to healthcare in India," said Kumar Amar Jamdhiar, CEO of Medi360. Runners-up include MUrgency, a medical resources aggregator, Mother Diagnostics, a low-cost digital X-ray device, Mimyk Medical Simulations, an immersive medical simulation technology, and VOTIS Subdermal Imaging, a noninvasive and inexpensive technology to identify foot pathologies in diabetics. Winners will now be considered for up to USD $500,000 (INR 3.5 crore) in grants and equity funding by Unitus Seed Fund and its AmpHealth program to fund their continued work and expansion. "Presenting at the HITLAB Innovators Summit is an unparalleled opportunity for innovators to showcase their work before an international audience of leaders in public health, medicine, science, technology, and design," said Stan Kachnowski, 50 March-April 2018 w w w.m e d e g a te to d a y.co m

HITLAB Chair. "We are excited to see how these digital startups will improve the healthcare system in India. The support that Unitus and HITLAB can provide these impactful organizations as they grow will prove invaluable as they bring innovative, transformational technologies to the people who need them." The HITLAB World Cup judges - representing senior leadership at Unitus, HITLAB, Boston Scientific, and All India Institute of Medical Sciences (AIIMS) - reviewed applications from a wide range of innovative companies working in artificial intelligence, telehealth, home health, mobile applications, and biotech devices. Entries were judged on their impact, innovation, sustainability, and feasibility. The Innovators Summit featured speakers from leading organizations

including Johnson & Johnson, Stryker, IBM, PATH, Terumo, and more. The theme for this Summit - the fourth in India - was Enabling Inclusive Digital Health Innovation and Diffusion. For more than 15 years, HITLAB has helped leading organizations ideate, create, evaluate, and diffuse technology-based solutions to pressing healthcare challenges. It has hosted the annual HITLAB World Cup Challenge since 2006. Past innovations have ranged from a tech-enabled dynamic scoliosis brace to a voice-activated blockchain ecosystem for diabetic patients and caregivers. Winners have since raised over $50 million in followon investment funding and launched commercially viable products that transform lives.

PRODUCT LINE

A game changer for Cervical Cancer India: In women cancer cases as well as mortality is uphill. The main reason can be attributed to low awareness and late detection. As per the data “Our country stands third after China and USA for the highest number of cancer cases among women which are growing per annum at 4.5-5%. Every eight minutes, one woman in India loses the life battle due to cervical cancer. Approximately 1.2 lakh women are suffering from cervical cancer in the country and in the coming years cervix cancer will top the list. India alone stands for approximately 25% of global deaths due to it. HPV is also implicated in cancer of the anus, vulva, vagina and penis, as well as some head and neck cancers. One of the most recent advancements in molecular diagnostic market is the •single-cell assay for HPV E6/E7 mRNA detection in cervical sample. Premas Life Sciences Pvt., Ltd. a specialised Life Science Distribution Company, has brought the new Diagnostic tool “IncellDx HPV Oncotect 3Dx”in an exclusive tie up with IncellDx, Inc.. The biggest USP is that it offers a more accurate Cervical Cancer Screening Tool. “95% of women who test positive for High Risk HPV will not progress to Cervical Cancer, so the major problem is how we effectively identify the 5% who will progress. Well the solution lies with the IncellDx HPV Oncotect 3Dx which offers a more accurate Cervical Cancer Screening Tool. It differentiates benign HPV infection from precancerous lesions. It boasts of a higher specificity and positive predictive

52 March-April 2018 w w w.m e d e g a te to d a y.co m

value than HPV DNA testing. Also it has a higher specificity for disease does not lower the sensitivity/ Negative predictive value (NPV). Furthermore it has lower false positives than current cervical cancer screening standards.” Said Mr. Praveen Gupta, Managing Director of Premas Life Sciences “HPV OncoTect 3Dx offers improvement in specificity and higher positive predictive value for transforming infections (CIN2+). Hence it is easier to make more accurate prognosis if a patient needs Colposcopy/ Biopsy or just needs to be monitored for Infection progression. It has a specificity of 85% based on CIN 2+ cytology compared with 30-40% specificity with HPV DNA testing. There is a higher likelihood of finding a high grade lesion (CIN 2+) during colposcopy when a patient has a positive HPV Oncotect 3Dx test than with an ASCUS/HPV positive result alone. For LSIL or ASC-H patients, a positive HPV Oncotect 3Dx may indicate the presence of a high grade lesion. A negative HPV Oncotect 3Dx result correlates with a lower likelihood of a high grade lesion.” Further added Mr. Praveen Gupta. Oncotect 3Dx additionally offers simplicity of Collection. It uses the same liquid based pap vial. The AIIMS Institute in New Delhi recently completed a successful study utilizing IncellDx’ s next generation (3Dx) investigational molecular assay which quantifies HPV E6, E7 mRNA in single cells that precisely identifies the integration of E6, E7 mRNA overexpression with the measurement of cell cycle and cell proliferation.

DOCTOR SPEAK

Why Ayurveda Should be the First Choice for Chronic Kidney Disease lives due to AIDS. A paper by the University of Toronto notes that urban and rural India are equally affected by kidney failure deaths with the rate of death higher in urban areas. So, what is causing the spike in renal diseases in India? A major reason is that an increase in lifestyle diseases and problems such as diabetes, obesity, hypertension, and dehydration are taking a massive toll on the functioning of the kidney. Often the symptoms of diabetes mask the symptoms of renal failure and it is too late when kidney failure is detected. Even when chronic kidney disease is detected, patients prefer quick fixes like pain killers which aggravate the problem, rather than treating the root causes of the illness. In the long run, they are left with the painful and expensive choice of dialysis for survival. Is there a cost-effective treatment for CKD that does not exact a heavy toll on the human body?

Ayurveda to the rescue

Dr. Partap Chauhan Director, Jiva Ayurveda

Dr. Partap Chauhan, Director of Jiva Ayurveda, is an author, public speaker, TV personality and master Ayurvedic physician. Since 1992, he has dedicated himself to popularizing Ayurveda across the world. Author of two bestselling books, Eternal Health and Eternal Beauty, and dozens of videos on various health problems, Dr. Chauhan teaches Ayurveda both at Jiva as well as in other countries

female, middle-class patient from Delhi had been sporadically seeking medical help for fatigue and high blood pressure. Added to these ailments she was also diabetic and obese. It was only when the symptoms became more persistent with the loss of appetite and reduced urine discharge, that an examination proved that her kidneys were functioning at 20 per cent less than the normal. The choices she suddenly faced were stark and expensive --- kidney transplant or dialysis. Chronic kidney disease or CKD is a silent killer – in 2015, 1,36,000 Indians lost their lives to kidney failure, a rise of 50,000 from the 86,000 renal failure deaths in 2003. In fact, double the number of people lost their lives due to renal failure in 2015 than those who lost their

54 March-April 2018 w w w.m e d e g a te to d a y.co m

Ayurveda offers treatment for all stages of different renal problems. At the core of Ayurveda’s success in treating renal problems, or any other ailment for that matter, is customization. Each patient has a unique set of Prakriti, doshic properties and causative factors - all of which are considered before giving treatment and medicines. This level of customization makes it possible to address the disease with more accuracy. Wholesome rejuvenation and treatment at the cellular level In addition to customized medication, Ayurvedic treatment also offers personalized lifestyle and diet recommendations which has a holistic effect on the body. A significant specialty of Ayurveda is the application of Panchakarma therapy. Depending on the condition of the patient, one or more of 40 different therapies is applied to remove toxins accumulated due to a faulty kidney. Panchakarma therapy also stimulate the body’s natural repairing mechanism and rejuvenates renal tissues and cells.

Promotes overall wellbeing According to the data from the Indian Renal Foundation, the cost of kidney failure is extremely high in India. Haemodialysis with 12 sessions every month costs around Rs 12,000 to Rs 15,000. Peritoneal dialysis costs around Rs 18,000 to Rs 20,000 every month. Kidney transplants can cost Rs 4 lakhs to Rs 6 lakh, depending on the hospital. Ayurvedic Rasayana therapy has multiple benefits. Ayurvedic treatment strengthens the fundamental aspects of the body, so, by the end of treatment for kidney problems, patients report feeling a renewed sense of wellness and good health. It is essential to select an Ayurveda specialist with the right expertise and track record before committing to therapy.

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