Future Medicine

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EDITOR’S NOTE Making a real-time diagnosis of shame

I

ndia made a shameful start in the New Year, with the death of a physiotherapy intern following brutal rape in the national capital in the dying moments of 2012.

The shame and shock over the tragedy is far from over.

Volume 2 Issue 1 | January 2013 Editor Ravi Deecee Deputy Editor Sanjeev Neelakantan Assistant Editor Dipin Damodharan Senior Reporter & Research Assistant Sreekanth Ravindran Senior Reporters Lakshmi Narayanan Prashob K P RESPONSE TEAM Coordinating Editor Sumithra Sathyan Reporters Tony William Shalet James Neethu Mohan Design & Layout Kailasnath Anil P John

Head - Business M Kumar ADVT SALES Senior Managers Kainakari Shibu Rajasree Varma Anu P M Biju P Alex K S Syam Kumar Vinod Joseph ( Delhi) Rohil Kumar A B (Bengaluru) Managers Febin K Francis Bipin Kumar V S MARKETING Sr Manager Sabu Varghese Mathew Assistant Managers Priya P A Mobin E Mathew Circulation Athul P M Sone Varghese

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4 FUTURE MEDICINE I January 2013

The public is seething with anger over the inability of the Central government to devise a security mechanism whereby women feel secure in whatever work environment or life situations they are in. We cannot afford to be deaf, dumb, or blind to the moral crises of ever-mounting crimes against women. According to the National Crime Records Bureau data, one woman gets raped in India every 22 minutes. What’s wrong with our country? Is it (rising crime) a mere law and order problem? Is there a problem with our culture? Have the activism and protestations over such crimes come too late in the day? Are we missing the bigger picture?

Delve into history and you will realise one thing clearly: our value systems have been eroding at a faster pace. Our daily problems are not just about social and economic disparities anymore. Our communities have developed fissures within and each one is an island unto himself/ herself. The mad rush for material comforts has made us pathetically poor in terms of humanism. Only a benevolent few are making genuine attempts to steer the course of the nation towards nobler causes and meaningful change.

For instance, the World Leprosy Day is around the corner, and the chances of it being viewed as just another Day in our life with no sense of compassion for the suffering lots are very much on the heavier side. Our Cover Story is on an institute based in South India that has been engaged in a tough fight against Leprosy for the past six decades.

How is it a tough fight? Well, an ageing bull epitomises the heart and soul of the institution’s model of care for Leprosy patients. That’s not all. We recount the story of great saints who dedicated their lives to such needy people, the idea being simple: finding inspiration from our past.

If one trail leads to an unresponsive community system, the other one takes us to hazardous lifestyles.

Don’t miss our special package on cardiology.

Stay positive!

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CONTENTS

STORY 18 COVER LEPROSY: Where’s the healing touch?

On January 29, the world will observe the Leprosy Day. It will be a day when new pledges will be taken for targeted eradication of Leprosy. India alone makes up for 65 per cent of Leprosy cases in the world, as of 2011. What happens when society doesn’t care for people of its own fold? We bring you the story of Damien Institute of Thrissur, Kerala, where an ageing bull epitomises the heart and soul of care for Leprosy patients

14 52

CLINICAL RESEARCH Apurva Shah, Chairman, ACRO

Cardiology Special Is your Heart in sync with Life?

56

GUTKHA MENACE: Binoy Mathew of Voluntary Health Association of India

INDIAN HOSPITAL: KG Hospital, Coimbatore, Tamil Nadu

33

How healthy is your lifestyle? How much do you know about the food you consume? Do you have time for physical workouts? Has your stress reached unmanageable levels? Are any health disorders bothering you? Comfort your heart!

Italian Ayurveda 69 Customisation of Ayurveda Customisation of Ayurveda is happening in a new way and SNA Oushadhasala of Thrissur is at the forefront. The credit for creation of Italian Ayurveda goes to SNA Oushadhasala

6 FUTURE MEDICINE I January 2013

62

Miracle Worker of NIMS Medicity From Business To Charity Faizal Khan is no doctor by profession. Yet, he knows how to take care of each and every nuance of healthcare from a practical and humanist point of view. That’s what makes him a miracle worker of NIMS Medicity

31

Hair care solutions

50

Health insurance

60

Tooth decay

12

Pituitary tumours

67

Focus

71

Allied Healthcare

Dr Divya Ramkumar

Dr Jitendar Kumar Sharma

Dr Ravi Hebballi

Dr Ram Kumar Menon

KVM Hospital, Cherthala

Palakkad Surgical Industries

January 2013 I FUTURE MEDICINE 7

MEDICAL DIGEST

Free bus rides for cancer patients CHANDIGARH: Taking a serious view of the plight of cancer patients who are struggling to meet their treatment expenses and daily needs, Haryana Chief Minister Bhupinder Singh Hooda has approved free travel for them in the state’s buses.

About 50,000 cancer patients travel in the Haryana Roadways

buses to reach various hospitals for treatment every year. A cancer patient has to visit a hospital about 15 times a year, which costs him a lot of money, the Haryana government spokesperson said.

Haryana Health Minister Rao Narender Singh said civil surgeons would soon issue identity cards to cancer patients in their districts to help them avail of the free travel facility. “The identity card will be valid for a maximum of 15 visits (to and from) or one year. After the expiry of the validity, the patient would have to submit it in the office of the civil surgeon for issuance of a new card,” he said, adding, the health department would compensate the transport department.

Fortis sets cancer record!

NEW DELHI: Fortis Hospital

has created a new record by screening 751 women for cervical cancer in an eight-hour marathon session as part of its ‘Teal To Heal Together’ programme. The hospital broke a Guinness World Record, beating the earlier record of 350 participants by Kaiser Permanente, San Diego, US. “Though cervical cancer ranks as the number one killer disease in India, breast cancer has received utmost attention.

Through this campaign, Fortis is aiming to spread awareness on how cervical cancer is perceived and prevented nationwide,” said Varun Khanna, the Regional Director (East and West)

8 FUTURE MEDICINE I January 2013

of Fortis Healthcare.

Over 50 gynaecologists and oncologists had screened the participants. According to a survey quoted by Fortis, over 1,30,000 new cases of cervical cancer are detected each year. It is estimated that the figure will touch 2,26,000 by 2025.

Michigan gets new abortion law

MICHIGAN: A law has come into place to check abortion practices in Michigan, US. The law, which received the veto vote of Michigan’s Republican Governor Rick Snyder, brings abortion clinics under the surveillance of the state and puts in place a screening protocol that will ensure women are not being forced to get an abortion.

The new law stipulates that health facilities or clinics that perform more than 120 abortions a year have to become licensed freestanding surgical outpatient facilities. It also demands that physicians “properly and respectfully dispose of foetal remains”. “This bill respects a woman’s right to choose while helping protect her health and safety, including making sure a pregnant person is not being coerced into a decision,” Snyder said.

In recent times, conservative Republicans in over a dozen US states have been trying to stem state funding for Planned Parenthood, a family planning provider that performs abortions.

Student fitness in China BEIJING: Students across China will be taking to a new fitness regimen this year. The Chinese government is set to introduce a nationwide fitness monitoring programme for school children. According to Minister for Education Yuan Guiren, the monitoring will be conducted by a third party institution and its result will be released to the students’ parents at regular intervals. Speaking at a meeting on sports work in schools, the minister said that sports work concerns children’s physical and mental health, and their lifetime happiness. He said schools must guarantee physical education.

NEW DELHI: A new report says

He warned schools where students’ health has been on a constant decline for three consecutive years. Such schools will be vetoed during evaluation, said Yuan. A sizeable number of Chinese students suffer from overweight and poor eyesight.

Graphic anti-smoking ad LONDON: Britain’s Department

of Health has come up with a series of hard-hitting government advertisements featuring people smoking cigarettes with a tumour growing from the end.

India’s paramedic shortage

These advertisements will tell smokers that just 15 cigarettes can cause a mutation that leads to cancerous tumours. It has been eight years since the government’s “fatty cigarette” anti-smoking advertisements.

This £2.7-million advertisement campaign will appear online, on television, and posters until February. Smokers will also be told about NHS quit kits that are available free from pharmacies.

More than a third of smokers still believe the health risks from smoking are greatly exaggerated, statistics from the Department of Health showed.

that India is in need of about 64 lakh paramedic staff, mainly in states like Uttar Pradesh, West Bengal, Maharashtra, Bihar, and Andhra Pradesh. “There is a total national shortage of about 64 lakh AHPs (Allied Health Professionals) with highest gaps in the states of Uttar Pradesh, West Bengal, Maharashtra, Bihar, and Andhra Pradesh,” according to the report of the National Initiative for Allied Health Sciences (NIAHS).

The report, titled ‘From Paramedics to Allied Health Professionals: Landscaping the Journey and Way Forward’, was released by Union Minister of Health and Family Welfare Ghulam Nabi Azad.

Paramedics in other parts of the world are usually professionals providing emergency care and ambulance services.

“It is imperative to standardise a comprehensive definition of AHPs along with a defined career pathway, salary structure, and cadre formation to ensure their growth prospects,” the report noted.

The report said the Union Ministry of Health and Family Welfare aims to address the shortage by establishing one national and eight regional institutes of allied health sciences across the country.

January 2013 I FUTURE MEDICINE 9

MEDICAL CONFERENCE

NIMHANS will host 41st IAPMRCON at Bengaluru BENGALURU: The 41st national

annual conference of the Indian Association of Physical Medicine and Rehabilitation (IAPMRCON) is to be hosted by NIMHANS here from January 31 to February 3 this year. The National Institute of Mental Health and Neuro Sciences (NIMHANS), also known as the Mecca of neuro sciences in the country, will provide the ideal platform to quench the academic thirst of the participants.

Multiple departments of the institute have been working in various fields of rehabilitation. As multi-disciplinary rehabilitation with holistic approach towards patient care is the need of the hour, this annual assembly will bring about an interaction between physiatrists, neurologists, neurosurgeons, and those working in the field of psycho-social rehabilitation.

Young physiatrists exploring new avenues

like intervention physiatry, pulmonary and cardiac rehabilitation will share their experiences. IAPMRCON 2013 will be a clinical, academic, and research experience for all the delegates.

International Stroke Conference to be held at Hawaiian island of developing more effective prevention and treatments. Stroke systems of care, quality, and outcomes are also key parts of the conference.

The conference will provide unique opportunities to meet and network with colleagues from around the world with wideranging research interests and expertise in stroke prevention, diagnosis, treatment and rehabilitation.

WASHINGTON: The International Stroke Conference 2013 will take place between February 6 and 8 at the Hawaii Convention Center on the island of Oahu in Honolulu, Hawaii. The programme will focus on basic, clinical, and translational sciences as they evolve toward a more complete understanding of stroke pathophysiology with the overall goal 10 FUTURE MEDICINE I January 2013

The Stroke Nursing Symposium and the ISC Pre-Conference Symposium will focus on scientific advances in cerebrovascular disease, emphasising upon their application in the real world. This conference will attract neurologists, neurosurgeons, neuroradiologists, neurointerventionalists, endovascular specialists, emergency medicine specialists, physiatrists, nurses, rehabilitation specialists, and primary care doctors who care for stroke patients.

PITUITARY TUMOURS

The Pituitary: Master gland of the

endocrine system A

pituitary is an abnormal growth in the pituitary gland, the part of the brain that regulates the body’s balance of hormones. The pituitary gland is a pea-sized gland located at the base of the brain. The pituitary helps control the release of hormones from other endocrine glands, such as the thyroid and adrenal glands.

The pituitary also releases hormones that directly affect body tissues, such as bones and the breast’s milk glands. These hormones include Adrenocorticotropic hormone (ACTH), Growth hormone (GH), Prolactin, and Thyroid-stimulating hormone (TSH).

When a tumour grows, hormonereleasing cells of the pituitary may be damaged, causing Hypopituitarism (low levels of pituitary hormones).

The causes of pituitary tumours are unknown. However, some are part of a hereditary disorder called Multiple Endocrine Neoplasia (MEN I). Most pituitary tumours produce excess hormones resulting in Hyperthyroidism (excess thyroid hormone), causing weight loss, sweating, palpitation, sweating, and anxiety; Cushing syndrome (excess cortisol) causes weight gain, lethargy, Diabetes Mellitus, increased susceptibility to infections and stretch marks on the body; Gigantism or Acromegaly ( excess growth hormone) leads to abnormal height with coarsening of body morphology; and then there’s Nipple discharge (excess prolactin).

Large pituitary tumours can cause pressure symptoms leading to headache, lethargy, nasal discharge, nausea and vomiting, or olfactory problems (decreased sense of smell).

A reasonable number of patients who complain of vision problems,

12 FUTURE MEDICINE I January 2013

Dr Ram Kumar Menon Consultant neurosurgeon Imaging) of the brain is done to assess the size, location, morphology, and compression and extension of nearby structures.

Pituitary tumours are usually not cancerous and, therefore, won’t spread to other areas of the body. However, as they grow, they may place pressure on important nerves and blood vessels.

Surgery to remove the tumour is often necessary, especially if the tumour is pressing on the optic nerves, which could cause blindness.

Most of the time, pituitary tumors can be removed through the nose and sinuses. The Endonasal Transsphenoidal approach is the medical parlance for this approach.

Under this technique, using an endoscope, the nasal corridor is used to reach the sphenoid sinus. The pituitary gland sits on a trough on the roof of the sphenoid bone. However, some tumours cannot be removed this way and will need to be removed through the skull (Transcranial).

such as difficulty in seeing objects in the outer half of visual field, double vision, drooping of eyes, constriction of the visual field, usually go to an ophthalmology clinic.

On some occasions, the onset of symptoms can be sudden, leading to a condition called Pituitary Apoplexy.

A clinician performs physical evaluation, followed by a series of blood tests to assess the hormone levels, like the basal cortisol test, Dexamethasone suppression test, IGF-1 (Insulin Growth factor) test, prolactin test, Thyroid function tests, and Testosterone and FSH (folliclestimulating hormone) tests. A formal visual testing and visual field charting is done to detect visual defect and field loss. MRI (Magnetic Resonance

Radiation therapy may be used to shrink the tumour, either in combination with surgery or for people who cannot have surgery.

Medications may shrink certain types of tumours. Bromocriptine or cabergoline are the first-line therapy for tumours that release prolactin.

These drugs decrease prolactin levels and shrink the tumour. Octreotide or pegvisomant is sometimes used for tumours that release growth hormone, especially when surgery is unlikely to result in a cure.

(Dr Ram Kumar Menon, MS, DNB, MCh, has settled down in Thrissur, Kerala, where he works with Elite Mission Hospital and Care Well Clinical Centre as a consultant neurosurgeon)

ORAL CANCER Gutkha Menace

Gutkha,

a serious health hazard

It is estimated that tobacco results in the death of over ten lakh Indians a year. About 75,000 to 80,000 new cases of oral cancer are registered in India annualy, causing a strain on the healthcare system

G

utkha is a highly addictive and toxic product, owing to the amount of nicotine and tobacco content in it. Currently, India has the highest number of oral cancer cases in the world. The areca nut or betel nut used in the preparation of gutkha is a serious health hazard and a known carcinogenic substance. Areca nut is consumed widely in India in the form of ‘paan’ or ‘supari’ under the mistaken belief that it is actually a mouth freshener, stress reliever, or that it aids in digestion.

Areca nut, just like tobacco, is a psycho stimulant and an addictive substance. Areca nut is, in fact, estimated to be the fourth most common addictive substance (after tobacco, alcohol, and caffeine). The World Health Organisation’s International Agency for Research on Cancer lists areca nut as a Group-I carcinogen. Even without adding tobacco, areca nut chewing is known to cause cancers of the larynx, stomach, lung, and cervix in humans.

14 FUTURE MEDICINE I January 2013

By Binoy Mathew Apart from cancer, areca nut addiction has also been found to be cause of heart attacks, arrhythmia, metabolic syndrome, and diabetes.

Children born to mothers who habitually chew areca nut are seen to be smaller in size and usually have withdrawal syndrome.

Apart from areca nut, gutkha contains several toxic and harmful chemicals such as Eugenol, N-Nitrosamines, Sodium Carbonate, Ammonium Carbonate, Ammonia, etc. Apart from these, they contain high levels of heavy metals such as lead, arsenic that cause cancer, organ failure, and various nervous diseases.

The Indian Institute of Environmental Medicine estimates that on an average, tobacco contains at least 19 known carcinogens and at least 30 metallic compounds comprising heavy metals. Further, the Cancer Tobacco Research Institute (affiliate of the Indian Council of Agricultural Research) estimates that the popular brands of gutkha and pan masala, such

as Manikchand, Rajnigandha, Chaini Khaini etc, contain nicotine.

Gutkha, or chewing tobacco, is a known carcinogen and it is known to cause oral cancer and cancer of the esophagus, pharynx, larynx,

• •

throat, esophageal cancers.

Loss of appetite Pregnant women in India who used gutkha had a threefold increased risk of having a low birth weight infant

Indian scenario

The World Health Organisation’s International Agency for Research on Cancer lists areca nut as a Group-I carcinogen.

Even without adding tobacco, areca nut chewing is known to cause cancers of the larynx, stomach, lung, and cervix in humans

stomach, and pancreas. Apart from cancer, tobacco also results in various health problems such as Gum Disease, Peripheral Vascular Disease, Hypertension, Peptic Ulcer Disease, and Coronary Artery Disease.

Health hazards of Gutkha •

•

•

It is estimated that tobacco results in the death of over 10 lakh Indians a year.

Further, about 75,000 to 80,000 new cases of oral cancer are registered in India annually and this creates a huge strain on the public and private healthcare system.

Currently, India has the highest number of oral cancer cases in the world.

Apart from cancer, tobacco results in various health problems such as Gum Disease, Peripheral Vascular Disease, Hypertension, Peptic Ulcer Disease, and Coronary Artery Disease.

Gutkha leads to Oral Sub-Mucous Fibrosis (SMF), a pre-cancerous disease that is a first step to cancer. This has increased 20 to 30 times across the country. It also leads to

According to Global Adult Tobacco Survey (GATS) India, the estimated number of tobacco users in India is 274.9 million, of which 25.9 per cent are users of smokeless tobacco, while 5.7 per cent are cigarette smokers and 9.2 per cent smoke beedi. This reveals that more Indians (almost 75 per cent) consume smokeless forms of tobacco that includes paan, gutkha, pan masala, khaini, and mawa. Gradually, the use of chewing tobacco is reaching dangerously endemic levels in the country with eight per cent of adults in the country chewing gutkha.

Nearly 80 per cent of all oral cancer cases are due to the consumption of tobacco products like gutkha, pan masala, betel quid with tobacco and khaini. According to a study released by Tata Memorial Hospital in March 2012, about 1.2 lakh deaths in 2010 occurred due to tobacco alone and most number of deaths (nearly 84,000 in men and 36,000 in women) were from oral cancer due to smokeless tobacco.

India spends approximately Rs 300 billion annually in both public and private spending on treatment of tobacco-related illness, accounting for roughly one-fourth of all health spending.

According to the WHO, the total economic cost of tobacco use in India for 2004 amounted to $1.7 billion, which is 16 per cent more than the total excise tax revenue collected from all tobacco products in India in the financial year 2003-04 ($1.46 billion).

Considering the health hazards related to chewing tobacco, which causes mouth, throat cancer, 15 states - Madhya Pradesh, Kerala, Bihar, Maharashtra, Himachal Pradesh, Rajasthan, Haryana, Jharkhand, Chhattisgarh, Gujarat, Punjab, Uttarakhand, Mizoram, Delhi, and Sikkim – and the union territory of Chandigarh have banned gutkha.

These 15 states have banned the sale, manufacture, and distribution of gutkha, khaini, and pan masala containing tobacco, based on the regulation issued on August 1, 2011 by the Food Safety and Standards Authority of India (FSSAI), a statutory body under the health ministry to handle food-related issues.

According to the rule 2.3.4 of the Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations, 2011, “Product not to contain any substance which may be injurious

January 2013 I FUTURE MEDICINE 15

ORAL CANCER Gutkha Menace

to health: Tobacco and nicotine shall not be used as ingredients in any food products�.

With 15 states and one union territory announcing the ban on gutkha and pan masala containing tobacco/nicotine, the bans have impacted about 38 million gutkha users across the country. This percentage is based on GATS 2010 and the population numbers are based on 2011 census.

India’s smokeless tobacco industry unleashes misleading mass media campaign to undermine gutkha ban, desperate to get the ban on gutkha revoked

In a desperate and unlawful attempt to get the recent bans on manufacturing, storage, distribution, and sale of gutkha and other chewing products containing tobacco or nicotine revoked, the smokeless tobacco industry has sponsored misleading advertisements in leading newspapers across the country, questioning the policy on smokeless tobacco ban.

The advertisements released in the joint ownership of the Central Arecanut and Cocoa Marketing and Processing Co-operation Ltd, Smokeless Tobacco Association and All India Kattha Factories Association bring incorrect information in order to create confusion among the public and the enforcement agencies in the states that are planning for implementation of the FSSAI notification. Such a deceptive strategy is the final resort of the Indian gutkha industry which had suffered a huge loss due to the progressive implementation of FSSAI notification and its new rules and regulations.

In its advertisements, the gutkha industry has contended that when both cigarettes and tobacco are already regulated under the Cigarettes and Other Tobacco Products Act (COTPA) of 2003, then governments need not use the FSSAI Act of 2011 to target gutkha.

16 FUTURE MEDICINE I January 2013

The FSSAI Act is being used to ban gutkha because it considers it as a food product. Any food item containing any substance including gutkha and nicotine, which may be injurious to health, is prohibited under the Act. Unfortunately, cigarette is not a food item. Besides, there is no provision of ban under COTPA. This can only be regulated.

The advertisements further say that one pouch of gutkha contains 0.2 grams of tobacco versus 0.63 grams in cigarette. This is misleading because the size of the gutkha pouch varies from 1 gm to 3.5 gm. Besides, no authentic estimates of contents are available so far.

The advertisements also argue that a cigarette has 4,000 chemicals, while gutkha has only 3,000 chemicals. Smokeless tobacco contains 3,095 chemicals, out of which 28 are carcinogenic. Even a single cancer-causing chemical can cause disease, disability, and death. So, it is immaterial to say that cigarette has more chemicals. The consumption of gutkha is making more than 15 million Indians impoverished every year due to high treatment costs.

The figure of over 40 million people losing their jobs is also wrong. According to 2004-05 estimates of the government, the total employment in the formal sector by the tobacco industry was seven million. Even if one adds the

employment by the informal sector, it will not even come close to 40 million. As per the Directorate of Tobacco Development, the area under cultivation for smokeless tobacco is just 40,000 hectares.

Why not use this area to grow crops and feed the hungry in the country?

The area under tobacco cultivation for all tobacco products in 2007-08 was 3.47 lakh hectares. More than 1.5 crore Indians are impoverished every year due to tobacco.

In a landmark hearing, the Supreme Court observed that since pan masala, gutkha or supari are eaten for taste and nourishment, they are all food within the meaning of Section 2(v) of the PFA Act. The gutkha/pan masala industry had filed writ petitions in the High Courts of Maharashtra, Rajasthan, Madhya Pradesh, Bihar and Kerala asking for a stay on the ban, but all the High Courts have upheld the ban declaring it constitutionally valid.

It is shocking that instead of abiding by the FSSAI regulation in letter and spirit, the smokeless tobacco industry is trying to make a mockery of it through a misinformation campaign in the media and selling new alternatives which could be even more hazardous than the banned chewing tobacco products.

(The author is Advocacy Officer, Tobacco Control, Voluntary Health Association of India)

COVER STORY Leprosy: Where’s the healing touch?

A hill of neglect,

This is not a cock-and-bull story.

It’s the story of a ‘saintly’ bull and a group of lesser mortals confined to a hill-based sanatorium in Thrissur, Kerala, by one of the world’s most dangerous diseases – Leprosy – and a split in family ties. The darker side of this story is unmistakably horrific, yet, we have tried to be as positive as possible.

At least hope never abandons the needy. So, we begin with the crack of dawn and the birth of a new hope - the hope of deliverance from a life of agony

, and a tough

By Lakshmi Narayanan

J

ust when a lush green hill spread over 110 acres in Mulayam village in Thrissur district of Kerala is ready to bathe under the golden rays of a brand new day, nine-year-old Manikantan is warming up to embark on his first trip of the day with a cartload of tiffin carriers to pull along.

He seems lost in his own thoughts in the final stage of mastication, possibly making a mental calculation of an arduous journey that will take

Photos by Lakshmi Narayanan 18 FUTURE MEDICINE I January 2013

him to a cluster of cottages beyond a 20-acre vegetated area. He has been making this trip thrice a day for over four years now, just to deliver breakfast, lunch, and dinner to a group of people abandoned by their near and dear ones because of contraction of a deadly health condition called Hansen’s disease, or Leprosy. Had there been any volunteers for this daily tiffin delivery service, Manikantan could have been spared from the labour. Thankfully, animals obey their masters, and Manikantan knows the drill quite well now. He halts before each cottage, shaking his head to make the bell around his neck clang and call out the inhabitants for collection of breakfast. The land strip in this part of the hill is undulated,

fight

but then, neither the ruggedness of life nor the nature can ever tame a strong-willed bull. He covers all the cottages in a short span of nearly two hours on a daily basis. After the drill, Manikantan gently retreats to the kitchen area, knowing well that he has to make two more trips later.

On certain days, an old man who has recovered from Leprosy accompanies the bull. But there’s no mistaking the fact that life is at the mercy of a bull!

Welcome to Damien Institute, the only refuge for 82 people, including about 40 Leprosy patients and those who have failed to convince their near and dear ones about their recovery from the disease. The entire hill in Mulayam is a sanctuary of Damien Institute, which has been healing,

Nine-year-old Manikantan ready for his daily service for Leprosy patients

sheltering, and providing Leprosy patients with their daily bread, with a token annual governmental assistance of Rs 25 for each patient. A visit to this sanctuary also comes at a premium.

The autorickshaw drivers have special charges for the sanctuary-bound as if that were a compensation for putting them at the risk of Leprosy.

Damien: then and now

Set up in 1952 by Monsignor Paul Chittilappilly at Ayyappankavu in Mulayam, Damien Institute received financial support from the Kerala government and some missionaries during the early years. It started with four Leprosy patients, but within a few years’ time, the figure swelled up to 300, including patients from other parts of South India. When the numbers began to rise, Damien Institute developed a new system of Leprosy care, known as SET (survey, education, and treatment). It started providing free treatments for affected patients.

But it soon became a neglected island of hope, with apathy setting in from all corners. Yet, nothing ever dented Damien management’s confidence.

The number speaks for itself - till date, Damien has treated more than 20,000 patients.

Nature is in full glory at Ayyappankavu. A waterfall and a river add to the charm of this elevated green belt. But the pain arising out of the personal tragedies of the residents of Damien Institute far outweigh their zest for life. Today, Damien Institute owns the entire hill, including a few plots that were donated by the Kerala government. The majority of the hill is covered by rubber plantations, a perennial source of income for Damien Institute.

A small bird house and a handicraft centre are the first things that greet a visitor. The beautiful wooden and wax sculptures speak volumes on the creative energy of Damien’s residents.

As you venture ahead, you will be surprised to learn that the Damien scheme of things is well-structured.

Damien Institute has an administrative block, a hospital with modern facilities, including an operation theatre and a laboratory, a church, a school, recreation centres, cattle farms, cultivable lands, cottages (given to cured patients), weaving units, cobbler units, and handicraft units.

“Damien Institute is blessed with all kinds of natural resources and

January 2013 I FUTURE MEDICINE 19

COVER STORY Leprosy: Where’s the healing touch?

The Damien Hospital

The Damien medical team conducts free check-ups every month through a mobile clinic in various parts of Thrissur district to ensure there is no spiral in Leprosy cases.

The constant monitoring makes sense considering the fact that Kerala reports at least four new Leprosy cases each month facilities. However, the saddest thing is that its only inhabitants are people who have lost everything in their lives and a medical team that leads an equally silent life. The facilities of the institute, especially the hospital and church, is open to the general public as well since this is a remote area with no other medical facility. We provide 24-hour services with two experi20 FUTURE MEDICINE I January 2013

enced medical practitioners, Dr Ukru and Dr Nirmala Krishnan. But the locals are indifferent. They keep away, thinking that this is a place exclusively meant for Leprosy patients. The mere mention of the word ‘Leprosy’ is enough to fuel the fear within.

I, too, had such a fear when I was appointed as the Director last year.

But things have to change. People do not know much about Leprosy. They should be educated about the disease.

Otherwise, Damien Institute as well as others who tend to Leprosy patients will always be treated like the Molokai Island in the Hawaiian archipelago, US, which became a permanent quarantine area of the Leprosy-affected in the 1860s. How can we afford to ignore the narrow public outlook towards this disease when India is one of the ten countries with the highest Leprosy patients?” asks Rev Fr Antony Mechery, the Director of Damien Institute.

About a decade ago, there were about 500 patients here. In a few years, the number decreased to a little over 100 with effective treatments and low mortality rate. As of today, there are 85 patients. Of these, 52 are permanent residents, including 30 females and 22 males.

The Damien medical team conducts free check-ups every month through a mobile clinic in various

parts of Thrissur district to ensure there is no spiral in Leprosy cases.

The constant monitoring makes sense considering the fact that Kerala reports at least four new Leprosy cases each month, says Rev Fr Mechery, adding, this only underscores that the disease is still far from complete eradication.

Patients at Damien Institute are of two kinds – the first comprise those who have been admitted for treatment following diagnosis, and the rest (numbering more than 40) are the ones who have been abandoned by their near and dear ones owing to the fear of living with a carrier of the deadly bacterial infection. In fact, there are many patients who have been with Damien Institute for the past 45 years. None of the families are even bothered to pay homage to relatives when they die. Because of this continued neglect, caretakers at Damien Institute cremate such people at a cemetery within the premises. In the past one year, at least five patients have died, including a 60-year-old patient who spent 14 years of his life at Damien Institute.

Self-sustenance in the face of rejection by society The behaviour and attitude of those in the mainstream society towards Leprosy patients have always

been fed by fear, abomination, and the overly cautious mindset of keeping a safe distance. It may seem that the victims of Leprosy have sinned greatly and there’s no way they can hope for redemption. Their total rejection by society had prompted the Damien management to think of a workable formula of self-sustenance and rehabilitation, says Rev Fr Mechery.

“Since Damien Institute had been into agricultural activities since inception, it was just a matter of creating separate manpower units for crop cultivation. In addition Rev Fr Antony Mechery, Director, to this, weaving, basket-making, Damien Institute and handicraftmaking were initiated as self-sustenance models for the Leprosy patients during the 1980s. Gradually, they were also trained to run cattle farms,” says Rev Fr Mechery.

The self-sustenance model soon ran into rough weather, with Damien management unable to find takers for

its agricultural products in the market just because they were produced by Leprosy patients. “I don’t know why the public is behaving like this. We have been treated badly. That is how the handicraft and agricultural items produced by the Leprosy patients were strictly being used for in-house needs.

Today, we have a handicraft unit where we have displayed the items made by the patients. And the crops, such as plantain, pumpkin, ladyfinger, ash gourd, snake gourd, and bitter gourd, are being used for self-consumption. Since we had an excess of agricultural goods, we scaled down our activities a bit over the years,” adds the Director of Damien Institute.

Life at Damien Institute Each day begins at 5 am with prayers, followed by medical checkups, a physical warm-up session, and breakfast. Then, the patients head for the fields. None of the patients are forced to work since they are not as physically fit as normal people.“Though agriculture is not financially viable, the management gives each patient-worker a daily wage of Rs 174. The institution provides all kinds of free treatments and healthy food, as directed by the physician. The weekly

menu includes eggs, meat, fish, and vegetables. The expenses are met by income generated from rubber plantations and funds from Leprosy Association of the UK. The Kerala government gives us an annual token assistance of Rs 25 per patient, while we spend Rs 45,000-50,000 per patient on a yearly basis. The government should at least provide medicines at subsidised rates,” says Rev Fr Mechery.

Treatment and rehabilitation Usually, patients lose their immunity power because of disease progression. They are susceptible to other diseases and body disorders because of this. In particular, between December and February, the majority of patients are affected by cold-related problems. They become bedridden with fever and accompanying illnesses.

This happens every year. The number of deaths also rises during this time.

This is when patients require more laboratory tests. But the local laboratory authorities refuse to test the fluids of Leprosy patients at their facilities. That is precisely why Damien Institute set up a well-equipped laboratory within its premises. It is open for the general public as well, but only Leprosy patients turn up for the tests.

The Damien Institute

January 2013 I FUTURE MEDICINE 21

COVER STORY Leprosy: Where’s the healing touch?

A cottage that has been provided to a person who had recovered from Leprosy

Leprosy but have nowhere to go could not be accommodated in the hospital premises. If that were the case, many would have succumbed to a psychological syndrome that would have made them believe that they are still suffering from the disease. Purely out of love for such people, Damien Institute started providing separate cottages for them, enabling them to lead a new, peaceful life. There are 20 to 25 cottages in the Damien campus.

Each cottage has one room, a kitchen, a verandah, and a beautiful garden.

However, cooking is not allowed in the cottages because these people need to follow a nutritious diet despite having made a recovery. That is why the food is delivered to them from the institute’s main kitchen three times a day. These people also take part in agricultural activities and are paid for that.

Extremities and solutions

“When the disease progression reaches a critical stage, a patient may lose his toe, fingers, or feet due to the rapid decaying of flesh. We provide a special type of leather shoes for patients following dismemberment or amputation. This not only enables them to walk, but also saves them from further immediate spread of disease to other parts of the body, thanks to the saturated and 22 FUTURE MEDICINE I January 2013

medicated leather. We have a unit that manufactures artificial limbs. Patients themselves are part of the production process. Nowadays, we are getting orders for artificial limbs from the nearby hospitals. So, if they can accept artificial limbs made by the Leprosyaffected, why can’t they also accept our handicraft and agricultural items?

I don’t understand the logic behind this selective behaviour,” says Jose, the Manager of Damien Institute.

Other facilities

Other than free treatments and provision of shelter to the patients, the Damien management also extends support for their dependents. It provides educational scholarships for their children, helping them pursue professional courses. Damien Institute is ready to absorb these dependents in its workforce once they complete their studies, but so far, no one has come forward to avail of this opportunity.

Besides, patients are allowed to visit their home if they wish to, and their

relatives are also permitted to visit them. But there has been no change in the mindset of the next of kin of these patients. So, they continue their stay at Damian Institute.

The Damien Hospital

Established a few years after the inception of the Damien Institute, the Damien Hospital is equipped with all modern facilities that are required to meet the multiple needs of Leprosy patients. The management has been making timely facility upgradation. As of today, the hospital has an operation theatre, X-ray rooms, laboratories, and a pharmacy. It has the capacity to provide treatments for more than 100 bedridden patients at a given time.

It has two separate wards for male and female patients, each consisting of 50 beds. Those who need special care and attention, or are at the last stage of their disease are given separate rooms. The hospital also has a mental rehabilitation centre called ‘Shanti Gram’, supported by the Kerala government. At present, more than 20 patients are undergoing treatment at this centre.

In all, about 40 patients are undergoing various kinds of treatment at the hospital. The medical team, headed by Dr Ukru and Dr Nirmala Krishnan, holds daily interactions and

routine check-ups. They are supported by eight Sisters, who are available round-theclock on a rotational basis. Sister Jaceentha heads this team.

“About two years ago, there were about 200 patients at the hospital. Now, the number has decreased. Bedridden patients are given special attention by our volunteers.

We try to make them happy by giving them access to television and other means of recreation. The patients here remind me of the painful past of the Molokoi Island. Many of them do not have any interaction with the outside world. They have spent a major part of their life here. Being orphaned is much more painful than the disease itself,” says Sister Jaceentha.

T

he

D

About Mycobacterium leprae

The Damien management always maintains cleanliness and hygiene in the hospital premises and the immediate surroundings.

Otherwise, it may increase the chances of infection. Mycobacterium leprae, the bacteria which causes Leprosy, spreads through blood, saliva, abscess, and other body fluids, including sexual fluids. It is a very slowgrowing bacteria, similar to the one that causes tuberculosis.

There are three types of Leprosy. The generalised form, Lepromatous, attacks peripheral nerves, the skin, the hands and feet, the mucous membranes (such as the lining of the nose), and the eyes. The Tuberculoid form is localised. Its effects are less widespread across the body. The third type is known as borderline or dimorphous Leprosy.

It has characteristics of both other forms.

Unsung hero

amien

m

odel

Recently, a Sister of Damien Institute died following contraction of the disease while tending to patients. None in the media reported this.

Next course of action

Damien Institute plans to build a park named after Saint Damien de Veuster, where the story of this great man will be retold through wax sculptures depicting each phase of his life. “The main objective behind this initiative is to end the public boycott of Leprosy patients. Society should give them a chance to lead a dignified life,” says Rev Fr Mechery.

Global initiative

The world is set to take new pledges on the World Leprosy Day on January 29 this year. We just hope Damian Institute’s residents would have a reason to smile.

o

f

s

elfsustenance January 2013 I FUTURE MEDICINE 23

COVER STORY Leprosy: Where’s the healing touch?

Hope for the hopeless

life. I still have a life, and I want to put it to good use by spending valuable time for people like me at Damien,” says Muhammad.

Muhammad had lost his immunity power when he was down with Leprosy. It caused some physical disabilities. The scars on his body tell a story of a painful past. But the past never frightens him. Instead, he uses it to inspire others.

Kunju

Muhammad

Muhammad, 59, a native of Palakkad district of Kerala, had arrived at Damien Institute at the age of seven in 1959 for treatment of Leprosy. Thanks to the special care and effective treatment he got here, he recovered from the disease. But he refused to go back to his relatives, and continues to be a part of the Damien family. He not only pursued education with assistance from Damiens, but also learned the nitty-gritty of agriculture. Today, he is one of the main people taking care of Damien’s agricultural interests. He got married in the early 1980s and leads a peaceful life with his family at a cottage in the Damien campus.

If Muhammad can’t be located in the fields, it means he is delivering food to Damien’s patients and staff with the help of Manikantan, a nine-year-old bull.

“I am happy. I have led a peaceful life at Damien Institute. I can’t think of a life beyond these walls. Being a Leprosy patient doesn’t mean the end of 24 FUTURE MEDICINE I January 2013

For the past 45 years, Kunju, 63, has been with Damien Institute.

He was brought here by natives of Coimbatore, Tamil Nadu, for treatment of Leprosy at the age of 17. He knows nothing about his parents or relatives. During the initial phase of his treatment, Kunju was indifferent to the Damien management and doctors.

After many years of treatment, he recovered. Because of language barriers, the management couldn’t educate Kunju. He is not the talkative kind since he has a serious hearing problem. Yet, he is enthusiastic about any job he undertakes here. Ready to serve anyone, anytime, he hangs around the Director’s office for instructions.

Babu

Babu, 52, is a native of Thrissur, undergoing treatment for Leprosy at Damien Institute for the past few years. Family has always been the soul of his life. But he lost his soul when he contracted Leprosy. Over a period of time, he recovered from the disease.

And recently, he told the Director of Damien Institute that he will be going for his daughter’s marriage. Excited, he purchased gifts for his dear girl by spending all the money he had earned from his labour in the Damien fields.

But his wife and relatives turned him away, saying that if the bridegroom’s

Patients at The Damien Hospital

family comes to know about his disease, they would cancel the marriage.

The groom’s family had been told that Babu was long dead. The man is yet to recover from the shock, but he’s still happy with the family he has already earned at Damien.

Nani

Nani, 55, has been with Damien Institute for the past ten years. When she recovered from Leprosy, the Damien management approached her relatives, pleading for her acceptance by the family. But her daughter and son said it would affect their social status and endanger their health. When the management informed Nani about this, she never shed a tear. Instead, she asked the management to give her a chance to make a new beginning in life. Today, she’s a part of Damien residents.

u o y s thingould sh bout a w o n k prosy Le 1 What is Mycobacterium leprae?

lepromatous (BL) forms.

In 1873, Dr Armauer Hansen of Norway discovered that Leprosy was caused by a bacillus (rod-shaped) bacterium known as Mycobacterium leprae. Leprosy, also known as Hansen’s disease, is a chronic infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa. It is a disease that was prevalent in the ancient times. The first known outbreak of Leprosy dates back to 600 BC. Throughout history, the afflicted have often been ostracised. There have been many outbreaks of Leprosy during the late 19th and early 20th centuries. It is still not under control in many parts of the world, including India. According to statistics provided by the World Health Organisation, about 1,82,000 people, mainly in Asia and Africa, were affected by this disease at the beginning of 2012. Mycobacterium leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear in certain cases.

Lepromatous Leprosy is also characterised by large numbers of organisms in the skin, many skin lesions with slight hypopigmentation, and less sensory loss in the lesions. While people with Lepromatous Leprosy have high titer antibodies to Mycobacterium leprae, they also have an impaired cellular immune response to the bacillus. Changes in immunity of the host as well as treatment can result in worsening of the clinical course of the disease.

2 Types of Leprosy

Leprosy symptoms generally appear three to five years after a person becomes infected with the bacteria that cause the disease. However, it can take as short as a few months or several decades. The first signs are patches of skin which look paler than normal. Slowly, the reddish patches will begin to enlarge. Sometimes, the person discovers nodules on the skin. In some cases, yellow patches will appear over the body, especially on the back. Self-diagnosis is difficult, and sometimes, people are not diagnosed or treated quickly enough. Besides, the symptoms appear over skin. The patient may be affected by eye problems, muscle weakness, skin stiffness, wounds on skin, decreased sensation to touch, heat, or pain. Lesions may not heal so easily. It may take several weeks to months, with no sensation in the hands, arms, feet, and legs.

The word “Leprosy” has been derived from the French term “leper” and the Greek term “lepros”, which means scaly, referring to the scales that form on the skin in some cases of Leprosy. There are mainly two types of Leprosy: Tuberculoid and Lepromatous.

Leprosy affects the skin, peripheral nerves, and upper airways but has a wide range of clinical manifestations.

Clinical forms of Leprosy represent a spectrum reflecting the cellular immune response to Mycobacterium leprae.

Patients with good T-cell immunity towards Mycobacterium leprae exhibit Tuberculoid (TT) Leprosy, which is also known as pauci-bacillary Leprosy, a milder form of the disease, characterised by skin discolouration.

In the Tuberculoid form of the disease, the skin appears as light red or purplish spots. Those with poor T-cell immunity towards Mycobacterium leprae typically exhibit Lepromatous (LL) Leprosy or multi-bacillary Leprosy, which is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa, resulting in congestion and nose bleeds. In between these forms of Leprosy are the borderline tuberculoid (BT), borderline-borderline (BB), and borderline

Tuberculoid Leprosy is the more benign type, even though it is accompanied by nerve involvement, which leads to numbness (usually of the extremities), contractures, and ulceration. In Lepromatous Leprosy, the skin lesions appear as yellow or brown infiltrated nodules (protuberances) that affect the mucous membranes of the eyes, nose, and throat. There is a general thickening of the skin, especially the face and ears. Lepromatous Leprosy is the more easily spread of the two.

3 Symptoms of Leprosy

4 How to diagnose Leprosy

The main test is called skin biopsy. It helps in diagnosis of Lepromatous or Tuberculoid Leprosy. The other test is called Lepromin skin test, which can be used to distinguish Lepromatous from Tuberculoid Leprosy, but it is not used for diagnosis. Skin-scraping examination for acid fast bacteria helps in knowing the seriousness of the disease.

January 2013 I FUTURE MEDICINE 25

COVER STORY Leprosy: Where’s the healing touch?

5 How does it spread?

* Leprosy mainly spreads through direct contact with the patient, mainly through respiratory droplets. * Environmental conditions, the degree of susceptibility of the person, the extent of exposure etc are also important. * Mycobacterium leprae is mainly found in unhygienic and unclean situations. That is why Leprosy is known to spread in slum areas. * It cannot spread from an expectant mother to her unborn baby. * Although feral armadillos and non-human primates are known to carry Mycobacterium leprae, leprosy transmission from animals to humans has only been confirmed in a couple of cases. * The chance of spreading leprosy through the saliva, puss in wounds and other body fluids are high.

Leprosy:

6 Treatment for leprosy

There is no vaccination to prevent the disease. Leprosy is curable with Multi-Drug Therapy (MDT). If MDT is taken within two weeks of a reported infection, the disease could be stopped from spreading to others. These drugs need to be taken for either six or a 12-month period.

Treatment for leprosy differs from person to person. It depends on the form of the disease.

Treatment for Tuberculoid Leprosy goes on up to one year. In the case of Lepromatous Leprosy, it is two years.

7 Complications

* Disfigurement * Muscle weakness * Permanent nerve damage in the arms and legs * Sensory loss

8 Precautions and preventions

Avoid close physical contact with untreated people. People on long-term medication become non-infectious as they do not transmit the organism that causes the disease. Physiotherapy exercises can help patients in maintaining a range of movement in finger joints and prevent deformities from worsening. Comprehensive care involves teaching patients to care for themselves.

, O’s data g to WH in rd 0 o 1 c c A from 5 n reports territories, o d e s a b er s and oth alence countrie red prev te is g re f l a b in lo ginn g o the g at the be . y s s e s ro a p c e of L 1,941 ,8 1 t a d o g 2011 2012 sto r detected durin e b ared to The num as comp , 5 7 ,0 9 was 2,1 in 2010.

2,28,474

The Indian scenario India is one of the Asian countries with the highest Leprosy patient population. Worse still, according to WHO’s August 2011 data, 65 per cent of the global Leprosy cases come from India alone. The Union Ministry of Health and Family Welfare said recently that 126,800 fresh cases of Leprosy were recorded in the country last year.

26 FUTURE MEDICINE I January 2013

A micr

\ scopic view eases gerous dis e world n a d e th f one o s of th Leprosy is ge toll in many part to three lakh u o h tw a t g s at lea hile claimin very year, E Leprosy, w ng t y. c a a d tr to n o c d even rl x e o the isti ross the w illion from m e re people ac bilities th sical disa d two to y te h a p m m ti o s fr e an uffer pulation s . patient po e bacterial disease th y b caused

on rganisati Health O al Leprosy d rl o W The Glob more nted the impleme 11–2015 to focus d 0 2 s y tion an Strateg d popula anced e rv e rs e on und s for enh ible area inaccess . coverage Map based on WHO Report in 2011

A total of 0.83 lakh Leprosy cases were recorded till April 2012, reflecting a Prevalence Rate (PR) of 0.68 per 10,000 people. A total of 209 high endemic districts were identified for special actions during 2011-12. Uttar Pradesh has the highest Leprosy patient population, followed by West Bengal, Maharashtra, Bihar, Gujarat, Andhra Pradesh, and Chhattisgarh, respectively.

January 2013 I FUTURE MEDICINE 27

COVER STORY

If crops need water, patients

Leprosy: Where’s the healing touch?

TWO FACES OF CARE: ONE IS NATURE-GIVEN; THE OTHER SELF-DRIVEN This is the only water resource in the Damien Campus. Water is sourced from this natural reservoir for daily needs as well as irrigation purposes. The nature has been kind to the Damiens.

The water resource has never dried up. If the crops, grown for self-sustenance, need adequate water supply for irrigation, the same holds true for the patients. They are always in need of saviours, who are hard to come by.

28 FUTURE MEDICINE I January 2013

need saviours Baba Amte

Mother Teresa

“

Desertion is the biggest disease

T

he biggest disease today is not leprosy or tuberculosis, but rather the feeling of being unwanted, uncared for, and deserted by everybody. I am accepting this prize in the name of the hungry, of the naked, of the homeless, of the blind, of the lepers, of all those who feel unwanted, unloved, uncared for throughout society,” said Mother Teresa while receiving the Nobel Peace Prize in Oslo, back in 1979. It was the deep commitment towards the poor and needy that transformed Agnes Gonxha Bojaxhiu, an Albanian nun, into the mother of thousands of leprosy patients who were abandoned by the mainstream society.

In 1952, Mother Teresa, along with a group of nuns, opened a charity home called ‘Nirmal Hriday’ (Place of the Immaculate Heart) in Kolkata. During that time, leprosy was a big menace and infected persons were abandoned even by their families. Owing to the widespread fear towards this peculiar disease, Mother Teresa initially had to struggle a lot to find a way for rehabilitation of these neglected ones. She eventually created a Leprosy Fund and a Leprosy Day to educate the public about the disease and establish a number of mobile leprosy clinics (the first one opened in September 1957) to provide patients with medicine and bandages near their home. Sometime in the sixties, Mother Teresa had established a colony for leprosy patients called “Shanti Nagar” (The Place of Peace) where individuals infected with this disease could live and work peacefully without being humiliated by the public.

Though Mother Teresa won several accolades and numerous honours from various quarters, including the Nobel Prize for Peace, she never took any personal credit for her social work and attributed everything to the Almighty. She said that it was God’s work and she was just a tool used to facilitate it.

C

The ‘Abhay Sadhak’ of Anandwan

alled by Gandhiji as “Abhay Sadhak” (seeker of the truth), Muralidhar Devdas Amte, popularly known as Baba Amte, was born into a rich Brahmin family in Wardha district of Maharashtra. After his graduation in Law, Amte became an active member of Mahatma Gandhi’s ashram in Sevagram. A staunch Gandhian, Amte was also influenced by the teachings of Vinoba Bhave, Rabindranath Tagore, and Sane Guruji.

In 1951, Amte founded Anandwan to work for the welfare of the underprivileged and poor. Those days, he noticed the abandonment of people suffering from Leprosy, and the pain, agony, and misery of the victims made him pick up the cudgels for their cause.

His work is still being carried on by his disciplined followers, who have rehabilitated thousands of poor Leprosy patients at Anandwan.

Anandwan is not just a rehabilitation centre where thousands of leprosy patients and other disabled men find food and shelter, but it is also a school from where they learn lessons of self-help, self respect, and selfless service. It is an institution from where they learn lessons of co-operation and peaceful co-existence. Amte’s philosophy was very simple: “Work builds; Charity destroys”. In the words of Tibetan religious leader Dalai Lama, “Baba Amte was a real symbol of practical compassion who has led a real transform ation... it was the proper way to develop India.”

January 2013 I FUTURE MEDICINE 29

COVER STORY Leprosy: Where’s the healing touch?

The

Hero of Molokai Island

T

he Hero of Molokai Island, Hawaii, US, was born into a farmer’s family in Belgium in 1840. Inspired by his siblings, he became a Brother at the age of 20. Since he lacked education, his superiors initially thought he was not a good candidate for priesthood. But his knowledge of Latin eventually helped him become a priest and embark on a mission when his brother couldn’t make it to Hawaii as a missionary due to illness.

On March 19, 1864, he arrived at Honolulu Harbour on Oahu in Hawaii as a missionary. He was ordained into priesthood on May 21, 1864, at the Cathedral of Our Lady of Peace. A year later, he was assigned to the Catholic Mission in North Kohala on the island of Hawaii. During this period, the Kingdom of Hawaii was facing a public health crisis. Many native Hawaiians were infected by several diseases brought on by foreign traders and sailors. Many died of influenza, syphilis, and other ailments. One of the diseases that claimed a lot of lives was Leprosy.

That was a time when Leprosy was thought to be highly contagious and incurable. Fearing a contagion, King Kamehameha V approved the “Act to Prevent the Spread of Leprosy”.

Under the law, those afflicted by Leprosy were quarantined on the island of Molokai. The situation was so miserable that Bishop Louis Désiré Maigret, the Vicar Apostolic, thought of providing the sick with the assistance of a Catholic priest. Father Damien was the first priest to volunteer, and on May 10, 1873, he arrived at the secluded settlement at Kalaupapa, where Bishop Maigret presented him to 816 diseased people. Other than his religious service, Father Damien dressed ulcers, built homes and furniture, made coffins, and dug graves. He was so instrumental in enforcement of basic laws, streamlining farming activities, and setting up schools that the people wanted him to stay back in Molokai. And he did.

In the 1880s, Father Damien felt numbness in his legs. So, he put both his legs into hot water to test whether it would cause pain.

He felt no pain of heat, but found that he had sustained burn injuries. That’s when he realised that he too had contracted the disease. Soon, he got bedridden. In 1889, he breathed his last. In recognition of his great service to the people of Molokai, he was canonised as Saint on October 11, 2009.

T N Jagadisan’s publication in 1965, titled “Mahatma Gandhi Answers the Challenge of Leprosy”, quoted the Father of the Nation as saying, “The political and journalistic world can boast of very few heroes who compare with Father Damien of Molokai. The Catholic Church, on the contrary, counts by the thousands those who after the example of Fr Damien have devoted themselves to the victims of leprosy.

It is worthwhile to look for the sources of such heroism.”

Source: Wikipedia 30 FUTURE MEDICINE I January 2013

HAIR LOSS

Hair loss?

Do not panic,

there are solutions!

Dr Divya Ramkumar Dermatologist & cosmetologist

T

he average human scalp has more than 100,000 hairs. The growth phase of scalp hair is approximately 1,000 days (two to six years). Scalp hair grows at a rate of 0.3 to 0.4 mm/day, i.e. about six inches a year.

Other hairs like that of eyebrows and eyelashes have a shorter growth phase of about one to six months. Humans have a mosaic pattern of hair growth: hair loss and growth are not cyclic or seasonal (like in some animals) but occur randomly, so there is continuous hair loss.

Each hair follicle goes through stages: anagen (growth phase), catagen (involution phase) and telogen (resting phase), and exogen (the release of dead hair). Almost 90 per cent of scalp hairs are in the anagen phase and up to 100 hairs are lost from the head each day and a similar number enters anagen daily. The duration of anagen determines the length of hair and the volume of hair bulb determines the diameter.

Hair loss may be localised or diffuse.

Localised loss is due to a number of causes and is not discussed here. Diffuse hair loss can affect both sexes at any age. Anything that interrupts the normal hair cycle can trigger diffuse hair loss. Diffuse loss usually occurs without scarring and is more or less uniform. The important causes are thyroid abnormalities, physical stress (eg. surgery), or severe psychological stress, following very high fevers, crash diets (inadequate protein) and chronic starvation, malabsorption syndromes, pancreatic disease, essential fatty acid deficiency, use of certain drugs like vitamin A, Heparin, Coumadin, and Propranolol, childbirth, acute blood loss, certain poisonings (thallium, arsenic), cancer chemotherapy, and radiation therapy. Chronic systemic disorders, such as systemic amyloidosis, hepatic failure, chronic renal failure, inflammatory bowel disease, and lymphoproliferative disorders, can cause hair shedding. Hair loss has also been reported in autoimmune diseases such as systemic lupus erythematosus and dermatomyositis, as well as in chronic infections such as HIV and January 2013 I FUTURE MEDICINE 31

HAIR LOSS Dr Divya Ramkumar

secondary syphilis. Inflammatory disorders such as psoriasis, seborrheic dermatitis, and allergic contact dermatitis can all cause diffuse telogen hair loss.

Damage to hair leading to increased loss can also be mechanical (excessive brushing, fastening with elastic bands), chemical (bleaches, tints, dyes, perms etc), and physical (excessive use of heat from dryers or intense exposure to sun).

Evaluation

Physicians should be careful not to underestimate the emotional impact of hair loss for some patients. A detailed history (of patients) is taken into account. Loss (sudden or gradual) and the duration of loss should be known. Did the patient have any illness or fevers three months prior to hair loss? Are patients on any medication or were they exposed to any chemicals? Even the over-the-counter product a patient is taking should be suspected.

Is the diet proper?

Androgenetic alopecia should always be ruled out. The scalp should be examined for degree and pattern of hair loss. The hair shafts should be assessed for length, diameter, and breakage.

The scalp should be examined for inflammation, erythema, and scaling. A daily count of shed hair is also useful.

Investigations like hemoglobin levels, thyroid function, ferretin levels, serum zinc levels, hair pull test and hair shaft microscopy, trichogram and scalp biopsy can be done after consultation with a dermatologist. A comprehensive metabolic panel to exclude chronic renal or liver disease can be done in suspected cases.

Treatment

The treatment depends on the cause and type of hair loss. An adequately balanced 32 FUTURE MEDICINE I January 2013

diet, especially rich in proteins, is to be taken.

Deficiencies, if any, are to be corrected and triggers are to be removed. Tablets containing biotin fortified with multivitamins and minerals are given. Saw palmetto extracts is one of the newer available drugs. If a drug is suspected to be triggering hair fall, it should be stopped or changed. If there is associated dandruff, regular cleansing with an anti-fungal shampoo is to be done. Topical minoxidil (available in concentrations ranging from two to ten per cent) alone, or with tretinoin or amexidil, can be started for severe loss (FDA-approved for androgenetic alopecia). Minoxidil is available in different forms ranging from solution and foams to gels for patient convenience and is to be used twice daily on dry non-greasy scalp. For those people who find it difficult to use it twice a day, the combination with tretinoin can be used at night.

Some of the newer therapies which have proven to have some efficacy are laser hair comb, stem cell therapy, platelet rich plasma, mesotherapy, and dermarollers. Laser comb works by transferring light energy to cellular energy in the follicles. The device claims to make hair grow faster and thicker by encouraging blood flow to the follicles. Stem Cells Autologous Transplantation is another newer and effective hair loss treatment. PRP (Platelet-Rich Plasma) is a concentrated source of autologous platelets in a small volume plasma. It contains different Growth Factors (cytokines) and is an innovative, safe, and effective method of hair growth. Scalp Mesotherapy is a non-surgical hair treatment, which includes multiple microinjections of growth factors like Thymosin Peptide (TB-4) into the mesodermal layer of the scalp skin.

Dermarollers stimulate regeneration in the areas it is applied on. It can also work to stimulate hair re-growth.

When you see excessive hair fall, do not panic. Do not fall for glossy advertisements promoting various hair products. Consult your dermatologist at the earliest for a proper evaluation. Follow their instructions properly and take good care of your hair!

No matter how strong our hair is, it is subjected to many harmful factors that we have no control over. But we can actively counteract many of these factors and protect our hair from inside.

Dr Divya Ramkumar, MD, works with Sun Medical and Research Centre & Carewell Clinical Centre in Thrissur, Kerala

CARDIOLOGY SPECIAL

January 2013 I FUTURE MEDICINE 33

CARDIOLOGY SPECIAL Types of heart diseases

The not-so-heartening news!

India’s ever-growing burden of cardiac diseases is squeezing the lifespan of a sizeable section of the population, especially the youth, mainly because of their ignorant and hazardous ways of living. Before going into the main factors causing heart diseases among Indians through a series of interviews with eminent cardiologists, Future Medicine takes a look at various types of heart diseases Bureau

34 FUTURE MEDICINE I January 2013

The best and most beautiful things cannot be seen or even touched. They must be felt with the heart.

- Helen Keller Heart occupies a special place in the human body. It is as mysterious as the age-old myths of creation. None in the medical community is quite sure even today about the emotive, or behavioural expressions of this unique organ, though reams have been written about its direct bearing on the evolution or degeneration of mankind. Some say it is a harbour of human compassion and empathy. Maybe that’s one reason why it’s too delicate an organ when it comes to handling too much of surprise or shock. Scientifically, the heart is a vital force that pumps blood to all parts of the body. The main function of the heart, which is a combination

of valves, vessels, and muscles, is to pump oxygen-rich blood to every living cell in the body. It beats continuously throughout an individual’s lifespan.

Cessation of the heart beat always results in death. The number of heart beats per individual could vary from 80,000 to 100,000 a day, and it is estimated that the heart pumps about 2,000 gallons of blood every day.

This implies that a human heart beats approximately two to three billion times and pumps between 50 and 70 million gallons of blood during a lifespan. While oxygenated blood from the heart is delivered through special blood vessels called arteries, it is the veins, another blood vessel, that bring deoxygenated blood cells to the lungs, which are oxygenated and sent back to heart.

The word “cardiac” has been derived

from the Greek word “Kardia”, which means heart. And cardiac disease is the general term that encompasses all forms of heart malfunctions. Cardiac diseases mainly fall into three categories; Coronary Artery Disease, Cardiac Valvular Disease, and Myocarditis.

Coronary Artery Disease (CAD): CAD is the most common type of heart disease and a leading cause of death across the world. It is a state when the arteries that supply blood to heart muscles get hardened and narrowed due to the concentration of Cholesterol and other material, called plaque, on their inner walls. This concentration is called atherosclerosis. As the concentration increases, less blood flows through the arteries. As a result, the heart muscle can’t get the blood or oxygen it requires. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the blood supply to the heart, causing permanent heart damage.

Coronary artery bypass surgery and angioplasty (a nonsurgical procedure that can be used to open blocked arteries) are among the available treatments.

Cardiac Valvular Disease (CVD): Four valves of the heart, namely, tricuspid, pulmonary, mitral, and aortic direct the flow of blood through its chambers. These valves are composed of thin leaflets, which prevent a backflow of blood by closing itself and permit the blood to move forward to its next destination by opening itself. When a valve fails to close properly, the disorder is called mitral valve prolapse. This condition can lead to a regurgitation or backflow of blood. Similarly, if a valve fails to open properly, it could lead to a condition called valvular stenosis. This condition could impair the forward flow of blood to the body. In both cases, the heart has to work much harder while pumping enough blood to the body, gradually leading to heart muscle damage. Congestive heart failure, syncope (fainting), and arrhythmias (a disorder of the heart rate) are common signs of CVD. There are many conditions that lead to CVD. Congenital defects and infections, including rheumatic fever, are the most common conditions. When the heart valves are seriously damaged, impairing blood flow to the rest of the body, or causing heart muscle damage, surgery to replace the defective valve remains the only remedy.

Myocarditis: This situation is caused by the inflammation of the heart muscles. It can be caused by a variety of infections and conditions such as viruses, immune diseases, pregnancy, and other types of infections.

The most common cause of myocarditis is the infection of the heart muscles by a virus that gradually invades the muscles to cause local inflammation. Once the initial infection subsides, the body’s immune system continues to inflict inflammatory damage to the heart muscles. This immune response actually prolongs the situation.

Myocarditis can be mild and has virtually no symptoms. The most frequent symptom of this infection is pain in the chest. When Myocarditis is more serious, it leads to weakening of the heart muscle. Myocarditis can

January 2013 I FUTURE MEDICINE 35

CARDIOLOGY SPECIAL Types of heart diseases

then cause heart failure (with symptoms of shortness of breath, fatigue, and fluid accumulation in the lungs) as well as heart rhythm irregularities from inflammation of the electrical system of the heart.

Myocarditis is diagnosed by detecting signs of irritation of heart muscle. Electrical testing can suggest irritation of heart muscle and demonstrate irregular beating of the heart.

Topography of fats in a typical Indian

Other heart diseases

Aneurysm: Aneurysm occurs when an area of the aorta’s wall weakens and balloons its normal size. If the aneurysm occurs near the heart, it is called a thoracic (chest) aortic aneurysm. Aneurysms can also develop in other parts of the body, such as the abdomen or the brain. A thoracic aortic aneurysm can rupture aorta’s wall and cause excessive bleeding and shock. It is fatal if not treated immediately. Aneurysm can be cured through surgeries.

Atrial Fibrillation: This disorder is caused due to the rhythmic disturbances in the heartbeat. Instead of beating in a regular pattern, a part of the heart beats irregularly and at a much higher pace. Though a patient can live with atrial fibrillation for years, it could lead to stroke or more serious heart rhythm disturbances. Electrocardiograms, Holter monitors, tilt table tests, and electrophysiology tests can reveal this disorder. It can be treated through medications, implanting pacemakers and cardioverter-defibrillators, and surgical procedures.

Congenital Heart Defects (CHD): CHDs are inborn defects in the structure of a human heart, generally affecting the interior walls of the heart, valves, arteries, and veins. According to estimates, heart defects are the most common birth defects affecting 10 of every 1,000 newborns. Over the years, diagnosis and treatment of CHDs have improved considerably.

Myths and Facts about Fats 1. Myth: Fat-free means healthy.

Fact: A “fat-free” label doesn’t mean you can eat all you want without consequences to your waistline. Many fat-free foods are high in sugar, refined carbohydrates, and calories.

2.Myth: Eating a low-fat diet is the key to weight loss.

Fact: Cutting calories is the key to weight loss, and since fats are filling, they can help curb overeating.

36 FUTURE MEDICINE I January 2013

3. Myth: All fats are equal – and equally bad for you.

Fact: Saturated fats and trans fats are bad for you because they raise your cholesterol and increase your risk for heart disease. But monounsaturated fats and polyunsaturated fats are good for you, lowering cholesterol and the risk of heart disease.

4. Myth: Lowering the amount of fat that you eat is what matters the most.

Fact: The mix of fats that you eat, rather than the total amount in your diet, is what matters most when it comes to your cholesterol and health.

CARDIOLOGY SPECIAL Interview with cardiology experts

India’s heartache Today, the average age of a person suffering from a heart attack has come down drastically, thanks to poor lifestyles. The rate of coronary heart diseases among Indians, particularly the youth, is almost twice as high as compared to Westerners. Over the years, heart diseases have emerged as the number one global killer.

Technology has certainly made life easier and simpler, but the quality of life has taken a severe beating. The combination of a sedentary lifestyle and a rich diet has caused a spiral in complaints of clogged blood vessels, heart attacks, and strokes. Despite tremendous advances in cardiac care the world over, more and more patients continue to die from heart diseases or live with significant morbidity. The prevalence of coronary artery diseases is rising steeply in India.

The rate of coronary heart disease rose from one per cent in 1960 to 14 per cent in 2011 among India’s urban population. Future Medicine raises serious matters of the heart with prominent cardiologists Dr M S Valiathan, the former President of the Indian National Science Academy, the first Vice-Chancellor of Manipal University, and the Chairman of the Academic Council of Mar Athanasios College For Advanced Studies, Thiruvalla, Kerala, Dr Mohan Nair, the Chief of Cardiology at Max Healthcare Hospital and St Stephen’s Hospital, Delhi, Dr Epari Satish Kumar, the Chief Cardiologist at MIOT Hospital, Chennai, and Dr (Col) Manjinder Singh Sandhu, the Director of Cardiology at Artemis Hospital, Haryana. At first glance, all of the suggestions made by these cardiology experts may seem repetitive in nature. But the whole idea of hitting upon one thing again and again made sense to us in the Indian context of behaviouralism, given the casual approach towards acceptance of healthy ideas and expert opinions. The writing has always been there on the wall, but a lot many Indians have never paid attention to matters of the heart. It’s not too late. Take heart and listen up...

By Sumithra Sathyan January 2013 I FUTURE MEDICINE 37

CARDIOLOGY SPECIAL Interview with cardiology expert

Interview with Dr M S Valiathan Tell us about your experiences in cardiology.

I had my training in cardiothoracic surgery at three university hospitals in the US Johns Hopkins, George Washington, and Georgetown. I served as a cardiothoracic surgeon in three hospitals in India – Safdarjung, Delhi, Railway Hospital, Chennai, and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum. Throughout my career of 25 years as a cardiothoracic surgeon, my special interests were surgery to correct congenital anomalies in children, valve replacements in adults etc.

Can you tell us how can one maintain a healthy heart?

The preventive steps are wellknown. They include regular physical activity, healthy food with plenty of green vegetables and fruits with fats contributing no more than 30 per cent of the total calorie intake, keeping one’s weight to a level prescribed in life tables, avoidance of smoking and excess alcohol, and not taking oneself too seriously – which is a time-tested way to avoid stress.

What are your memorable experiences?

During my 20-year stint at Sree Chitra Tirunal Institute for Medical Sciences and Technology, I could combine cardiac surgery, research in cardiac pathology, and technology development in a seamless manner.

38 FUTURE MEDICINE I January 2013

Do you think lifestyle changes can weaken the heart?

Yes. Many trends in our contemporary lifestyle smoking, lack of physical activity, overeating and obesity, frantic activity resulting in constant mental tension – all these would predispose an individual to cardiac ailments.

So, what are the remedies?

A healthy mind guiding a healthy lifestyle is the best recipe for cardiac health.

South Asians are known to have a genetic predisposition to develop ‘metabolic syndrome’, which includes coronary atherosclerosis. We can do nothing to escape our genetic predisposition. But we can do a lot to prevent the predisposition from expressing as coronary artery sclerosis and disease by following a healthy lifestyle. Of course, we have good facilities in India for balloon angioplasty, coronary artery bypass etc, but don’t forget that they are done when coronary disease has advanced to the stage of blockage. Why not try prevention by switching to an appropriate lifestyle?

A pioneer in medical science Dr Marthanda Varma Sankaran Valiathan is a renowned cardiac surgeon and a Fellow of the Royal College of Surgeons. Born on May 24, 1934, in Mavelikkara in Alleppey district of Kerala, Dr Valiathan graduated in medicine from Kerala University in 1956 and underwent post-graduate training in surgery in the United Kingdom before earning the Fellowship of the Royal Colleges of Surgeons of Edinburgh and England in 1960. He also did his Masters in Surgery from Liverpool University. He specialised in cardiac surgery at Johns Hopkins, George Washington, and Georgetown University Hospitals in the US and became a Fellow of the Royal College of Physicians and Surgeons, Canada. He served on the faculty of Georgetown University Hospital, US, Post-graduate Medical Institute, Chandigarh, Indian Institute of Technology, Madras, and the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram.

Recognised for his role in pioneering the joint culture of medicine and technology and laying the foundation for the medical devices industry in India, he headed SCTIMST from 1974-1994, when it was notified as an institute of national importance by an Act of Parliament. After this stint, he became the first Vice-Chancellor of Manipal University and played a significant role in its development.

As a Homi Bhabha Senior Fellow and a student of Sanskrit, he had carried out a study of the ‘Charaka Samhita’. His work, ‘The Legacy of Charaka’, was published by Orient Longman in 2003. The companion volumes on the legacies of the great trio of Ayurveda - Charaka, Suśruta and Vagbhata - were released by the same publisher in 2006 and 2009.

Currently, he is a National Research Professor of the Government of India, pioneering scientific studies in Ayurveda. His contributions to medical sciences and technology have brought him many honours and awards, including the Padma Vibhushan in 2005.

January 2013 I FUTURE MEDICINE 39

CARDIOLOGY SPECIAL Interview with cardiology expert

Interview with Dr Mohan Nair What are your suggestions for heart patients?

People should have a healthy lifestyle. They should undergo regular medical check-ups, especially if they have crossed 40, and see whether they have any cardiac risk factors, including high blood pressure, or Diabetes. They should inform the doctor if they have a family history of heart diseases.

What is your most memorable experience in this field?

It pertains to the use of Angioplasty on heart patients. It’s always a great satisfaction to see heart patients making a recovery and leading a normal life with a better sense of preventive medications and lifestyle changes.

What kind of lifestyle changes are we talking about?

Indians are genetically more prone to heart diseases than any other ethnic group in the world. In addition to this, the high incidence of smoking, a sedentary lifestyle, and poor eating habits make us extremely vulnerable to heart diseases.

By 2020, we may have the largest number of heart patients in the world.

How can one guard himself/ herself against heart diseases?

One should cultivate healthy food habits. Our daily food should have large portions of fresh fruits and vegetables, and limited quantity of bad fats (mainly red meat, milk and milk products, and coconut/coconut oil). The calorie intake should help a person maintain the ideal 40 FUTURE MEDICINE I January 2013

body weight. People should also maintain a healthy lifestyle. They should avoid smoking and alcohol, develop a fitness regimen (for example, 40 minutes of brisk walking or equivalent at least five times a week), and learn to cope with stress.

What’s the survival rate of bypass patients?

Technically, one patient can have any number of bypass surgeries, but the risk increases with each bypass procedure. Survival depends on several factors, including age, damage to the heart muscle, presence of Diabetes, or Renal Disease, and nonadherence to medications and lifestyle recommendations.

Do medicines offer the hope of complete cure?

Medicines do not cure. They can provide adequate relief in terms of symptoms, retard progression of disease, and lessen complications.

Tell us about some common medicines taken by heart patients.

Aspirin: Taken daily at a dose of 75100 mg per day, it dramatically reduces the risk of heart attack and stroke.

Statins: These are Cholesterol lowering agents that can prevent disease as well as suppress progression of disease.

Beta Blockers: These drugs significantly reduce the chances of a second heart attack and improve one’s lifespan.

Top interventional cardiologist Dr Mohan Nair is the Chief of Cardiology

at St Stephen’s Hospital, Delhi, and Max Hospital, Delhi. He is also the Director of Electrophysiology and Arrhythmia Services at Max Healthcare India, the second largest private healthcare chain in Delhi. Apart from rendering clinical and interventional cardiology services, Dr Nair is responsible for anchoring the Electrophysiology procedures across all Max Hospitals in India. He had worked as Assistant Professor of Cardiology at G B Pant Hospital and Maulana Azad Medical College, Delhi, the Visiting Professor of Cardiology at CMC, Ludhiana, the Visiting Faculty in Cardiology at University of Rouen, France.

Dr Nair’s areas of interest have been interventional cardiology and electrophysiology. He has more than 5,000 coronary angioplasty procedures and 300 balloon mitral valvuloplasties to his credit in interventional cardiology. He has performed about 3,500 diagnostic Electrophysiology procedures and 2,500 radiofrequency catheter

ablations. This makes him one of the top 10 interventional cardiologists in India and one of the leading electrophysiologists of South Asia.

He has produced more than 100 publications and made several paper presentations at national as well as international levels.

He has also helped various hospitals and healthcare institutions in India, China, and Sri Lanka in introducing cardiac programmes.

These hospitals include the Apollo Hospitals, Chennai; Nizam’s Institute, Hyderabad, JIPMER, Pondicherry, and Sri Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, among several others.

Dr Nair has been part of almost all major national and international electrophysiology meetings. He has also been on the faculty of Live Physician Education Programme on Angioplasty and Electrophysiology in France, Sri Lanka, and China. He has been in the forefront of Pacing and Defibrillator Therapy in India. Currently, he is the Designated Proctor for Atrio Biventricular Pacing in India.

January 2013 I FUTURE MEDICINE 41

CARDIOLOGY SPECIAL Interview with cardiology expert

Interview with Dr Epari Satish Kumar

Heart care mantras Healthy lifestyle choices

Be active and stressfree. Today’s fast-paced life and workplace pressures escalate stress levels, taking a toll on one’s heart. We must realise that the healing power of the body decreases under stress, leading to complications like hypertension and poor immunity. Today, even youngsters are prone to heart ailments. So, it’s very important to stay healthy and manage stress levels by understanding the risk factors, such as high cholesterol levels, smoking, and lack of exercise, and making simple changes in lifestyle. Studies show that 80 per cent of coronary artery disease cases, 90 per cent of diabetes cases, and about one-third of cancer cases can be avoided through healthy changes in lifestyle.

Simple tips to decrease heart attacks and maintain a healthy cardiac status Avoid smoking

Smoking reduces life expectancy by 15-25 years. If you are a smoker, you are twice more likely to have a heart attack than a non-smoker.

Cut down on salt

Too much of salt can cause high blood pressure, increasing the risk of developing coronary heart disease.

Watch your diet

Try to have a balanced diet. Eat fresh fruits and vegetables, and starch foods such as wholegrain bread and rice.

Monitor your alcohol

Too much of alcohol can damage the heart muscle, increase blood pressure, and lead to 42 FUTURE MEDICINE I January 2013

weight gain. Avoid intake of alcohol or at least limit it to one to two units a day and gradually decrease its consumption.

Get active

At least aim for 30 minutes of moderate exercise a day. A fitness regimen will not only benefit the heart but also improve mental health and well-being.

Monitor your BP, blood sugar, and cholesterol levels

Routine medical check-ups will ring an alarm.

Manage your waist

Cholesterol deposition in blood vessels begins in the first decade of life. Carrying a lot of extra weight as fat can greatly affect your health.

Make small but healthy changes in your diet.

Manage your stress level

If you find things are getting on top of you, you may fail to eat properly, smoke, and drink too much.

This may increase your risk of a heart attack. Practice yoga/meditation. Take a vacation.

Check your family history

If a close relative is at risk of developing coronary heart disease from smoking, high BP, high cholesterol, lack of physical activity, obesity and diabetes, then you could be at risk too.

Laughter is the best therapy

Laughter will works wonders for you, anytime. It is an instant way to break free from pressure.

Angioplasty expert After completing MBBS and MD in general medicine from MKCG Medical College, Berhampur, Odisha, Dr Epari Satish Kumar came to Chennai in 2002 to do his DNB in Cardiology at Apollo Hospital, Chennai. Subsequent to completion of a course in cardiology, he worked at Apollo Hospital, Bilaspur, for a brief period, and in December 2007, he joined MIOT Hospital as Consultant Interventional Cardiologist. Over a period of time, he became the Chief Cardiologist at MIOT. MIOT Heart Revive Center is a 24X7 comprehensive heart care centre dedicated to handling, diagnosing and treating all emergencies relating to cardiac disorders. It is the only cardiac centre in India with two state-of-the-art cath labs. Dr Kumar also underwent training in Germany in complicated angioplasties. He has had a chance to do a lot of interesting, challenging, and complicated angioplasties, including Left Main, bifurcation stenting, and primary angioplasties (done in the case of heart attack). He has also done a lot of Pacemaker and Implantable Cardio Defibrillator Implantations.

Memorable experience

I am happy that I was able to do primary angioplasties in younger patients coming to our institute within the golden hour. I was successful in bringing them back to a normal life.

Lifestyle risks

A sedentary lifestyle, smoking, junk food, and lack of exercise make our people genetically three times more vulnerable to heart attacks than Europeans and Americans. A heart-healthy diet can reduce your risk of heart disease or stroke by 80 per cent.

Food habits

Limit saturated fats and cut out trans fats entirely. Both types of fat can raise your LDL, or “bad� cholesterol level, increasing the risk of a heart attack and stroke. Limit solid fat.

Substitute. Swap out high-fat foods for their lower-fat counterparts. Reduce canned or processed foods. Cook at home, using spices for flavour. Focus on high-fibre foods. Eat a variety of fruits and vegetables. Control portion size and your weight.

Rise in cardiac cases in India

India has been described as the diabetic capital of the world. The epidemic of cardiovascular diseases (coronary artery disease and stroke) in India is also advancing rapidly. India is experiencing an epidemiological health transition characterised by rapid decline in nutritional and parasitic diseases (pre-transitional diseases) with an alarming rise in cardiovascular diseases (CVDs), mainly coronary heart disease, and stroke. Population surveys conducted over two decades have shown that coronary heart disease in Indians occurs at an early age and is more aggressive, extensive, and malignant. At least 52.2 per cent of deaths due to CVD occur below the age of 70 years in India as compared to only 22.8 per cent in the developed world. India has also reported a nine-fold increase in coronary heart disease (CHD) in urban centres.

Effectiveness of medicine

Aspirin and statins are effective in primary and secondary prevention of coronary artery disease and stroke. However, no medicines are effective in curing coronary artery disease.

Common medicines like aspirin, clopidogrel, statins, beta blockers and ACE inhibitors have been used for treatment of heart patients.

January 2013 I FUTURE MEDICINE 43

CARDIOLOGY SPECIAL Interview with cardiology expert

Interview with Dr (Col) Manjinder Singh Tell us about your experiences in cardiology in your career thus far?

“Career” as such is a vexed term. I feel I am still a learner in the huge ocean of cardiology. However, my experience in cardiology, starting from my PGI days, has been an exhilarating one. I have seen, developed, learned, and gradually grown with modern cardiology.

The Army gave me ample ground and support in my early days. Currently, I am practicing “niche” cardiology procedures in one of the best (cardiac) centres of India.

What are your suggestions for maintenance of a healthy heart?

For a healthy heart, it is very important to do away with reversible risk factors such as smoking and stress. It is also important to have a proper prevention, check, control, and treatment plan for hypertension and Type 2 Diabetes Mellitus etc, which are partially reversible. With effective lifestyle changes, it is possible to keep hypertension and Type 2 Diabetes Mellitus at bay.

One should be vigilant and observant and check for early signs of heart disease.

What are your memorable experiences in this field?

I have many memorable experiences. I have treated very young heart patients and even attended to a father-son duo simultaneously.

How do lifestyle changes weaken the heart?

Adoption of the so-called “modern” urban lifestyle by the population does predispose us to development of hypertension and Diabetes.

Remember that as Indians, we are predisposed to earlier development of coronary angiography by about 10-15 years, as compared to the Western 44 FUTURE MEDICINE I January 2013

population.

What remedies do you propose for a heart patient?

We need to have a comprehensive health plan and ensure effective implementation of our projects. We have to delve deeply into the question of addressing the magnitude of our problem and formulate an effective and workable policy.

We have to make effective dietary and lifestyle changes to prevent and delay development to Diabetes Mellitus and hypertension. We have to promote smoking cessation, salt restriction, diminish saturated and trans fats in diet, and take to a fitness regimen.

It may sound utopian, but a blanket ban on sale and consumption of all tobacco products and elimination of trans fats should be our goal. The medical fraternity and the community at large should be partners in this noble project. We should be emphasising more on primordial and primary prevention rather than only secondary and tertiary care, which is currently the flavour. Perhaps, we should be targeting mothers and children for effective health promotion and preventive care.

What kind of food habits are considered healthy?

Now, that is an area of conjecture. According to studies, a Mediterranean type of diet has been found to be the best. It allows intake of plenty of fresh fruits and vegetables, fats on moderation, with restriction of carbohydrates, rich protein, particularly fish and marine sources, limited consumption of meat, and high dairy products and nuts.

One thing is clear that a high carbohydrate diet is harmful. Carbohydrates should constitute less than 50 per cent of our energy requirements, fats should be in the range of 30-35 per cent and proteins making up for the rest. We also have to reduce trans fats from diets. One effective way to do that will be to cut away all stored and processed

food from diet. Care should actually start from early childhood for effective prevention.

What should one do for a healthy lifestyle?

For a healthy lifestyle, we should: • Quit smoking and eliminate tobacco products.

• Limit alcohol intake.

• Promote physical activity.

• Reduce stress in our life.

How huge is the burden of cardiac diseases in India?

Illustrious AFMC alumnus Dr (Col) Manjinder Singh Sandhu graduated from Armed

Forces Medical College in 1986. He did his MD (Medicine) from Pune University and DNB (Medicine) in 1993. He was awarded the gold medal in MD. He did his DM (Cardiology) from PGIMER, Chandigarh, in 2001. He had a distinguished career in the Army Medical Corps. His last posting was at Base Hospital, Delhi Cantonment, as Senior Advisor (Medicine and Cardiology). He also held the post of Additional Professor of Medicine and Cardiology at Army College of Medical Sciences, Delhi Cantonment. A Principal Investigator in research projects of the Department of Biotechnology, Ministry of Science and Technology, Govt of India, and Armed Forces Medical Research Committee, he has taught post-graduate students in Medicine and Cardiology. He has had the honour of being the accompanying Cardiologist to the President of India.

Dr Sandhu is an active member of the Association of Physicians of India, the Cardiological Society of India, the American Heart Association, the European Society of Cardiology, and the European Association of Percutaneous Interventions. He is a fellow of American College of Cardiology and Society for Cardiac Angiography and Interventions. His areas of expertise include complex coronary interventions, rotational atherectomy, transradial interventions, peripheral interventions (carotid and renal, device closure of congenital heart defects, pacemakers, ICDs and cardiac resynchronisation therapy implants), and Balloon Valvuloplasty.

The burden of coronary artery disease/ heart diseases are alarmingly increasing in India. By 2015, we are projected to have about 64 million heart patients going by conservative estimates. The current data available is of 2005, when we had about 34 million heart patients. This is only the tip of the iceberg. Many more are suffering from the ignominy of care. The number of sufferers has increased. There has been an increase in awareness, but that is limited as compared to the burden. My personal analysis is that we are lagging behind in preventive care and provision of world class secondary level care at affordable costs. We should look at reevaluation of our preventive policies.

Bypass patients with preserved cardiac function can aim at normal or near-normal lifespan. They have to quit smoking, take medicines regularly, and be vigilant about their symptoms and care. Bypass patients with compromised cardiac functions actually live lesser, but with effective medications, care, use of devices etc, their situation can be improved remarkably.

How effective are medicines?

We must understand that medications are not for complete cure. By effective medication, we can blunt the onslaught of diseases. With effective use of aspirin, statins, ACE inhibitor etc, we can reduce the brunt of Ischemic Heart Disease significantly. However, caution should be made of injudicious and unwanted medications as it can do more harm than good.

What are the common medications?

Common medications include aspirin and other anti-platelets, Statins, ACE inhibitor, Anti-diabetics, Diuretics, Calcium channel blocker, Betablocker, and Digitalis.

January 2013 I FUTURE MEDICINE 45

CARDIOLOGY SPECIAL – ADULT INTERVENTION CARDIOLOGY Dr Jamshed J Dalal

India’s nowhere close to

the research done abroad A specialist in coronary angiography and angioplasty, Dr Jamshed J Dalal is a rare triple Doctorate. He did his first coronary angiography in the United Kingdom in 1978. Since then, he has attended to more than 15,000 cardiology cases in the past three decades.

He also began the angiography programme in India in 1984 (available in only four hospitals across Mumbai) along with a few fellow cardiologists. He has been involved in the coronary angioplasty programme since the invention of the angioplasty procedure. He has been teaching the procedure to doctors in India and China for the past 20 years. As the Chief Cardiologist at Holy Family Hospital in Bandra, Mumbai, he set up its ICCU unit. In 1987, as the Honorary Cardiologist at Hinduja Hospital, he set up the Cardiac Catheterisation Lab there and started the coronary angiography and angioplasty procedures. He headed the department for eight years and established it as a leading cardiac centre in India. In 1995, he joined the then underconstruction Lilavati Hospital and contributed towards setting up the hospital, mainly the Department of Cardiology. Since its inception to his departure from the hospital in 2009, as the Coordinator of the Cardiovascular Division, he guided the specialty to international levels. In 1999, he, along with two colleagues, was instrumental in the establishment of Wockhardt Heart Hospital at Mulund, Mumbai. In 2008, he joined Kokilaben Dhirubhai Hospital as the Director of the Centre for Cardiac Sciences. The man behind the coronary and peripheral vascular and surgical programme, he is in the process of starting the paediatric cardiology and electrophysiology specialties. In an exclusive interview with Future Medicine, Dr Dalal talks about the Indian scenario in adult interventional cardiology

By Prashob K P 46 FUTURE MEDICINE I January 2013

What is adult interventional cardiology and what are the treatments available in this field in India?

Adult intervention usually means coronary bypass surgery, or coronary angioplasty, for treatment of coronary artery disease. For electrical disturbances, it would include implantation of pacemakers, intracardiac defibrillators and ablation procedures. In patients with valve disorders, it would include balloon valvotomies and the recently-introduced percutaneous valve replacement.

Tell us about the imaging-based diagnostic techniques and minimally invasive modalities in treatment of cardiovascular diseases.

The imaging techniques would include 2D and 3D echocardiography, CT coronary angiography, cardiac MRI, and nuclear testing with technetium and PET scanning.

What are the challenges in adult interventional cardiology and how advanced is India in this field?

This field is very advanced in India.

Bypass surgery and angioplasty, using latest devices and stents, is at par with the best anywhere. Electrophysiology is done less frequently than abroad and

certain ablation techniques are not as evolved, though implantion of cardiac resynchronisation therapies and ICD is routine.

And percutaneous aortic valve replacement is yet to start.

Isn’t high-priced treatment a disabling factor? How can the costs be brought down?

Yes, it is. However, there is a large population which is able to afford these life-saving treatments. On the other hand, the cost of stents and other devices is also steadily reducing.

Tell us about the techniques and medical procedures undertaken at Kokilaben Dhirubhai Ambani Hospital and the success rate in extending optimal patient care?

All procedures in adult interventional cardiology are done in this hospital, except percutaneous valve replacement.

These are done at the hospital with the same risk as the West.

How sound is the research environment for adult interventional cardiology in India? Are we still dependent on foreign diagnostic and technological solutions?

Yes. We are nowhere close to the research done abroad. The research done here is mainly clinical and not true basic research. Somehow, our patients are not willing to participate, saying they do not wish to participate in “experiments”.

We should be very thankful to the Westerners for active participation (in research).

Who requires the assistance of interventional cardiology and what’s the best you can offer in terms of longevity?

Patients with blockages in their arteries with angina and patients who develop heart attacks require the assistance of interventional cardiology.

Patients with heart attacks, or

unstable angina, benefit the most and improve their survival rate.

Is India’s cardiac patient population on the rise? What are the reasons for this and how can we contain the trend?

Yes, it is on the rise. We have bad genetics and this in association with the change in lifestyle, including stress, bad diet, and lack of exercise, and the increase in Diabetes and hypertension cases result in a marked increase in heart disease cases.

Can you suggest a few preventive measures for the common man?

People should bring about lifestyle changes, start exercises, maintain a good diet, reserve time for yoga and meditation, and avoid excess alcohol intake. Also, go for regular medical check-ups for early detection and treatment of Diabetes and hypertension.

How significant is post-operative care for cardiac patients? Is India lacking in this or any related area?

Post-op care has greatly improved in our country and is on par with the best. Good ICUs with intensivists trained in postop care is vital.

Good nursing with specialised nurses and modern monitoring systems have contributed to this improvement.

Reducing infection rate is our biggest problem and is being actively targeted.

January 2013 I FUTURE MEDICINE 47

MENSTRUATION

What’s Amenorrhea?

A

menorrhea is the absence of menstrual period in a woman of reproductive age. Amenorrhea is a normal feature in prepubertal, pregnant, and postmenopausal women. For a woman to bleed cyclically, she needs a uterus, whose inner layer responds to ovarian hormones and ovaries, which produce female hormone oestrogen and progesterone in turn to the action of pituitary hormones, follicle-stimulating hormone (FSH) and luteinising hormone (LH).

Dr N P Vijayalakshmy Chief Medical Officer of Vijaya Institute of Medical Sciences

rather called a lifestyle disorder. Maybe proper exercise will result in correction of metabolic disorders. When Hyperinsulinemia is seen, medicines can be taken to correct the ovarian hormone levels.

Most people are faced with obesity problems, hirsutism, or discoloration at the back of neck, folds of hands, and these pigmented areas are called Acanthosis Nigricans. To some extent, this can be

The woman must also have continuous outflow tract, namely, uterine canal and a patent vagina. The outlet of vagina is partially covered by a membrane called “Hymen”. In some children, this may be a complete one, resulting in collection of menstrual blood in the uterus that causes a condition called “Hematometra”. Sometimes, this blood will go to the tubes and cause “Hematosalpinx”. These girls experience cyclical abdominal pain and distention of abdomen. Examination will show imperforate hymen. The treatment is simple - making a cross incision in hymen and letting out the menstrual blood will result in regular menstruation.

Transverse vaginal septum is another condition which can cause amenorrhea.

Surgical correction will result in normal flow. Cervical stenosis can cause collection of menstrual blood. Correction of stenosis will result in normal occurrence of menstruation.

Sometimes, the inner layer of endometrium is susceptible to diseases like TB, resulting in nonresponse to the ovarian hormone and Amenorrhea.

Endometrium biopsy is conducted to confirm the infection and proper treatment will result in menstruation. A condition where a woman never had vaginal bleeding is called Primary Amenorrhea.

There are some conditions where ovaries are affected later in polycystic ovaries. This results in Secondary Amenorrhea. PCO, Hyperprolcatinemia, Hyperandrogenimea, and Hypothyroidism can cause prolonged Amenorrhea. Most of these conditions can be identified by simple blood test and simple medications will correct the condition. However, PCO is a symptom complex that sometimes needs elaborate investigations and treatment. This is now 48 FUTURE MEDICINE I January 2013

corrected, once treated with appropriate hormone.

Some girls, who are too obese, need laser therapy or electrolysis along with oral hormone therapy.

All hormones are not very safe in all patients. Some results in mood swings, depression, and patients stop treatment without telling the doctor.

Women of reproductive age, whose menstrual cycle does not come back to normal even after medications, may have to undergo laparoscopy wherever selective ovarian follicular puncture is done, which results in cycle correction and conception.

Dr N P Vijayalakshmy MD, DGO, is the Chief Medical Officer of Vijaya Institute of Medical Sciences, Kadavanthra, Cochin, Kerala

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HEALTH INSURANCE

Publicly funded schemes: Effects & side-effects

I

ndia’s health insurance landscape has undergone tremendous changes in the last three years with the launch of several more schemes, largely by the Central and state governments. It is fascinating to observe the rapid and significant change in the geometry of health insurance coverage in the country (January 31, 2011, PC report).

Though there has been a plethora of schemes funded publicly (mostly by state governments), like Rajiv Aarogyasri (Andhra Pradesh), Kalaignar’s Insurance Scheme for Life Saving Treatment (Tamil Nadu), Vajpayee Arogyasri and Yeshasvini programmes in Karnataka, the forthcoming scheme in Maharashtra on the lines of Andhra Pradesh, they have so far failed to provide evidence on two most important aspects: •

Control/decline of catastrophic

50 FUTURE MEDICINE I January 2013

•

expenditure due to the functioning of these schemes has not proved that they have succeeded in achieving the targets. The catastrophic expenditure among the population covered under these schemes has been increasing. The schemes target high-cost tertiary care procedures, including cochlear implant, transplantations, and similar services. However, it is sufficiently established that the major share of private expenditure on health happens in OPD settings (70 to 80 per cent) and a major share of this (up to 70 per cent) is due to drugs - something very unequally covered in all schemes (even if some of them extend a 10-day or more drug therapy support).

The schemes seem to targeting irrationally driven packages in a few cases. For eg: Hysterectomy is covered, but caesarian section is excluded from the package.

The reason could be the higher package price of the former.

The scalability and sustainability of these schemes as a model of care, to cover the entire population in the country, or even a state, is something which cannot be ascertained with promising figures even for the next five to six years; The risk to overutilise and overprescribe could have further damaging effects on the sustainability of the schemes, and needs periodic evaluation and assessment.

Key Learning: •

•

The schemes should not diversify their treatment packages in such a way that private hospitals become a hub of high-cost procedures The package of schemes should be based on the burden of

Dr Jitendar Kumar Sharma Member, Faculty of Health Sciences at University of Adelaide, Australia

•

•

disease and not on availability of procedures at corporate hubs in metros Cost-effectiveness of the procedures in terms of utility of funds and public health is something that has not been ascertained yet for any publicly provided health insurance scheme. This means that we do not actually know whether there could be a better investment on public health from the same funds that are used to cover highcost tertiary care procedures in corporate hospitals.

Not a single procedure in any of these schemes actually include a preventive or promotive procedure like breast cancer screening, diagnosis of malnutrition, follow-up of immunisation drop-out, treatment of any adverse effect following immunisation etc.

The schemes, even if they continue in their present form, must come up with a package that reflects clinical effectiveness, burden of disease, costeffectiveness, and the nation’s health priorities.

Dr Jitendar Kumar Sharma has served as Hospital Administrator for a number of years at Sri Sathya Sai Institute. Later, he served as a consultant to the World Bank and the World Health Organisation in the division of medical devices.

He is part of the Faculty of Health Sciences at University of Adelaide, Australia, and Advisor to Health Technology Innovation Centre of the Indian Institute of Technology, Madras. He has authored many research papers and two books.

CLINICAL RESEARCH CHALLENGES Apurva Shah, Chairman of ACRO

India at a

crossroads

Apurva Shah is the Chairman of the Association of Contract Research Organisations (ACRO).

His challenge is to position Contract Research Organisations (CROs) as a top level provider of comprehensive clinical solutions to the biopharmaceutical industry. He is helping ACRO promote quality research, uphold ethics, share best practices, promote synergies among members, and deliberate and act upon common concerns over Indian regulations and the industry environment. Founder and Managing Director of Veeda Clinical Research Pvt Ltd, he set up a medical college and two 500-bed hospitals in Central India as a trustee of the Ujjain Charitable Trust Hospital & Research Centre. In an interview with Future Medicine, Shah explains why India is at a crossroads in clinical research

By Prashob K P First of all, how do contract research organisations (CROs) help the healthcare sector? Is India new to this concept?

CROs help the healthcare sector indirectly in several ways: • By helping pharmaceutical companies develop new drugs, CROs play a role in bringing new drugs to the market, and by developing generic drugs, they help in reducing the costs of healthcare.

• When we conduct drug trials, we introduce a lot of SOPs (standard operating procedures) and best practices in hospitals and clinics. This helps in raising awareness and improving healthcare delivery in some cases.

• We get sponsors to invest in medical equipment that some of the hospitals might not have, thereby improving the infrastructure in those healthcare institutions.

• By doing screening camps, we help in early diagnosis of diseases.

52 FUTURE MEDICINE I January 2013

•

CROs provide new drugs to some patients, especially terminally ill patients of cancer, which could help extend or improve their lives. These drugs would otherwise not be available in the market or the patients would not be able to afford them.

What made you shift to clinical research and what are the opportunities in this field?

We got interested in this business because it was a sunrise industry. It offered us an opportunity to make a difference in this industry in India. Being a peopleand knowledge-oriented business, we could really take advantage of the bright Indian minds, and by offering them the opportunity to learn new drug research, we intended to differentiate ourselves. At Veeda, we wanted to be the bridge between the East and the West.

This industry offers a very long-term growth opportunity due to the requirement for new drugs for chronic and life-threatening illnesses. India, being

an upcoming market for research and medicines, would offer us the opportunity for long-term sustained growth.

What kind of a clinical research environment does India provide, both in terms of policies and technological prowess?

Currently, India is at a crossroads.

It can take advantage of the big socio-economic opportunity where it already has made substantial inroads or let this opportunity pass away to other upcoming regions in Asia and elsewhere by not reforming the laws and processes in time.

We have suffered a great bit in the past few years due to the inability of the government to regulate the industry, update the laws, or enforce them strictly. The result is that the good players are being penalised for the wrongdoings of a select few who use this opportunity to exploit the people/patients and make a quick buck. That’s precisely how the benefits this industry can bring to the country and its people are being stolen.

What are the implications of clinical trials in India and what is the role of ACRO in this field?

and educated manpower, and the conducive regulatory environment that allows quality research suitable to the industry requirements.

ACRO works to raise the awareness of the benefits of this industry to India and also works with the regulators to update the laws so that we can develop India as a global centre for R&D, where ethical and quality research is conducted.

There are a lot of developed and developing countries who are aggressively pushing for promotion of research. Unlike India, they are doing so because they see the benefits and are ready to create a conducive environment for growth of research in their country.

Tell us about the safety and ethical standards one has to follow for clinical research in India.

Give us an idea of the regulations and guidelines being practiced by CROs in India.

It’s all about patient safety. That’s the most fundamental part of GCP (good clinical practices) that we all follow globally. It is very critical that we understand the Indian environment and draft laws that can suit our requirements, protect our people, and help us do high quality research. Both the aspects cannot be compromised at all.

Which country has the largest clinical research industry? What keeps them ahead in the game?

The US has the largest market share, but Asia and other new areas are growing very fast. The factors that affect growth are the local drug market, the availability of the trained

The Indian regulators are trying to bring in reforms by introducing the guidelines for compensation, compulsory registration of ethics committees etc. All this is very good.

But the process needs to be speeded up, or else, it will be too little, too late!

The government needs to first understand the socio-economic advantages of this industry for us and then create the right environment by drafting the right laws and enforcing them. They need to walk their talk, then only we can develop this industry in India and one day in the not so far future, we can develop medicines for our local illnesses at locally acceptable prices.

What are the key challenges faced by the clinical research industry?

The biggest challenge today is that of the bad image created by the lack of a stable regulatory system.

The other issue is the bad image that has been created by the media due to the wrongdoings by some select few players. Because of them, the whole industry is seen in bad light. The fact is that a lot of good quality and ethical research is being done in India.

Though it has been going on for a long time, it has never been highlighted. We hope that the government realises that we are losing a big opportunity.

Can you cite a few examples of healthcare solutions that have made it to the mainstream from the clinical research labs?

All the new drugs that we consume have gone through clinical research and so have all the new devices that are used to treat illnesses. Without a thorough clinical research process, we cannot be sure of taking medicines.

Thousands of lives are saved or are given a better quality of life due to their participation in trials. We all owe our lives to the tens of thousands who have helped us by participating as subjects in trials in the past.

January 2013 I FUTURE MEDICINE 53

SEXUAL HEALTH

Dr A CHAKRAVARTHY

Erectile dysfunction can affect family life

Consultant In Reproductive and Sexual Medicine

S

exual relationship between spouses is extremely personal and delicate. An imbalance in sexual behaviour, attitudes, periodicity, and endurance can change the whole dynamics of a conjugal relationship. But mostly, the problem arises with dissatisfaction with the quality of sexual life owing to erectile dysfunction.

Erectile dysfunction can have a lasting effect on a person’s psychology or his relationship with his partner. A person may feel embarrassed and ashamed about the problem, making it tough for him to communicate with his partner about the issue. Erectile dysfunction is one of main issues causing a split in one-fifth of marital relationships.

Going by the usual complaints of couples, most of them are unable to make workable suggestions to each other in the event of erectile dysfunction. This communication failure could affect the trust and intimacy between a husband and wife. The person facing the erectile problem may withdraw emotionally and physically, with the fear of failure pushing him to the brink.

And, in turn, his spouse may start to believe that her husband is losing interest in her. In reality, the person isn’t losing interest, though he may be manifesting signs of frustration during sexual intercourse. All that both spouses need is a bit of affection and a hug. But then, in most cases, that’s just not what happens. They start exhibiting their choked up 54 FUTURE MEDICINE I January 2013

emotions, often leading to a rift.

What is erectile dysfunction?

Erectile dysfunction is the prevailing or consistent inability to induce or sustain an erection of the male sexual organ to interact in sexual activity. Most men sometimes fail to induce an erection, or lose it in between the sexual act.

There aren’t any accurate statistics to prove that a huge percentage of men face this problem. But it has been learnt that about half of the male population aged between 35 and 70 have frequent issues of achieving or maintaining an erection. The amount of men with physiological problems concerning erectile dysfunction is low (including those

under the age of forty). However, the problem increases with age in certain cases.

Causes of erectile dysfunction

Various kinds of diseases, medications, injuries, and psychological issues can cause erectile dysfunction. Here are a number of common causes: Psychological causes: Performance anxiety: Most men have erection issues during sexual performance. If this happens persistently, the very thought of engaging in sexual intercourse can trigger nervous reactions that can forestall erection.

Situational psychological issues: Troubled relationships can affect a man’s sexual behaviour. He may be unable to attain erection

just because of some nagging issue related to his spouse.

Vaginismus/partner’s mental state can also cause erectile dysfunction in men.

Orientation: Those with same-sex feelings may never be able to induce an erection for sex with a female partner.

Physical causes: Circulatory problems: An erection happens once the spongy tissue of a man’s penis fills with blood and a valve at the bottom of it traps the blood. Diabetes, high force per unit area, steroid or alcohol intake, clots, and arterial sclerosis (hardening of the arteries) can interfere with an erection. Besides, erectile dysfunction is a warning signal for an impending heart attack.

Hormonal disorders: Deficiency of internal secretion of male hormone (androgen) as well as thyroid hormone abnormalities can alter the erectile function as well as libido.

Diabetes Mellitus: A study from Ghana suggests that about 70 per cent people with Diabetes Mellitus were suffering from erectile dysfunction.

Depression: This may be a common reason for erectile dysfunction. Depression could be a physical disorder induced by medicinal intake. This might affect you even if you are comfortable in a given sexual scenario.

Alcoholism: Chronic alcoholism can cause erectile dysfunction, even though there’s no alcohol in the blood at the time of sex.

Smoking: Smoking causes constriction of blood vessels. This might decrease blood flow to the erectile organ.

Peyronie’s Disease: This disease causes fibres and plaques to appear within the genital organ, interrupting blood flow as well as affecting the shape of the organ.

Cancer: It interferes with the nerves or the arteries that are very important for an erection.

Surgery: Surgery to the pelvis, and particularly prostate surgery for glandular carcinoma, will harm the nerves and arteries, which are essential for an erection.

Spinal cord or pelvic girdle injury: An injury can snap the nerves’ stimulating effect on the male organ.

Drugs: The following drugs can cause erectile dysfunction: • Medications for hypertension • Anti-depressants • Steroids • Sedatives • Alcohol • Tranquilisers • Anti-tumour medications • Cocaine

Symptoms and complications of dysfunction

When a person is unable to induce or sustain an erection, it is called “dysfunction”. It may even be known as “erectile difficulties”.

Diagnosing ED

A doctor has to know the history of a person’s health, to start with.

Standardised personality assessment or surveys concerning erectile function and satisfaction during sexual activity could also determine the character of impotency. Blood pressure and tests of secretion levels are checked.

There are tests that aim to differentiate between psychological, nervous, and circulatory causes. One is the nocturnal penile tumescence (NPT) test. A measuring instrument is connected to the erectile organ for constant monitoring of erections throughout sleep. Men without physical disorders typically have erections throughout REM (rapid eye movement) sleep. Several devices as well as a Doppler study can track blood flow in and out of the erectile

organ and determine circulatory issues.

Treatment of erectile dysfunction For physical causes: • Medications of the genre PDE5 inhibitors like Viagra, Cialis etc • Vacuum Assisted Devices • Correction of hormonal abnormalities • Surgery for Peyronie’s Disease • Control of Diabetes Mellitus • Control of hypertension and hypercholesterolemia • Intra Cavernosal Injections • Penile implants – if no other method is successful

Treatment for psychological causes:

Sex Therapy: It is a form of psychotherapy, integrating biomedical and psycho-social components for treatment of sexual problems. It helps partners overcome their performance anxiety.

Prevention of erectile dysfunction: Pre-Marital Counselling: With adequate knowledge about sexuality, future couples can relieve themselves of anxiety. Ensure: • Good intimacy • Healthy food habits • Regular exercise • Quit/avoid smoking • Stop/reduce alcohol consumption

Dr A Chakravarthy, MBBS; MBA (Hospital Management); MHSc (Reproductive & Sexual Medicine) is a Consultant in Reproductive & Sexual Medicine based in Thiruvananthapuram, Kerala mail@drchakravarthy.com January 2013 I FUTURE MEDICINE 55

HOSPITAL FOCUS KG Hospital, Coimbatore, Tamil Nadu

Where Daridra Narayan meets

Vaidya Narayan Code Blue, Emergency room! That’s all Padma Shri Dr G Bakthavathsalam needs to say to call for the attention of a team of specialists and support staff at KG Hospital in Coimbatore, Tamil Nadu, towards an emergency case. In split seconds, the telephone operator complies with the command and a message booms through the speakers installed at various parts of the stateof-the-art hospital: “Your attention please: Code Blue, Emergency Room.”

The announcement is made once more, and in less than a minute, four doctors, including a cardiac specialist, a general doctor, a neurologist, and a duty doctor, five nurses armed with emergency medical kits, and two stretcher-bearers are ready to attend to the emergency of the hour. The commitment, motive, and goal of the team are amply clear and simple – saving the life of a patient in a critical condition with strategic planning

By Tony William

56 FUTURE MEDICINE I January 2013

T

hat’s the new face of medical care, and KG Hospital is ever-ready to stand up for the cause of the common man. Dr GB, as the Chairman of KG Hospital is popularly known, is a man of his word as a surgeon, teacher, philanthropist, industrialist, and entrepreneur. And his vision has guided KG Hospital to great heights in medical excellence.

Now, coming back to Code Blue, is it something you get to hear or see at government hospitals?

Most of them are neck deep in moody blues rather.

That is, an uninspiring work environment where the mood is always dull, to say the least. How many doctors would be there in the emergency?

Wouldn’t the onus of locating a doctor be on the nurse? Even if a doctor arrives on time, the support system may not be in place to meet the immediate needs of a critically ill patient. That is exactly where KG Hospital stands out. “Saving life should always be the topmost concern, irrespective of the criticality of a patient,” says Dr GB. “This basic sense of prioritisation reflects the preparedness of the medical staff. At KG Hospital, the patient comes first. Work is worship. The hospital is our temple.

Maintaining the sanctity of this temple is our utmost concern,” says Dr GB.

No doubt, he says, a great number of Indian healthcare institutions are capable of meeting the global standards in terms of quality and standard of

care. “However, the centres of excellence are more of the nature of islands of excellence. They are unapproachable for people from weaker sections of society. In many hospitals, even the best specialists are not approachable. They never disclose their numbers to patients. But look at KG Hospital. I share my number with everyone. The emergency hour is always the Godly hour. If ‘God’ is unavailable at the hour of crisis, what will patients do?”

What about the problem of commercialisation of healthcare? Dr GB says, “Healthcare is a business, a business of saving lives. Earlier, we had modest rooms and buildings. But now we have airconditioned rooms because people want it. People are taking pre-emptive moves, trying to guard themselves against a host of diseases with early diagnosis.”

His daughter and President of KG Hospital, R Vasanthi, reasons: “Profit is only a by-product at KG Hospital. The profit made at KG Hospital is reinvested in the hospital itself for better services.

No money goes out of the hospital. A hospital has to be run like a business, otherwise it won’t survive.

Who would go to a hospital which is infamous for its irresponsible staff or poor quality management system?

“KG Hospital is managed in a cohesive manner.

Our staff is our family,” says Vasanthi. Her father concurs, “It is very easy for an organisation to

January 2013 I FUTURE MEDICINE 57

HOSPITAL FOCUS KG Hospital, Coimbatore, Tamil Nadu

say that our employees are part of our extended family. But it is a tough task to bring about this transformation. Over the past 34 years, I have been able to achieve a success rate of about 90 per cent towards this end. The transformation process is long drawn. It is like brushing your teeth. You have to do it every day. If you fail to do it a single day, there will be foul smell. Doctors and their support staff should work as representatives of God. Whenever a ‘daridra narayan’ (poor person) knocks on the door, one must be ready to perform the duty of a ‘vaidya narayan’ (doctor) in the fullest capacity,” says Dr GB. “I ask my ‘family members’ to give their 100 per cent to their duties. I would never like to hear excuses from them in this regard. Duty always comes first,” says Dr GB. KG Hospital, being run by a trust, was founded

and West) in healthcare? Recalling his days in the US, Dr GB says that everything there is 40 per cent more costly than in India. “We have conducted about 95,000 free eye operations as of today. Charity-based medical care of this magnitude doesn’t happen in the US. We just have to ensure the right mix at the end of the day. So, the best a medical aspirant can think of is to get familiarised with the (efficient) American medical system through training and come back as an American in terms of expertise but an Indian to the core.”

“Ignorance is the greatest disease in India. We don’t know what we are capable of. It is here that education can make a big difference. Why else would an auto driver become a slave of a three-inch cancer stick (beedis)? They are ignorant of the dangers,”

This 128-Slice Computed Tomography (CT) Scanner is revolutionising non-invasive diagnosis

by K Govindasamy Naidu, an industrialist and philanthropist. What started out as a 10-bed hospital in 1974 is a 500-bed facility today, with 48 specialty departments. Cardiology, Cosmetology, Dermatology, Diabetology, Emergency, Endocrinology, Endoscopy, Gastroenterology, Geriatrics, Neurology, Ophthalmology, Paediatrics, Pulmonology, Rheumatology, Stroke Unit, Surgical Oncology are a few of KG Hospital’s core specialties.

But how can we get the best of both worlds (East

58 FUTURE MEDICINE I January 2013

says Dr GB. KG Hospital is best known for its cardiology and emergency departments. “Within a year, we plan to expand the oncology department,” says Vasanthi.

That sounds promising indeed.

The mobile ICU of KG Hospital has been christened ‘Responder 2000’. A state-of-the-art mobile ICU ambulance has been playing a very crucial role in saving lives. The ambulance has all kinds of modern medical devices and equipment. “A

KG Hospital has an active corporate social responsibility department as well.

The hospital has conducted over 95,000 free intraocular eye surgeries, hundreds of free eye camps, and screened nearly 5,00,000 patients. In 2003, former President of India, Dr A P J Abdul Kalam, had inaugurated a novel free surgery programme for poor children of Tamil Nadu. Over 1,000 children have benefitted from this scheme. More than 500 free heart surgeries were conducted under the ‘Little Heart Foundation’ programme.

Under a scheme called “Ilam Sirar Irudhaya Padhukappu Thittam”, an initiative of the Tamil Nadu Government, heart surgeries on 400 poor children were conducted. This scheme is still in operation. Besides, more than 3,000 people have been provided with free dialysis.

Dr GB is a down to earth man. He knows how to stay connected to people and provide them with the right kind of care. His idea of care is simple and straightforward – “A doctor must be able, available, affordable, accountable, and adaptable. Doctors must work for 16 hours a day. The medical profession is divine.

Each hour, we should strive to do the best and save as many lives as possible.” few months ago, we admitted a man who could die from multiple organ failure. His condition had reached such a critical stage that none of the hospitals could offer him hope. We thought we could help him. Last week, he went home walking on his own. Who is the happiest man today? I am. My family was able to bring him back to life,” says Dr GB. KG Hospital is in the forefront of introducing the latest medical technologies. The 128-Slice Computed Tomography (CT) scanner is revolutionising noninvasive diagnosis. This machine can scan the whole body within a few seconds and provide incredibly sharp 3D images of any organ. This technology is revolutionising diagnosis in Cardiology, Oncology, Neurology, and many other areas.

January 2013 I FUTURE MEDICINE 59

DENTAL CARE

Pay attention to

tooth deca D

ental decay, or dental caries, happens when acids in the mouth dissolve the outer layers of the teeth. The symptoms of tooth decay are: • • • •

toothache sensitivity of teeth pain discoloured spots on the teeth

What causes tooth decay?

The mouth is full of bacteria, which combine with small food particles and saliva to form a sticky film known as “plaque” that builds up on the teeth. Bacteria present in the plaque react with the food particles in the mouth to produce acid. The acid in plaque is harmful to the teeth as it breaks down the tooth’s surface by eroding the enamel. In due course of time, a cavity can develop on the surface of the tooth. Once the enamel is broken down, the plaque and bacteria penetrate the dentine faster as it is softer than the enamel. If the cavity is not treated at this stage, the plaque and bacteria enter the pulp of the tooth where the nerves are present, making it very painful. An added infection in the pulp may also result in a painful dental abscess.

Treating and preventing tooth decay

Tooth decay is one of the most prevalent dental problems. Dental cavity in its initial stages can be 60 FUTURE MEDICINE I January 2013

treated by a dentist with removal of the decay and filling, or restoration.

If the decay is in very early stages, the dentist will remove the decayed part and apply a fluoride varnish to the area which will help stop further decay.

If tooth decay has spread to the pulp, the pulp may have to be removed and replaced with a medicament.

The tooth will thus be saved in this process. This procedure is known as “root canal treatment”. Root canal therapy, if done by an experienced

dentist, is a painless procedure these days and the results are predictable.

In serious cases of tooth decay, where most of the tooth structure is lost and cannot be restored with a filling, the tooth may be extracted.

After loss of such teeth, the dentist may have to replace the tooth with a partial denture, bridge, or implant, to maintain the shape of the face and function of the surrounding teeth.

Factors that increase risk of tooth decay

Poor oral hygiene: If one does not

Dr Ravi R Hebballi Consultant Oral & Maxillofacial Surgeon

regularly brush the teeth, there is a higher risk of tooth decay. One should brush teeth at least twice a day to prevent plaque on the teeth.

Diet: Food and drinks high in carbohydrates, particularly between meals, will increase the risk of tooth decay. Tooth decay is often associated with sweet and sticky food and drink, such as chocolate, sweets, sugar, and fizzy drinks.

Smoking: Smokers have a higher chance of developing tooth decay as tobacco smoke interferes with

production of saliva, which helps keep the surface of your teeth clean.

Though tooth decay is commonly seen, it can be prevented to a certain extent. Looking after your teeth well and visiting a dentist regularly are important steps towards preventing tooth decay. Save the teeth and make them last!

Dr Ravi R Hebballi is a Consultant Oral & Maxillofacial Surgeon based in Bengaluru, Karnataka

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Thrikunnapuzha, Alappuzha, Kerala, India

Marari Beach, Alappuzha, Kerala, India

Alappuzha, Kerala, India

Administrative & Sales Office:

EDAKKADU GROUP OF COMPANIES

ATDC Alleppey, 2nd Floor, Municipal Library Shopping Complex, Thathampally P. O., Alleppey 688 013, Kerala, India Tel: +91 477 2264462, 2261693, 2230583, Tel/Fax: +91 477 2231145 E-mail: info@atdcalleppey.com I Web: atdcalleppey.com

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January 2013 I FUTURE MEDICINE 61

FOCUS NIMS Medicity, Thiruvananthapuram, Kerala

The Miracle Worker The air of melancholy, the odour of spirit, laboured grumblings, and howling of ambulance sirens are the first things that come to mind when you think of hospitals.

And it is indeed no wonder they don’t make it to the list of preferred destinations, despite being the most visited ones. Now, here’s a hospital that tells a different story, the story of a miracle worker who made charity his second nature Bureau

M

ajid Khan grew up in a small village where human life was cheap. As a small boy, he witnessed many tragedies from close quarters, thanks to the dearth of access to life support systems. The boy was so moved by the miserable nature of people living in poor conditions that he made up his mind to do something about it. Yet, given the magnitude of change he wanted to bring, it took him more than 50 years to set up a hospital and realise his childhood dream - to bring healthcare within the reach of the poor. Nevertheless, the wait was worth it. A super speciality hospital was set up in 2006, and Majid Khan entrusted his son, Faizal Khan,

People who see healthcare as a money-spinning business don’t deserve to be in it. Hospitals should be the centres for social work and, as a rule, shouldn’t work like a steel factory Faizal Khan, Managing Director, NIMS Hospital, Thiruvananthapuram 62 FUTURE MEDICINE I January 2013

with the responsibility of running the hospital.

Cut to present

The air of harmony, an attribute that you rarely associate with hospitals, is the first thing that catches your attention when you enter NIMS. With Faizal Khan at the helm of

of Medicity

mode?

People who see healthcare as a money-spinning business don’t deserve to be in it. Hospitals should be the centres for social work and, as a rule, shouldn’t work like a steel factory, or a business factory.

Missionary hospitals like Little Flower Hospital and St Thomas hospital are worthy models of emulation.

I’m not saying that hospitals shouldn’t make money.

But it’s immoral to shift the burden of costs to the patient for the sake of profiteering. Ideally, hospitals should strive to make best use of medical practice for the greater public good. The only matter of concern should be to bring healthcare to the public at affordable rates. Target achievement and volume expansion shouldn’t be the working principle in the healthcare sector.

Health spending has pushed many homes to the brink of bankruptcy. Many hospitals seem to be specialising in fleecing patients. But NIMS manages to offer affordable healthcare, notwithstanding the cost-intensive technology and discrepant drug pricing. How do you manage?

Apparently, with the cost of technology and price of drugs on the rise, it is increasingly difficult to offer cost-effective services. We don’t have many alternatives left. The fees we charge for tests and room rents are the only areas of compromise. affairs, NIMS Medicity is one of the few super speciality hospitals in Kerala. Faizal Khan, the Managing Director of NIMS Hospital, is not a doctor by profession. But then, there is more to him than meets the eye. For starters, he barely needs a stethoscope to know the pulse of a patient and his deep knowledge in healthcare is too hard to be missed. Read further to know more about NIMS Medicity and Faizal Khan, from the man himself. In an exclusive interview with Future Medicine, Faizal Khan gets candid on his mission, inspiration, and future plans

How can the general public make an educated choice with respect to the choice of a hospital in the context of a disease and the treatment facilities?

The problem is with the mindset of people. Super speciality hospitals are often confused with hi-tech hospitals, though it’s not the case always. People are often chased away by the burden of expense it brings along. People shouldn’t decide by themselves in the context of an illness. I’m not against basic hospitals, but the general public should realise that basic hospitals have their limitations. They sometimes look at the immediate symptoms without delving deep into the root cause(s). Unlike basic hospitals, super speciality hospitals offer total solutions. With more resources at hand, they can run the necessary tests to trace the real cause of a disease. Only super speciality hospitals can afford internal references since they have all the major departments and act as a one-stop shop for the diagnosis and treatment.

Is the healthcare sector turning into a marketplace with the entry of new players and major hospitals going into an expansion

Also, we make sure doctors don’t make money through the backdoor. We offer them a reasonable package and they don’t have to rely on commissions.

Does the new crop (of doctors) lack the medical ethics that rob the profession of its quintessential human touch?

Generation gap is a reality. The new generation has fresh ideas and are armed with the latest knowhow. The old generation has its advantages too. Nevertheless, at the end of the day, what really matters is the commitment and sincerity they have towards their profession.

What is your take on the lobbyist attitudes on drug regulations and pricing?

Drug regulations and pricing are dictated by lobbies. The government’s intervention has failed to produce a positive change, thanks to the clout of the powerful lobbies. Moreover, the want of good pharmaceutical companies makes the situation worse.

NIMS Heart Foundation is your flagship project. The work you’ve been doing in the area of cardiac care is nothing short than phenomenal. How satisfying is it to be part of this overwhelming experience?

I will let the numbers tell the story. We perform 30-35 heart surgeries, 200-220 angiograms, and 60-70 angioplasties every month. The numbers may vary, but the success rates never do. We have a phenomenal 100 per cent success rate in our

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FOCUS NIMS Medicity, Thiruvananthapuram, Kerala

angioplasty division. And for every 10 surgeries we do, one is free of cost.

We offer medical packages at subsidised rates in accordance with the requirement of a patient. We have also given Rs 50,000-60,000 discounts in certain cases. Our tests are cheaper than those offered in government hospitals. The cost of a heart surgery starts from Rs 90,000, which is a small amount when compared with the standard rates.

Could you tell me about the selection procedure for free surgeries?

The selection procedure is carried out through medical camps. We conduct 14-15 medical camps every month, and patients eligible for free medical care are picked from these camps.

We are pioneers in free heart surgery. Currently, the state has six to seven free heart surgery programmes, but money for these schemes is

medicine. It’s a 5,000-year-old science and it would be unfair on our part if we overlook its importance.

Kunjali Gurukkal, a traditional practitioner, is a miracle in the area of cancer care. He maintains a phenomenal success rate of 70 per cent in cancer treatment. We hold camps under his guidance on a regular basis. Our research on naturopathy also holds out a lot of promise.

NIMS is known for having introduced many modern techniques that brought radical changes in the field of medicine in India. What more can we expect from you in future?

Our activities are not limited to healthcare.

We want our presence to be felt in different areas, 64 FUTURE MEDICINE I January 2013

generated through sponsorships. In the case of NIMS, the entire money for free heart surgery programmes comes from my pocket.

What prospects do Kerala have in the area of medical tourism?

Medical tourism has huge prospects. But overcommercialisation might damage the reputation of Kerala as a hub of Ayurveda. With massage parlours cropping up like mushrooms and a lot of untrained practitioners thriving in the business, our genuineness is at stake. If the checks and balances are in place, there is no reason why we can’t grow into a global hub in healthcare.

It came as a pleasant surprise that your hospital has a specialised department dedicated to Ayurveda in contrast to the modern Allopathy image you project.

How do the two go hand in hand?

I have huge respect for Ayurveda and traditional

including arts and culture, to name a few. NIMS has adopted a village and more adoptions are underway.

We are proud to announce that our university is launching a satellite for disaster management and agriculture purposes. A group of 30 senior scientists are working on it. The first phase is over. When the whole plan comes through, we would be the first university in India to launch a satellite as the previous three attempts by other universities had met with failure.

Our R&D front has made a remarkable progress in tracking down the cause of the high incidence of bone cancer in Malappuram district. Discussions are also underway for a port-based project in Nairobi.

FOCUS Caritas Hospital, Kottayam, Kerala

Charity is our middle name

Caritas is a unique name. The word Caritas stands for “charity” in Latin.

The hospital is touted as the best super specialty hospital in Central Kerala. The motto of the hospital is “Kenotic love saves life”. Kenotic love is selfless love; the act of emptying oneself to make space for the divine grace. Guided by the motto, Caritas brings healthcare to the people in need, irrespective of their religion, caste, or financial status

“

Bureau

In the entire history of the hospital, we have never given up on a single patient just because of his/her weak financial status,” says Fr Thomas Aanimmoottil, the Director of Caritas Hospital. Caritas is spread over 23 acres at the heart of Thellakom, seven kms away from Kottayam town. The hospital was founded in 1962 by the then Archbishop of Kottayam, Fr Thomas Tharayil, with the help of a few wellwishers from Germany. The hospital is run under the auspices of the Catholic Diocese of Kottayam. The modest beginnings are a thing of the past now, as the hospital has grown into a 635-bedded super specialty with the ISO 9001 accreditation.

Nearly 3.5 lakh outpatients and

50,000 inpatients receive treatment every year at Caritas. This super specialty hospital has 41 departments that work round the clock to bring the best medical care to its patients.

The hospital has a well-assembled team of seasoned and highly qualified doctors who work hand in hand with highly able junior doctors. Caritas has a zero compromise approach in recruiting nursing staffs. They are picked strictly on the basis of their competency levels. With the blessings and unstinting support of Mar Mathew Moolakkatt, the Archbishop of Kottayam, and Mar Joseph Pandarasseril, the Auxiliary Bishop of Kottayam, the hospital is all set to scale up its model of care.

Caritas takes up many noble

initiatives in the area of cancer care, cardiac treatments, and renal diseases, to name a few of its core specialties, which help the hospital live up to its name.

Caritas touches the lives of many people, with multiple activities on the charity front. The Heart Foundation provides treatment at subsidised rates for patients who can’t afford the medical expense. On the occasion of the fiftieth anniversary of Caritas Hospital, it offered underprivileged patients a 50 per cent discount for open heart surgeries. The hospital gives three free dialyses for patients who have been taking treatment from the hospital for more than three years. ESHS Scheme is a programme that provides treatment for people January 2013 I FUTURE MEDICINE 65

FOCUS Caritas Hospital, Kottayam, Kerala

department offers specialty procedures like endoscopy, digital colonoscopy, endoscopic biopsy, duodenoscope for ERCP procedures etc.

The Intensive Trauma Care Unit and emergency medicine department composes specialist doctors from the departments of surgery, internal medicine, neuro medicine, neuro surgery, radiology, ENT, orthopaedics etc. The department has a wellequipped seven-bed Intensive Trauma Care Unit to deal with patients suffering from intensive trauma.

Fr Thomas Aanimmoottil, Director, Caritas Hospital, Kottayam serving in the armed forces. Caritas has also joined hands with the government to offer many schemes to help patients in need.

Caritas Heart Institute was set up in 1986. Though it started as an eight-bed acute cardiac department, it evolved as a full-fledged cardiac centre with 15 ICU beds and facilities for all major non-invasive diagnosis and treatment by 1991. The process to construct cardiac catheterisation laboratories and cardiovascular theatres with new outpatient and inpatient blocks is underway. The cardiology department has 24 spacious individual cubicles of Coronary Intensive Care Unit (CICU).

With the latest Colour Doppler Echocardiogram, computerised ECG and TMT, and facilities for temporary and permanent pacemakers, the hospital is all set to break new grounds in the area of cardiac care in Central Kerala.

The interventional cardiology division has facilities for pacemaker implantations, angiogram, angioplasty, and stenting. The department also has an ultramodern Hybrid Cathlab.

Open and bypass surgeries, keyhole surgeries, aortic and re-do surgeries are also performed here.

The gastroenterology department of the hospital is considered the best in Central Kerala. Highly qualified doctors and state-of-the-art infrastructure helped Caritas build the reputation of this department. The 66 FUTURE MEDICINE I January 2013

The neuro medicine and neuro surgery department of the hospital offers advanced spinal surgery and head injury surgeries.

The department has facilities for Electroencephalography (EEG), Electroneuromyography (EMG), evoked potential, photosensitivity testing and neuro imaging. Transcranial Doppler is the latest feather in Caritas’ cap. This device is used for brain mapping and helps track the blood flow in the brain.

Early diagnosis holds the key to cancer treatment, and Caritas has an early detection cancer clinic. The highly advanced forms of radiation treatment with Linear Accelerator and Linear Accelerator with IMRT facility are made available to the patients.

The 82-bed department also offers supportive services like chemotherapy and Brachy therapy. The surgical

oncology department undertakes all types of cancer surgeries. Breast conservation and reconstruction, hepato, pancreatic, esophageal, lung surgeries and other organ conserving surgeries are carried out by preeminent surgeons with the aid of advanced surgical techniques. The radiation oncology department has CT-based virtual simulation and an advanced HDR Brachy therapy unit.

Medical oncology includes paediatric oncology, lymphoma and leukaemia clinic. The pain and palliative care department takes care of the terminally ill patients.

Caritas had set up the first dialysis unit in Kerala in the year 1972. It now has 22 dialysis machines and performs more than 10,000 dialyses per year. The services offered include haemodialysis, continuous ambulatory peritoneal dialysis, continuous renal replacement therapy (CRRT) and renal transplantation surgery.

The medical institutions of Caritas have set a new benchmark in the field of medical education. The hospital has three institutes. Caritas College of Pharmacy, which offers the DPharm course. It has an annual student intake of 60. Caritas School of Nursing offers training in general nursing and midwifery. Caritas College of Nursing offers BSc in Nursing. Caritas Hospital also has an Ayurveda division that adds to its image of holistic healthcare.

FOCUS KVM Hospital, Cherthala, Kerala

From England, with love for India, and

Neurosurgery “

Bureau

I am the head, body, tail, and everything of the Neurosurgery Department of KVM Hospital, Cherthala.” When Dr Avinash Haridas says this, you may mistake it for arrogance. But when you hear from him about the efforts that have gone into the creation of a well-equipped Neurosurgery Department at KVM Hospital from a model that was rudimentary, you will agree that it’s a matter of pride indeed. “We didn’t reopen the department.

We started a new Department of Neurosurgery from scratch. And it is always challenging. Today, no one wants to get out of the comfort zone.

Even I could have continued my job in England. I had a great job in London, working at one of the pioneering neuroscience hospitals in the world, a handsome salary, and better living conditions. But each time I visited India, I felt that we were lagging behind the rest of the world. During those visits, I would ask myself, ‘what has been my contribution to improving the condition of my country?’, and the answer used to be – ‘Nothing so far’! It was the love for my country and the burning desire to make a significant contribution (to its developmental endeavours) that prompted me to quit that job and take up this Herculean task,” says Dr Avinash.

Dr Avinash has 12 years of international work experience. He has worked in the neurosurgery wing of some famous hospitals in England, including the 150-year-old first dedicated neuroscience hospital – The National Hospital for Neurology and Neurosurgery (Queen Square), Great Ormond Street Hospital for Children, King’s College Hospital, Royal Free Hospital, Charing Cross hospital, Hope Hospital, Royal Preston Hospital, Hurstwood Park Neurological Centre, Queens Hospital, and St Bartholomew’s and Royal London Hospital. He has worked with more than 70 consultant neurosurgeons in England that helped him gain a special understanding of a variety of

techniques and approaches on management of various neurosurgical ailments.

So, what’s the difference between Indian and foreign healthcare models? “The Dr Avinash Haridas, Head, Neurosurgery general medical Department, KVM Hospital approach is different there (in the West). The doctor and the patient enjoy an equal status. The situation is different here (in India). Only diagnosis and treatment happen here most of the time. Even taking a second opinion from another doctor can sometimes be considered offensive here. One of my patients had to face the ire of a doctor just because he had approached us for a second opinion,” says Dr Avinash. He continues, “We had a working environment (in England) whereby we shared our knowledge of treating a disease with the patients. All possible modalities of treatment, including conservative methods, were explained to them. For every disease, there are many options of treatment. The patient has to be made aware of all conservative, medical, and surgical options.

Even the recovery percentage, in the event of a surgery, is revealed to him in advance. I don’t like to generalise, but in the Indian healthcare sector, many a time, diagnosis is followed by treatment without the doctor having fully explained the disease in detail and the various options of treatment. Hiding information and giving only partial information regarding the various treatment options to the patient is unethical. When I have a January 2013 I FUTURE MEDICINE 67

FOCUS KVM Hospital, Cherthala, Kerala

patient with a serious neurological disease, I encourage him/her to go for a second opinion, as it would always be helpful to both the patient and the doctor.”

“Neurosurgery is an expensive field because most of our quality instruments, equipment, and even consumables are manufactured abroad – mainly in the United States

two other major teaching hospitals have this microscope in Kerala. A state-of-the-art drill system enables us to quickly open the skull in an emergency. The setting up of the neurosurgery operating theatre has been a labour of love. It has been designed to match and even exceed European and American standards.

The ultraclean operating theatre can

two mortalities, we have attained a success rate of more than 99.5 per cent in treatment of head injuries. This is far better than the results that we had in London and most likely better than most in India. We have also been able to do operations for spinal disc prolapse, removal of spinal tumours, brain tumours, and pituitary tumours.

On two occasions, we were able to save the vision of young patients with sudden complete visual loss secondary to bleeding into a pituitary tumour.

On both occasions, complete excision of the tumour was achieved through a keyhole approach using endoscopes via the nose. This resulted in full visual recovery in one and near complete visual recovery in the other, and both were able to return to work,” says the Head of the Neurosurgery Department of KVM Hospital.

In five years’ time, Dr Avinash wants to build a Centre for Neuroscience. “It would be a brain hospital. Since we intend to provide all departments related to Neurology and Neurosurgery at this hospital, the investment will be huge. I want this Centre to put Kerala and India on the world map for Neurology and Neurosurgery. It would be a high quality centre providing facilities for diagnosis and treatment of all neurological ailments. It will provide a platform for advanced research and training in Neurology, Neurosurgery, and Neuroscience,” says Dr Avinash.

Dr Avinash Haridas (right) conducting a surgery and Germany,” says Dr Avinash. “To provide high quality care, we need the best equipment, and for this, we are so highly dependent on the West.”

He adds, “The Neurosurgery department at KVM hospital has been able to achieve great results because we did not make any compromises while setting up our department.

Attention to detail has been our mantra. For example, our operating microscope for Neurosurgery is the best available in the world today and was imported from Germany. Only 68 FUTURE MEDICINE I January 2013

filter particles up to 0.3 microns and the laminar airflow is designed to have clean air at the operating site at all times. All this and other attention to detail helps us in reducing the complications to the bare minimum as one operates on the crown jewel of God’s creation – the human brain” says Dr Avinash.

He has attended to more than 1,000 patients in 2012. Of these, 502 patients had sustained head injuries, mostly from road accidents. “But for

KVM Hospital has a solid reputation in Alappuzha with about 40 years of public faith vouching for its quality and inspirational model of care and affection. Within the next five years, Dr Avinash says, KVM would emerge as a viable alternative for patients, standing tall in Kerala’s healthcare sector. “It takes a lot of time for a child to grow. By the time he becomes a young adult, he’s bursting with ideas and ready to take on the world. After all these years, KVM Hospital is at the stage of a young adult and God willing, we should be able to deliver something that the nation is proud of,” says Dr Avinash.

FOCUS SNA Oushadhasala, Thrissur, Kerala

When in Rome, do as the Italians do,

with an Indian touch This is the era of customisation of Ayurveda at a global level.

Customisation?

Yes. To start with, have you heard of ‘Italian Ayurveda’? Still clueless? Read on…

By Tony William

“

If there is something called ‘Italian Ayurveda’ today, the credit for its creation goes to SNA Oushadhasala,” says Dr Antonio Morandi, a famous Italian neurologist, President of the Ayurveda Medical Association of Italy, and Chairman and Director of ‘Ayurvedic Point’, an institution in Milan that imparts training to new age doctors in the traditional branch of medicine with the provision of a sound learning base by SNA Oushadhashala Pvt Ltd, Thrissur, Kerala.

So, what’s Italian Ayurveda all about.

Hear it from the team behind it all. “We are driven by the vision that the healing potential of Ayurveda must be spread not on basis of products, but on the basis of principles. Since 2005, we have been trying to identify plants in Italy that have the same medicinal properties of herbs found here (in Kerala). For example,

in Italy, a plant called “Oak” almost has the same medicinal properties of ‘Neermaruthu’ (a medicinal plant found in Kerala). When we set out on a serious research to find out more parallels in terms of medicinal plants, it produced some astonishing results,” says Dr A N Narayanan Nambi, Director of Research and Education at SNA Oushadhasala.

The customisation of Ayurveda is the biggest thing that SNA Oushadhasala has been able to do at a global level. “The whole idea suits a greater number of people. From Ayurveda, we have learnt that if you can find medicine from your own surroundings, then it is the best. It actually means that you are in perfect harmony with your own environment,” says Dr P T N Vasudevan Mooss, the Chairman and Managing Director of SNA Oushadhasala.

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FOCUS SNA Oushadhasala, Thrissur, Kerala

SNA Oushadhasala does not need and popularity of Ayurveda in the SNA Oushadhasala is set to scale an introduction to Keralites. With 1970s prompted SNA to support new heights with a dream project more than 93 years of tradition and three institutions abroad - European called “International Institute of heritage in Ayurveda, this institution Institute of Vedic Studies at France, Traditional Medicine”. “We don’t have is one of the pioneers of Ayurveda European Academy of Ayurveda in one at least in Kerala. I think it is the at the global level. In 2002, SNA Germany, and Equal International in right time to think of that,” says Dr Oushadhasala began offering courses Australia. “Other than educational Nambi. at Italy through Ayurvedic Point. endeavours, SNA Oushadhasala SNA Oushadhasala also has plans Dr Morandi, the Chairman and has presence in all these countries to shift its factory to a place called Director of Ayurvedic Point, says through its products,” says Dr Poomala and concentrate more on that he is fortunate for having been Vasudevan Mooss. “Actually, the idea of setting up an Ayurvedic chosen for SNA Oushadhasala’s Ayurveda is more of a lifestyle hospital, points out Dr Vasudevan global endeavours in Ayurveda than just a science offering healing Mooss. “Some old Ayurvedic medicine education. The association with solutions. It helps us adapt healthy manufacturers have stopped SNA Oushadhasala only helped Dr lifestyles. Ayurvedic principles can producing a few formulations that Morandi learn a great deal about its be localised in tune with the climatic have been known since ancient times credibility and commitment. “I met conditions of each country. It has because of poor sales. But we have Dr Morandi for the first time at the been mentioned in the Sama Veda been into the production of more World Ayurvedic Conference in Kochi that for all the diseases affecting us, Ayurvedic medicines based on ancient in 2002. We had a discussion there. there are regional medicinal remedies. treatises and conducting awareness Later, he came to SNA Oushadhasala and shared his dream to collaborate with an institution having deep knowledge of the traditional medicinal system,” recalls Dr Nambi. “We planned the learning modules (at Ayurvedic Point and SNA Oushadhasala) in such a way that a modern medical doctor could Dr Narayanan Nambi, Director, Dr Antonio Morandi, Chairman Dr P T N Vasudevan Mooss, learn everything about Research & Education, SNA & Director, Ayurvedic Point Chairman & Managing Director, SNA Ayurveda in four years.

The customised or local version of We made it compulsory for classes to introduce new doctors to Ayurveda is very important in this doctors to undergo 16 hours of these medicines. Genuine Ayurveda context,” says Dr Vasudevan Mooss. learning every week. We have a has a vast scope and it would never similar course for paramedical staff Some criticise Ayurveda for decline,” says Dr Vasudevan Mooss. too. We made a modest beginning its limitations in cure for certain So, how do they keep up with with only 15 students. We had only diseases. “This is a wrong perception the challenge of preparing bottled two courses in those days. And as of Ayurveda,” clarifies Dr Nambi. “A Ayurvedic medicines? Dr Vasudevan of today, we have more than 500 medical system cannot be measured Mooss clarifies that even now, a few students. In view of the heartening by the effectiveness of the system. In medicines need preservatives. “Many climatic conditions in Kerala, we a system like Ayurveda, it is not the of our drugs act as preservatives, like designed the course in such a way that system’s credibility but individual’s honey in ‘lehyam’, or self-generated programme participants could learn a credibility that matters. The diagnostic good amount of theory at Ayurvedic methods preferred by every Ayurvedic alcohol in ‘arishtam’.”

Point and engage in practicals at SNA Application of an age-old science doctor may vary. It depends on the Oushadhasala in Kerala. The Italian of healing to the modern day needs depth of knowledge of each doctor,” Medical Council gave its nod to our of a man caught between a fastsays Dr Nambi, adding that but for programme and spared programme paced life and little room for healthy some communicable diseases like participants from Continuous Medical lifestyles is something that comes Malaria and so on, India has never Evaluation,” says Dr Nambi. naturally to SNA Oushadhasala. That’s been hit by a massive health disaster.

This isn’t SNA Oushadhasala’s “Had the prevailing medical system where heritage meets future needs, first global experiment in the realm been ineffective, we would have been literally! Thanks to customisation of of Ayurveda. The wide acceptance affected by major diseases.”

Ayurveda!

70 FUTURE MEDICINE I January 2013

FOCUS Palakkad Surgical Industries (PSI)

PSI factor of the

surgical kind

Founded in the year 1961 with the assurance of providing qualitative, innovative, and durable products, Palakkad Surgical Industries (PSI) is quite an early bird in the allied healthcare sector and a name to reckon with today. Known for clinical precision in deliverance of surgical instruments and equipment that meet the entire gamut of critical healthcare needs, PSI has earned the ISO 9001:2008 certification and TUV SUD international service corporation certification for continuous maintenance of a quality management system in manufacturing, marketing, and servicing of operation theatre equipment and orthopaedic implants. One of the earliest manufacturers of high precision ophthalmic surgical instruments and equipment like surgical table and surgeon’s chairs, PSI revolutionised the sector by bringing such products into the Indian market for the very first time. PSI later forayed into the manufacturing of orthopaedic implants and instrumentation in 1984.

Following this, PSI launched its electrically-operated surgical table for the first time in India in 1994. PSI has also earned CE certification for motorised surgical table, ISO 13485:2003 for quality management in medical devices, and CE certification for PSI Maximus, an advanced, fully automatic electro-hydraulic surgical table. PSI has also been into the successful export of surgical tables since 2001. It has a tie-up with Pro Med Instrumente GmbH, Germany, for marketing and servicing of DORO Skull Clamps and retractors. In an interview with Future Medicine, P M Ravindran, the Chief Executive of PSI, talks about the sectoral dynamics Bureau January 2013 I FUTURE MEDICINE 71

FOCUS Palakkad Surgical Industries (PSI)

What are the main challenges in the manufacturing sector today?

A high amount of import is the main challenge we face in this sector today. Import duty is something which prevents high penetration of many companies into this sector. This comes as a blessing for manufacturers like us. However, when the government reduces import duty, it adds to our concerns.

Another point of concern is the non-availability of skilled workforce.

Unemployment is high and we are unable to get suitable manpower.

The authorities P M Ravindran, Chief Executive, concerned (both in the government as Palakkad Surgical Industries well as the private sector) need to work on this issue.

What makes Palakkad Surgicals unique?

We are into the manufacturing of surgical equipment with main focus on quality. Indian products lack quality and features of international brands. We make products of international quality using the best raw material and spares. We follow strict quality control before the products leave our premises. We have network all over India through various agencies. Almost all the major hospital groups in Kerala are our major clients. We can claim almost 10 per cent of the market share in the surgical instrumentation sector.

Do you expect any help from the government?

We really lack governmental support. We need the support of at least 20 government departments.

But the outdated laws and irresponsible 72 FUTURE MEDICINE I January 2013

bureaucrats make it difficult for the industry players. China is growing because of governmental support to the entrepreneurs. They provide infrastructure, manpower, and technology support. Besides, the Chinese government itself organises fairs and exhibitions to promote entrepreneurs. The Kerala government also organises conclaves like Emerging Kerala, but that is not enough for small entrepreneurs like us.

The government can support us by providing a technology bank wherein entrepreneurs can avail of technical knowhow.

A conclave of industry, technocrats, and hospitals would be of great help in transforming an idea into a finished equipment.

How important is research and development in this field?

In India, we don’t have much space and facilities for research and development. We can only make modifications in the existing products. We make surgical instruments on the basis of our own user specifications. Our technical support team can indigenously meet a hospital’s requirements. Even the global giants in the surgical manufacturing field have limited products. Their success comes from a good global network and unique marketing techniques. Small entrepreneurs do not have the wherewithal in comparison.

Tell us about your product pipeline?

Our product range include operation tables for different surgical specialties, patient recovery trolley, autoclaves, theatre pendants, surgeons chairs, micro surgery instruments etc. Our main emphasis is on selection of the right raw material, high quality engineering, stringent quality control, and prompt after-sale-service.

FOCUS Sparsh Hospital, Bengaluru, Karnataka

A giver and no taker, he’s quite a healer

Dr Sharan Shivaraj Patil, Chairman and Chief Orthopaedic Surgeon of Sparsh Hospital, Bengaluru, is a healer with the Midas touch.

He believes in giving more than a patient asks for and prefers an ‘imbalance’ in the give-and-take principle that always favours the customer.

In an interview with Future Medicine, Dr Patil says he aims to take healthcare to a whole new level in the next five years Bureau

You have managed to grow into the seventh best Orthopaedic hospital in India in a short time. Where do you see yourself two years from now?

During the first five years, we focussed on building a team; doing cutting edge work; and making a difference in the community. Our focus now is on education of peers.

We conduct a lot of scientific meets for all orthopaedic surgeons. We invite them and share our knowledge. We don’t want these forums to remain event-specific. We intend to evolve them as movements. More people should do it. More doctors should take it up. We are doing a lot by teaching colleagues, helping them imbibe the ethics. Through them, we can reach a larger audience. So, over the next

two years, we aspire to be the leaders in the medical fraternity. We want to be the leaders in the orthopaedic community. Through leadership, we can reach out to more people not just at Sparsh, but to many more brands and population groups. We want to touch base with people beyond our current reach. We already have a huge international patient volume at our hospitals. In fact, our team has just returned from the Maldives. Africa is our next destination. For Africa, Asia is the only hope. They don’t have great institutions that can produce doctors.

Even if they start setting up such institutions, it will take at least 50 years to make a big difference. They can’t turn to the West for help. Asia is their only hope. In Asia, India is their January 2013 I FUTURE MEDICINE 73

FOCUS Sparsh Hospital, Bengaluru, Karnataka

into the area of research of basic orthopaedics, the raw materials, and finer aspects of research at molecular level. India as a nation cannot look at the West forever. The time has come for us to do our own work. We need to be self-sufficient. For that, hospitals like us are in a position to do the research. In the next five years, we intend to start a research park where we can engage lot of healthcare centres, companies, and professionals. We want to come out with our own products, designs, and raw materials.

How has the tie-up with giants like Endo-clinic helped you in improving the quality of your service?

biggest hope, and we want to play a role there.

Business as an entrepreneur and social commitment as a surgeon are two totally different things. How do you play both roles efficiently?

It’s a challenge. I am very fortunate to have enough people around me to help with these things. I am not into administration. I go about my work with a simple formula. Anything done with the best intentions for our patients cannot go wrong. Once something starts making sense to people, it also makes business sense.

So far, this formula has worked for us.

Everything that helps the patients will also help the hospital and surgeons grow, with the best support staff and technology in place.

You can’t buy healthcare. The patients must feel that they have got the best deal out of us. In fact, they should feel that what they paid was not enough; that they got more out of Sharan Patil and Sparsh Hospital for less. They should feel thankful to the hospital. I want to be the giver and not the taker. Yes, I charge money.

We have to run the show. But I give more than what we charge. I give them the joy and the satisfaction. I want to maintain that imbalance.

Congenital disorders are very common these days. Have we been 74 FUTURE MEDICINE I January 2013

able to perfect medical procedures for prevention of such disorders?

Ultrasound is a useful practice.

There is room for medical termination of a lot of muscular abnormalities depending on how early they are brought to notice.

At your hospital, surgeons occupy managerial posts. Now, that’s quite a unique model of healthcare administration. What inspired you?

I think doctor entrepreneurs are the need of the hour. Doctors have enough IQ to understand the business and nuances of entrepreneurship.

If doctors can step into this space, India will not go the American way.

India will be special, different, and unique. I hope more doctors would take up entrepreneurship and make a difference.

What are your activities in the area of clinical research?

We are keen on building our infrastructure. We have three hospitals. The clinical data is exquisitely kept together. When you have big numbers, clinical research becomes very easy because everything is documented. We are very good at driving processes and protocols. I am happy with the clinical research we are doing because we are right on the ball on that. For the next five years, we would definitely want to step

I always believe that there’s a lot to learn from a lot of people across the globe. We should not fool ourselves by thinking that only we know the conditions well to bring in innovation. I believe in partnerships and Endo-clinic is one such extraordinary institution. Endoclinic is the leader in joint replacement surgery in terms of global volumes.

We have had a very strategic, fruitful tie-up with them for the past two years. Our surgeons have learned from them and applied the acquired knowledge here. The same way, Endoclinic professionals also learn from us.

I believe that only through a tie-up like this, we can learn and match the global standards. I think it’s important for us to take a global position rather than focus on localisation. In the next five years, everybody will look at quality.

You cannot hoodwink people. We would like to be the beacon of quality.

The whole country was caught in a sense of awe and amazement when you managed to pull off a miracle by saving the life of Lakshmi Tatma.

Could you walk me through those challenging days?

Lakshmi Tatma has been an amazing part of Sparsh. I saw it as an opportunity to prove our mettle, and we did just that by pulling off the surgery. We did that 27-hour surgery for free and India made an impact in the global health map with the success of the surgery.

FOCUS MS Ramaiah Memorial Hospital, Bengaluru, Karnataka

When healthcare hits a road block

What is your idea of medical entrepreneurship?

I don’t look at it as a business. I am much more focussed when I look at it from the patients’ point of view – their needs and requirements. I always knew that if I take care of these needs, the rest will follow on its own.

What makes MS Ramaiah Memorial Hospital special?

Our hospital pitches in for the middle class group and that’s why our prices are competitive. We bring all facilities under one roof. We provide cost-effective treatment to millions of middle class families who can’t afford elite hospitals. We constantly upgrade ourselves to ensure the delivery of quality services. We are a NABH-accredited hospital. We meet the requirements of our patients in every possible manner.

Where does India stand in the map of global healthcare?

I think India is doing a reasonably good job in terms of health infrastructure. Basically, the problem is with the external infrastructure. A lot of our international patients get worried when they look at the poor condition of roads, heaps of garbage, and the unsanitary conditions. They find our surroundings very repulsive. Though we all should do our bit to make our surroundings better, we have no control over areas beyond our limit. Barring the lapses in the external infrastructure, the results have been very good for international patients so far. Our prices are very competitive and the quality of our medical care matches international standards. There’s no reason why India can’t be the global leaders in healthcare, provided we attend to our external infrastructure problems on time.

Dr Naresh Shetty, Medical Director of MS Ramaiah Memorial Hospital, Bengaluru, is positively confident about the quality of healthcare infrastructure in India. There’s no need to look at the West, says Dr Shetty, without losing sight of the urgent need for plugging the infrastructural gaps.

In an interview with Future Medicine, Dr Shetty calls for an overhaul of the external infrastructure that supports healthcare Bureau

How important is the bedside manner in the healing process?

It is important indeed. I think today’s doctors are gradually losing the healing touch. There was a time when the doctor held the hand of a patient. I think patients are missing such doctors today. But unfortunately, with too many patients and, too much on their hands, doctors do not have the time to hold patients’ hands. However, we also have to look at the changing situation in India. More and more nuclear families are coming up and children do not have the time to take care of their parents. The general decline in values is changing healthcare needs.

What are the most important contributions you have made to the community?

We do not see the hospital business as a means to make money. The hospital is under a trust and our only concern is to make enough money to run the January 2013 I FUTURE MEDICINE 75

FOCUS MS Ramaiah Memorial Hospital, Bengaluru, Karnataka

show and introduce newer gadgets to improve on the infrastructure.

Recently, we had a session on organ donation.

Most of our doctors agreed to donate their organs. There are lots of patients who need dialyses for months and maybe years. Their life would be much better if they get donors. It’s always good to leave your organ for a person in need.

To improve our competitive edge, we have collaborations with Narayana Hrudayalaya and HCG for our cardiology and oncology departments. We have set up clinics in the remote areas to reach out to people in the rural areas. The idea is to work as a hub and spoke model.

What do you have to say about the ethical implications involved in clinical trials?

It is a necessary evil. Without clinical trials, medical science wouldn’t be able to make much progress.

Somehow, it has got a bad reputation.

Certain guidelines need to be put in place and research should only be done in specific areas. Research is the key to advancement in medical science. The perception that only poor people volunteer for clinical trials is wrong. We should be open to the enormous opportunities offered by clinical trials. All the drugs we use today are the results of clinical trials.

One needs to be very pragmatic. The guidelines should be in place and there should be ethical committees to audit clinical trials.

How important is investigating a hospital before a patient commits himself?

76 FUTURE MEDICINE I January 2013

NABH is a good way of investigating a hospital. They index the hospitals and it is a reliable tool to assess the quality of a hospital.

What’s the dream that drives you forward?

The dream is to make India a disease-free nation.

Is it possible?

It’s not. At least we can reach many millions who probably can’t afford it. Possibly, we can make them understand the basics of preventive healthcare. At the moment, we are spending our money on the curative aspect of healthcare. I think prevention, too, needs equal attention.

That will take care of half the diseases.

What is the risk factor involved in exposing fresh medical residents to real-time learning?

None of us are perfect. At MS Ramaiah Memorial Hospital, we have a system where students work under the expert guidance of seasoned doctors.

The pecking order is in place, and there’s no room for a student to take matters into his own hands. We are in a far better position today. We ensure that patients get the best deal. That’s

why teaching hospitals are the first preference in the West.

What are your long-term goals?

We have joined hands with Illinois University, US, for medical education programmes for our doctors. Our doctors can obtain an international degree. This will also help us enhance our skills and capacity. We also aim to establish and support strong, socially relevant research.

I think the time has come for all the medical professionals to join hands and contribute to preventive healthcare. We need to frame new guidelines. It is important to educate doctors about ethical and evidencebased medicine. People are living longer and rehabilitation has become a problem. Old age homes have become a reality. In cases of chronic diseases, we can only hope to mitigate the pain and sufferings of the patient.

Ayurveda holds out a lot of promise. But it is not systematically aligned. We cannot look at the West forever. We need a holistic model of healthcare that incorporates the traditional practices with sound principles.

CAPITAL SHAME

“She was a brave and courageous girl who fought till the very last minute for her dignity and life. She is a true hero and symbolises the best in Indian youth and women” On December 16 last year, just when people were about to break into celebrations for Christmas and New Year, a physiotherapy student was gangraped, brutally beaten up, and thrown out of a moving bus in the national capital.

The girl, who valiantly fought her assailants, battled with death for over a week before succumbing to her injuries at a hospital in Singapore. As the nation weeps in shame, the Indian leadership just joined the mourners as usual, with no assurance of security for women.

Here’s what they had to say...

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Pranab Mukherjee, President

“I want to tell the nation that while she may have lost her battle for life, it is up to all of us to ensure that her death will not have been in vain” Manmohan Singh, Prime Minister

“Her unbounded courage and her indomitable spirit will never die and will never be forgotten… My heart is heavy with sorrow and anguish for the young woman, who fought so bravely against impossible odd” Sonia Gandhi, Congress President

Here’s what we have to say:

“There’s something wrong with the culture of the day. It’s not just a law and order problem anymore. It is a wake-up call for us to realise that respect for the opposite sex comes from a true understanding of the self and one’s culture.

What’s happening to our culture?”