Future medicine by MK Menon

EXPERT INTERVIEW: Cardiac Surgeon Dr K M Cherian

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PHILANTHROPIST

Dr Devi Prasad Shetty AIDS BREAKTHROUGH?

The Berlin Patient

ONCOLOGISTâ&#x20AC;&#x2122;S DIARY

Dr Selvi Radhakrishna

A NEW HEALER ON THE BLOCK

Meet the new game changer of the healthcare sector, Zahabiya Khorakiwala, the Managing Director of Wockhardt Hospitals

EDITOR’S NOTE Give healthcare a human face

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“I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone...” - Hippocratic Oath ast month, a XIth standard student who had sustained burn injuries succumbed to death at a private hospital in Kolkata after the medical staff refused to provide her treatment following nonpayment of bills. In Jalandhar, a five-day-old infant died in a civil hospital when she was taken off the incubator over non-payment of Rs 200 towards life support. This is not the first time that such incidents of medical cruelty are taking place in our country. It’s just that most of these inhuman acts do not get reported in the media owing to the remoteness of an area, or smart burial of the matter with quickly arrived at compromises and compensations. More than the cardinal Hippocratic Oath, it’s the overarching influence of greed, under a veil of sanctimony, that continues to guide the soul of medical professionals purely engaged in the business of healthcare. The poor are often left in the lurch. The problem is systemic. One of the most glaring examples of wheeling and dealing are the private hospitals which manage to get land from the government at subsidised rates, but never fulfill their obligation of free service to the poor. Lack of awareness among the poor about the benefits available to them at private hospitals, and the unavailability of below poverty line cards due to bureaucratic hassles only add to the profits of the private hospitals and the gravity of the accessibility and affordability problem of the poor. India needs to learn from progressive, publicly funded, independent healthcare systems in the West, such as the National Health Service of the UK and Medicaid of the US, to ensure that people of all ages have easy, equal access to holistic medical services irrespective of their economic status. In this edition of Future Medicine, we focus on three personalities, Zahabiya Khorakiwala, the Managing Director of Wockhardt Hospitals, Dr Devi Prasad Shetty, the Founder and Chairman of Narayana Hrudayalaya, and renowned cardiac surgeon Dr K M Cherian, who are bringing about a humane change in the healthcare system in their own ways. Be a part of this change by giving hope to the hapless and needy.

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FUTURE MEDICINE I August 2012

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WITH THE FUTURE OF THE

HEALTHCARE INDUSTRY 21 – 23 November 2012 Dubai International Convention & Exhibition Centre Dubai, UAE @getex1

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CONTENTS

COVER STORY Alice in Healthcare Land Meet the new age Alice, the noble-hearted and brave Zahabiya Khorakiwala. She’s a little over two years old in the healthcare industry. Yet, she has already proved her mettle by steering Wockhardt Hospitals into a new era of growth and innovation

ONCOLOGIST’S DIARY Dr Selvi Radhakrishna

PHILANTHROPIST Dr Devi Prasad Shetty

36 40

EXPERT INTERVIEW Dr K M Cherian

CAREERS & COURSES Nursing

Renowned cardiac surgeon, philanthropist, and the founder of Karnataka-based multispecialty hospital Narayana Hrudayalaya, Dr Devi Prasad Shetty tells how India can bring about Walmartisation of healthcare

CARDIOLOGY A centre for common man Meditrina Hospital, located at Pattom in Thiruvananthapuram district of Kerala, is a specialised centre for Angioplasty. The hospital is committed to providing the best healthcare services at affordable costs

FUTURE MEDICINE I August 2012

EXCLUSIVE INTERVIEW ‘Berlin Patient’ cured of AIDS virus? Timothy Ray Brown is the new symbol of hope for AIDS patients. After undergoing a stem cell transplant, he miraculously recovered from HIV infection and leukaemia. Researchers in the US have disputed claims of a breakthrough in HIV/AIDS treatment, saying that they have found traces of HIV in Timothy’s system. However, German hematologist Dr Gero Hutter says the virus has not replicated in his patient for five-and-a-half years

Cervical Arthroplasty

Tribal Healthcare

High drug prices

Nitta Gelatin India Ltd

Pharma Scan

Traditional Medicine

Dr Ram Kumar Menon

Kannampadi, Idukki

Ways to make it cheaper

Ace provider of nutrients

Gujarat

Acupuncture

FUTURE MEDICINE I August 2012

MEDICAL DIGEST

Nod for GVK Bioscience’s unit AHMEDABAD: The US Food and Drug Administration has given the green light to the Ahmedabad unit of GVK Bioscience, a contract research organisation, to carry out bioavailability and bioequivalence studies. The Ahmedabad facility, commissioned in 2010, has three clinics with 110 beds. The facility has already been inspected and approved by the Drugs Controller General of India, ANVISA-Brazil and the Turkish Health Ministry, the Hyderabadbased firm said in a statement. The Ahmedabad facility carries out bio-availability and bio-equiv-

alence (BA/BE) studies, the results of which are submitted to various regulatory agencies, including the US Food and Drug Administration, TGA (Australia), European regulatory agencies, Health Canada, ANVISABrazil and Turkey’s Health Ministry. “The sponsor can now carry out the BA/BE studies at our site in Ahmedabad or Hyderabad with a wider choice of population and capacities,” said Manni Kantipudi, CEO, GVK BIO. The Hyderabad facility is a full service provider of BA/BE services with four clinics and 144 beds, supported by a bio-analytical facility.

Better stoves for better health KATHMANDU: Nepal will produce nearly half-a-million improved cooking stoves over the next five years to benefit rural communities and encourage healthy lifestyles among millions of people, particularly women and children. Most rural households in Nepal use traditional stoves that burn biomass - mainly wood, but also agricultural residue and animal dung - for cooking and heating. Such stoves are highly inefficient and emit large amounts of smoke that contribute to indoor air pollution. There is strong

evidence that indoor pollution causes pneumonia and other acute respiratory infections among children under five, and chronic obstructive pulmonary disease and lung cancer among adults, according to the World Health Organisation. An estimated 7,500 Nepalese die each year due to indoor air pollution, women and children being the most affected. Improved cooking stoves are designed to limit these negative health effects. Since 1999, Nepal has developed 621,000 such stoves, benefiting three million people.

Sri Lanka to amend Food Act COLOMBO: In an effort to improve people’s health conditions, the Health Ministry of Sri Lanka plans to amend the Food Act. Health Minister Maithripala Sirisena has said that the amendments to the Act would come into effect from this November. He said that the amendments have been proposed after taking into consideration

issues like food security and environmental pollution. The local media said that the new amendments would label as “illegal” all hotels and food processing units operating near pesticide companies, flood sites or any other industrial site. The amendments will also include guidelines on hygiene for hotel and restaurant workers.

FUTURE MEDICINE I August 2012

Visegrad Group doctors against low pay PRAGUE: Trade unions of doctors from the Czech Republic, Hungary, Poland and Slovakia are demanding higher salaries for hospital doctors and opposing reforms that limit healthcare as a public service, Czech Doctors’ Chamber President Milan Kubek has said. Doctors from the Visegrad Group (V4) countries plan to stage a symbolic joint protest event in November. No details of the protest have been released so far. The Czech doctors’ unions only said that mass departures from work may follow if

the protest is not successful. Doctors in the Czech Republic and Slovakia have already submitted mass resignation notices in the past few years, and this threat helped them push through their demands. Kubek said doctors from the four states often leave their home countries and work in the West. “Poland has enormous problems. About 20,000 doctors left Poland in the past decade,” Kubek said. According to the OECD’s data, there were 3.6 doctors per 1000 inhabitants in the Czech Republic, and 2.2 doctors per 1000 inhabitants in Poland.

Diabetes campaign in Dubai DUBAI: The Dubai Health Authority (DHA) aims to conduct health screenings for government employees as part of its diabetes campaign, launched in 2009 under the patronage of Sheikh Majid bin Mohammed bin Rashid Al Maktoum, Chairman of Dubai Culture and Arts Authority. Dr Mohamed Farghaly, Head of Acute and Chronic Care at DHA, said that in 2012, the screening programme would take place in all the government departments. Blood sugar, blood pressure,

IHH Healthcare’s expansion plans KUALA LUMPUR: Asia’s largest hospital operator IHH Healthcare Bhd, which made its debut on Bursa Malaysia and Singapore Exchange recently, is planning expansion in China and Hong Kong. The listing of IHH was the third largest initial public offer in the world this year after Felda Global Ventures Bhd and Facebook. Analysts said IHH Healthcare’s prominent dual listing made it the second largest healthcare company in the world. It was also one of the biggest private healthcare providers with multiple geographical exposure, having

FUTURE MEDICINE I August 2012

grown aggressively via acquisitions over the past two years. IHH Healthcare Managing Director Dr Lim Cheok Peng said IHH had eight clinics in Shanghai, Chengdu and Hong Kong. “The intention is to grow this platform of primary healthcare clinics in China. We are also looking at other hospital opportunities. At the moment, we are entering into a contract to run two hospitals in Shanghai,” he said, adding, IHH was also bidding for a private hospital deal, which the government is tendering out in Hong Kong.

body mass index, and carbon monoxide levels of smokers would be checked under the programme. He said that DHA has already screened 11,800 employees in six government departments so far. The plan is to screen 70,000 employees. Dr Farghaly said, “The aim of the campaign is to conduct mass awareness initiatives to ensure early detection of diabetes. This campaign is important for diabetics as well, as it will ensure that they are educated on how to manage the disease effectively.”

MEDICAL CONFERENCE

Medical Asia to be held in October at Bangkok BANGKOK: Thailand will host Medical Asia, one of the major events in the South-east Asian medical industry. Professionals from hospital, diagnostic, pharamaceutical, rehabilitation and related sectors will take part in this event, scheduled to take place at Bangkok International Trade and Exhibition (BITEC) from October 31 to November 2 this year. Medical Asia will feature intense discussions and interactions on the current trends in medical tourism, look into the availability of medical equipment, and review the general initiatives being taken to enhance healthcare access. Participants will toy with new ideas to optimise the benefits of medical procedures and their effects. Establishments will also be displaying their products and services before medical trading organisations, providing a chance to form business relations with suitable exhibitors from different countries. The â&#x20AC;&#x2DC;Medical networking nightâ&#x20AC;&#x2122;, a threeday medical conference by the Thai Medical Council, medical technology seminars, and hospital tours will be the highlights of the event. The event is expected to attract more than 6,000 medical professionals and trade visitors.

Cambridge will host NET 2012 conference LONDON: The NET 2012 International Conference, the leading annual conference for networking in healthcare education, will take place at Cambridge from September 4 to 6 this year. NET 2012 is meant for everyone involved in healthcare education, especially educators, practitioners, researchers and students. NET 2012 is a unique opportunity to share innovative ideas and experiences with a wide range of participants from the UK and other countries. It is designed for those interested in the latest developments in healthcare education. Professor Elizabeth Mary Chiarella, Professor of Sydney Nursing School and University of Sydney, Professor Hugh McKenna, Pro-Vice-Chancellor (Research and Innovation), University of Ulster, UK, will be the keynote speakers at the event. Online registration is open for the general public. The aim of NET 2012 is to encourage healthcare professionals to hold debates, reflect on healthcare issues, and focus on networking for those with shared interests and promote lifelong learning.

Tamil Nadu is venue for SRIPS meeting CHENNAI: The annual conference of the Southern Regional Indian Pharmacological Society (SRIPS) is scheduled to take place at Chettinad Hospital and Research Institute (CHRI), Kanchipuram, Tamil Nadu, on September 8 and 9 this year. The conference will focus on integrating pharmacology with related disciplines and other systems of medicine, enabling participants to identify newer areas of collaborative research. The conference programmes will include the Dr L K Oration, guest lectures, symposia, panel discussion, paper presentations, and poster presentations. Each oral and poster session will have best paper prizes.

FUTURE MEDICINE I August 2012

HEALTH STUDIES

Diabetic? Say cheese and reduce the risk! LONDON: A new research has claimed that cheese can prevent diabetes. British and Dutch researchers found that eating just two slices of cheese a day cuts the risk of type 2 diabetes by 12 per cent, the Daily Mail reported. Diabetes can cause heart attacks, strokes, blindness and nerve problems, without yet having been diagnosed. The researchers looked at the diets of 16,800 healthy adults and 12,400 patients with type 2 diabetes from eight European countries, including the UK. The study, published in the American Journal of Clinical Nutrition, found that those who ate at least 55 grams of cheese a day - around two slices - were 12 per cent less likely to develop type 2 diabetes. The risk fell by the same amount for those who ate 55 grams of yoghurt a day.

For years, National Health Survey guidelines in the UK have advised against eating too much dairy products, cake, or red meat, as they are high in saturated fat. This is thought to increase cholesterol and raise the risk of diabetes. Researchers, including academics from the Medical Research Council, Cambridge, said that not all saturated fats are as harmful as others, and some may even be beneficial. One theory is that the so-called probiotic bacteria in cheese and yoghurt

can lower cholesterol and produce certain vitamins which prevent diabetes. And cheese, milk and yoghurt are also high in vitamin D, calcium and magnesium, which may help protect against the condition.

Study links avocado with IVF success LONDON: Eating avocados and dressing salads with olive oil could help women trying to have a baby through in-vitro fertilisation (IVF), researchers have claimed. The study by researchers at the Harvard School of Public Health found that monounsaturated fat, which is found in olive oil, sunflower oil, nuts and seeds, was better than any other kind of dietary fat for would-be mothers. Those who ate the highest amounts were 3.4 times more likely to have a child after IVF compared to those who ate the lowest amounts, the researchers found. In contrast, women who ate mostly saturated fat, found in butter and red meat, produced fewer good eggs that could be used in fertility treatment, they found. FUTURE MEDICINE I August 2012

The researchers believe that monounsaturated fats, which are already known to protect the heart, could improve fertility by lowering inflammation in the body. â&#x20AC;&#x153;The best kinds of food to eat are avocados, which have a lot of monounsaturated fat and low levels of other sorts of fat, and olive oil,â&#x20AC;? study

leader Professor Jorge Chavarro was quoted as saying by the Daily Mail. Prof Chavarro, however, said the study was small and the findings required further investigation. In the study, the researchers looked at 147 women having IVF at the Massachusetts General Hospital Fertility Center. Their intake of different dietary fats was recorded and the result of fertility treatment compared between the highest and lowest intake in each category. Women eating the highest levels of all types of fat had fewer good eggs available for use in treatment. Prof Chavarro said that the link was driven by saturated fat intake, as high levels of polyunsaturated fat consumption leads to production of poorer quality embryos.

BREAKTHROUGHS

New hope for stroke patients

he world’s strongest micromotor could revolutionise stroke treatment, thanks to a partnership between The Royal Melbourne Hospital and RMIT University. The motor is small enough to fit through the tiny vessels of the brain, and has the equivalent driving power of a small kitchen appliance. At only 250 microns wide, the motor is about the width of a human hair and the size of a grain of salt. It has been developed with the aim of treating strokes (caused by blocked arteries) and cerebral aneurysms (weaknesses in brain arteries) in patients who can’t be saved with standard neurointervention endovascular tools. The technological breakthrough came after RMIT School of Electrical and Computer Engineering professors James Friend and Leslie Yeo, and neurointerventionist and Associate Professor Bernard Yan from The Royal Melbourne Hospital recognised the need to drastically improve the surgical equipment used to manage these life-threatening conditions. “We can now look to develop instruments which can be steered with precision, guiding the catheter to its destination more quickly and accurately. This will have a dramatic improvement in stroke survival rates,” Yan said. The research breakthrough has been published by the American Institute of Physics.

Detecting Osteoporosis bone loss

n an article published by PNAS Journal, a group of scientists claim that they have found a way to spot Osteoporosis bone loss at the earliest stage of the disease. As of now, the condition can go undetected for years and may only be diagnosed with scans after weakening of the bones has led to a fracture. The new test, designed partly with astronauts in mind as they too can suffer bone loss due to the microgravity of space, looks for traces of bone calcium in the urine. The technique developed by scientists at Arizona State University working with the US space agency analyses calcium isotopes - different atoms of the element calcium, derived from bone and each with their own specific number of neutrons. This could, therefore, have a future role in the clinical evaluation of patients. The balance or abundance of these different isotopes changes when bone is destroyed and formed and can, therefore, indicate early changes in bone density. To put it to the test, the researchers studied a dozen healthy volunteers whom they confined to bed rest for 30 days. Prolonged bed rest triggers bone loss. The technique was able to detect bone loss after as little as one week of bed rest.

Stopping spread of cancer to bones

medical discovery by Victorian scientists could stop breast cancer from spreading to the bones and becoming deadly. Researchers from the Peter MacCallum Cancer Centre and Monash Institute of Medical Research in Melbourne have found that some breast cancer cells can turn off a signal that causes the immune system to attack them. Switching off the interferon immune signal lets the cancer cells secretly spread to secondary sites, most commonly the bones. “We have discovered a mask that breast cancer cells put on, allowing them to hide and spread to bone, thriving undetected,” Peter MacCallum Cancer Centre’s Dr Belinda Parker said. Researchers hope that existing interferon therapies could be used to “unmask” the cancer cells. Dr Parker said once the cells were detectable and open to attacks from the immune system, they could contain them to the breast and stop them from forming secondary tumours. Prof Paul Hertzog of Monash Institute of Medical Research said interferon responses were critical in protecting people from infection. “This discovery gives us the groundwork to develop and test new diagnostic and treatment strategies,” he said.

FUTURE MEDICINE I August 2012

VOICES

“The Central government should give more attention to liberalisation of laws on organ donation. They should be more encouraging to the donors” Dr Sudheendran, Kerala’s first liver transplantation surgeon

“The siege that was imposed on the Gaza Strip has created excessive loss and damage in different aspects of the Palestinian health sector. The Gaza Strip has turned into a huge prison with no access to medical supplies” Mahmoud Daher, WHO’s Representative in Gaza

“The three biggest challenges India faces in the healthcare sector are: paucity of hospital beds; lack of skilled human resources; and rise in infectious and non-communicable diseases” Dr Prathap Reddy, Chairman of the Apollo Group of Hospitals

Ancient Wisdom

“Almost 90% of doctors in rural India practise traditional medicine. Even then, while calculating the doctor-patient ratio, we are never taken into consideration. If the BRHC course is introduced, we would be further isolated in government policies” Dr Jai Chhangani, Secretary, Homoeopathic Integrated Medical Practitioners Association of Maharashtra

“There is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug” Hippocrates

FUTURE MEDICINE I August 2012

Cathy Wong PERSONALITIES

Spreading the message of alternative medicine Cathy Wong, a celebrity nutritionist, naturopathic doctor and well-known author, has been popularising healing techniques under the alternative medicine system for over a decade Bureau

ith boundless love for nature, a naturopathic doctor and a celebrity nutritionist, Cathy Wong, has been promoting healing techniques under the alternative medicine system for over a decade now. Since 2000, Cathy has been serving as the guide on alternative medicine for About.com, the most popular web source for health-related information. She is using the power of Internet to popularise various treatments in alternative medicine. “The Internet is a rich source of information on alternative medicine, but it’s important to be fully informed about the pros and cons of an alternative therapy or remedy before trying it,” says Cathy. That’s the reason why Cathy has picked up an assignment with About.com, which is owned by The New York Times Company. “This site will help you become well-informed about the many options available to you in alternative medicine. It will also keep you updated about the latest developments in the field of alternative medicine,” adds Cathy. The daughter of a Chinese father and Korean

FUTURE MEDICINE I August 2012

mother, Cathy is an expert in Chinese traditional medicine, especially Acupuncture. Cathy, a science graduate from University of Toronto, is the author of the famous books, The Inside Out Diet: 4 Weeks to Natural Weight Loss, Total Body Health, and Radiance. She is also a graduate of the Canadian College of Naturopathic Medicine. Cathy holds a diploma in Acupuncture and completed an internship at the pediatric neurology clinic at Mackay Memorial Hospital. She is certified in mind/body medicine from the Mind/Body Medical Institute, an affiliate of the Harvard Medical School Department of Continuing Education. Cathy is a certified nutrition specialist with the American College of Nutrition. She is also an expert in yoga, massage, acupuncture, treating back pain. A credible source of information on health issues, Cathy has been featured in various global publications, including Health, First For Women, Men’s Health, Natural Health, Martha Stewart Whole Living, Woman’s Day, Time Out New York, Delicious Living, Vegetarian Times, and Natural Solutions.

PHILANTHROPIST Dr Devi Prasad Shetty

Low-cost healthcare is the way ahead for India Renowned cardiac surgeon, philanthropist, and Founder and Chairman of Karnatakabased multi-specialty hospital Narayana Hrudayalaya, Dr Devi Prasad Shetty is the first surgeon in India to perform the neo-natal open heart surgery, the world’s first surgeon to perform a surgery to close a hole in the heart with a microchip camera, the first person to conduct the first-ever surgery using the stomach blood vessels to bypass the blocked arteries of the heart, the first person to use an artificial heart in India, and the man behind Asia’s first cardiomyoplasty operation. He is also a strong advocate of Walmartisation of healthcare, that is, easy and low-cost availability of healthcare facilities across the country. In an interview with Future Medicine, Dr Shetty talks about some crucial healthcare issues in India By Lakshmi Narayanan You are a proponent of Walmartisation of healthcare. Tell us how can such a model be worked out in India? We believe that low-cost healthcare is the way forward in India and outside India. Ten years ago, cost was not an issue for the US hospitals. Today, the US and Europe are struggling to offer healthcare to their citizens. The only way cost can come down is by economies of scale, wherein hospitals would be doing a large number of procedures and utilising the infrastructure for at least 14-16 hours a day. The tax payers’ money could pay for healthcare 20 years ago, when people retired at the age of 60 and lived

for a few more years. Today, people retire at the age of 60, but live on to celebrate their 95th birthday. In such a scenario, we have to look at an alternative methodology to fund healthcare. Healthcare costs cannot be borne out of pocket. It is like somebody availing of an insurance cover for his car. Put it simply, you can’t afford it. We need a mechanism wherein every citizen of our country can contribute a tiny amount of money every month towards healthcare. When everyone pays a small amount of money, it becomes a huge pile of money which can take care of about 5-7% of the people who need healthcare. We have 750 million Indians having mobile

FUTURE MEDICINE I August 2012

We have a shortage of 500 new medical colleges. If we start 100 new medical colleges every year for the next five years, we will have adequate manpower by 2025. However, these medical colleges should be built by the government, which can subsidise medical education so that poor people can become doctors. We have an acute shortage of doctors. The Medical Council of India (MCI) may have about seven lakh registered doctors, but the active doctors will not be more than five lakh. The MCI’s records are not very accurate when it comes to deleting the names of doctors who are no more practising or dead. Besides, our country has a shortage of at least one million doctors and at least 1.5 million nurses Dr Devi Prasad Shetty, Founder and Chairman, Narayana Hrudayalaya

phones, and let’s assume that 500 are active. They spend about Rs 150 per month just to speak on the mobile phone. If you can collect an extra Rs 10 from them, we can have the most robust health insurance programme. What are the shortcomings of the healthcare system today and how can we overcome these gaps? The biggest shortcoming in the healthcare sector is the lack of skilled manpower. If you go through the data of the Bureau of Labour Statistics of the US, you will find that out of the 20 fastest growing occupations in the US, 15 are in healthcare. Unfortunately, none of those 15 training programmes exist in our country. For our policy-makers, healthcare education is all about training doctors, nurses and some medical technicians. We are gradually becoming a country of old people. When a 90-year-old man is invalid at home, he does not require hospitalisation. However, he requires a home healthcare aid to look after him. There is a requirement of over a million home healthcare aid employees today. Unfortunately, we don’t have a training programme to train these skilled manpower. Similarly, there is a need for many other technically skilled manpower in the field of healthcare. But, owing to the fear that such training programmes may downgrade the importance of doctors, we do not start them at all. FUTURE MEDICINE I August 2012

Tell us how Narayana Hrudayalaya has succeeded in making healthcare affordable? Narayana Hrudayalaya has a different philosophy altogether. Today, when a new hospital built by a company comes up, the promoters would tell the employees that this hospital is built for the rich people, but we also care for the poor. Whereas when we start a hospital, we tell the employees that our hospital is built for the poor, but we also care for the rich. This is the fundamental difference. As long as we look at the poor people as the main customer of the organisation, the entire concept of low-cost healthcare cannot become viable. We perform the largest number of heart surgeries in the world today. We attract patients from 76 countries. We train heart surgeons from the United Kingdom, the United States and many other Asian and African countries. This is happening because of the numbers. Unless we build large size projects reducing costs, the cost of healthcare will not come down, and quality will not improve. How effectively has telemedicine technology helped you in expanding the reach of health solutions? Using telemedicine, we have treated over 53,000 patients in remote locations. Now, it is getting exciting with Skype and the video-conferencing facility on mobile phones. There will come a time when patients

PHILANTHROPIST Dr Devi Prasad Shetty can be treated in their bedroom with hand-held devices and the inexpensive video-conferencing facility, and boundaries between countries will be broken. The Prime Minister has said that availability of medical professionals is an impediment. Is it a problem of proper channelisation or deployment? We have a shortage of 500 new medical colleges. If we start 100 new medical colleges every year for the next five years, we will have adequate manpower by 2025. However, these medical colleges should be built by the government, which can subsidise medical education so that poor people can become doctors. We have an acute shortage of doctors. The Medical Council of India (MCI) may have about seven lakh registered doctors, but the active doctors will not be more than five lakh. The MCI’s records are not very accurate when it comes to deleting the names of doctors who are no more practising or dead. Besides, our country has a shortage of at least one million doctors and at least 1.5 million nurses. Are you satisfied with the achievements of the National Rural Health Mission (NRHM)? NRHM is doing a great job, but it can be bettered by production of documents on deliverables with the numbers so that everyone knows how the money has been spent, and how the country has the best return on investment. I strongly feel that the same mission should be expanded to urban healthcare. You can’t force doctors to work in villages. Otherwise,

you will have a bunch of doctors who hate their jobs, and obviously, the patients are not going to be happy. We don’t need a doctor with an MBBS title to work in primary health centres. We have a huge number of alternative medicine doctors who are well-trained. They can do this job very well with a bit of training. Our medical education system has to undergo a dramatic change. We need to become more practically trained doctors and not theory masters. Medical students should be more involved in actual patient care. They should not be sitting in the library mugging about various syndromes. Unfortunately, if they don’t spend time with the books, they can’t get into a post-graduate training programme, which is a great bottleneck. All over the world, training slots for post-graduation is more than the under-graduation. So, any doctor who graduates has an opportunity to become a specialist. Unfortunately, in our country, less than 20-30% of the doctors get an opportunity to receive post-graduate training in the field of their choice. What’s your message to those aspiring for a career in medicine? My message for the aspiring doctors is that, this is a great profession with great opportunities. This is one of the very few professions wherein you get everything, starting from blessings, satisfaction and recognition to a reasonable salary.

Using telemedicine, Narayana Hrudayalaya has treated over 53,000 patients in remote locations

FUTURE MEDICINE I August 2012

Rural NewHealthcare Healer On The Block COVER STORY A

Meet the new age Alice, the noble-hearted, brave Zahabiya Khorakiwala. Before you start comparing her with Lewis Carroll’s Alice, here’s a clarification. She hasn’t fallen into a rabbit hole, and neither is she lost in a maze, looking for a way back home. Rather, she has embarked on a self-chosen mission to provide the best clinical practices to India’s ailing population and help them get back home in a much healthier condition. At a personal level, she never shies away from going the extra mile to reassure patients of a safe and speedy recovery. Her mission began a little over two years ago when Wockhardt Hospitals had reduced its stock with the sale of 10 hospitals. Just when the critics were busy writing a post-mortem on the transaction, the heiress apparent steered the hospital chain out of rough weather and proved them wrong. With a super specialty hospital project in South Mumbai set to commence operations by this year-end, she has placed Wockhardt Hospitals on a platform of innovation and resurgence. Now, the hospital chain is also on an expansion mode, ready to spread its presence across the country with new facilities in Delhi, parts of Central India, and other emerging cities By Sanjeev Neelakantan & Sreekanth Ravindran

FUTURE MEDICINE I August 2012

Wockhardt Hospital at Nashik

ealthcare is a delicate business invoking the moral consciousness of a service provider to serve the best medical solutions unconditionally. Only an ever-clear conscience, coupled with deft moves of clinical precision, can guarantee you success in terms of growth as well as delivery of services. Knowing this pretty well, Zahabiya Khorakiwala, the young scion of a celebrity business family in India, took over the reins of Wockhardt Hospitals, a major hospital chain in the tertiary healthcare sector, at a time when it had just wound up the sale of its ten hospitals to Fortis Healthcare. Yet, within a short span of two-anda-half years, Zahabiya, the youngest daughter of Wockhardt Founder

Chairman and Group CEO Dr Habil F Khorakiwala, has not only managed to emerge from the proverbial trial by fire unscathed, but also proved to the best of critics that the hospital chain could well embark on a new journey of promise and development under her youthful leadership. Being anointed as the head of a family business at the age of 27 may sound like a cliché in India these days, given the frequency of unabashed media sensationalism over business takeovers involving young blood. This takeover story, however, stands out for two reasons: one, this heiress apparent has successfully managed to consign the troubled past of her hospital chain into the backburner and kick-start a new era of growth, an evidence being the

Core strengths & objectives •

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Wockhardt Hospitals will strive to set new benchmarks for clinical outcomes by providing the highest quality of care, deploying the best clinical talent (doctors) and highly trained nursing and paramedical staff, and offering the latest treatments across our specialties (cardiac care, orthopaedics, neuro, aesthetics, GI) Wockhardt Hospitals’ relationship with Harvard Medical Internati-

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onal will drive clinical knowledge sharing and skill set development to bring the relevant and modern treatment options to patients in India. Over the last 10 years, we have incorporated global clinical standards and protocols for patient treatment and care In 2010, Wockhardt had launched a new 160-bed multi-specialty hospital in Goa. This is ideally poised for medical value travel. Its core specialties are cardiac care, orthopaedics, aesthetics and urology

upcoming South Mumbai super specialty hospital project; and two, she has a judicious mix of inquisitiveness and empathy, that helps her learn more about the clinical side of healthcare, despite her non-medical background, and strike a personal chord with the patients. Meet the lady at the helm, the suave, radiant, confident and effervescent Zahabiya. With no trappings of power, this 29-year-old woman’s straight speak can immediately bring down the metaphoric wall of inaccessibility and elitism and lighten up the atmosphere. She comfortably glides into a discussion on India’s serious healthcare issues that require urgent attention. “India is in need of better infrastructure to improve accessibility of healthcare facilities for people in the rural areas. It is an issue

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Set to launch a 21-storey new age Wockhardt Hospital in South Mumbai with 350 beds and 100 ICU beds Tended to about 3.5 lakh patients last year About 1,200 patients avail of medical advice and treatment at Wockhardt Hospitals on a daily basis from 200 super specialist doctors The topline has almost doubled for existing Wockhardt Hospitals since 2010, i.e. a growth of almost 100%

Rural NewHealthcare Healer On The Block COVER STORY A that requires immediate redressal. Any improvement on this front can help the government in increasing the universal health access coverage,” says Zahabiya, the Managing Director of Wockhardt Hospitals.

Early years

So, has somebody groomed her for this role? Does she have any role model? Zahabiya comes across as a focussed woman with a simple demeanour, balanced world view and excellent cross-cultural communication skills. “I had completed most of my education in India till 10th standard. Then, I went to Switzerland for two years, where I did my A levels. I did my undergraduation from New York University, spent my freshman year in Italy, and the rest in New York. After that, I came back to India and worked for three years… I was partly involved with Wockhardt, both pharmaceuticals and hospitals, and had received an orientation after majoring in psychology from New York University. In 2010, I had completed my MBA from Indian School of Business, Hyderabad, and since then, I have been with Wockhardt Hospitals, more formally and concretely,” recalls Zahabiya.

A people’s person

As for grooming for the new role, she says, “A lot of the learning (process) happens at the ground level. We have eight hospitals in the chain. I spend more time interacting with people across the chain as it is a people-intensive business, where every individual has to contribute significantly for his/her profile or role. We have about 2,000 staff. From a patient’s perspective, understanding the clinical space is more important. My keenness to learn about the medical side has helped me understand the medical business, though I don’t have a medical degree. The critical factor is to align administrators, doctors, nursing and other staff towards our core objective of continuously monitoring and improving on our clinical outcomes for best patient care.” A self-dependent woman, Zahabiya says she has no role models. “Everyone has strengths and weaknesses.

Wockhardt South Mumbai Hospital’s Features • • • •

A multi-specialty tertiary care 350-bed hospital with 100 critical care beds Six floors of parking space A sky-lit atrium in patient care areas to ensure that every ward bed has access to light Access to a robust emergency medicine programme through three GPS-enabled cardiac ambulances

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Model of Wockhardt’s upcoming Super Specialty Hospital in South Mumbai

Hospital information system operates on Wi-Fi system. Enables 100% Electronic Medical Record archiving and retrieving State-of-the-art equipment: surgical, therapeutic and diagnostic Two ultra-modern cath labs with IVUS and FFR Eight operating rooms built to international specifications For the first time in India, a hospital will have 100 critical care beds that display all reports of the patient on the monitor to

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facilitate optimum and speedy evidence-based care Latest diagnostics – a 3.0 Tesla digital MRI and a 256 slice CT scan, which enables faster and safer scans An aesthetic surgery centre that supports treatment of patients in a confidential manner The infrastructure and technology are ably supported and driven by a team of professionals, including clinical, para-clinical and support staff, in a caring environment that enhances the quality of life

FUTURE MEDICINE I August 2012

Bringing novel surgeries to India Delta Hip Surgery: Orthopaedic surgeons at

Wockhardt Hospital, Goa, are now using the novel ‘Delta Motion’ hip replacement surgery. It helps young patients return to a normal lifestyle with no restrictions on any activity. Under the Delta Motion technology, the implant has a large diameter head, enabling young patients to make a greater range of movements such as squatting and sitting cross-legged. Essentially, it is the ‘ceramic on ceramic’ technology that offers a resistance to wear and tear, and the implants have the potential of lasting a lifetime. This is important considering that until recently, total hip replacement was not an option for young patients since the traditionally implanted hip components

Focus on your strengths and compensate for limitations. My father has been a strong influence on my thinking and value system.”

Enhancing healthcare access

Speaking of Wockhardt Hospitals’ growing presence in India, she says, “As of today, we have three hospitals in Gujarat (in Rajkot, Bhavnagar and Surat), two hospitals in Nagpur, one in Vashi, one in Nashik, and one in Goa, which is our latest addition. A super specialty hospital in South Mumbai will commence operations by this year-end. It will be a 350-bed hospital housed in a 21-storeyed building.

would have worn out in a few years’ time given the range of activity, making them undergo a repeat surgery.

Oxford Knee Replacement Surgery: This

unique surgery was carried out recently on a patient at Wockhardt Hospital, Goa. The advantage of this procedure is that it repairs only the damaged parts of the knee and retains those areas which are undamaged. This is a first of its kind surgery in the state. The recovery of the patient is faster and less painful. The ‘mobile bearing’ nature of the device is such that it provides a more natural-knee feeling for the patient and gives him a wider range of movements. This cutting edge technology is of great benefit to the young patient population since this reduces the need for a total knee replacement surgery as the patient ages.

It will have 100 ICU beds… On the whole, our emphasis is on Gujarat, Central India, and Mumbai. If you see our existing network, you will realise that we have made an enormous impact in society in the areas where tertiary care was found to be lacking. We brought qualitative tertiary care to Tier-II cities Bhavnagar and Rajkot. We can make an impact in emerging cities. It is very viable as well as profitable to do business in such cities. We are planning to leverage our operations in Delhi, parts of Central India, and other emerging cities across India.” Wockhardt, she says, is essentially a tertiary care

Wockhardt Hospital in Goa, where the first of its kind Delta Hip Surgery and Oxford Knee Replacement Surgery are available FUTURE MEDICINE I August 2012

Rural NewHealthcare Healer On The Block COVER STORY A Middle East, Europe, and Russia. India is gradually developing as a medical hub. Our Goa hospital is ideally located to serve patients from across the world,” says Zahabiya, ruling out any plans of overseas operations.

Newer areas of medicine

We are receiving medical tourism patients from various countries across Africa, the Middle East, Europe, and Russia. India is gradually developing as a medical hub. Our Goa hospital is poised to serve patients from across the world Zahabiya Khorakiwala, Managing Director, Wockhardt Hospitals

hospital, a super-specialised phase of medicine. Cardiac care, orthopaedics, neurosurgeries, aesthetic surgery, bloodless surgery, interventional radiology, rheumatology, brain and spine care, bone and joint care, minimal access surgery, laparoscopic surgery and urology are some of the core specialties of Wockhardt Hospitals. “We have a new division for aesthetics and plastic surgeries at our Goa centre, where it has a natural inflow of medical value travel. It is called the Wockhardt Institute of Aesthetics. There, we have procedures such as liposuction, face lift, breast augmentation and so on. We will be introducing this (aesthetics) in our South Mumbai hospital as well,” says Zahabiya.

Vision for Wockhardt

Zahabiya is clear about her vision for Wockhardt Hospitals. “We will set a benchmark of quality healthcare both domestically and globally. Our core objective is to focus on contemporary medicine and bring in innovation… That’s where our partnership with Harvard Medical International will support us. This partnership is ten years old and will take a much more concrete shape in the years to come. We have access to clinical knowledge and acumen.”

Tapping the medical tourism market

Wockhardt Hospitals, especially the Goa centre, are tapping the increasing potential of medical tourism. “We are receiving medical travel patients from various countries across Africa, the

Wockhardt Hospitals are conducting newer forms of surgery. “For instance, using the Oxford Knee Surgery technique, partial knee replacement was conducted at our Goa centre for a foreign patient. This is a first of its kind in the state. Similarly, we have also conducted the Delta Motion Hip, a partial hip surgery.” The hospital chain also intends to venture into other specialised areas of medicine. “Oncology is definitely an area where there is a huge demandsupply gap. Cardiac is our core speciality where we would always be at the forefront of contemporary and life-saving treatments,” reasons Zahabiya.

Human resource planning

Availability of nurses and paramedical staff is a major problem these days. But Wockhardt Hospitals have special human resource programmes to address the issue of shortage of nurses. “To bridge capacity shortage in the nursing space, we have initiated special programmes to attract talents. Our Nursing Leadership Development Programme is unique. In all, we have 800 nurses across our hospitals to proactively drive patient care. Every year, we groom 25 nursing leaders. With the help of Harvard, we have created a shared Nursing Governance structure that focusses on training, quality, and patient safety,” says Zahabiya.

Rural healthcare initiatives

“On the corporate social responsibility front, we have Wockhardt Foundation that focusses on social activities in the health sector. My brother runs that organisation. One of our programmes is the Mobile 1000 initiative. Mobile 1000s are vans with a doctor, medicines, and a driver. Each Mobile 1000 visits villagers and provides them medical consultations and medicines free of cost. As of now, we have 60 such vans to improve rural healthcare. The objective is to have 1000 vans over the next six to seven years,” says Zahabiya. “We also provide treatment for cleft lip and palate deformities. Treatment for cleft lip surgeries are provided at Rajkot, Vashi and Goa. Children born with congenital heart defects are also given relief and operated upon at our hospitals. The corporate sector needs to play a proactive role for the marginalised sections of society and make an impact,” adds Zahabiya. Zahabiya may not know how to use the scalpel, but that doesn’t stop her from being an integral part of the healthcare mission. She is a humanist to the core, and she knows how to lead from the front. Watch this space for more on Zahabiya’s achievements in the near future.

FUTURE MEDICINE I August 2012

GUEST COLUMN

You can benefit from cervical arthroplasty

egenerative cervical disc disease is a common cause of neck pain and morbidity among people these days. Many patients are refractory to non-operative treatment, and anterior cervical discectomy and fusion is a traditional treatment technique. Under this technique, a bone graft is harvested from the patientâ&#x20AC;&#x2122;s iliac crest and placed in the intervertebral space, over which a predesigned titanium plate is fixed to the adjacent vertebra using screws. However, in this technique, single level procedure can alter spinal kinematics and multilevel fusion can affect cervical spinal motion. Biomechanical studies have documented increased intradiscal pressures in adjacent disc segments after fusion. To overcome this, doctors are relying on a technique called cervical arthroplasty (cervical total disc replacement) that has evolved in the recent years. Under this technique, using a micro neurosurgical approach, the offending cervical disc compressing the nerve root or the spinal cord is removed and an artificial cervical disc (prosthetic disc) is placed in the intervertebral space. These

discs are of different makes with a combination of different materials like titanium, ceramic, carbide, and polyurethane with variations in their design. They come in variable sizes. Cervical arthroplasty has the potential to provide the benefit of anterior neural decompression without compromising on segmental mobility. Patients with significant degenerative changes and no segmental motion cannot be expected to regain mobility by implanting a total prosthetic disc replacement. It is contraindicated in the case of deformity. Recent infection or osteomyelitis would also preclude its use. I have been using this technique successfully in patients with neck pain and radiculopathy (pain radiating to the arms), discogenic myelopathy (compression of the spinal cord due to the extruded disc), or a combination of both. (Dr Ram Kumar Menon has settled down in Thrissur district of Kerala, where he works with Elite Mission Hospital and Care Well Clinical Centre as a consultant neurosurgeon)

MRI of a patient with disc herniation between C5 and C6 compressing the spinal cord and difficulty in walking and holding objects.

Dr Ram Kumar Menon

Some of these discs are shown in the images below

Prestige ST

Bryan disc (cervical)

Prestige LP

Cervicore

Prodisc C

Image intensifier image showing the prosthetic disc in the C5-C6 intervertebral space.

This patient showed complete resolution of the symptoms soon after surgery and was discharged after 48 hours. He has resumed normal activities.

FUTURE MEDICINE I August 2012

TRIBAL HEALTHCARE Kannampadi, Idukki

Access to proper healthcare facility

is 60 kms away

Far removed from the hustle and bustle of cities and towns, tribal settlements are the last posts of civilisation, where the only panacea for survival is self-sufficiency, self-reliance and selfempowerment. When it comes to matters of healthcare, even for ordinary ailments, tribals have to undertake long, arduous journeys to the barely equipped primary health centres in nearby towns. Thanks to the UPA governmentâ&#x20AC;&#x2122;s National Rural Health Mission, there have been some improvements in delivery of healthcare solutions to the tribal communities. But then, a few areas of concern remain. Future Medicine surveyed a tribal settlement in the Velappara Range of the Western Ghats in Idukki district of Kerala to see whether the tribals there faced any serious problem with regard to access to proper healthcare facilities. They gave an eyeopening, and at times, hair-raising accounts of their survival saga By Sanjeev Neelakantan & Sreekanth Ravindran

ur journey into a tribal settlement in the Velappara Range of Idukki district of Kerala made us take the stomach-churning winding roads on the Kattappana route. After traversing 22 kms from Peermade Taluk, we reached Valakode, a small village on the periphery of a wildlife sanctuary. We abandoned our taxi there and hired a jeep since only heavy duty vehicles could stand the rigours of a 10-km undulating rumblestrip. At the beginning of the journey, we got to see a catchment area of the Periyar river and some water rapids. All the while the driver kept telling us the certainty of encountering a tusker. Fortunately, that didnâ&#x20AC;&#x2122;t happen. After a 45-minute spine-jerking ride, we reached our destination, the tribal settlement of Kannampadi. A few departmental stores and tea shops here and there, a sub centre about a km away in Kizhikam, and a

government high school were the first signs of development that greeted our eye. Then, two officials of the NGO Peermade Development Society (PDS), which works for the welfare of the tribals here, introduced us to three welldressed women and an English-speaking gentleman at their office near the tribal settlement. Upon enquiry, we were told that these people belonged to the tribal community. Their fluency in language, attire and body language suggested no backwardness. Rather, they seemed quite a part of the mainland. That changed our notion of backwardness of the Ulladan and Oorali tribals in Kannampadi to an extent, but the innocuous narration of some of their real healthcare problems only underscored the tragic side of their lives. The first woman, Valsala, is an accredited social health activist (ASHA)

trained under the National Rural Health Mission (NRHM). The second, Rosamma, is a PDS-trained volunteer promoting the use of Ayurvedic medicines among the tribals, and the third, Anita, is the in-charge of the PDS collection centre, where agricultural produce of the tribals is procured at reasonable rates. The 40-something gentleman, Kumaran, is a teacher who has done his MA in Economics. The profile of these tribals and stories of others who have secured jobs in government departments show that they are gradually emerging out of their closeted world and bringing about a meaningful difference in their lifestyles. But they are facing some serious roadblocks in their journey towards holistic development.

Serious healthcare issues

â&#x20AC;&#x153;The tribals have one sub centre (at Kizhikam) for treatment of their

FUTURE MEDICINE I August 2012

In recent times, there have been at least three cases of pregnant women delivering in the midst of a bumpy ride to a hospital in Nedumkandam, about 60 kms from Kannampadi. Pregnant women go to this hospital because the primary health centre at Upputhara does not have any facilities for safe delivery. It is difficult to get vehicles here. There is no ambulance facility. Roads are in a bad shape, and blacktopping is not allowed by the Forest Department Kumaran, Teacher and member of Ulladan tribe

regular health problems. A doctor arrives at the sub centre once or twice a week, but medicines are not available there. For serious problems, we have to go to the primary health centre in Upputhara, about 13 kms from Kannampadi,” says Kumaran. “Our primary need is the availability of a regular doctor in or around the tribal settlement.” While NRHM initiatives have given health entitlements to tribal children through the

Anganwadi system under the Integrated Child Development Scheme, the Janani Suraksha Yojana has been a big failure here. “In recent times, there have been at least three cases of pregnant women delivering in the midst of a bumpy ride to a hospital in Nedumkandam, about 60 kms from Kannampadi. Pregnant women go to this hospital because the primary health centre at Upputhara does not have any facilities for safe delivery,” says

While NRHM initiatives have given health entitlements to tribal children through the Anganwadi system, the Janani Suraksha Yojana is a big failure in Kannampadi, a settlement of the Ulladan and Oorali tribes FUTURE MEDICINE I August 2012

TRIBAL HEALTHCARE Kannampadi, Idukki

(From left) Rosamma, an NGO-trained volunteer promoting use of Ayurvedic medicines, Anita, in-charge of an agricultural produce collection centre, and Valsala, an accredited social health activist Kumaran, adding, “It is difficult to get vehicles here. There is no ambulance facility. Roads are in a bad shape, and blacktopping is not allowed by the Forest Department.” The tribal community has no complaints about the immunisation drives. But they are faced with the problem of high-risk behaviour among young children. While some have taken to alcohol, given its easy availability, a few are becoming drug addicts. “The government should hold regular awareness campaigns and workshops to sensitise the tribals about the dangers of high-risk behaviour. Now, unlike before, tribals are falling victim to lifestyle diseases like high blood pressure and diabetes as well,” says Valsala. On the sanitation front, Kumaran says, a majority

of tribals have modern dwellings, including toilets, though a few still defecate in the forest. “Because of lack of transport facilities to Kannampadi, construction costs are also very high. A brick costing Rs 5 could cost around Rs 20 here. That’s one reason why some can’t afford modern homes,” says Kumaran. Thanks to ASHA’s campaign, tribals have been maintaining cleanliness in and around their homes. The involvement of PDS in promotion of Ayurvedic medicines has also helped the cashstrapped tribals. “Basic Ayurvedic training was provided to 20 members of a Self-Help Group. This has helped us in preparing traditional medicines like ‘Murivenna’,” says Rosamma, adding that the involvement of PDS in developmental and welfare initiatives has given them a fresh hope. For the record, PDS is the only NGO working in this tribal settlement of about 500 families, comprising about 2,000 members. Apart from helping tribals earn a better income from the sale of their farm produce at a collection centre, PDS has also been assisting dull students in completing their high school studies. Though a number of students are now venturing out of Kannampadi to pursue higher studies in cities, the ones who are left behind are faced with the problem of lack of good teachers at the government high school. Besides, some people who stay in the interiors take hours to reach the school since they avoid certain routes fearing an encounter with elephants. On the whole, Kannampadi is gradually emerging out of its backward tag. The Central and state governments’ immediate intervention on the healthcare and education fronts can help them make a big impact in terms of development. For now, the consolation is that growth doesn’t seem stunted here.

Tribals have to undertake a spine-jerking ride on this rumblestrip in the forest reserve to reach the nearest town

FUTURE MEDICINE I August 2012

WHERE TO STUDY Curacao

Become a healer at the Island of Healing Ever been to Curacao? Situated in the southern Caribbean Sea off the Venezuelan Coast, this is a constituent country of the Kingdom of the Netherlands, famous for its coral reefs and scuba diving destinations. In Portuguese, the word ‘Curacao’ means the state of being cured. During the earlier times, a group of Portuguese sailors suffering from scurvy had landed in Curacao and cured themselves by eating a fruit containing vitamin C. Since then, it came to be known as the ‘Island of Healing’. Apart from being a picturesque tourist destination, Curacao is emerging as a major medical study destination in the Caribbean Islands. Among the institutes here, St Martinus University Faculty of Medicine, recognised by the WHO and the Medical Council of India, provides quality education Bureau

constituent country of the Kingdom of the Netherlands, Curacao is famous for the Curacao Dolphin Therapy and Research Center (CDTC), where patients suffering from physical or mental disabilities such as cerebral palsy, autism, and down’s syndrome are given a chance to interact with dolphins under a unique programme. The therapy offered at CDTC uses the principles of behavioural therapy. Research has shown that interaction with dolphins can bring about improvement in the concentration capacity, or the ability of a patient to focus. Curacao’s association with healing

doesn’t end there. Today, it is emerging as one of the major medical study destinations in the Caribbean Islands. A scuba diver’s paradise and a tourism hotspot, Curacao has some beautiful coral reefs that makes it a progressive wellness destination as well. The cost of living in Curacao is comparatively low, so there’s no pressure on foreign students to take up part-time jobs while pursuing studies here. The only medical college in Curacao to be approved by the Medical Council of India, St Martinus University Faculty of Medicine (SMUFOM) offers students quality education. It is one of the two private medical schools in the Caribbean

that offers a two-semester-per-year system, consistent with the Liaison Committee on Medical Educationaccredited US, Canadian, and most medical schools around the world. St Martinus College was established in 1842 as the first school of the Netherland Antilles, run by the Nuns of the Catholic church, the Sisters of Roosendaal. In the 1990s, the Sisters decided to hand over charge to a team of professionals with the objective of turning this institution into a medical and health sciences university. After a complete renovation, the campus was transformed into SMUFOM. At SMUFOM, students are exposed

FUTURE MEDICINE I August 2012

to clinical settings at a 300-bed regional hospital in the island from the first semester itself. SMUFOMâ&#x20AC;&#x2122;s mission is to provide a well-balanced instructional programme, enabling students to achieve their full potential and become qualified physicians and exceptional leaders in the field of medicine.

Programmes offered

SMUFOM offers a rigorous programme that integrates the basic

sciences with the clinical practices of medicine. The Programme in Basic Sciences is offered over four semesters of 20 weeks each. There is a scheduled mid-semester break after mid-term exams. There are 35 contact hours of teaching per week in each of the first four semesters. After completing this, students have to pass the entire course with a GPA of 2.0. Clinical sciences are taught during the third and fourth years.

Aiming highest level of academic success In an interview with Future Medicine, Priyam Sharma, Managing Director, St Martinus University, talks about the vision that drives the institute Whatâ&#x20AC;&#x2122;s your vision plan? At St Martinus University Faculty of Medicine (www.martinus.edu), our vision is to create the best global medical school, where students from various countries can receive education and become respected citizens of any country they choose to live in. We strive to provide a wellbalanced instructional programme that enables students to reach their highest level of academic success. Our staff is committed to creating FUTURE MEDICINE I August 2012

a student-centered educational environment that stresses on high expectations. Our goal is to maintain an active partnership, involving students, teachers, community, and staff, and develop a love for learning while embracing our diversity and unique talents in a safe, challenging, respectful and supportive environment. Our faculty, staff and students accomplish our mission by providing student assistance inside and outside the classroom. Teaching

There are two semesters of 24 weeks each in the third year. Core clerkships are delivered in the third year. There are two semesters of 16 weeks each in the fourth year. SMUFOM students with OCI status (Overseas Citizenship of India) and Indian citizens are eligible for the screening test conducted by the Medical Council of India. St Martinus students are eligible to practise in India after completing their degree.

WHERE TO STUDY Curacao

assistants are available to help fellow students succeed. We acquire the best equipment and staff. We have developed a curriculum which will aid students in preparation for the United States Medical Licensing Examination (USMLE), and clinical rotations. We provide the skills and knowledge that will lead to a successful and rewarding career. Our aim is to help students reach their full potential and become qualified physicians and exceptional leaders in the field of medicine. What exactly are you looking for in a candidate seeking admission in your institute and what’s the yardstick for assessment of skills and leadership traits? We are looking for candidates who are not only excellent academic achievers, but are able to help the community around them by having other talents. Music, art, sports and games, debates, theatre etc. are some of the disciplines we look into. In addition to passing an entrance examination, we ask them to submit a detailed application form and also write an essay about themselves. For the session starting on January 7, 2013, the entrance examination is in September 2012. What has been your contribution to the world of medicine? Has the university undertaken any state-funded scientific study or research project that adds value to your educational system?

Our contribution to the world of medicine has been one of the best one can have – producing world class physicians! The university has several research projects that are underway with medical institutes from the US, Belgium and Holland. What kind of research is your university into? Do the students get enough opportunities to work on interesting projects? Students get ample opportunity to work on diabetes, arthritis, genetics, and cardiology-related projects. We also sponsor our students and faculty members and encourage them to work with their counterparts in the US medical institutes. Do you have plans to broaden your curriculum/ courses by including new subjects? Yes, we are going to open a branch to confer Bachelor’s, Master’s and Doctor’s degrees in Physiotherapy. In addition, we have plans to open a dental college and a nursing college in the near future. What’s the profile of your students? Do you have any students from Asia? The majority of our students come from the US and Canada. About 10% of our student population is from India. We had launched a promotional campaign in India this year. We have three intakes every year – in January, July, and September.

FUTURE MEDICINE I August 2012

SURGEON SPEAK

Why different price tags for same drug? Dr K K Shanbhogue is an Assistant Professor of Surgery at Kasturba Medical College, Mangalore, and a Senior General Surgeon at Kasargod Institute of Medical Sciences, Kerala. He had completed his MBBS from Kasturba Medical College in 1972, MD in 1975, and MS in 1978. After that, he had joined the Kerala Government Service and served it for six years. In an interaction with Future Medicine, Dr Shanbhogue shares his experiences as a surgeon Inspiration to become a surgeon The untimely death of my father due to lack of proper medical treatment had prompted me to become a doctor. Then, I gradually learnt that among doctors, surgeons are highly respected and that a surgeon is the epitome of knowledge in the field of medicine. That persuaded me to pursue MBBS and take up surgery as my specialisation. My surgical teachers at Kasturba Medical College had also inspired me through their teachings to become a surgeon.

Memorable surgical experience A few years ago, I was actively involved in the activities of the Lion’s Club, Kasargod, Kerala. I had suggested that the Lion’s Club should hold plastic surgery camps for poor patients, instead of organising medical camps. Accepting my proposal, the Lion’s Club advertised in the newspapers. We received a lot of requests for free plastic surgery. Among the applicants was a 28-year-old woman who had a defect in the upper lip. She had decided to remain a spinster because of this condition. However, six months after a successful surgery, she, along with her father, came to my hospital to invite me for her marriage. I was emotionally moved when she touched my feet, seeking blessings. I had never thought

Dr K K Shanbhogue

that I could bring about such a huge difference in someone’s life.

Essential traits of a surgeon Experience makes a surgeon perfect. A surgeon should maintain utmost transparency with his patients. This keeps up the patients’ confidence. A surgeon should update himself about the latest technologies because surgical technologies are changing with the passage of each day. A surgeon should have good knowledge about basic medicine as well, without which he/she cannot even move forward.

Suggestions for improvement in the healthcare system Commercialisation of medical education has made healthcare costs unaffordable since new doctors are making up for expenses on studies by heavily charging their patients. The government should immediately take some steps to check commercialisation of medical education. At the same time, drug companies have been charging varying amounts for the same medicine. Such malpractices should be stopped forthwith. Prepared by Shani K

FUTURE MEDICINE I August 2012

NOW ON STANDS Conflicts VS Education Also read COUNTERPOINT Prashant Bhushan

BRAINWAVE Beena Paul CAMPUS FOCUS NMIMS Mumbai

EXPERT TALK Kiran Mazumdar-Shaw

Asiaâ&#x20AC;&#x2122;s Largest Circulated Education Magazine www.educationinsider.net

EXPERT INTERVIEW Dr K M Cherian

India’s first-ever medical village is shaping up in TN Dr K M Cherian, the man behind many pioneering heart surgeries, is currently working on his dream project, a fully integrated medical village, in Elavur, Tamil Nadu. Future Medicine gives details of this groundbreaking project that will drastically change the dynamics of healthcare in the near future as this is also India’s first-ever medical village By Tony William

t a time when the pulse of the medical system is much in tune with the materialistic urge among the practitioners, the common man is caught between the devil and the deep blue sea. The only islets of hope in such a scenario are the architects of innovative medical procedures and scientific breakthroughs who have dedicated their life for the cause of those in desperate need of best treatments at affordable costs. For Dr K M Cherian, who shares with renowned cardiac surgeon Dr P Venugopal the honour of having pioneered the heart transplantation surgery in India, healthcare is about providing the best possible service to the ailing people. It is a mission that always stands above the self, a duty that calls for a profound strategy to circumvent exorbitant costs, and a deed that can be measured by the satisfaction of the consumer. For medical graduates who are opposing tooth and nail the Central government’s move to make one-year rural posting for new doctors mandatory, and for those indulging in vain debates over poor coverage in universal health access, here’s some food for thought. Knowing that the urban population has the privilege of the best healthcare facilities, and that the rural poor are always left to fend for themselves, Dr Cherian is busy giving final shape to his dream project, Frontier Mediville, in a village called Elavur, bordering both Tamil Nadu and Andhra Pradesh.

So, what is Frontier Mediville all about? Dr Cherian wants to create a model healthcare village in Elavur, the first of its kind in this country. As part of this initiative, he had acquired 360 acres in the village for development of the project. The first phase of the project would be ready in two-three months. Healthcare is not the only solution being offered under the project, as Dr Cherian and his team have already trained young girls from the village in tissue engineering and biotechnology, enabling them to take up jobs at Mediville. Young Peepal trees, Olive trees, Arjuna trees and mangrove saplings dot the Mediville campus. It also has a herbarium, a garden carved in shapes corresponding to the Zodiac signs, and a bamboo garden, reflecting Dr Cherian’s love for the environment. The Mediville project will be supported by Cherian’s Frontier Lifeline Hospital, located at Moggappair in Ambattur area of Chennai, about 30 kms from Elavur. This hospital too has become famous for its world class healthcare services, prompting Dr Cherian to chart out a roadmap for expansion. He plans to extend Frontier Lifeline’s reach to Lagos, Nigeria and Myanmar. He believes that quality and low-cost healthcare must be provided to all human beings irrespective of nations. Another special feature of the Mediville project is a Bioscience Park. Recently, Frontier Lifeline

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Hospital had shifted its Bioscience Unit to Frontier Mediville as part of efforts to enhance the efficacy and scope of research and development. There are plans to upgrade the unit as a Contract Research Organisation. As of now, the Bioscience Unit undertakes advanced research in tissue engineering, biological cardiovascular implants, stem cell research and technology, and umbilical cord blood storage. The highly experienced scientists of the Bioscience Park will cater to the research and testing needs of pharmaceutical, traditional medicine, medical devices, bioprosthetics, biotechnology, agrochemical, and industrial chemical companies. Dr Cherian has had the chance to work in many foreign countries, including Australia, China, the USA and New Zealand. But the love for his country had prompted him to join the Indian Railways as an Assistant Medical Officer. He is the only Indian whose name has been inscribed on a stone at Kos Island, Greece, (the

birthplace of Hippocrates, the Father of Medicine), in recognition of his contributions in the field of cardiac care. He has about 36,000 heart operations to his credit. He is the first man in India to conduct a lung-cum-heart transplant, the first bilateral lung transplant, the first paediatric heart transplant and the first auto transplant. There’s an interesting story behind Dr Cherian’s passion for medicine. During his childhood, he used to operate upon lizards, believing that if one is pre-destined to become something, he would definitely achieve it. Pre-destined? That’s another story: Once a tribal woman had told his mother that he would enter the medical field and become a heart surgeon. Call it a coincidence, or divine intervention, this prediction was made even before his birth. The tribal woman had even specified the day of the child’s birth. His mother had not revealed this secret to him until he chose medicine for his higher studies. Dr Cherian still wonders about that lady’s predictions.

Another special feature of the Mediville project is a Bioscience Park. Recently, Frontier Lifeline Hospital had shifted its Bioscience Unit to Frontier Mediville as part of efforts to enhance the efficacy and scope of research and development. There are plans to upgrade the unit as a Contract Research Organisation

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EXPERT INTERVIEW Dr K M Cherian

‘Care for the sick, not business’ When this correspondent visited Dr K M Cherian at Frontier Lifeline Hospital in Moggappair, he was busy giving interviews to various newspapers, attending to his emergency cases, and holding consultations with doctors. Finally, after all important engagements, he gave me an audience. Excerpts from the interview: Today, more than a service, healthcare has become a profitable industry. How do you view this problem? Healthcare has certainly become an industry. But caring for the sick should be seen as a humanitarian gesture. The primary responsibility of doctors should be to look after patients. Healthcare should not be viewed as a business. Today, a lot of people do this, especially the corporate players. Tell us about your dream project Frontier Mediville. Frontier Mediville is something new (in this country). These days, everybody is busy building ‘medical cities’. But we are building a ‘medical village’. When you talk about infrastructure, it should not restrict your responsibility to construction of huge buildings, high-end roads, airports, or shipyards. After all, infrastructure means giving network access to people in all possible forms. If people are not healthy, of whose use will such infrastructure be? Frontier Mediville is our commitment towards the rural people. Why did you choose Elavur? I chose Elavur because of its geographic advantages. It lies close to the national highway and borders both Andhra Pradesh and Tamil Nadu. Besides, towards the Eastern side we have the Bay of Bengal, and the Nandi Hills on the Western side. You can see the sunrise as well as the sunset from here. It’s difficult to get such a spot. Is any foreign country assisting Frontier Mediville by providing technology or medicines? The Tamil Nadu Industrial Development Corporation and the Department of Science and Technology are taking part in this project. We have no foreign participation. But we do have foreign collaborations. What’s the present stage of this project? Under the first phase of Frontier Mediville, a Science Park and Training Centre are being developed. The first phase would be ready in two-three months. It would take time to complete the other phases. How has the media and society supported this

project? We are supporting society in the truest sense by giving jobs to poor people. Girls from poor social and economic backgrounds had been given training in our laboratories. Now, they have been absorbed in our laboratories. They are working in biotechnologyrelated areas. Tell us about the job opportunities Frontier Mediville has generated at Elavur village? We have already generated about 200 jobs in the locality during the first phase of the project. Once work on all the phases are over, we will be able to generate at least 3,000 jobs. Several girls from Elavur village have been trained by Frontier Lifeline in certain areas of biotechnology and tissue engineering. Is this your idea of building the nation’s human resource capacities through women empowerment? Yes, it is. You must note one thing about these girls. They can now work with dignity. All the girls who underwent the training are now employed in Frontier Lifeline. You have been to China, Australia, New Zealand, and the USA. What’s the difference between India and these countries in terms of healthcare? The USA, Australia and New Zealand are advanced countries with high technology, mostly supported by their governments. As far as China is concerned, they have huge hospitals, but that ‘human touch’ is not there. All these countries could be far advanced in technology, but I would say that they are still lagging behind because they have lost that ‘human touch’. What’s your message for aspiring doctors? Firstly, they should be motivated. Secondly, they should be committed. They should work hard. Lastly, they should be honest and compassionate. Compassion should come with passion.

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CAREERS AND COURSES Nursing

The sick need a helping hand Nursing is one of the ever-green career options, thanks to the ever-growing demand for nurses in the healthcare sector across the world. With new specialisations and courses coming in, aspiring nurses have a lot to forward to. High salaries in this profession are not just limited to foreign countries. Even the domestic scene is gradually improving. Now, the government intends to give a further fillip to the nursing sector with the introduction of new vocational schools in all parts of the country FM Bureau

wing to an incessant demand for medical attendants across the world, nursing remains one of the most sought after careers for educated youths. Nursing is an ideal profession for only those compassionate people who have an immense will power and spirit to serve the diseased and the weak in a dynamic and stressful environment that may demand longer work hours. According to estimates, nurses make up the largest workforce within the clinical healthcare industry. Nursing comes with a variety of roles and responsibilities.

Job profile

Nursing involves taking care of patients suffering from all sorts of physical and psychological maladies. Nurses constantly have to monitor the condition of these patients and administer prescribed medicines at regular intervals. They also have to assist medical specialists and help them set up medical equipment in operation theatres and clinical laboratories. Nurses also provide assistance to people who are unable to lead a normal life due to various reasons or are recovering from some kind of illness. Other than these general activities, nurses have the option of specialisation in several disciplines, including midwifery, cardiac care, intensive care, orthopaedics and paediatrics. Nurses also have to keep abreast with the latest technological developments in the field of medicine. Nurses work closely with physicians as an integral part of the patient healthcare team. Once a doctor takes some key decisions regarding diagnosis, treatment, and medication, it is the nursesâ&#x20AC;&#x2122; responsibility to administer care on an ongoing basis to ensure successful recuperation of the patient. As they are supposed to spend more time with patients than doctors, nurses must be particularly adept while interacting with patients, putting them at ease,

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and assisting them in their recovery, and overall well-being.

How to become a registered nurse?

Aspirants can enter this profession at different levels. Students can get enrolled into the Auxiliary Nurse Midwife/ Health Worker (ANM) course, which is conducted at select hospitals across the country. The duration of this diploma course is one-and-a-half years and it can be pursued immediately after matriculation. The General Nursing and Midwifery (GNM) programme is a three-and-ahalf-year diploma course. The eligibility criterion for this programme is ten plus two, with biology, chemistry and physics as main subjects. The candidate must secure an aggregate of 40% marks in the above mentioned subjects. Apart from ANM and GNM, students can apply for the BSc (Nursing) programme at various medical colleges. Since this is a graduate programme, there are ample avenues for career growth. The eligibility criterion for this programme is a 10+2 with 45% aggregate in biology, chemistry, English, and physics, and a minimum age of 17 years. After completing this four-and-ahalf-year BSc programme, professionals can even aspire for higher studies such as MSc, MPhil, or PhD. While pursuing their post-graduate programme, nurses get the opportunity to specialise in various fields of medicine, including Cardio Thoracic Care, Critical Care, Emergency and Disaster Nursing, Neonatal Nursing, Nursing Education and Administration Oncology, Operation Room Care, Orthopaedic and Rehabilitation, and Nursing Practitioner in Midwifery and Psychiatric Nursing.

Job prospects

Nurses do not remain unemployed. They easily get jobs in private and government-run hospitals, nursing homes, orphanages, old age homes, industries, sanatoriums and the armed forces. They can also seek employment at the Indian Red Cross Society, Indian Nursing Council, State Nursing Councils and various other nursing institutions. Even nurses who have completed the ANM course get ample opportunities to work as primary health workers and midwifes at primary health centres that are spread across the length and breadth of the country. Nurses can also take up administrative and teaching positions at FUTURE MEDICINE I August 2012

medical colleges and nursing schools. Enterprising individuals can start their own nursing bureaus or even work on their own terms and conditions. Apart from these innumerable openings in the domestic sector, nurses who earn international nursing certifications and fulfill the prescribed immigration criteria generally move to greener pastures abroad. With increasing focus on healthcare, job prospects for nurses look brighter than ever before. On its part, the government is striving hard to give impetus to the nursing sector. The government has plans to set up more than 130 ANM and GNM schools each. Also, there is a plan to strengthen the State Nursing Councils and Nursing Cells in various states. Furthermore, these plans include setting up of new Nursing Colleges across the country. The government has also allowed special hospitals to start MSc Nursing programmes without corresponding graduate courses. The norms for admission to nursing schools have also been relaxed so that married women can seek admission to various nursing programmes. There is a great demand for highly skilled nurses abroad. In fact, India has emerged as the largest provider of nurses to foreign countries. The lure of big money and better living conditions abroad often attracts experienced nurses from India. A major reason for scarcity of nurses in the domestic sector is their flight to foreign lands. Beginners in this profession

The government has plans to set up more than 130 ANM and GNM schools each. Also, there is a plan to strengthen the State Nursing Councils and Nursing Cells in various states. Furthermore, these plans include setting up of new Nursing Colleges across the country generally earn a monthly salary in the range of Rs 7,000 to Rs 10,000. Midlevel positions can fetch a pay packet anywhere between Rs 18,000 and Rs 30,000. Highly experienced nurses can even get a salary of Rs 48,000 to Rs 72,000 per month. Nurses who are employed in foreign countries, such as the US, Canada, England and the Middle East, can easily earn even heftier monthly pay packets. Nursing is not just about taking care of the sick. Other opportunities for qualified nurses include teaching, administration, and research jobs. An interesting aspect of this profession is that a vast majority of nurses are women. However, in recent times, men have also been showing interest in the profession.

BONE OF CONTENTION Artificial pricing

High drug prices afflict the poor The skyrocketing prices of life-saving medicines are pushing the poor over the edge. To check artificial pricing, the All Kerala Retail Druggistsâ&#x20AC;&#x2122; Association plans to make bulk purchases directly from drug companies and sell them at wholesale rates, instead of the MRP. Also, government-run Consumerfed is in talks with drug companies for bulk purchases without the involvement of middlemen By Ziad P S

ajan, a bus conductor and the sole breadwinner of his family, was taken to a government hospital near his house after he showed symptoms of cardiac arrest. The doctor told a relative of Rajan that he needed the immediate administration of a lifesaving injection, which, unfortunately, was out of stock at the hospital store. The poor family was asked to get the medicine from outside, where it had to

spend more than Rs 3,000, much higher than the actual cost. This is not an isolated incident. Itâ&#x20AC;&#x2122;s a common scene in government hospitals across Kerala. Every time the poor, as though by fate, are left to bear the burden of heavy medicine prices. The problem is not just limited to the skyrocketing prices of life-saving medicines. Government hospitals in the state have their own limitations

in many other respects. There are not enough beds, doctors, and medical equipment, other than unavailability of important medicines. In such a scenario, the poor are forced to turn to private hospitals where treatment comes at premium rates. While issues concerning infrastructure can be tackled with timely intervention of the government, the issue pertaining to artificial, exorbitant pricing of medicines always

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To make drugs affordable for the common man... As far as the common man is concerned, the rising price of drugs is now becoming a serious issue. In what comes as a relief, five state governments have united to make drugs affordable for the common man. The Chief Executive Officers of the Central drug procurement remains unattended. What has the government been doing to control the drug prices? What provisions are there for the poor, enabling them to avail of medicines at subsidised rates? Do the governmentâ&#x20AC;&#x2122;s interpretations of the situation carry any weight? The ultimate control over medicine prices remains with manufacturers, both national and international. The primary reason behind the spiralling prices of medicines is the enormous clout of the manufacturers that influences the mechanism behind artificial pricing, says an official of All Kerala Chemists and Druggist Association (AKCDA). At present, there is no provision enabling major drug companies to sell medicines directly to retailers. All drug majors rely on distributors because of their bulk buying capacity. The margin for distributors and retailers is poor as most drug companies do not produce drugs which come under the Drugs Price Control Order. Therefore, retailers are compelled to sell drugs at the MRP. While there are more than 1,500 distributors and 10,000 retailers in Kerala, there is no stern government regulation to control them. Seventy-four life-saving medicines were included in the Drugs Price Control Order 1995, which made up almost 30% of total medicines marketed on cost-based pricing. Later, the companies gradually reduced the number of medicines, leading to unavailability of life-saving drugs. This compelled people to choose alternative medicines at higher prices. Since bulk purchase is the key factor that prevents drug companies from selling to retailers, the All Kerala Retail Druggistsâ&#x20AC;&#x2122; Association (AKRDA), an organisation formed by retail shoppers within AKCDA, plans to make bulk purchases directly from the drug companies. With contributions from all its members, AKRDA can FUTURE MEDICINE I August 2012

agencies in Gujarat, Karnataka, Rajasthan, Tamil Nadu, and Kerala recently decided to form an alliance to make drugs more accessible to the common man. These states signed the Thiruvananthapuram Declaration, deciding to formulate common policies on drug procurement and data sharing to make drugs accessible to the common man. According to Biju Prabhakar, Managing Director of Kerala Medical Services Corporation, this is the first initiative in the country aimed at controlling drug prices.

buy large quantities from companies. lower prices. The civil supplies rationing This will, in turn, enable retailers to get system can be emulated to ensure that drugs at wholesale rates. If everything medicine supply services are provided goes as per the plan, customers will to the poor in a more transparent and be getting medicines at rates lower humane manner. The government should than the MRP. Currently, there are at least try to make high-cost medicines some big retail networks in the state available at low prices for people below which offer discounts on purchases the poverty line. for their privileged customers. So do some government A discussion is underway agencies. Government- between Consumerfed and major run Consumerfed drug companies for bulk is one such agency, purchase without the where medicines are sold at subsidised involvement of middlemen. In a rates. Unfortunately, recent statement, Cosumerfed you are not going to had said that it could sell find many medicines there as those may be medicines through its Neethi unavailable owing to Stores at much lower prices if the the lobbying in the industry. A discussion commission that is being given to the agencies was avoided. It is underway between Consumerfed and major has also decided to build drug companies for bulk purchase without warehouses in all districts to store medicines the involvement of middlemen. In a recent statement, Cosumerfed had said that it could sell medicines through its Neethi Stores at much lower prices if the commission that is being given to the agencies was avoided. It has also decided to build warehouses in all districts to store medicines. Besides, if medicines are sold through governmentrun outlets, the competition in the field will disappear and the poor can buy life-saving drugs at

MEDICAL TOURISM Malaysia

2020 vision boosts healthcare sector

Malaysia is aiming to become a developed country by 2020, and its advances in the healthcare sector are signs of the shape of things to come. These days, tourists from across the world prefer Malaysia for cosmetic surgeries, given the low costs involved in such procedures in this country. But the medical expertise here is not just limited to bodily makeovers. Malaysian hospitals are famous for their success in bypass surgeries and fertility treatments as well By Prashob K P

alaysia, known for its cultural, historical, and scenic attractions, has emerged as a major healthcare destination in Asia. The country has been attracting a high number of medical tourists because of its efficient and strong modern healthcare infrastructure, world renowned medical facilities, and medical expertise. Owing to its highquality, low-cost medical procedures, tourists have been zeroing in on Malaysian healthcare facilities for cosmetic surgeries. But the core expertise of Malaysian hospitals lies in

cardiac bypass surgeries and fertility treatments. The success rates for in-vitro fertilisation in Malaysia are just as high as those in the US. The Ministry of Health intends to develop Malaysia as the most preferred destination for medical tourists. Malaysia is also working on its vision to become a developed country by 2020, and health tourism will be a major driver of growth. Encouraged by this initiative of the government, hotels and resorts have allied with hospitals to develop special health tourism packages for international clients.

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Penang’s a hit in medical tourism In an interview with Future Medicine, Ng Gim Bee, Marketing and Business Development Manager, Penang Adventist Hospital (PAH), Malaysia, talks about Malaysia’s potential in medical tourism and PAH’s specialties What are the core specialties at Penang Adventist Hospital? We specialise in heart and vascular care, wellness (preventive health and lifestyle intervention programme), orthopaedic and spinal surgeries, neurosurgeries, digestive and liver health, internal medicine, general surgeries, urology, oncology, obstetrics and gynaecology. PAH realises the importance of physicians as the gateway for its target customers. In order to apply this knowledge, PAH has segmented the hospital in various specialties so that customers will know that it provides a vast array of services through some of the best physicians at affordable costs. PAH organises medical and clinical talks with other private hospitals, visits, exhibitions, sales call and trade shows in targeted countries to enhance community relations. At a time when medical costs are rising, how do you provide the best care at minimal costs? We have collaborations with insurance companies, managed care organisations and third party administrators. The cost of medical healthcare is usually too high for low-income earners. Hence PAH emphasises on the importance of preventive health to help its customers. How progressive is Malaysia’s medical tourism industry? The key medical tourism destinations in Malaysia are Kuala Lumpur, Melaka, Penang and Johor. Of late, Penang has become the top destination for medical tourism. According to the Penang Health Association, Penang garnered RM 162 million in revenue from

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medical tourism in 2009. In 2010, the revenue increased to about RM 220 million. In 2010, Penang had 250,000 medical tourists. Ninety per cent of them were Indonesians. They share a similar culture as well as language. Tell us something about the expertise of your doctors. The Adventist Heart and Vascular Centre at PAH provides the best cardiovascular treatments in Penang. PAH treats over 50,000 heart patients, performs over 200 cardiac catheterisations, conducts over 220 percutaneous transluminal coronary angioplasties and percutaneous coronary interventions, and over 500 open heart surgeries annually. What are the key initiatives of PAH’s not-for-profit hospitals, clinics and dispensaries? PAH’s key initiatives for the not-for-profit concept is based on the CARING core values: C-Community, A-Achievement, R-Relevance, I-Integrity, N-Nurture, G-Godliness. We are patient-centred healthcare providers. Our not-for-profit concept means that our revenue is used to expand, improve and support our hospital for the sake of providing better healthcare to the community. How many foreign patients does Malaysia receive in a given year and what percentage of patient traffic do you receive? In 2010, Penang contributed about 70% (RM 220 million) of the medical tourism receipts. Of the 250,000 medical tourists, PAH received 59,317 patients. What are the challenges in Malaysia’s healthcare industry today and how do you overcome them? One of the challenges is to convince new medical tourists to choose Malaysia as their ideal destination for healthcare since neighbouring countries Singapore and Thailand are famous for medical tourism. What are your expansion plans and do you have strategic partnership with any Indian hospital chains? We have an eight-year expansion plan that includes a 19-storey building, a new oncology centre and centres of excellence for many medical disciplines in Penang. We do not have any strategic partnership with any Indian hospital at the moment, but we are scouting for one.

DIARY OF AN ONCOLOGIST

Dr Selvi Radhakrishna

Scores of women not seeking medical help for breast problems A nxiety and fear undoubtedly lead to some degree of depression among all cancer patients. It is an emotional rollercoaster, especially in case of breast cancers, as the diagnosis is a difficult, challenging process, especially when it’s a new patient. As a doctor, I have to enact the role of a sister, daughter, granddaughter, or friend to build a unique and personal relationship with my patients. Distrust

is a deep-rooted phenomenon in our society, and there is always an overwhelming tendency to take second and third opinions regarding a diagnosis. Family and well-wishers force their views of disagreement with the diagnosis in an attempt to distract their dear ones from the harsh reality. Overprotection and wrong assumptions within our society that a woman cannot handle the big word “Cancer” is actually

detrimental. The problem only gets aggravated by the economic burden this disease brings to a family. Breast cancer treatment burns a big hole in the pocket and strains relationships so much that I have even seen families falling apart. There are scores of women in our country who may not seek medical help for breastrelated problems if women doctors are not available. They simply leave it to

Mammography is the process of using low-energy X-rays to examine the human breast. It is used as a diagnostic and a screening tool for early detection of breast cancer

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A woman undergoing Mammography test chance and fate. It is very disheartening to see somebody with an advanced disease, particularly when the person knows pretty well that this condition could have been detected at least a few years earlier. Even in the West, where I had undergone training, many women are more comfortable with a woman specialist than a male doctor. “You can’t tell certain things to men,” they would say. Once a young mother, accompanied by her husband, had approached me for a consultation. Since she had an intercaste marriage, her family ostracised her. When we began the treatment, her husband started losing interest in her as she was becoming “useless” to him. He deserted her, saying that he did not want to spend any more money on his wife. Fortunately, her brother came to the rescue, helping her complete the treatment. Once she regained her physical vitality, her husband shamelessly pleaded her to be a part of FUTURE MEDICINE I August 2012

his life once again. Six months later, the problem recurred, and once again, her husband deserted her. She was heartbroken, and I could not find words to console her. She then enquired about the stage of the disease, her chances of survival, and the cost of the treatment. That was the end of it. She never returned for further treatment. Later, I came to know that her sister had adopted her daughter, and that she had spent her last six months with her sister’s family. More than the disease, what mattered to her most was the desertion by her husband, for whom she had fought with her entire family. Despite this bitter episode of her life, she died peacefully surrounded by her loved ones. She continues to hold a very special place in my heart. I salute her for the courage and strength with which she had confronted all challenges in her life. All men are not alike. Here’s the story of a husband who did all he could to save his wife’s life from the

disease. A senior doctor and colleague, he had himself diagnosed his wife’s breast cancer. But by then, it was at an advanced stage. Nothing was left untried, and he was completely devoted to her care. It had not only ruined his medical practice, but also forced him to sell his house. Her treatment had become that expensive. He still kept trying. Providentially, destiny did not play foul with this gentleman’s efforts and his wife’s faith. In between the treatment, she had the luck of witnessing her daughter’s marriage, child birth, child’s first birthday, thread ceremony, and graduation. She’s living on hope, fighting each day of her life, and her husband is always ready to go to the other end of the earth to buy her some more time. This is a perfect example of love defying death. Nothing that you learn in medical college prepares you to deal with the tough situations and vulnerable patients. There are times when I toss and turn, wondering if I could have made it better or done it differently. I often ask

DIARY OF AN ONCOLOGIST in Oncology, mainly due to progression in research globally. Mutilating surgeries have given way to removal of lump. In the case of breast cancer, we remove only the cancerous portion. Targeted treatments (with drugs that kill only cancer cells and spare normal cells) are proving to be successful in curing breast cancer.

Breast cancer cells myself what I would have done had I been a patient. It is really hard. It is very difficult to be objective when you get emotionally involved with a patient and start making decisions for them rather than giving them the choice. In spite of such tough situations, I motivate myself to carry on with this noble job. The most special moments are when patients return to me year after year to invite me to their family functions, or to share with me their home-made pickles, or to introduce me to their grandchildren. I believe that cancer is curable if it is detected early. Today, there are many advanced forms of treatment

Breast cancer in India

It is the most common form of cancer affecting the majority of women in India. It is estimated that about 100,000 new cases are being diagnosed annually, with the age adjusted incidence rates varying between 16 and 25 per 100,000 population. The trend of rising incidence rates is likely to continue due to changes in lifestyle factors such as childbearing and dietary habits. Western lifestyle, increased consumption of fat products, obesity, late marriages, delayed child bearing, and low child conception and reduced breastfeeding rates are believed to be behind this increased risk of breast cancer.

Present status

About one lakh cases are being diagnosed annually, with the age adjusted incidence rates varying between 16 and 25 per lakh population

A vast majority of women do not consult a doctor or do not demand medical care during the initial stages due to various reasons such as illiteracy, lack of awareness and financial constraints. Owing to lack of awareness about this disease and the absence of a breast cancer screening programme, the majority of breast cancers are being diagnosed at a very advanced stage. Stage distribution at present is less favourable than in developed countries, with 50-70% of cases presenting for treatment being locally advanced or metastatic cancer.

Diagnosis age in India

According to estimates, breast cancer has been affecting Indian women during their forties and early fifties unlike in the West, where the majority of incidence rates are reported among women who

are in the post-menopausal period (fifties and sixties). In India, pre-menopausal women constitute around 50% of patients. The average age of patients in six hospital-based cancer registries ranged between 44.2 years in Dibrugargh, 46.8 years in Delhi, 47 years in Jaipur, and 49.6 years in Bengaluru and Chennai respectively.

Treatment facilities in India

Healthcare facilities are very heterogeneous across the country, and the quality of breast cancer diagnosis and treatment varies widely from place to place. The other factors that need to be understood are the patientâ&#x20AC;&#x2122;s outlook, the location of the patient and the hospital, the affordability for treatment, and family support. There is a shortage of high quality multimodality institutions that are both accessible and affordable. These limitations result in a compromised quality of care to patients with established disease. Since availability and the quality of treatment facilities varies from one place to another, survival rates are also consequently low, and there is a clear need to improve availability and accessibility of facilities for diagnosis and treatment, as well as education and awareness. Consequent to late stage presentation and inaccessibility of proper treatment facilities, the survival outcome among breast cancer patients in India is very poor as compared to Western countries. We are still largely underprepared to deal with this increase in incidence of breast cancer. Awareness amongst women and medical fraternity about breast cancer incidence, early detection techniques and treatment possibilities should improve. Original research on ethnic diversities about breast cancer has to be encouraged. (Dr Selvi Radhakrishna graduated from Madras Medical College in 1988. She completed her basic and post-graduate surgical training in Chennai and the UK and obtained DNB and FRCS, and Diploma in Clinical Oncology from University of Birmingham. She has received further training in breast surgery at Adyar Cancer Institute, and Hull and Edinburgh Breast Unit. She is practising as an Oncoplastic Breast Surgeon at Chennai Breast Centre and Apollo Specialty Hospital.)

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INDIAN HOSPITAL FOCUS Meditrina Hospital, Thiruvananthapuram

A cardiology centre for the common man Meditrina Hospital, located at Pattom in Thiruvananthapuram district of Kerala, is a specialised centre for Angioplasty. Dr Prathap Kumar, a cardiologist famous for having attempted the first Open Heart Angioplasty in the world and the Managing Director of Meditrina Hospital, says he is driven by the social commitment to provide the common man the best healthcare services at affordable costs. The hospital has super-specialty departments in Cardiology, Urology, Orthopaedics, General Surgery, Radiology, Internal Medicine, Diabetology, Medical Gastroenterology, Dermatology, Pathology and ENT, other than an exclusive Varicose Vein Clinic and Diabetic Foot Clinic By Prashob K P

n India, public spending accounts for only 22% of the expenses on healthcare, the rest being private expenditure. Nearly one million Indians die every year due to inadequate healthcare facilities. About 700 million people have no access to specialist care since 80% of specialists are working in urban areas. India also faces a huge need gap in terms of availability of hospital beds per 1,000 population. With a world average of 3.96 hospital beds per 1000 population, India has just a little over 0.7 hospital beds per 1,000 population. Reason? Budgetary support for expansion of public health facilities has been inadequate from governments. These are some of the observations made in the report of the Working Group on tertiary care institutions for the 12th Five Year Plan. With no respite from the increase

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in disease burden, India’s healthcare sector is in a critical condition, mainly due to the shortage of state-of-the-art primary and secondary hospitals. The inability of government hospitals to take on the huge rush of patients in terms of providing specialised care always results in mass referrals to private healthcare establishments. Such a trend created a huge space for high-end, specialised treatment, and private hospital chains cashed in on this by leading the charge in what is now being called the tertiary healthcare sector. But the main problem with tertiary healthcare institutions is that they are known for prohibitively expensive treatments. That’s where a large number of hospitals are filling the gap between secondary and tertiary healthcare, making it possible for the common man to avail of specialised treatments at affordable costs. Meditrina Hospital, located at Pattom in Thiruvananthapuram, is one of the leading specialised centres of treatment in the state. Presently, this specialist medical centre has superspecialty departments in Cardiology, Urology,

‘Meditrina Hridayamritham’ is a unique programme that provides advanced heart care technologies, such as Angioplasty, Stenting, and Angiography, to the common man.

Meditrina’s track record

The success of a healthcare venture depends on the credentials of the person at the helm. In the case of Meditrina Hospital, Dr Prathap is famous for having attempted the first Open Heart Angioplasty in the world. “I enjoy the dual role. Being the Managing Director of Meditrina Hospital, I have the freedom to work on innovative strategies, and as an experienced doctor, I know a great deal about the best technologies and instrument systems required for professional use,” says Dr Prathap, who completed his higher studies in Italy and has worked in Bangladesh. He has an impressive track record of 13 years and more than 6,000 Angioplasties. “Out of the 500 Angioplasties that we have conducted at Meditrina Hospital, around 25 per cent of the cases have been referred to us by multi-specialty hospitals. We have

Private hospitals are only being looked at as the “tax milking sources” by the government. There should be an earnest attempt to take the relationship to a new level where joint operations can bring about a drastic change in the healthcare scenario of the country Dr Prathap Kumar, Managing Director, Meditrina Hospital, Thiruvananthapuram

Orthopaedics, General Surgery, Radiology, Internal Medicine, Diabetology, Medical Gastroenterology, Dermatology, Pathology and ENT, other than an exclusive Varicose Vein Clinic and Diabetic Foot Clinic. Famous cardiologist Dr Prathap Kumar, the inspiration behind this specialised medical centre, attributes Meditrina Hospital’s success and growth to the faith and confidence reposed by the common man in the staff of this hospital. “People have been trusting us, and we also have dedicated manpower. This strength enabled us to perform 500 successful Angioplasties within a period of 15 months,” says Dr Prathap. The main objective of Meditrina Hospital is to provide new, advanced services in cardiology. Latest cardiology heart treatments like Balloon Angioplasty are provided at this hospital. FUTURE MEDICINE I August 2012

achieved a success rate of 90 per cent cure even in complex cases,” says Dr Prathap. “Apart from the treatments provided at Meditrina Hospital, we have organised 56 medical camps and conducted five free Angioplasties for people from the downtrodden sections of society,” says Dr Prathap. “Driven by the goal of ‘Compassionate Patient Care’, at Meditrina Hospital, we ensure the highest quality, safe patient care with a continuing and meaningful commitment.” On the technological side, Meditrina Hospital has adopted the latest technologies to provide the best personalised care to every patient at any given point of time. Dr Prathap says that the hospital aims to become the premier healthcare provider in India and the finest destination in cardiology. The word ‘Meditrina’ refers to the Roman Goddess of Healing. “By naming the hospital after a

INDIAN HOSPITAL FOCUS Meditrina Hospital, Thiruvananthapuram

Roman Goddess, I have only paid tribute to Italy, where I had spent my formative years as a cardiologist,” says Dr Prathap. Speaking on the essence of healing, he says, private hospitals are only being looked at as the “tax milking sources” by the government. There should be an earnest attempt to take the relationship to a new level where joint operations can bring about a drastic change in the healthcare scenario of the country.

Amenities at Meditirina

Meditrina Hospital has a 24-hour Casualty, Trauma Care, Clinical Lab and Pharmacy services. It also has an ICU Ambulance Service, considered to be the best in Thiruvananthapuram. The ambulance has all latest facilities for safe transportation of a patient to hospital in emergency situations. Meditrina also has Cardiac Centres at St. Thomas Hospital in Changanassery, S H Medical Centre in Kottayam, and Holy Family Hospital in Thodupuzha. Under the Meditrina Hridayamritham project, 150 people are offered free surgery and treatment. “We have plans to include 150 more patients through sponsorships from socially committed individuals and charitable institutions,” says Dr Prathap. Meditrina Hospital strives to provide world class medical facilities and offer the services of highly

qualified, nationally and internationally experienced doctors. “We will keep our social commitments by providing treatment at affordable costs,” says Dr Prathap, adding that Meditrina Hospital looks forward to meeting the highest possible standards of efficiency. “We have initiated Coronary Angioplasty, perfected with the use of Intra Vascular Ultra Sound and Fractional Flow-Wire. This is rarely done even in major institutions. As the main focus of Meditrina is on Cardiology, the hospital has a full-fledged cardiac unit, high-tech Cath Lab with digital imaging, and Angiogram and Angioplasty facilities. The Cardiac Care Unit is well-equipped with an exclusive monitoring facility. We have a Computerised Treadmill Unit for cardiac stress testing, a Heart Failure Clinic, a Special Clinic for high risk cardiac patients, and a Cardiac Rehabilitation Centre as well. “Our aim is to bring world class healthcare services within the reach of the common man. Focussing on specialty medical services, our experienced team will honour social commitments without compromising on quality while offering treatment at affordable costs. For a hospital, treatment is more important than business. We accord more importance to social values and medical ethics,” says Dr Prathap.

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Nitta Gelatin India Ltd SUCCESS STORY

Ace provider of quality nutrients for 33 years Leading Indo-Japanese venture Nitta Gelatin India Ltd (NGIL) manufactures Gelatin, Collagen Peptide, Ossein, Di Calcium Phosphate, and Chitosan that serve multiple purposes in the food, farm and poultry, FMCG, and pharmaceutical industries. It exports these products to 35 countries. While the company is being promoted by the Kerala State Industrial Development Corporation, Nitta Gelatin Inc, Japan is backing it on the technical and marketing fronts. With over 30 years of experience and about 20 per cent market share in India, NGIL is contemplating development of Gelatin from alternate raw materials By Prashob K P

ich in amino acids, amino sugar, fibrous protein, and other such health properties, Gelatin, Collagen Peptide, Ossein, Di Calcium Phosphate, and Chitosan form the main product pipeline of leading Indo-Japanese venture Nitta Gelatin India Ltd (NGIL). Each of these products are being used for multiple purposes in the food, farm and poultry, FMCG, and pharmaceutical industries. These days, the nearly transparent, faintly yellow, odourless Gelatin is being used as the shell of medical capsules, easily soluble in human body, and as thickening agents in desserts and jelly sweets. Gelatin is a mixture of Peptides and proteins produced by partial hydrolysis of Collagen extracted from the skin and crushed bones of animals such as domesticated cattle,

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chicken, and pigs. In some countries, alternative raw materials like fish skin is also being used to produce Gelatin. NGIL is promoted by the Kerala State Industrial Development Corporation (KSIDC) and Nitta Gelatin Inc, Japan. NGIL exports around 60 per cent of its product output to 35 countries. The company started the commercial production of Ossein, the Collagen of bones, in 1979. The Gelatin plant was commissioned in 1998, and NGIL also secured the ISO 9001-2008 certification. Under the guidance of its parent, NGIL has been reporting a good growth for the past three decades.

SUCCESS STORY Nitta Gelatin India Ltd

‘We are facing acute shortage of Gelatin’ In an interview with Future Medicine, NGIL Managing Director G Suseelan shares details of the company’s operations, expansion plans, and new products in the pipeline What led to the formation of NGIL and what have been its contributions to the healthcare sector? NGIL is one of the most successful IndoJapanese industrial ventures, incorporated in 1975. While KSIDC is the local promoter, Nitta Gelatin Inc, Japan is backing us on the technical and marketing fronts. Quality wise, NGIL is among the best companies in the country. Through dedicated human resources and technological advancements, NGIL assures the best quality products. NGIL exercises stringent quality control not only in the selection of raw material, but also at every stage of production, until the product is finally delivered to the customer. The company is uniquely placed to draw on the vast resources of its collaborators

and ensures that the products are consistently of high quality. In the pharma industry, Gelatin is mainly used for hard and soft gel capsules. Gelatin is a natural material. It has no side affects. It is highly digestible and serves as a natural protective coating for medicines. It is used in pharmaceutical applications. NGIL also produces Gelatin for blood plasma expander. Tell us about your product pipeline, the utility of each product, and clients. From 1979 to 1998, we operated as an intermediate supplier. Ever since we started to produce Gelatin, our activities were in business-to-business mode. Our customers include leading capsule as well as healthcare companies across the world. Associated Capsules, Dr Reddys, Cipla, Sun Pharma, Strides Arcolab are among them. In 2010, we got into the business-to-consumer operations. Now, we are producing Collagen Peptide by processing Gelatin further. It is used in healthcare applications like Osteoarthritis

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Prophylaxis, sport nutrition, beauty products, and protein enrichment. Clinical studies indicate that Collagen Peptide stimulates Collagen synthesis in Chondrocytes. Hence it supports the joint cartilage. The product is widely established in the US, Europe and Japan and is gaining acceptance in India too as a functional food supplement for joint health. Collagen Peptide has no side effects, as it is a natural product. We are also looking at opportunities for exports of this great product and hence partnering with associates in various countries. Apart from this, we have also developed Collagen Peptide-based products, which can be used for Osteoporosis, skin care, pressure ulcers, and wounds. Clinical researches have been done, and we expect to launch it in 2013. What are the challenges of the allied healthcare industry today? We are facing acute shortage of Gelatin. The rapid growth of the global pharmaceutical and health and nutrition market has resulted in stable demand for Gelatin and Collagen Peptide. So, the government has to think about this matter. Though there is a huge potential for exports, the shortage (of Gelatin) affects growth. Now, we are importing Gelatin to meet the export needs, but it is not a viable option. The pharmaceutical association has requested the government to resolve this issue. We are also looking at alternate raw materials like fish skin, hide etc. to produce Gelatin, which is now a common practice in many countries.

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Whatâ&#x20AC;&#x2122;s your take on the growing concern over the use of Gelatin in food products? In Europe and the US, Gelatin is used as a daily food item. As Gelatin is a natural thing, there is nothing to worry about health issues. Gelatin is used to preserve food items, especially meat. Most commonly, it is used in the pharma sector and in cosmetic products. In India, Gelatin is not very widely used as a food item, but now, products like jelly sweets are being consumed by the younger generation. In future, Gelatin will be an inevitable food ingredient. Whatâ&#x20AC;&#x2122;s your market share in India and do you have any plan to expand production? Our market share in India is about 15 to 20 per cent. We have limited quality conscious, high value customers. Our main focus currently is on businessto-consumer mode of activity, in order to sustain the growth. We are also planning to produce Gelatin from alternate raw materials so that we can meet future needs. How has your parent company been supporting you? The quality assurance is always monitored by our parent company. They are giving us proper guidance and support on the technical development front. They are satisfied with our production. In certain areas like Europe and the Middle East, we are supplying on behalf of them. The quality of Nitta products all over the world is the same. In India, we are the only company of Nitta Gelatin Inc, Japan.

GRASSROOTS INITIATIVE Development & Healthcare

NGO rears rural, tribal societies in a novel way Development and healthcare are conjoined twins. Segregation of one from the other can cause ruptures in the evolutionary cycle of mankind and nature. So, the vital organs of society and the government that are engaged in the upbringing of these twins must have an in-depth knowledge of the geographic and demographic profile of a particular region. Or else, even the best of growth plans may fall flat. Fortunately, our society has a great number of visionaries who understand the misery of the people living on the fringes and know how to create a sustainable growth environment, craft simple life solutions and raise the conjoined twins of development and healthcare in a responsible manner. In this edition, we focus on the initiatives of a socially committed Bishop and a Catholic Diocese that led to the birth of an NGO ceaselessly working towards improving the quality of life of tribals and villagers in three districts of Kerala. The story takes us three decades back in history By Our Correspondent daily transactions for livelihood. These tribals were still depending on a barter system, wherein they exchanged their farm produce, (spices, mainly cardamom), for a handful of bare essentials from the traders. Saddened by their plight, he started thinking of a way to get these tribals out of their misery. Bishop Arackal then knocked on the doors of various governmental agencies, seeking introduction of some tribal development projects. He also enlightened the tribals on their exploitation by traders and made them aware of a better means to market their Mar Mathew Arackal, Bishop of Kanjirapally Diocese farm produce in a more effective and fruitful n 1978, the social mission of Mar way. Taking note of his efforts, the Tribal Mathew Arackal, the current Bishop Welfare Department too chipped in with of Kanjirapally Diocese and the then some welfare schemes. priest, brought him in touch with the Gradually, as the plight of the Ulladan tribes of Vanchivayal village in tribals improved, well-wishers started Peermade Taluk of Idukki district. He got suggesting that Bishop Arackal should a true picture of the exploitative life they give a concrete shape to his mission by had been leading upon witnessing their

forming an organisation exclusively working for tribal welfare. In 1980, Peermade Development Society (PDS) was registered under the TravancoreCochin Literary and Charitable Societies Act of 1955 as a social service wing of the Kanjirapally Diocese under the stewardship of Bishop Arackal. What began as a tribal development initiative three decades ago has evolved into an integrated developmental mission covering 52 villages, spread over Idukki, Pathanamthitta and Kottayam districts of Kerala. Let’s take a look at various programmes of PDS that should ideally be remodelled, emulated and adopted by developmental agencies and governmental organisations to help the socially and economically backward people gain equity and access to healthier modes of living.

Organising and empowering villagers

“Development should go beyond administrative boundaries. It should not merely be location-specific. The geographic units and demographic profile have to be taken into consideration before any development initiatives are undertaken. Granting subsidies to tribals and villagers is not enough,” says Joseph Mathew, Chief Coordinator at PDS. Therefore, he says, PDS thought of organising and empowering tribals and villagers by making them active partners

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Service is our vocation. We spare no opportunity to serve our brothers and sisters. It is our mission to bring them into the mainstream. Our goal is to empower men and women through every programme Rev Dr Hubby Mathew, Executive Director, Peermade Development Society

in the developmental process. PDS started organising tribals and villagers in groups and asked them to identify and prioritise their day-today problems. PDS not only introduced them to this concept of self-evaluation, but also trained them to take on managerial and supervisory roles in such processes. They made a good start with the formation of a farmers’ club and a women’s club. Gradually, PDS taught them how to manage their own credit. That’s how the concept of a credit union came into existence, helping these people in keeping local money lenders at bay. In 1987, the first credit union started receiving deposits and loans. For the record, a credit union comprised 249 families. While other developmental initiatives were afoot, PDS never gave up on the concept of self-sufficiency. In 1997-98, PDS, in collaboration with Canadabased Save A Family Plan, helped some villagers

establish a discussion forum, comprising family units. Again, the purpose of such a forum was to overcome day-to-day problems. The success of this initiative inspired PDS to help villagers form Swayam Sahaya Sangam (Self Help Group - SHG). The state-owned National Bank for Agriculture and Rural Development (NABARD) recognised the potential of SHGs and started supporting this initiative. Various other agencies such as Catholic Organisation for Joint Financing of Development Programmes and Misereor as well as the rural development and agriculture departments of the state government too evinced interest. This new-found interest among various agencies paved the way for the transformation of credit unions into SHGs, each comprising 20 families. As a next step, PDS taught villagers about the need to save their earnings. PDS thus introduced them to

Officials of Peermade Development Society training village women

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GRASSROOTS INITIATIVE Development & Healthcare Around 3,000 acres have been brought under organic farming in Idukki district

an informal banking system with a women’s group at the helm. Today, there are 1,820 SHGs across 52 villages in Pathanamthitta, Kottayam and Idukki districts. Vision, Strategy & Areas of Operation PDS has a structured organisational set-up, with Rev Dr Hubby Mathew, a social visionary with over 30 years of experience in social empowerment activities, as its head. Its governing body is led by Rev Dr Mathew Paikkat. Inspired by the Biblical passage “That they may have life and have it abundantly (John 10:10),” the vision of PDS is simple and workable. The first step in a developmental initiative is to organise and unite people. Secondly, SHGs are formed. Thirdly, the villagers are trained for capacity building. There are various kinds of training programmes to teach villagers different aspects of development and management. They are taught to hold daily/weekly/monthly review meetings, manage accounts and conduct audit/appraisal/evaluation of their programmes. Upon successful completion of the training programmes, villagers are provided affiliation certificates by PDS, which monitors their reports regularly. The basic objective is to groom leaders. As part of this objective, PDS encouraged villagers to form

“Federations” and Village Development Councils, which constituted leaders of SHGs, on the basis of regions. Further, an organiser from each village was nominated to bring about accountability among the village development councils. These organisers took stock of the developmental programmes by holding a joint session once in six months. Thus, they took care of monitoring, evaluation, implementation and further planning. All these components of developmental planning facilitated the adoption of the Participatory Rural Appraisal Method, which enabled villagers to take up innovative projects after a situational study. “This is an effective model of policy-making and formulation at the grassroots level,” says Mathew. All PDS projects are based on the model of sustainable development. Today, about 30,000 families are part of the PDS system of SHGs. PDS has also expanded its area of operation to 20 tribal settlements in Idukki district. The strategies of capacity building and creation of awareness have been adopted to enable tribal communities to enhance their potentialities. Strategies like promotion of SHGs, establishment of consumer stores, cultivation of medicinal plants with buy-back arrangements, collection of organic spices and organic tea leaves from tribal

farmers at a price higher than the market rate, and implementation of watershed development programmes have helped in ensuring tribal welfare. Besides, PDS has an organic agroproducts and export division, which purchases spices from certified farmers. They are processed before exports, at the PDS organic spice processing unit. This ensures better income for farmers, who are also part of the Sahyadri Farmers’ Consortium. PDS operations can be classified into four areas: a) Natural Resource Management; b) Sustainable Health; c) Rural Technology Development; and d) Human and Institution Development. Natural Resource Management In the early 1990s, a close interaction with the residents of Peruvanthanam village in Peermade Taluk made PDS realise that there is a need for a watershed management system that could enable them to make judicious use of all available resources. Modelled after Anna Hazare’s watershed development programme in Ralegan Siddhi, PDS developed Kerala’s first watershed project with the help of the European Economic Community. In all, PDS has developed eight such projects in Idukki district over the years. It is one of the support voluntary organisations of the Council of Advancement of People’s Action and Rural Technology (CAPART) for promotion of the watershed development programme in Kerala, Tamil Nadu, Andhra Pradesh and Puducherry. These programmes have helped conserve land, water and biomass.

Sustainable Health

Organic Farming: PDS’s initiative in organic farming is a counter movement against degenerative and unaffordable chemical applications. By applying research and technology solutions, it has helped thousands of marginal farmers in taking up organic farming. It provides them organic seeds, earthworms and compost. Around 3,000 acres have been brought under organic farming in Idukki district. As of now, PDS is one of Asia’s biggest exporters of organic farming products. Biotechnology: PDS has a highly sophisticated tissue culture unit for mass promotion of medicinal plants using biotechnology tools. Biocontrol agents: PDS has wellequipped laboratories for research,

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development, and multiplication of important biocontrol agents. Biocontrol agents like Metarhizium and Beauveria are being multiplied in collaboration with the Indian Cardamom Research Institute. Sahyadri Ayurveda Division: This PDS unit promotes Ayurveda and other traditional branches of medicine. It includes a 13-acre ethno-medicinal forest, herbal nursery, seed and raw drug museum. It has a community programme involving 4,000 families from nearby villages. The GMP-certified Sahyadri Ayurvedic Pharmaceuticals produces 236 varieties of Ayurvedic medicines, promoted through SHGs and other organisations. PDS also runs the state-of-the-art Sahyadri Institute of Ayurveda, which trains Ayurveda nurses and therapists. Technology Resource Centre: Approved by CAPART, it has all the expertise and infrastructure to carry out experiments in the areas of organic agriculture, indigenous health, tissue culture, and crop biotechnology. This centre trains voluntary organisations, local farmers, and model farmers on organic farming and indigenous health practices.

Rural Technology Development & Grassroots Innovations

Since inception, PDS has been engaged in promoting rural technologies and grassroots innovations. Documentation of farmer’s innovations and unique traditional knowledge, development of appropriate projects and models for value addition, and dissemination of rural technology are some of the pioneering works done by PDS. PDS is the regional collaborator of the National Innovation Foundation and Honey Bee Network for Kerala. It is engaged in scouting and documenting grassroots innovation from Kerala and Lakshadweep. Over 50 innovations documented by PDS have received national level recognition. The Innovators’ Technology Development Centre, established by PDS, is a unique model for value addition, product refinement, and IPR protection of grassroots innovation through a land to lab approach.

Human and Institution Development

Started in 1995, Marian College is an undertaking of PDS providing FUTURE MEDICINE I August 2012

quality education in information technology, commerce, social work and management. The National Assessment and Accreditation Council has given the college an ‘A’ Grade with a cumulative grade point average of 3.45 on a fourpoint scale.

Other initiatives & recognitions

Women’s development programme: The launch of a women’s development department gave a fresh direction to the community development initiative of PDS. There are about 32,000 women in over 1,800 SHGs. The skills of these and other women from villages and tribal settlements are developed through training programmes on umbrella-making, quail farming, book binding, rabbit rearing, soap-making, maintenance of plant nurseries, wool knitting, repair of electronic goods, electric embroidery, and screen printing. Family Sponsorship Programme: Canada-based Save A Family Plan, Austria-based Family Care Programme and Akiton Erzengel Rafael, and the German Sponsorship Programme give guidance and financial help for this programme of PDS. About 1,330 families have been helped so far through this project, which aims to provide them basic minimum amenities. Research: Since 1990, PDS has been receiving support from the Department of Science and Technology of the Government of India for researches in agriculture, Ayurveda, animal husbandry, and anthropology. PDS’s Core Support Programme has been sanctioned for the second time by the Department of Science & Technology of the Government of India with effect

from July 2009. Under this programme, technological solutions are provided to different population groups in rural areas. A senior programme officer, an agriculture scientist, a business development officer, and an engineer are working under the programme. The programme supports knowledgebased enterprises among women groups, tribal and other weaker sections by developing indigenous knowledge and technologies. It identifies the problems of tribals and other weaker sections of Kerala and equips/empowers NGOs and young professionals to take up science and technology projects and solve their problems. Tribals and villagers are taught how to carry out organic farming in spices, rice, banana and tuber crops. There are also technologies for reducing drudgery. The Women’s Technology Park Project is one such initiative promoting technology-based entrepreneurship among women in Idukki district. Entrepreneurship Development: PDS is the programme implementing agency of NABARD for conducting the Rural Entrepreneurship Development Programme in Idukki district. Rashtriya Mahila Khosh: A national credit agency under the Department of Women and Child Development of the Government of India has appointed PDS as the nodal agency for its women’s micro credit programme for the eastern districts of Kerala. If healthcare and development are given equal attention at the grassroots level, there’s no reason why the tribal and rural population cannot lead a healthy life of self-sufficiency without the pressure of joining the mainstream.

Sahyadri Research & Training Centre

BATTLING HIV/AIDS

‘Berlin Patient’ totally cured of AIDS virus? Timothy Ray Brown, believed to be the only man to have been cured of AIDS, plans to join the search for a cure for others by founding an AIDS research foundation. “I am living proof that there could be a cure for AIDS,” Brown, widely known as the ‘Berlin Patient’, announced at a press conference in Washington last month. “I am now choosing to dedicate my life, my body, and my story to finding a cure for AIDS.” Brown said he would partner with the World AIDS Institute to raise money for research into a cure. But researchers in California have found traces of HIV in his tissues, raising a question mark Bureau

he world is on the verge of a significant breakthrough in the fight against Acquired Immune Deficiency Syndrome (AIDS). In his first American press conference last month, Timothy Ray Brown of San Francisco, known in medical circles as the “Berlin Patient”, declared: “I am HIV negative. I am cured of the AIDS virus.” Brown, 46, was diagnosed as HIV positive 18 years ago and had begun antiretroviral treatment. His case was complicated by acute myeloid leukaemia, which was diagnosed in 2006. It was this diagnosis

that has resulted in the possibility of a cure for AIDS. His physician, German hematologist Dr Gero Hutter, introduced Brown to a revolutionary treatment for leukaemia that turned out to be a cure for both diseases. Dr Hutter gave Brown a stem cell bone marrow transplant from a donor who had a natural immunity to HIV, called a CCR5 mutation, which is found in less than one per cent of Northern Europe’s population. After receiving the transplant, Brown was found to have no active HIV cells in his body.

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Brown is now being called as the “miracle patient”, although some scientists question whether HIV cells have actually disappeared from his body and if the man indeed can no longer infect others.The disease has claimed millions of lives across the globe and continues to threaten

the well-being of many others, particularly in Africa. Finding a cure for the ailment has been highly challenging and has consumed enormous resources. It is yet to be seen whether the approach that has worked wonders in the case of Brown will work for others.

‘Recovered is the right term’ To make a better sense of the breakthrough, Future Medicine interviewed Dr Gero Hutter. Excerpts: Firstly, tell us how have you achieved the breakthrough. Was it an accident or a purposeful blood stem cell transplant to treat leukaemia as well as HIV? It was with purpose. After it was clear that the HIV patient will receive an allogeneic stem cell transplantation, there were several months left

The results (of other researchers) are controversial and somehow contradicting. However, there might be traces of HIV left in the patient, but for the past five-and-a-half years, the virus has not replicated. So the right term could be ‘recovered’ from HIV infection. The question of eradication is still unsolved to look for a donor with a special HIV-resistance mutation. After testing several matching donors, we found at least one of them with that specific CCR5-delta32 mutation. Can you explain the role of ‘delta32 mutation’ in this treatment? HIV requires the chemokine receptor CCR5 for invasion of the target cells. HIV can also use other chemokine receptors, but in the presence of CCR5, the virus always prefers CCR5 - the CCR5-delta32 mutation confers to an inactive

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CCR5 receptor. People with homozygous mutation do not express CCR5. By changing patients’ CCR5 state to a CCR5 non-presenter, HIV has lost their target cells. Due to a currently unknown mechanism, HIV could change his affinity to other chemokine receptors. Some researchers claim that there are still traces of the virus in Timothy Ray Brown’s body. What do you have to say about this? The results (of other researchers) are controversial and somehow contradicting. However, there might be traces of HIV left in the patient, but for the past five-and-a-half years, the virus has not replicated. So the right term could be “recovered” from HIV infection. The question of eradication is still unsolved. What’s the next plan of action towards evolving a clinical process for treatment of HIV patients? There are upcoming promising trials, which mimic the natural CCR5-delta32 mutation like the Sangamo zinc-finger trial. One of the currently treated patients has also achieved viral control like the Berlin patient. No other HIV treatment has achieved this before. How have the medical and scientific communities received your breakthrough? I have presented the preliminary results at the 2008 Conference on Retroviruses and Opportunistic Infections. After that, a report in the Wall Street Journal of a meeting in Boston had started a worldwide media campaign. The scientific report was published in February 2009 in the New England Journal of Medicine.

PHARMA SCAN Gujarat

Bouncing back with

foreign investments Leading pharma giants are catapulting Gujarat’s pharmaceutical industry back into the global centre stage, the front-runner being a joint venture between Israel-based Teva Pharmaceutical Industries and the US-based Procter & Gamble that plans to invest Rs 500 crore in the state. Until the slowdown in 2009, Gujarat’s pharma companies have been performing consistently in terms of production as well as exports. Now, it’s time to shake Gujarat’s pharma companies out of slumber By Dipin Damodharan Narendra Damodardas Modi and Gujarat seem to be the buzzwords for both Indian and global business players these days. With the prospects of foreign investment once again looking up, Gujarat’s pharmaceutical sector, which was hit by a slowdown in 2009, is set to bounce back in the growth charts and move to the global centre stage. Currently, Gujarat accounts for about 40 per cent of the country’s total pharmaceutical production. After the

2009 slowdown in the pharma sector, the state has been trying hard to regain its title as the best pharma hub. Chief Minister Modi, popular for his investorfriendly policies, has a reason to smile now, with many leading global pharma companies, including Israel-based pharma giant Teva Pharmaceutical Industries (TPI), vying for a strong foothold in Gujarat. Reports from the Food and Drug Control Administration (FDCA),

Gujarat, point out that the advent of Teva in Gujarat would be in the form of a joint venture with the $80 billion US-based Procter & Gamble (P&G). TPI and P&G joint venture P&G Teva will soon set up its first manufacturing facility at Sanand in Gujarat. TPI, listed at the New York Stock Exchange, has plans to set up an over the counter drug manufacturing facility with an initial investment of Rs 250 crore. The $20 billion Israelbased Teva, which has more than 1000

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The $20 billion Israel-based Pharma giant Teva and $80 billion US-based Proctor & Gamble will invest Rs 500 crore in Gujarat products and an employee strength of 60,000, is among the top 15 global pharmaceutical companies. P&G Teva will invest a total of Rs 500 crore in Gujarat. Sources from the Gujarat government tells Future Medicine that many pharma companies from various developed countries, including Germany, are now keenly showing interest in setting up their manufacturing plants in the state. The US-based generic pharma manufacturer Amneal Pharmaceuticals, New Jersey-based Apicore LLC, the manufacturer of specialty Active Pharmaceutical Ingredients, and Singapore-based Biosensors International, among others, have plans to start manufacturing units in the state. Growth years of Gujarat’s pharma sector Growth in Gujarat’s pharma sector

can be traced back to the early 1990s, with the dawn of globalisation and liberalisation opening up the markets. With the advent of liberalised policies, the pharma companies in Gujarat had witnessed a giant leap in their production and exports. The comparatively low cost in production and research attracts pharma companies to the state. During the 2007-08 period, the state had registered a commendable growth rate, 14-15 per cent in the pharma sector alone. But after that, the growth crashed as the exports hit a negative growth rate. The growth had come down to around 9 per cent in the 2008-09 period. The state’s share in national pharmaceutical production, which once stood around 42 per cent, had fallen to 20 per cent during 2008-09. Pharma companies had begun to prefer tax-free hill states like Uttarakhand, Himachal

Pradesh and Sikkim. As the tax exemption period in those states came to an end in 2010, the companies are coming back to Gujarat. In addition to that, the state government has decreased the excise duty to 4 per cent from 16 per cent in 2006-07. Naturally, in such a scenario, Gujarat becomes more attractive for pharma companies. As a result, the pharmaceutical exports from Gujarat again moved northwards in the 2010-11 fiscal; the exports hold a growth rate of 12 per cent. Data from the Indian Drug Manufacturers Association show that the total exports from Gujarat in the pharma sector touched around Rs 11,000 crore in the 2010-11 fiscal. Companies like Sun Pharma, Zydus Cadila, Torrent and Dishman have been expanding their global footprint through acquisitions and international alliances during the last decade.

Companies in expansion mode Dishman Ahmedabad-based Dishman Pharmaceuticals and Chemicals employs over 1,000 people worldwide. The Bombay Stock Exchange (BSE) listed firm had an annual net sales of around $200 million in 2011. Recently, the company’s wholly-owned subsidiary Carbogen Amcis AG., Switzerland has acquired Creapharm Parenterals, a subsidiary of France-based Greapharm Group.

Torrent Pharmaceuticals Torrent Pharmaceuticals, the flagship company of Torrent Group, is based in Ahmedabad. The company, operating in more than 50

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countries, has an annual turnover of Rs 2650 crore. The Q1 revenues of Torrent stood at Rs 767 crore in this fiscal, up by 19% from Rs 642 crore in the same quarter last year.

Zydus Cadila

With its base in Ahmedabad, Zydus Cadila, is on its second phase of expansion. The group has presence in four continents, the Americas, Asia, and Europe. The company has shown good results in the first quarter of this fiscal, with a net profit of Rs 135 million against Rs 85 million in the corresponding period last year. Sales in the last quarter climbed to Rs 1,033 million from Rs 914 million in the corresponding quarter of the previous year.

• Gujarat accounts for about 40 per cent of the country’s total pharmaceutical production • Pharma exports had a growth rate of 12 per cent in 2010-11 fiscal

TECH TRENDS IN MEDICINE

Faster microfluidic chip

esearchers from Boston University, Harvard, and the Beth Israel Deaconess Medical Center have reported in the journal PLoS ONE that they have built a faster, cheaper, and disposable microfluidic chip that rivals in accuracy the gold-standard diagnostic test known as RT-PCR. For their four-year study, funded by the National Institutes of Health and involving 146 patients with flu-like symptoms, researchers essentially miniaturised the RT-PCR test into a chip the size of a standard microscope slide and analysed two types of nasal specimens as accurately as the lab-scale method.

Temperature check, the iPhone way

edisana ThermoDock gets you one step closer to having a medical toolkit like Dr McCoy on ‘Star Trek’. This is an infrared device that plugs into your iPhone. Point it at your forehead, your dog, or your iPad 3, and take its temperature. The nice thing about infrared is that you don’t have to stick the ThermoDock where the sun doesn’t shine. This gadget can also be used to check the ambient temperature of your room, or great outdoors.

3D atlas of the brain

edical education app publisher eMedia of Ireland has just released Pocket Brain, a fully searchable interactive 3D atlas of the human brain, for the iPhone and iPad. For $19.99, the interactive app for iPhone and iPad renders the old-fashioned textbook pretty close to obsolete. A few particularly inspired features: the 3D rotating brain includes nine layers to explore, relevant clinical cases, easy note insertion, various quizzes, and more. And because all content lives in the app itself, no Wi-Fi or 3G is required.

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Pharmerging markets SECTORAL GROWTH

Global medicines market poised to grow at 5-7% The annual global spending on medicines will rise from $956 billion in 2011 to nearly $1.2 trillion in 2016, and the four major Pharmerging Markets - China, Brazil, Russia and India - will experience an unprecedented growth in the next four years because of greater government investment in healthcare, rising demand for drugs, and the willingness of multinational players to launch products in these regions, says a new report Bureau

recent forecast issued by the USbased IMS Institute of Healthcare Informatics, a leading provider of information, services and technology for the healthcare industry around the world, reveals that the global market for medicines is poised to grow from 3-4 per cent in 2012 to 5-7 per cent in 2016. In its report titled The Global Use of Medicines: Outlook through 2016, the institute observes that the annual global spending on medicines will rise from $956 billion in 2011 to nearly $1.2 trillion in 2016, representing a compound annual growth rate of 3-6 per cent. Growth in annual global spending is expected to more than double by 2016 to as much as $70 billion, up from $30 billion this year, driven by volume increases in the Pharmerging Markets and an uptick in spending in developed nations. Developed markets are expected to experience their lowest annual growth this year, at less than one per cent or $3 billion, and then rebound to $18-20 billion in annual growth in the 2014-16

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period, the report adds. “As health systems around the world grapple with macroeconomic pressures and the demand for expanded access and improved outcomes, medicines will play an even more vital role in patient care over the next five years,” says a senior analyst with IMS Institute for Healthcare Informatics. “The trilliondollar spending on medicines we forecast for 2016 represents a rebound in growth that will accentuate the challenges of access and affordability facing those who consume and pay for healthcare around the world,” he adds.

Paradigm shift

Annual spending on medicines in the Pharmerging Markets will witness an increase from $194 billion in 2011 to $345-375 billion by 2016, or $91 in drug spending per capita. This increase will be driven by rising incomes, continued low cost for drugs, and governmentsponsored programmes designed to increase access to treatments – by limiting patients’ exposure to costs and encouraging greater use of medicines.

Generics and other products, including over-the-counter medicines, diagnostics and non-therapeutics, will account for approximately 83 per cent of the increase, the analysis indicates. According to studies conducted by IMS, the four major Pharmerging Markets, China, Brazil, Russia and India, will experience an unprecedented growth because of positive developments such as greater government investment in healthcare, rising demand for drugs, and the willingness of multinational players to launch products in these regions. The report also identifies the following trends in the industry: Health systems in developed economies will experience slow growth in medical spending Spending on medicines in developed nations will see a growth between $60 and $70 billion from 2011 to 2016, following an increase of $104 billion between 2006 and 2011. Despite the highest number of patent expiries in history, spending in the US will grow by $35-45 billion over the next five

SECTORAL GROWTH Pharmerging markets

Source: IMS Health, Market Prognosis, April 2011; Market size ranking in constant US$

years, as newer medicines that address unmet needs are being introduced and patient access expands in 2014 due to implementation of the Affordable Care Act. In Europe, growth will be in the -1 to 2 per cent range, owing to austerity programmes and healthcare costcontainment initiatives. The Japanese market for medicines is forecast to grow by 1-4 per cent annually through 2016, slightly lower than the rate during the prior five years and reflecting biennial price cuts scheduled for 2012, 2014 and 2016. Pharma manufacturers will see minimal growth in their branded products in the coming years The market for branded medicines will experience flat to 3 per cent annual growth through 2016 to $615-645 billion, up from $596 billion in 2011. In the major developed markets, branded medicine growth will be severely constrained at only $10 billion over the five-year period due to patent expiries, increased cost-containment actions by payers, and modest spending on newlylaunched products. The Pharmerging Markets are expected to contribute $25-30 billion in branded product growth over the same period. Off-invoice discounts and rebates will offset about $5 billion of global branded medicine growth. Manufacturers of small molecule generics to experience accelerating growth

Global generic spending is expected to increase from $242 billion in 2011 to $400-430 billion by 2016, fuelled by volume growth in Pharmerging Markets and the ongoing transition to generics in developed nations. The impact of patent expiries primarily will be felt in the US. In the recession-hit Europe, limited savings from expiring patents are prompting policy shifts to encourage greater use of generics and lower reimbursement for these products. Providers will have more treatment options with the launch of additional new medicines Global launches for New Molecular Entities (NMEs), basically molecules developed by innovator companies in the early drug discovery stage, will rebound during the next five years. From 2011 to 2016, 160-185 NMEs are expected to be launched, compared with 142 between 2007 and 2011. Innovative therapies to extend or improve patients’ quality of life are anticipated for treatment of Alzheimer’s, autoimmune diseases,

diabetes, and a number of cancer and orphan diseases. Treatments for global priority diseases, such as malaria, tuberculosis, and neglected diseases, are expected to improve, although gaps will remain. Biologics manufacturers will benefit from expanding market opportunity Biologics, medicines created by biological process, are expected to account for about 17 per cent of total global spending on medicines by 2016, as important clinical advances continue to emerge from researches across the world. Seven of the top ten global medicines by spending will be derived out of biological processes within the next five years. Adoption of bio-similars as low-cost alternatives to the original biologic medicines will remain limited, as biologics remain protected by patents or market exclusivity in many countries. The report also warns that it won’t be a plain and smooth sailing for many pharmaceutical companies, especially those operating in the generic domain as ‘big companies’ as they are becoming less innovative. This essentially means that the growth pipeline for generic drug makers is becoming narrow and their competition is increasing. Also, Europe and the US companies are increasingly turning their attention to ‘tough to copy’ products and even entering the generic market to supplement their growth.

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YOGA & MEDITATION

Serpent pose can strengthen abdomen muscles

Yoga is a mental, physical and spiritual discipline that has its roots in the ancient systems of healing. It can help a person stay healthy, peaceful and focussed by bringing about a union of body, mind and soul. Today, more and more people across the world are taking to the yogic way of life. As Patanjali, the architect of yoga, says: “Yoga is the means by which our mind can be made still, quiet and free from all distractions.” Yoga offers a one-point solution in one’s life. “Yoga therapy is a complete solution from all health problems. If a person practises it from childhood, his brain will sharpen and he will be able to lead a joyful life,” Sanjay Kumar, a yoga expert and Director of Art of Divine Yoga Foundation tells Future Medicine. He says that yoga is a natural way of life and the various Asanas (postures) in yoga can help in curing various ailments. In this edition, we focus on the benefits of Bhujangasana. By Dipin Damodharan

What is Bhujangasana? Bhujanga = serpent or snake.

Bhujangasana actually means the Snake Pose or Cobra Pose. This pose is famous for strengthening the abdominal muscles and back muscles. It is the seventh asana in the famous Suryanamaskara sequence. Lay on the floor with face down; make the palms flat on the floor, next to the chest. Note that your elbows are close to your body. Make sure that the heels and toes are FUTURE MEDICINE I August 2012

together. For beginners, it is good to place the nose or chin on the floor. Once you are comfortable, you have to place the forehead on the floor. Inhale slowly and stretch the entire body, and lift the head up and expand the chest forward. You have to roll upwards by using the back, neck and head. Then look upwards at 45 degrees. The elbows should be positioned right next to your body. The abdomen has to press down on the ground. Hold this position up to 15 or 30 seconds. While releasing, breathe out and slowly return to the original position.

Benefits • Will strengthen abdomen muscles • Very useful for diabetic patients • Relieves from stress and helps maintain youthfulness • Will improve the condition of heart

TRADITIONAL MEDICINE Acupuncture

Needling into an ancient

Chinese way of healing

Modern medicine is being supplemented by the traditional branches of medicine with natural healing methodologies that have been used since time immemorial. Acupuncture, an alternative medicinal solution, is still widely being used for curing many diseases and body disorders Bureau

odern day medical practitioners should be thankful to the Chinese for their immense contributions to the traditional systems of healing. Acupuncture is one such wonderful contribution made by the traditional Chinese healing experts. Its use can be traced to the ancient times in China, when soldiers hit by arrows were cured of chronic ailments that could not

be treated otherwise. This alternative medicinal methodology is still widely being used across the world against various diseases and body disorders. Acupuncture cannot be restricted to a specific branch of medicine. It is used by practitioners of Herbalism, Homoeopathy, Naturopathy, Orthopathy, Osteopathy, and Ayurveda. There are scores of research studies that have

proved the effectiveness of Acupuncture in curing certain types of pain and postoperative nausea.

Origin of Acupuncture

Acupuncture originated in the cold north-west parts of China, where herbs and other medical remedies were scarce. Thereafter, it spread from China to other parts of the world through travelling physicians, scholars, and pilgrims. In

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India, Acupuncture has been a part of Ayurveda since ancient times.

About Acupuncture

Acupuncture is a medical technique usually involving the shallow insertion of needles through the skin at particular points on the body called acupoints. Acupuncture is based on the idea of allowing the body to naturally heal itself from all kinds of ailments. It helps in sickness prevention, ailment removal, and slowing down the ageing process. The needles used in Acupuncture treatments are very thin, about the width of a hair. Under Acupuncture, thin, solid needles are inserted into the acupoints of the body, which stimulates the body and corrects the imbalances in the flow of Qi (it is the element of the body which enables the living beings to lead a healthy life). There are over 500 acupoints in a human body. Only the expert ones in this field can make best use of it. During Acupuncture, endorphins, that are a part of our body’s natural pain-control system, may be released into the central nervous system. It stimulates the spinal cord and other nerve systems of our body and releases pain-suppressing neurotransmitters. Acupuncture needles increases the amount of blood flow in the area around the needle. The increased blood flow may supply additional nutrients, or remove toxic substances, or both.

Benefits of Acupuncture

Clinical researches and studies on Acupuncture assure that it can treat a variety of diseases which affects the respiratory system, eyes and mouth, and gastro-intestinal, neurological and muscular disorders. Acupuncture provides the best results for headaches, migraine, and back pain. It is used to stop smoking, lose weight, lower blood pressure, and treat constipation, anxiety, insomnia, allergies, asthma and

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various skin disorders. Significantly, Acupuncture helps Diabetics and those suffering from Osteoarthritis. “Acupuncture has become a popular alternative treatment for Osteoarthritis. The usual treatment course is one to three months of weekly treatments, dietary and herbal prescriptions, and Tai Chi or Qigong exercises. There are various etiologies and variances of this condition, so a thorough evaluation with a licensed practitioner will assist in determining the proper course of action” says Dr Mao Ni, an Acupuncture expert from China.

Acupuncture and Diabetics

Experiments have shown that Acupuncture can activate Glucose 6-phosphatase, an important enzyme in carbohydrate metabolism, and affect the hypothalamus. It can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells, and accelerate the utilisation of glucose, resulting in lowering of blood sugar. It also lowers the release of pancreatic glucagons; attenuates symptoms of polyphagia (the urge to eat too much), polydipsia (excessive thirst), and polyuria (excessive passage of urine); prevents slowing of motor nerve conduction; improves microcirculation and myocardial contractility; enhances blood outflow, and regulates vascular peripheral resistance; obliterates atherosclerosis of the legs; induces secretion of endogenous beta-endorphin; and elevates a lowered pain threshold.

Types of Acupuncture

Acupuncture therapy varies from place to place and person to person. Shonishin - Acupuncture for Children: This treatment is applied on children for diseases like failure to thrive syndrome, weak constitution, Colic, excessive night crying, temper tantrums, indigestion, Gastroesophageal Reflux Disease, constipation, and diarrhea, night terrors, Attention Deficit Hyperactivity

Disorder, allergies, asthma, and colds, eczema and hives, ear infections, bedwetting etc. The application of Shonishin way of Acupuncture treatment varies according to the age and gender of the child. Cupping: This technique of Acupuncture is quite popular across the world. Under this technique, a glass cup, or bamboo jar, is heated from the inside with fire to create a vacuum and then placed on the afflicted area of the body. The cup’s suction pulls at the skin and is said to “suck out” the body’s toxins. Cupping stimulates the flow of blood, lymph, and Qi to the affected area; It can also relieve a person of swelling, muscle pain, back pain and pain from stiffness or injury. It also clears congestion in the chest, which occurs with common colds and influenza. Auricular Acupuncture: This technique is one of the widely used microsystems within Eastern medicine. Microsystems use one aspect of the body - for example, the ears, hands or feet - to treat conditions that are present anywhere in the body. It is commonly used for pain control and against drug, alcohol, and nicotine addictions. This technique is based on the idea that the ear is a microsystem of the entire body represented on the auricle, the outer portion of the ear.

Adverse effects of Acupuncture

Serious adverse effects include Pneumothorax, spinal lesions, and Hepatitis B transmission. Other possible side effects are fainting during treatment, nausea and vomiting, increased pain, diarrhea, local skin irritation, bruising, needle site bleeding, psychiatric disturbance, headaches, spinal cord injury, and punctured organs. Therefore, if you are planning to undergo Acupuncture, make sure that you consult only authorised and licensed practitioners.

CHILD PSYCHOLOGY

Dr V Anand Prakash Rao Ghorpade

Ways to tackle abnormal fear among children

irst and foremost, I would like to thank you for picking up this article to read. I invite you to accompany me in this inward journey of the mind and its common problems. A few days back, one anxious mother visited me to take advice from me about her only daughter’s abnormal fear and some physical symptoms which were noticed since a month-and-a-half. As I started examining her from the psychiatric angle, looking into the past events of the person that may have led to this problem, it became very clear that her psychological problem was not very serious and that her mother was overreacting to it. The seven-year-old child, who entered into first standard this year, had developed an abnormal fear from the smell of insecticide and the sighting of a millipede in the bathroom. During such panic attacks, she used to complain about a burning sensation all over the body, expressing the fear that she may not live at all. She was also not allowing others to switch on the mosquito repellant in

the house. These symptoms were absent when the child was with her friends or engaged in studies etc. This problem has not had any kind of impact on her sleep, appetite or studies. The child’s mother was over concerned about it because of a few doubts. Has this problem arisen because of parental attitude? Is this problem going to last for a long time or is it a transitory one? Psychiatrists consider these kind of problems in children as cases of simple phobia, which is very natural and common. They outgrow it over a period of time. Some children may not be able to outgrow it and may develop different kinds of abnormal fear during their adult life. Hence the slogan “Prevention is better than cure”. How can we prevent these kinds of abnormal fear among children? A child’s mind undergoes constant changes until adolescence because of various aspects of environmental stimuli to which they are exposed during their growth period. Curiosity and inquisitiveness are the hallmark of

childhood, which helps them gain more and more practical knowledge about life. During this period, the presence of a teacher/guide, invariably parents, is of paramount importance. Parents act like a role model to children to inculcate good values in them. This is what we call ego, whose function is to balance the inner desires and parental or social control. Balanced ego results in ideal or satisfactory behaviour and thus the personality of that individual is also stable. In the present case, there was a failure of ego which landed the child in an abnormal state. Parental approach towards such children has to be very refined and tactful, so that natural abilities are not thwarted and chances of he or she becoming a stable person are not lost. These preventive measures are of utmost importance, though they are usually not given enough attention, which results in psychological problems in later years. You may be wondering that talking is very easy but carrying it out in practice is difficult. You are right, but that does not mean that one has to take a helpless position. Rather, one has to think of correcting one’s mistakes often so that the quality of life is much better. Here, I would like to emphasise the values of one’s culture and religious practices, which should never be ignored because they offer good defence. Children are considered as the biopsy of the family. Whenever a child is brought for consultation, the whole family has to be examined before the child. Our journey ends here, and I wish you and your family a good and prosperous health. (Retired Professor & Head of the Department of Psychiatry, M S Ramaiah Medical College, Bengaluru. He is also the Consultant Psychiatrist at Indian Institute of Science, Bengaluru. The author can be reached at anandprakashg@yahoo.com)

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PHARMA FOCUS Shantha Biotech

Dr Harish Iyer

New age vaccines in the pipeline Established by Dr K I Varaprasad Reddy in 1993 as a research and development outfit at Osmania University, Hyderabad, under an industry-university interactive programme, Shantha Biotech has matured into a successful pharmaceutical venture in a short span of time. Today, it is a leading manufacturer of cost-effective vaccines. Following its acquisition by global pharma giant Sanofi Aventis in 2009, Shantha Biotech, the first in India to develop and market r-DNA Hepatitis-B Vaccine, is in the process of developing its pentavalent vaccine Shan5, which is undergoing clinical trials. In an exclusive interview with Future Medicine, Dr Harish Iyer, Shantha Biotech’s Managing Director and CEO, talks about the company’s research initiatives, growth platforms, and the synergy brought about by the acquisition By Sreekanth Ravindran

How has the company benefitted from its deal with Sanofi? Sanofi and Shantha share the same vision of the role of Shantha: a company driven by societal needs. Our goal is to make vaccines affordable for India and the South. Shantha is a great fit with Sanofi Pasteur; the Group is maintaining Shantha’s integrity and autonomy. The change comes from having more products, more expertise in the field of vaccines. It is like being able to rely on an experienced partner in Sanofi, who can come and help when you need it. Developing vaccines is a complex activity. It requires a high level of technical expertise, for which we are getting a lot of support from Sanofi Pasteur. Financial support is also key and Sanofi has demonstrated its continuous commitment in order to fulfill its strategy of developing a vaccine platform in the South, for the South, ensuring that Shantha becomes a leading vaccine manufacturer located in India and provides vaccines for emerging countries. In this context, I am at liberty of making operational decisions, benefitting from an unmatched level of experience in vaccine manufacturing and development from Sanofi Pasteur, and also support and experience from Dr Varaprasad Reddy, Shantha’s Founder, who accepted to chair the company Board and provides me with key advices. Tell us about your recent research initiatives on the vaccination front and your product portfolio. Shantha has always emphasised on research and development and it continues to do so. Presently, we are in the midst of developing a rotavirus vaccine. Over 100,000 children die each year of rotavirus infection. There is a clear need and we want to fulfill it. So, we are developing a vaccine licensed from National Institutes of Health (NIH) with the goal of making it accessible to all developing countries. It is currently in clinical trials and we hope to get it approved by 2015. We have also used innovative technology for the cholera vaccine, which was co-developed with the International Vaccine Institute based in Korea. Earlier, the only available vaccine of cholera was primarily used in a travellers’ market with a high price. We have now introduced Shanchol, which is approved by the WHO. We are supplying it as and when required, especially in areas hit by flood or earthquake. We are also doing a lot of research on a vaccine for Human Papilloma Virus (HPV) as the vaccines currently available for cervical cancer are very expensive. We hope to have an affordable vaccine in the market by 2018.

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Another vaccine of exceptional interest to us is the hexavalent vaccine for Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus Influenzae type b conjugate, and an inactivated polio vaccine (IPV). Studies have shown that once the number of cases go down to a certain level, IPV is a better choice for routine immunisation against polio. What’s the status of your vaccine manufacturing facility in Hyderabad? Shantha has designed and developed a truly world class research facility equipped with the latest tools of research in modern biotechnology, providing the scientists with the necessary wherewithal to carry on their work. Shantha is equipped with a state-ofthe-art R&D facility, ideally designed for the development of biologics, based on modern biotechnology. The facility is divided in four independent laboratories. R&D activities cover the development of vaccines against Rota Virus, HPV, and Typhoid. Shantha’s new facility is coming up at Muppireddypally in Hyderabad, about 10 kms away from the vaccine player existing facility in Medchal, and will manufacture a range of Shantha’s existing vaccine offerings including the Pentavalent vaccine Shan5, which is used to immunise infants from five diseases – Diptheria, Pertussis, Tetanus, Haemophilus and Hepatitis B. Other than vaccines, what are your company’s growth platforms? What’s FUTURE MEDICINE I August 2012

your vision for the future? We are looking forward to bringing Shan5 back into the market as it offers ease of administration by combining all the vaccines in one injection. Once we have Shan5 and these products on track, we will go ahead with more vaccines for diseases such as Hepatitis A, Rotavirus, HPV. Also, we hope to introduce IPV before a hexavalent vaccine that is in the pipeline. Additionally, we are in the process of building a new plant in Muppireddipally, a few kilometers from Hyderabad, for manufacturing the rotavirus and Shan5 vaccines. Is there a need to bring about amendments in India’s National Vaccine Policy? The National Vaccine Policy published in April 2011 looks very positive and is definitely a welcome start to initiate discussions and take concrete steps. There is a need for political will to back the National Vaccine Policy for the public to reap benefits. The provisions for incorporating vaccines in immunisation programmes that are relevant locally in the policy document are very sound. Almost 50 per cent of the vaccines produced in the world are manufactured by the industry in India and, if given adequate support, they can make a huge difference on the healthcare scenario in our country. Overall, healthcare, especially preventive healthcare in India, needs

much more investment. For me personally, preventive healthcare was one of the things that attracted me to Shantha, as it allows us to truly make a strong impact on public health in the developing world with affordable vaccines. Has the economic crisis in Europe affected the company’s growth prospects? This is a rather complex question as there are several interconnections between various economies these days. As far as I can tell, the crisis in Europe has not impacted Shantha’s growth prospects in any way as we deal primarily with public health in the developing world. Tell us about your corporate social responsibility initiatives. We have been supporting the local government school at Atwelly since 2007. We contribute to the monthly midday meal. In 2011, we decided to adopt the primary and secondary school at Mupireddipally in addition to the school at Atwelly. We gave our commitment to support the mid-day meal scheme like we do at the Atwelly school. Shantha supplies a small amount of vaccines to a few hospitals and foundations on a cost-free basis. As an example, we have partnered the Bangalore Kidney Foundation to sustain the free Hepatitis B immunisation programme for poor patients undergoing dialysis at BKF Dialysis Centre.

ALLIED INDUSTRY FOCUS Care N’ Cure

Qatar’s very own pharmapreneur Gifted with a knack to connect with people, E P Abdul Rahman dabbled in a lot of trades during his student days, from selling rubber stamps to watches, furniture and electronic goods. The turning point in his life came when he landed in the Middle East for employment in a pharmaceutical company in the 1980s. Today, Rahman is the proud owner of 18 pharmacies, including one wholesale trading unit, in Qatar. His company, Care N’ Cure, is the largest pharma retail chain in Qatar, catering to more than 100 corporate clients. So, what’s the secret behind this meteoric rise in life? In an interview with Future Medicine, Rahman goes into his ordinary past and narrates the extraordinary moments of his life By Sumithra Sathyan Do you have any background in business? While I was in college, one day, my father had showed me the advertisement of a printing press in Sivakasi seeking out agents for rubber stamps. He asked

me whether I was interested. I was ready to do anything for some extra pocket money. Initially, I used to take orders for rubber stamps from friends, teachers, and relatives. After some time, I started getting a lot of customers interested in rubber stamps. Then, I moved onto a lot of part-time activities, from selling watches to furniture and electronic goods. Even during my days at the medical college, I have sold needbased items to my own professors and friends. What brought you into the pharma industry? On completion of my studies in pharmacy, I had worked as a pharmacist

in a small town near my home in Chennamangallur in Calicut district. After two years, I went to the UAE and got a job at Julphar (Gulf Pharmaceutical Industries) as a helper. After a short period of time, I got promoted to the post of in-process control inspector in the quality control department. But I was interested in the sales, marketing and business of pharma. So, I started making efforts to improve my English as the company had a multinational environment. I had befriended a lot of people from different nationalities and that helped me in overcoming the language barrier. After two-and-a-half years, I had resigned from Julphar and joined a pharma distribution company as a sales executive to promote its food supplements. I had worked there for four months. Then came the turning point.

A chain of pharmacies will be established in India in the next five years. We are working on a pharmacy chain as a joint venture in Oman. Efforts are also on to emerge as a leading service provider ahead of the 2022 World Cup in Doha E P Abdul Rahman, Founder, Care N’ Cure

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Everybody wants to do things the right way. But for a good business man, it is important to do the right things at the right time, in the right proportion, with the right people, for the right cause. Never try shortcuts

During one of my regular market visits, I came across the office of a pharma distribution company, which had offered me a job. I couldn’t join them because of the notice period at Julphar. However, I decided to pay a courtesy visit to the Managing Director of the company. While there, I accidentally met Dr Yusuf, the Regional Director of Switzerland-based pharma company Mepha. That meeting changed the course of my life. He asked me whether I was interested in joining Mepha. Since it was a great opportunity to work in a reputed company, I jumped at the offer. He recruited me for the Qatar market, and within the next 20 days, I was in Doha. I went on to work in Mepha for 14 years. While at Mepha, I was involved in the supply of medical goods to construction companies with a friend of mine. This exposure helped me and my friend in starting our first retail pharmacy. What’s your level of involvement in the business? Being a pharmacist with a passion in sales and marketing, I am really enjoying this business. Having spent 14 years in marketing, I got a chance to learn about the market very well and establish a lot of contacts. That is how I reached a business stream that suits me. How do you handle competition? Competition doesn’t bother us. If we play our part well with proper planning and dedication, we are assured of our share in the market. Killing others or FUTURE MEDICINE I August 2012

eating their share is not our idea. Our philosophy is simple – if the cake is big, we also can have a good share of it. And there’s nothing wrong in making the cake bigger. Tell us about your business tie-ups. My first joint venture was a pharmacy and a restaurant with six partners. It has become a leading group in Qatar today, with interests in pharma retailing (17 pharmacies), agencies, restaurant, logistics, transporting, services, contracting, interior designing, automobile garage etc. Nine years ago, we initiated a joint venture with Dr Azad Moopan’s Aster Group. Now, Aster has five multispecialty medical centres, and several pharmacies and diagnostic centres. The first Indian-managed hospital in Qatar under this umbrella will commence its operations soon. I am a Director of Starcare Hospital, a multi-specialty hospital in Muscat, whose first anniversary was celebrated last month. I am a Director of Radio Me, a new FM Radio in Dubai. We will be launching the DRM station soon through which we are expecting to reach the whole Middle East. I am also the Director of Site Excite, a joint venture with E2E Coimbatore, a company involved in marketing, training and events for development of properties in and around Coimbatore. I am also the Director of Ghazal builders, Calicut. We are working on our first project,

72 holiday apartments, in Lakkidi, Wayanad. Tell us about your retail/wholesale corporate clients. Care N’ Cure has 18 pharmacies across Qatar. We serve our customers by providing much more than medicines. We have very effective logistics to give what our customer needs. We cater to the medical needs (medicines, consumables, medical equipment, ambulances) of more than 100 corporate customers. We represent 15 leading brands in Qatar under our agencies division (Care N’ Cure Trading). What’s your message to the youth? Everybody wants to do things the right way. But for a good business man, it is important to do the right things at the right time, in the right proportion, with the right people, for the right cause. Never try shortcuts. What are your future medical projects? A chain of pharmacies will be established in India in the next five years. We are working on a pharmacy chain as a joint venture in Oman. Efforts are also on to emerge as a leading service provider ahead of the 2022 World Cup in Doha. Tell us about your social commitments. I have been honoured by the Indian Community Benevolent Forum, which works under the aegis of the Indian Embassy in Qatar, with the Appreciation Award in 2008 for services rendered to the Indian community. I am also involved with various social organisations and free medical camps. I am also associated with the Qatar Indian Football Forum.

FOCUS Specialists’ Hospital, Ernakulam

Guided by a pioneer in plastic surgery Famous surgeon Dr K R Rajappan is one of the three pioneers in plastic surgery in Kerala. Three years after conducting 300 free surgeries for the poor in 1980, his desire to contribute more to society made him establish the Specialists’ Hospital in Ernakulam district. The hospital, which was among the first in the state to offer plastic surgery, still retains its uniqueness by providing the best treatment in core specialties such as ophthalmology, paediatrics, general medicine and cardiology, psychiatry, orthopaedics, gynaecology, physiotherapy, and plastic and microvascular surgery By Tony William

hen a radical group had chopped professor T J Joseph’s hand for causing alleged insult to Prophet Mohammed two years ago, there was little hope of saving him from a life-long disability. But then, six doctors of the Ernakulambased Specialists’ Hospital, led by Dr Jayakumar, fought against all odds and reattached his hand through a microvascular surgical procedure that lasted 15 hours. The surgery was coordinated by Dr K R Rajappan, considered to be one of the three pioneers in plastic surgery in Kerala. “That was the most challenging surgery we had ever done. His case was different. His hand was chopped at several parts, and the veins were broken in multiple regions. It was a great challenge to reattach his hand. Now, it

will take time for his hand to regain the strength required to make normal movements. But we have accomplished the impossible,” says Dr Rajappan. Formerly the in-charge of the Plastic Surgery Department of the Kottayam Medical College, Dr Rajappan was way ahead of others in the field. In 1980 alone, he had travelled across the state and conducted about 300 free surgeries for the poor. That year he had won the Individual International Meritorious Service Medal from International Lion’s President Lloyd Morgan for rendering free service to the poor people. Dr Rajappan’s earnest desire to enhance his contributions to society prompted him to establish the Specialists’ Hospital at Ernakulam in 1983. Within a short span of time, the Specialists’ Hospital created a space of its own. Today, the Specialists’ Hospital provides a wide range of services, including urology with laparoscopic urology and advanced urodynamics, ophthalmology, paediatrics, general medicine and

cardiology, psychiatry, orthopaedics, gynaecology, physiotherapy, and plastic and microvascular surgery. The hospital, which provides aesthetic plastic surgery for correction, restoration and reshaping of various body parts, delivers free, qualitative medical service for cleft lip and cleft palate with assistance from an American project called “Smile Train”. It also has an active Pain and Palliative Care Unit, christened ‘Snehathanal’, for free treatment of cancer patients. This unit also provides dialysis service. The Specialists’ Hospital is famous for handling complex cases with a high success ratio. Dr Rajappan recalls the case of a six-year-old boy who had lost a part of his face in an accident in 2011. The boy had undergone a complex facial surgery and returned to normal life within three months. “We are also known for nose surgeries. They are very challenging because even a slight mistake can change the whole look of a person. A politician from Ernakulam had undergone this surgery successfully,” says Dr Rajappan. The cost of plastic surgeries depends on the complexity of a case. Micro/ key hole surgeries are the costly ones, ranging from Rs 80,000 to Rs one lakh. Beautification/reshape surgery costs even more. “But India has the advantage of low costs as compared to foreign countries. There must be correct awareness programmes in this regard. Quality must be our answer to those who lack belief in the Indian medical system,” says Dr Rajappan.

FUTURE MEDICINE I August 2012

PRODUCT LAUNCHES

Novel test for bowel disease SAN DIEGO (US): Prometheus Laboratories Inc., a specialty pharmaceutical and diagnostic company, announced the market launch of its proprietary new generation monitoring test, PROMETHEUS Anser IFX. This test measures drug (infliximab) and drug antibody levels in one sample among inflammatory bowel disease (IBD) patients using infliximab - helping physicians identify potential causes for loss of treatment response and guide patient management decisions. This is the first commercial test utilising Prometheus’ proprietary homogenous mobility shift assay platform technology. Prometheus intends to use this platform. The Crohn’s and Colitis Foundation of America estimates that about 1.4 million Americans suffer from IBD. About 50% of IBD patients using infliximab may eventually experience a loss of treatment response during their treatment. For some patients, this loss of treatment response may be the result of insufficient infliximab levels. For others, the loss may be due to the development of antibodies to infliximab (ATI). If the loss of treatment response is due to the development of ATI, increasing the infliximab dose may be less effective than switching to another treatment agent.

Infant feeding accessories KELOWNA (CANADA): ReliaBrand (TM), a publicly traded company listed on the OTC Bulletin Board, has announced the much anticipated launch of its award-winning Adiri(R) brand of baby bottles and infant feeding accessories. “We are thrilled to be able to offer our most innovative infant feeding products to date through this new Adiri(R) NxGen(TM) branded

FUTURE MEDICINE I August 2012

New needle for patient comfort

FRANKLIN LAKES (US): BD Medical, a segment of BD (Becton, Dickinson and Company), recently announced the launch of the BD Hyflow needle, a unique 27-gauge thin-wall needle designed for use with BD’s prefillable syringe systems. The optimised inner diameter of the BD Hyflow needle enables injection of highly-viscous drug formulations without the use of a larger needle, which could be more painful for the patient. The BD Hyflow needle increases flow to facilitate use with auto injectors and infusors. This new needle technology also reduces the pressure required to inject, a critical attribute for patients with dexterity limitations. Furthermore, there is evidence to suggest that advanced needle technologies can help patients adhere to their treatment regimens. “As the conduit for drugs to enter the body, and the critical interface with the patient, needles can have a profound effect on the patient experience,” said Eric Borin, Vice-President and General Manager (Americas, BD Medical) Pharmaceutical Systems.

product offering,” said ReliaBrand(TM) CEO Antal Markus. The original Adiri(R) baby bottle was among the first to offer consumers a BPA-Free infant feeding experience in 2007 and went on to achieve more international design recognition than any other bottle in history. The iconic “natural breast shape” and patented “petal vent” are among the infant feeding enhancement features that helped Adiri(R) earn the Gold Medical Design

Excellence Award in 2008 and share top honours with the ‘Apple(R) iPod Touch(R)’ at the annual D&AD Awards in 2008.

INSPIRATION Dr K P Hegde

A doctor, Sanskrit scholar and story-teller The preoccupation of a flourishing medical practice doesn’t stop Dr K P Hegde from pursuing his creative endeavours through two dramatically different forms of expression – devotional theism and ‘Kathaprasangam’, or the art of storytelling through songs and dialogue. A writer of 18 devotional books in Sanskrit and a spirited Kathaprasangam artist, he knows how to strike a fine balance between his creative pursuits and social commitments By Shani K

r K P Hegde practises at Sahrudaya Hospital in Alleppey town, Kerala. His day begins quite early in the morning since a large number of patients start streaming in at the hospital as soon as it opens. They join a long queue and wait in patience for their turn to meet this physician. Dr Hegde’s schedule has always been hectic ever since he had commenced practice at this hosptial. Although it consumes a better part of the day, medicine has only given him the artistic freedom to pursue his creative endeavours through devotional theism and ‘Kathaprasangam’, or the art of storytelling through songs and dialogue. Wondering how he does all this? Though Dr Hegde has never learnt Sanskrit formally, his interest in the classical language has only helped him give an artistic shape to the devotional power within him. He used to pen down all his devotional thoughts, making Sanskrit his language of expression. “I was born at Kota in Udupi district of Karnataka. I was brought up in Andhra Pradesh, where I had pursued my MBBS and MD. After completion of my medical studies, I came to Kerala for practice. While working in Kerala, I got an opportunity to read the books of Swami Vivekananda... That opened up my mind, broadened my outlook, and inspired me to learn Sanskrit. I knew Telugu, so I did not feel any difficulty while learning Sanskrit all by myself ,” says Dr Hegde. “After learning Sanskrit, I tried to write Sanskrit devotional books. In the initial stage, I used to take a lot of time. But over a period of time, I found that it was easier for me to write in Sanskrit. Ever since I took a decision to continue writing in Sanskrit, I have been publishing one book on Vijaya Dashami every year. So far, I have written 18 Sanskrit devotional books,” says the 54-year-old doctor. ‘Sthothra Sannidhi’, ‘Sthothra Manjeri’, ‘Stothra Ratnavali’, and ‘Sreekrishna Vikreeditham’ are some of the books that have been published. His passion for Sanskrit doesn’t end there. While writing these books, he had finished four correspondence courses of Viswa

Samskrita Pratishthan in Sanskrit. “I do not claim that I was able to write these devotional books only because of my skill. Without the blessings of the almighty one and some elders, I could not have Dr K P Hegde, Physician, accomplished Sahrudaya Hospital, Alleppey this.” When he is not treating patients, or writing a book, Dr Hegde is actively involved in Kathaprasangam. Again, the medium of expression is Sanskrit. “I have been presenting Kathaprasangam at a nearby temple on every Shivarathri day. While enacting Kathaprasangam in Sanskrit, I do not forget to give the audience an explanation in Malayalam before the act. The audience, too, enjoys it,” says Dr Hegde with a chuckle. “Since I have been involved in these creative activities, my acceptance among the general public too is much more than a doctor can ask for,” adds Dr Hegde. He laments over the negligence of Sanskrit today. “It is necessary to promote Sanskrit. If you check the Sanskrit books that had been written thousands of years ago, you will realise that these books contain valuable information on medical practices such as Caesarean birth. Sanskrit books are a vault of knowledge. How we can ignore this much valued language?” asks Dr Hegde, who currently holds the post of Alleppey District President at Viswa Samskrita Pratishthan. “More than just a language, Sanskrit is part of a valuable culture.”

FUTURE MEDICINE I August 2012