eHealth February 2014

asia’s first monthly magazine on The Enterprise of Healthcare

volume 9 / issue 02 / february 2014 / ` 75 / US $10 / ISSN 0973-8959

A Call to Action Hospital Infrastructure & Infection Control

Linking Rural India

Kiran Mazumdar Shaw

on Technological Rise

eHealth Magazine

Fight the fight, Find the

cure

Kicking Cancer to the Curb ehealth.eletsonline.com

volume

09

issue

02

ISSN 0973-8959

Contents 34- Living with Lymphoma 37- India set to be Cancer

Capital Prof Chintamani, President-The Association of Breast Surgeons Of India, Vardhman Mahavir Medical College Safdarjung Hospital

40- Education, Awareness the

Key to Defeat Cancer Dr Nilesh Lokeshwar, Medical Oncologist, Global Hospitals, Mumbai

19

An Overview of the Hospitals Infrastructure – A Call to Action!

policy:

12- MSME Sector has Huge

Potential in Odisha Dr Damodar Rout, Minister of Health and Family Welfare and MSME, Government of Odisha

Expert Speak:

14- Technology for Linking Rural

India Kiran Mazumdar Shaw, Chairman and Managing Director, Biocon Limited

16- OTEET Aims at National Development K N Bhagat, Managing Trustee, OTTET, Odisha

COVER STORY:

19- An Overview of the Hospitals Infrastructure-A call to Action

22- Clean Care is Safer Care Hospital Hygiene and Infection Control

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25- Controlling HAI is about

Saving Life Avinash Ojha, CEO, RG Stone Urology and Laparoscopy Hospital

42- Shift in Population will lead

to more Cancer Patients Dr Vinod Raina, Director- Medical Oncology and Hematology, Fortis Memorial Research Institute, Gurgaon

44- Every Life Matters

Pradeep Jaisingh, MD and CEO, International Oncology Centre

26- Hospital Infrastructure and

Infection Control Dr Parvez Ahmad, Group Medical Director, Rainbow Group of Hospitals, Hyderabad

Special Focus:

28- Cancer- Emerging as the Biggest Killer Worldwide

46- Cancer of the Lung and Cervix: A bird’s eye view Dr Firoz Ahmad and Dr B R Das, SRL Limited

50-

Perfint HealthcareReaches New Milestone S Nandakumar, CEO and Co-Founder, Perfint Healthcare

eh eal th.eletso n lin e.com MOST

Latest Video on Elets TV

Read Articles on

ehealth.eletsonline.com LYMPHOMA – Biology to Therapy n

n

Specialty care for Newborns

Urologic Science Touching New Horizons n

Prostate Cancer – Radiation Therapy for Prostate Cancer n

eUttar Pradesh - IT For Better Healthcare

Anil Swarup, Additional Secretary, Cabinet Secretariat, Government of India

eOdisha 2014 – ICT for Progressive Healthcare Initiatives in Odisha tv.eletsonline.com

MOST

MOST

MOST

Rise in Cancer Insurance Claims

Rural Markets Driving Growth

Genetic Breast Cancer Testing Comes to India

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Shared Articles on India Celebrates three years without Polio

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Good Engineering is the Backbone of Healthcare Technology Developing an Automation Concept that is Right for your Laboratory Govt Lowers Age Bar for Senior Citizens /ehealthmagazine

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asia’s first monthly magazine on The Enterprise of Healthcare volume

09

issue

02

february 2014

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta group editor: Anoop Verma

Editorial Team

WEB DEVELOPMENT & IT INFRASTRUCTURE

Health Sr Assistant Editor: Shahid Akhter Correspondent: Ekta Srivastava governance Assistant Editor: Rachita Jha Research Associate: Sunil Kumar Sr Correspondent: Ankush Kumar, Mohd. Ujaley, Nayana Singh education Correspondent: Seema Gupta Sales & Marketing Team Assistant Manager: Vishukumar Hichkad, Mobile: +91-9886404680 (South) Manager - Sales: Douglas Digo Menezes, Mobile: +91-9821580403 (West)

Team Lead - Web Development: Ishvinder Singh Executive-IT Infrastructure: Zuber Ahmed Information Management Team Executive – Information Management: Khabirul Islam Finance & Operations Team Sr Manager – Finance: Ajit Sinha Legal Officer: Ramesh Prasad Verma Associate Manager – Accounts: Anubhav Rana Executive Officer – Accounts: Subhash Chandra Dimri

Subscription & Circulation Team Sr Executive - Subscription: Gunjan Singh, Mobile: +91-8860635832 Design Team Assistant Art Director: Shipra Rathoria Team Lead - Graphic Design: Bishwajeet Kumar Singh Sr Graphic Designer: Om Prakash Thakur Sr Web Designer: Shyam Kishore Editorial & Marketing Correspondence eHEALTH - Elets Technomedia Pvt Ltd Stellar IT Park, Office No: 7A/7B, 5th Floor, Annexe Tower, C-25 , Sector 62, Noida, Uttar Pradesh 201309, email: info@ehealthonline.org Phone: +91-120-4812600 Fax: +91-120-4812660

ehealth does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

The magazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. ehealth is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at Vinayak Print Media A-29, Sector-8, Noida, UP, INDIA & published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic and mechanical, including photocopy, or any information storage or retrieval system, without publisher’s permission.

ehealth.eletsonline.com | egov.eletsonline.com | education.eletsonline.com Send us your feedback for any of our Health news, interviews, features and articles. You can either comment on the individual webpage of a story, or drop us a mail: editorial@elets.in

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editorial

Cancer Needs to Come out of the Closet The science and silence associated with cancer demarcates the stark reality of the grim world we live in. Each country is struggling with cancer epidemic in its own way. Some nations have emerged successful and are on the path of transformation but where do we stand ? What have we achieved so far ? Is the public well informed and are we aware of the cancer lurking in the air, food and water ? Are the health professions playing their role in early detection, treatment, care and rehabilitation ?Have the policy makers charted out a road map to conquer cancer ?An honest answer followed by the sincere effort to achieve them is the need of the hour.

It is time to wake up before things get out of control and the situation spins from bad to worse.The total cancer cases are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020.

Despite great strides in cancer treatment, the relationship between irradiation and cancer cure has unleashed another puzzle that we need to address. CT today is routine and the radiation that it spews is a matter of grave concern. According to one study, no less than 5 percent of all future cancers may emerge from exposure to medical imaging ! This vital test protocol needs to be in place and judiciously used. There is epidemiologic evidence to demonstrate that a single CT scan exposure may be cancer causing.

The current issue explores the various facets and issues associated with cancer. This includes lymphoma which comes with no less than 60 subtypes, each with different genetic characteristics that responds differently to standard therapies. RGCON 2014 is all about the best minds in lymphoma research gathering on 15 and 16 of February.

Surely, we are on the verge of winning some of the cancer battles but victory seems to be elusive. The ubiquitous pink ribbon is well understood and the ban on tobacco is evident but the advocacy and awareness campaigns need to spread to other cancers that are engulfing us.

Dr Ravi Gupta ravi.gupta@elets.in

FEBRuary / 2014 ehealth.eletsonline.com

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news

New 3-D Imaging Technique Helps to Avoid Facelift Complications Millions of people each year remove wrinkles, soften creases and plump up their lips by injecting a gel-like material into their facial tissue. These cosmetic procedures are sometimes called “liquid facelifts” and are said to be minimally invasive.

It’s rare, but sometimes things go wrong. In a matter of minutes, patients’ skin can turn red or blotchy white and the injected area becomes painful. Vital blood supply to the face is restricted and if untreated, parts of the tissue will die. That scenario is irreversible and can leave deep scars.

It’s rare, but sometimes things go wrong. In a matter of minutes, patients’ skin can turn red or blotchy white and the injected area becomes painful. Vital blood supply to the face is restricted and if untreated, parts of the tissue will die. That scenario is irreversible and can leave deep scars.

Specialty Spine Clinic Chain Now in Delhi Qi Spine Clinic, India’s only specialty chain of spine clinics, today announced the launch of its Delhi operations, with the inauguration of 2 state-of-the-art clinics in Greater Kailash-1 and Punjabi Bagh respectively.

Qi Spine Clinic was founded in 2010 by Nithiij Arenja, a healthcare entrepreneur, who spotted a large lacuna in the existing treatment options available to people suffering from back & neck pain. Qi Spine Clinic has treated 5000 back pain patients with 93% success rate, using a revolutionary new cutting edge diagnosis & treatment protocol across its 5 clinics in Mumbai.

Technique Developed to Control Cervical Cancer A group of researchers from Mexico’s General Hospital, Health Secretariat, Medicine Faculty and the Institute of Cellular Physiology of the National Autonomous University of Mexico (UNAM) identified a therapeutic target for cervix cancer: gene CDKN3.

The researched performed at the lab indicates that when this gene is blocked in culture cancerous cells, the neoplastic proliferation greatly diminishes.

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Gazing at Electronic Health Records Diverts Doctors’ Attention from Patients When physicians spend too much time looking at the computer screen in the exam room, nonverbal cues may get overlooked and affect doctors’ ability to pay attention and communicate with patients, according to a Northwestern Medicine® study.

Published online in the International Journal of Medical Informatics, the study found that doctors who use electronic health records (EHR) in the exam room spend about a third of their visits looking at a computer screen.

In Certain Breast Cancers, Melatonin Reveals Potential to Slow Tumor Growth An early stage study shows melatonin – a hormone that regulates the body’s sleep and awake cycles – may have the potential to help slow the growth of certain breast cancer tumors, according to researchers from Henry Ford Hospital in Detroit and Foundation for Research Support of the State of São Paulo.

The study, published online in the journal PLoS One, finds that melatonin may inhibit tumor growth and cell production, as well as block the formation of new blood vessels in ERnegative breast cancer models.

Computer Algorithms Outperformed by Crowdsourced RNA Designs An enthusiastic group of non-experts, working through an online interface and receiving feedback from lab experiments, has produced designs for RNA molecules that are consistently more successful than those generated by the best computerized design algorithms, researchers at Carnegie Mellon University and Stanford University report.

Moreover, the researchers gathered some of the best design rules and practices generated by players of the online EteRNA design challenge and, using machine learning principles, generated their own automated design algorithm, EteRNABot, which also bested prior design algorithms. Though this improved computer design tool is faster than humans, the designs it generates still don’t match the quality of those of the online community, which now has more than 130,000 members.

Online Advice for Clinicians Treating Hepatitis C The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society-USA (IAS-USA), has announced the launch of a new website, HCVguidelines.org, that will offer up-to-date guidance for the treatment of hepatitis C virus (HCV) infection.

It is estimated that between 3 and 4 million Americans are infected with HCV and have chronic liver disease as a result. The most recent generation of direct-acting antivirals has the potential to cure most patients with HCV. However, the rapid pace of drug development has left medical providers and insurance companies unsure what the optimal treatments are. The guidance provided through HCVguidelines.org will assist clinicians in using these and other treatments in the care of their patients.

Virtus Health Services launches O Test in India O Test with best of class automated screening services expected to significantly reduce oral cancer mortality and morbidity resulting from of 60% of diagnosis only at advanced stages.

Virtus Health Services India (VHSI) today launched the O-Test, in India, which is a non-invasive, highly affordable early stage detection test for oral cancer. The O Test is supported by Virtus’ highly advanced automated screening software. This software designed by senior pathologists and applied to the entire process right from case history to medical examination and microscopic slide viewing, offers higher accuracy and speed of results generation.

Guidelines for Molecular Counting Using Fluorescent Proteins To know how many proteins assemble together at the nanoscale is fundamental for understanding protein function. Sometimes, proteins must be in an “oligomeric” state to be functional, although “oligomerization” of certain proteins can also lead to diseases.

The ability to determine protein stoichiometry and monitor changes in the balance between monomeric, dimeric and multi-meric proteins can allow scientists to see the differences between a properly functioning cell and a diseased cell. Therefore, there is a great interest in being able to count proteins and determine their stoichiometry.

In a recent study carried out at ICFO, the Institute of Photonic Sciences, the research group of Advanced fluorescence imaging and biophysics, led by Nest Fellow Dr. Melike Lakadamyali was able to quantify the photoactivation efficiency of all the known “ir-reversibly photoswitching fluorescent proteins” and establish a proper detailed reference framework for determining protein stoichiometry. To do this, they used a nanotemplate of known stoichiometry (the human Glycine receptor expressed in Xenopus oocytes) and studied several fluorescent proteins to see the percentage of proteins that was photoactivated. The results of this study have recently been published in Nature Methods.

FEBRUARY / 2014 ehealth.eletsonline.com

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news

Eye Q focuses on Glucoma Eye Q ahead of World Glaucoma Week 2014 from 9-15 March, 2014 plans to organise yoga sessions for yoga patients as according to interesting revelation, Yoga has proved to be an excellent remedy for Glaucoma patients.

During this year’s World Glaucoma Week Dr Devindra Sood, Director & Head, Glaucoma Services & Dean of Academics, Eye-Q Institutes of Glaucoma, Shalimar Bagh plans to conduct special programs which is intended to bring mass awareness about glaucoma as well as suggest cure and remedies to overcome the same.

Genetic Mutations known to cause Familial Alzheimer’s Disease New research, led by Rensselaer Polytechnic Institute researcher Chunyu Wang, has solved one mystery in the development of Familial Alzheimer’s Disease (FAD), a genetic variant of the disease that affects a small fraction of the Alzheimer’s population. In a paper published in the journal Nature Communications, Wang and his team follow the trail of two genetic mutations – V44M and V44A – known to cause FAD, and show how the mutations lead to biochemical changes long linked to the disease.

The hallmark of FAD is the accumulation of the Amyloid Beta 42 peptide (a short chain of amino acids) in unusually high concentrations within the brain. In a healthy brain, Amyloid Beta-42 (A-42) and a similar peptide, Amyloid Beta-40 (A-40), are found in a ratio of about 1 to 9. In a brain affected by FAD, this ratio is much higher. The two peptides are nearly identical: A-40 is a chain of 40 amino acids in length; A-42 is 42 amino acids in length. However, A-42 is much more toxic to neurons and plays a critical role in memory failure.

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Fortis Escorts Heart Institute heals African hearts Fortis Escorts Heart Institute (FEHI), a pioneer in the field of cardiac care in the country successfully conducted cardiac treatment for 17 Tanzania patients from Africa who came as part of the joint sponsorship of Lions Club of Dar-EsSalaam, Regency Medical Centre and Health Ministry of Zanzibar. A team of doctors led by Dr. Iyer, Executive Director, Pediatric Cardiac Surgery, Dr. Rajesh Sharma, Director, Pediatric Cardiac Surgery and Dr. Ashutosh Marwah, Senior Consultant, Pediatric Cardiologist were instrumental in giving a new lease of life to these patients.Hon’ble Minister of State for External Affairs, Government of India, Smt. Preneet Kaur was the Chief Guest at this heartwarming farewell meet, along with the Ambassador of Tanzania in India.

Hon’ble Minister of State for External Affairs, Government of India, Smt. Preneet Kaur, said, “It is immensely gratifying to see patients recovering from critical heart ailments recovering and now ready to go back to their country to start a healthy life. The smiles on their faces reflect a zest for life and I wish them all the luck. I congratulate Fortis Escorts Heart Institute for their dedication and commitment to the spirit of saving and enriching lives.”

Health Hazards of ‘Sulphur’ in Sugar Sugarcane is the principal raw material used for the manufacture of plantation white sugar. In India, sugar is refined using the the Double Sulphitation method. This is the most widely used and cheapest process of refining sugar as compared to other available process.However the major drawback of the Sulphitation proecsss is that Sulphur enters sugar during its refining process. The end product that we consume contains sulphur dioxide approximately to the extent 20 to 70 ppm depending on the process applied as also condition of the plant and the techniques applied for the manufacture of sugar(Refined or Normal process).

As per IS1 grade of white refined sugar, the maximum permissible limit is 70 ppm whereas International standard (refined) is about 10 ppm.Normally, outside India refined sugar is produced. Perhaps this limit has been prescribed keeping in view the impact of sulphur on human health.

policy

MSME Sector has

Huge Potential in Odisha “MSME in Odisha will do much better because of the presence of large industries,� says Dr Damodar Rout, Minister for Health & Family Welfare and MSME, Government of Odisha in conversation with Mohd Ujaley

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Government of Odisha is focusing on the development of MSME sector in the state. How do you look at MSME sector in your state?

Odisha has one of the largest tribal populations. What steps are you taking to improve healthcare service in tribal areas?

In eastern India, Odisha has got huge potential for development of MSME. We have created MSME development policy 2009 and now have started working accordingly. Recently, we organised an MSME exhibition, in which about nine foreign companies participated. We are also focusing on developing an efficient programme for entrepreneur sensitisation to train our youth. There is an excitement among youth to become entrepreneur, we have covered 314 blocks under various entrepreneur sensitisation programme. I think, MSME sector in Odisha can do much better compared to any other place in the country due to availability of mega-industries.

The mega industries, which currently maybegetting their needs from outside, can resource their needs from local MSMEs. The government is also proposing to set-up an MSME university in the state. We have given enough importance to MSME in our state and I think within two years there will be significant progress.

I cannot claim that healthcare has completely improved but we are doing our best. It’s a huge challenge because 22 percent newly born babies in tribal areas are seriously underweight and those who are dying within stipulated time are adding to the infant mortality rate.Those who are surviving are not healthy citizens. So we have taken some special steps in women healthcare.About 53 percent women are suffering from anaemia, unless we arrest that anaemic condition, the problem with newly born babies being

In your interview to eHealth magazine, you said that infrastructure deficiency is key challenge for Odisha. How things have improved over the years?

It is true that infrastructure deficiency is key challenge for the state. We have been trying hard. We have received some funds under Urban Health Mission and we shall use it in the best possible way to address some of the challenges. I have also taken up the issue with the Chief Minister and Finance Department; they have agreed to provide 2400 crores in coming three years at the rate of 800 crore per year to improve the healthcare infrastructure in the state. I think it will be really helpful for developing the infrastructure in the healthcare centres in the state.

fastest possible pace. We are trying to have the facility at all our primary health centres, community health centres, sub-divisional medical health centres, and all the medical colleges.

We have assured Mrs Shaw to make an exercise on this score. Recently, we have established BijuPatnaik Memorial Hospital with the help of private participant. We will also try to develop telemedicine facility for dangerous diseases like cancer, diabetes, hypertension, etc. The telemedicine centres can provide immediate diagnosis take and can also tele-consultation.

There are only two government medical college in the state. Is there any plan to open more

“The mega industries, which currently may be getting their needs from outside, can resource their needs from local MSME sickly will remain. The first step that we need to take is care of mother, then the child. On our request, government of India has set-up a tribal disease research centre and we are proposing three more such centres.

Very recently Kiran MazumdarShaw met the Chief Minister and proposed to set-up telemedicine centre in the state. How do you look at such initiatives?

We are introducing telemedicine at some of our medical centres.Mrs. Kiran Mazumdar Shaw wants to spread the eHealth system and also install telemedicine centres to cover the all the revenue villages say about 51000 villages. She wants to ensure that telemedicine facility is available in all the villages. It may not be possible at this moment, but we are trying to develop infrastructure at the

medical colleges to bridge the gap between demand and availability of the doctors?

We have huge shortage of doctors; the last government medical college was opened four decades ago. I agree, state needs more doctors and more medical colleges, now we are encouraging private medical colleges, so far eight colleges have come up. And, also 100 students have been admitted at AIIMS, Bhubaneswar and at a private medical college and in one medical college we have enhanced the seats to 100.Government of India has decided to set-up 65 new medical colleges in the country. We have approached them to establish four medical colleges in our state.

Government of India has agreed it in principle. Based on the centre-state partnership, we have proposed one medical college each at Balasore, Baripada, Balangir and Kodapur.

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expert speak

Technology for linking rural India

�I think women are trapped by their own diffidence to take on challenges. They somehow believe that they are not capable of doing certain things. This is nothing but the challenge of their mind. They have to break free from that mind-set, the moment you break free, you realise - it is not that difficult,�says Kiran Mazumdar Shaw Chairman & Managing Director, Biocon Limited in conversation with Mohd Ujaley

Recently you met the Chief Minister of Odisha, Naveen Patnaik. What kind of potential you see in the state especially, in the area of healthcare and poverty alleviation?

Odisha is a state that is challenged in many ways because it has a very high level of poverty. The state also faces the problems of natural calamity on an annual basis. And, as we all know illness further adds to poverty. Illness is the number one cause of rural indebtedness in our country; therefore it is a very serious challenge for the state like Odisha. If state government delievers universal healthcare to its people as one of the poverty alleviation programme, it can improve the life of the people. I believe to be successful in such endeavours, you will have to use technology. Since independence, we have focused on establishing a network of primary healthcare centres which feed into secondary and tertiary healthcare centres but we all know that it has not delievered the anticipated result because we lacked the required manpower to effectively deliever quality healthcare.In our meeting with Chief Minister, we discusseda way to create a public-private partnership (PPP) model where diagnostic units are created at every health location – it could be in a hospital, primary health centre to pro-

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vide quality healthcare to people of the state. And, also these diagnostic centres should be manned by local entrepreneures. We believe it will be a huge job creation opportunity for the state.

We understand our young MBBS doctors are reluctant to serve in rural areas. In such a scenario where do you see the role of technology and telemedicine and how crucial it is for state like Odisha which has one of the largest populations of tribal people?

If a young doctor do not wish to go to rural India then you have to use technology to link rural India to advance centres.We must use technology to bridge this gap and that technology is eHealth. eHealth is about diagnosis, which is very important, as only through proper diagnosis you can deliver cost effective treatment. An early diagnosis reduces the cost of treatment and will give better outcome. So in our discussion with chief minister we discuss the modalities of doing and how it can also be a huge job creating opportunity to the state.A diagnostic unit manned by local entrepreneurs will create jobs and also the training given to them to use diagnostic will upgrade their skills, which ultimately benefits the healthcare centre.In the case of tribal areas, diagnostic centres can be manned by a tribal person and a basic doctor who belongs to tribal village canwork in the diagnostic centre and doctor can be connectedto specialist in the advance centres to talk to the patient. If we do not use the technology, tribal people will never have quality healthcare.

What could be the way forward to fulfil the global objectives for India’s biotechnology industry?

Biotechnology in India has the huge potential to go global. We have shown it because biotechnologies operate in many fields. India has already become

the vaccine capital of the world because of her strong biotechnology base. We have also got the product that we are developing and taking it global such as biologics, insulin, biosimilar and novel biologics.In the area of diagnostic, the devices are becoming very important, the maximum number of start-up companies in our space is in the biomedical devices. And it is very exciting becauseevery one of the biomedical devices can deliver affordable diagnostics the worldover. Otheraspects of the biomedical technology such as Genomics and Agro-Biotech, Green Technology based on Enzymes and Bio-Fuels arealso becoming a big area.Agro-Biotechremained a challenged due to our regula-

ever I believe slowly but surely these things will get resolved.

Isn’t unfair for the government to expect Industry to invest in early stage research rather than focusing on exciting projects and then commercialise them?

I think government is actually helping companies in early stage research. Infact, I must say in India, DBT and DST is helping nascent industry to invest in early stage R&D. But the one who is not helping the sector are venture capitalist. They are finding it risk averse because of regulatory unpredictability.

Unless we create a regulatory environment where these companies can take

If a young doctor does not wish to go to rural India then you have to use technology to link rural India to advance centres.We must use technology to bridge this gap and that technology is eHealth. eHealth is about diagnosis, which is very important tion but it has huge potential for India.

So, I think, biotech is already going global. Indian has the potential of playing leadership role in biotech provided that we have all the right policies and regulation that allow us to do that.

In one your interviews, you said there seems to be lot of scepticism in country -- both from the investor community and from the government when it comes to R&D. Has things improved over the years?

Actually, it is very challenging to do research in India. For example there has been freeze on clinical trials and genetically modified crops, so when you have regulatory freeze, R&D become very difficult.And, it starts impacting the speed of R & D and companies start looking outside the country to do the R&D.How-

innovative ideas to the market,we are not going to see enough investments.

You are an icon to whole of India and especially to women.

What challenges do you see when a women try to embark on the path of entrepreneurship?

I think women are trapped by their own diffidence to take on challenges. They somehow believe that they are not capable of doing certain things. This is nothing but the challenge of their mind.

They have to break free from that mindset, the moment you break free, you realise - it is not that difficult. Lot of women has succeeded, look at banking sector which is very tough to manage but in India, women are leading these banks, no other country in the world have so many banks headed by women than the India.

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expert speak

OTTET Aims at National Development “ICT based modern technology can be used for interconnectivity and networking to integrate all other fields for all round development of society at large,� says K N Bhagat, Managing Trustee, OTTET, Odisha Please brief us about the initiatives that OTTET is taking in Odisha for promoting social development?

OTTET’s initiatives for social progress are undertaken through association of service oriented people in the society.

OTTET aims to bring about a blossoming in the lives of the citizens through efficient Educare, Medicare and Sociocare. Thus development involves awakening of the dormant spark in humans leading to the blossoming of their personality to unearth the hidden strength and abilities for the purpose of overall progress of society. This process also takes care of spiritual evolution of the people automatically in which individual transformation occupies a very important role. The design of our Ideals and Philosophy seeks to evolve Education, Healthcare Entrepreneurial Development scalable to a large mass and to larger number. While India needs to pay most attention to economic areas and employment generation, India is to emerge as a global leader in the service sectors with its vast and skilled human resource. The services will range from the simple to the most sophisticated ones using the emerging digital and communication revolution.

The service sector is not only to be a money-spinner but should also employ a good proportion of its people, often in self-employments, with abilities ranging from simple skills to super skills.

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What are the major challenges you usually face while working on various projects which have potential to improve the livelihood of the people?

The major challenge was a balanced approach to basic needs on the one hand, and depletion of scarce resources required meeting them on the other hand, which is essential.

The recent crisis which has caused not only economic but also social and organizational disasters was the absence of wisdom, trustworthiness, selfrestraint, and sensitivity to the well being of others. Another important factor that camps up repeatedly was that none of these merits of individual behavior can adequately and effectively be imposed externally. Hence, the need to inculcate human values that nurture a strong discretionary energy through a properly designed system of education and skill upgradation with human values. It has a very powerful demonstrative effect on public awareness. It is thus necessary that the government follows exemplary behavior so as to serve as an effective role model for all citizens. It is equally important that government as an institution sets right examples in terms of its laws, social and economic policies as well as its normal administrative practices and procedures. Clearly, the government has a heavy responsibility in creating a culture of adherence to high moral

standards and values so as to foster an appropriate environment for rectitude.

Such adherence should begin with the individual and permeate widely through the civil society.

Very recently, a OTTET-Biocon delegate met the Chief Minister of Odisha.Tell us what you have discussed and what are you planning to do in the state?

The delegation meeting with the Hon’ble Chief Minister, Odisha, was very unique in all respect. The Biocon Chief, Kiran Mazumdar-Shaw, the richest self-made business woman of the country, has displayed confidence in the leadership of Shri Naveen Patnaikji, Hon’ble Chief Minister, Odisha.

She congratulated him on the propoor, pro-people initiatives of the state government. We will be launching an initiative in PPP mode through which OTTET will provide access to quality healthcare at the door steps of 51,000+ villages of Odisha.It has got two parts; the first deals with the capacity to frame plans (programmes, projects, etc) that have a high probability of success, while the second part deals with its implementation.During discussion KiranMazumdar-Shaw emphasized that while the Planning Commission and the Public Health Foundation of India, under the scheme of Universal Health Care(UHC) are now planning to achieve healthcare for all in 10 years time, even countries like USA having best resources of technology and financial power is yet to achieve the same , the Government of Odisha has already started its implementation in the state which is considered first of its kind in the country. She indicated that Biocon in collaboration with OTTET will take forward the initiative of Govt. of Odisha and make it more comprehensive with the introduction of ICT network based Mobile Hospitals, Cancer and Diabetic Clinics and Health Card for All for the benefit of people of Odisha and society at large.

Your Tele-medicine initiatives have been appreciated, what are your plans to replicate it in another state of India?

The objective for installation of ehealth and telemedicine infrastructure in PPP mode is to achieve the UHC program of Planning Commission of Government of India.It aims at bridging the gap of demand–supply mismatch, Doctor-wise and Facility-wise. ICT based Telemedicine activities are not only dedicated for patient healthcare, but also in physician education and training. OTTET Telemedicine network is a network for Tele-consultation, Tele-Diagnostics and Tele-Education. The clinical component includes Tele-consulting for Preliminary Diagnosis, Pre-surgical Investigation and Post-surgical Follow up, Scheduling appointments for hospital visits, Expert opinion and patient counseling. All medical Colleges, DHHs, CHCs, PHCs and Sub-centers are considered as part of the network. The PPP initiative of OTTET has been widely appreci-

health system. The UHC program will be shortly initiated in the state of Karnataka and few other states where the pilot studies have already been made.

Tele-medicine is one part of ICT. What are the areas wherein ICT can be used for enhancing the access and quality?

OTTET has vision for Healthcare for All, Education for All, Services for All; for moral and spiritual re-generation of Mankind. In order to achieve the objectives OTTET has developed Village Integrated Program to translate the concept of Golden age into the Reality. OTTET has designed for facility centers at District, Subdivisional, Block, Grama Panchayat and Village level, for the development of Individual Care, Employment Care, Health Care, Infrastructure Care, Social Care, Educational Care, Cultural Care and Agricultural Care through which the following services can be provided at the village level: Financial Services, Marketing Communication Services (Advertising, Media, Consul-

“OTTET aims to bring about a blossoming in the lives of the citizens through efficient Educare, Medicare and Sociocare ated and OTTET has bagged several national and international awards including e-INDIA Award 2013 and FIPS Award 2013. In a boost to the PPP Initiative of OTTET, Biocon chief KiranMazumdar Shaw has joined and collaborated with OTTET to carry forward the initiative not only in the state of Odisha but also rollout the scheme of Universal Healthcare PanIndia. The collaboration will strive to emerge India as a global leader in the service sector with its vast and skilled human resources and to provide valuable contribution in strengthening and augmenting and existing public

tancy and Infotainment), Marketing Logistics, Trading and Distribution, Trade, Promoters Services, Human Resources, Technical & Management Consultancy,Testing, Certification and Calibration Services, Govt. administration Security Services, Repair & Maintenance, Tourism & Hotels, Leisure, Sports resorts, Cultural Activities, Preventive Health care Services, Many others as per the local needs.ICT based modern technology can be used for interconnectivity and networking to integrate all other fields for the all round development of people and society at large.

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zoom in

STERRAD

Bridges all Gaps T oday technologies play a vital role in improving patient outcome. For example, patient can undergo an arthroscopic procedure and return home within a day.

With such advancement in every technology, patient’s outcomes have greatly improved in surgeries across different fields including orthopedics.

This has become possible due to advancement in the surgical procedure from open to MIS. Also joint replacement surgery is possible with computer navigation which has substantially increased the accuracy of the surgery.

Sancheti Institute for Orthopedics and Rehabilitation, Pune, India, is one of the examples of a cutting edge technology based hospitals which renders in highly specialized services in all areas of orthopedics. The major areas include Joint replacement, arthroscopy, spinal surgery, rheumatology and arthritis, shoulder surgery ,plastic and reconstructive surgery, neurology, hand and microvascular surgery, faciomaxillary and dental surgery with sports injuries and so on, making it one of the largest super-specialty with all the orthopedic sub-specialties under one roof.

Whilst, today when hospital’s have become the high-tech centers of giving treatment and healing the patients with state-of-the art infrastructure and technologies, hospital associated infections (also called nosocomial infections) has become one of the critical focus areas for the healthcare industry. As Dr Parag Sancheti, Professor and Chairman, Sancheti Hospital says,’’ Infection has always been a major concern in

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Dr Parag Sancheti Professor and Chairman, Sancheti Hospital orthopedic surgeries and therefore infection prevention and control is particularly important at a specialized hospital treating a high volume of orthopedic surgical patients. Infection rates have to be lower than 0.5percent which is the gold standard where our efforts are focused to be there. Sterilization plays a vital role in achieving the same as post operative. We have successfully implemented several efficient and effective processes to address the issue of infection prevention and control. While we are proud of our low infection rate at Sancheti Hospital and the effects of our current anti-infection program, we must constantly make every effort to improve our infection control practices and associated patient outcomes.’’

Now with the complexities involved in these surgeries and with the high volume of surgeries, infection control and prevention have be-

come very important in orthopedic surgeries. Dr Sancheti added, ‘’we have a dedicated infection control team who regularly evaluates infection rates and set protocols to achieve the best standard in controlling the same. Continuous education is been imparted to fellow doctors & the nursing team to achieve best standards of patient care’’.

To cure and avoid such infections, there are different kinds of sterilization products available in the market and there are many new and old companies both which are trying to tackle with such problems by bringing out the best of the product. One of such products is the STERRAD technology, India which is helping as a tool in improving the patient outcome. Recently the same technology was installed in Sancheti Hospital. Dr. Sancheti believes STERRAD NX is the latest state of art technology when it comes to sterilization. It’s a low temperature hydrogen peroxide gas plasma sterilizer. Conventional sterilization methods have several limitations with respect to high volume orthopedic setup where fast instrument turnaround, safety and sterility of devices like arthroscopic, cameras, fiber-optics, etc are absolutely essential. This is where STERRAD bridges all gaps with its short cycle time of 28 minutes helps to do surgeries without any delays and most importantly this equipment has helped Sancheti Hospital to achieve 100 percent sterilization of surgical instruments when it comes to devices like arthroscopes & cameras.

To contact Dr Parag Sancheti: parag@sanchetihospital.org

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An Overview of the Hospitals Infrastructure – A Call to Action!

Today hospitals are not just about being simply nice or fancy than traditional hospitals. Rather, the focus is to create hospitals that actually help patients recover and be safe, and help staff do their jobs better. Japneet Kaur, ENN, giving an overall perspective on Indian Healthcare infrastructures

H

ealthcare services are in a dire need of a paradigm shift in terms of providing care more efficiently.

Healthcare today harms too frequently and routinely fails to deliver its potential benefits. The delivery of health and social care is undergoing profound change and being redesigned to improve capacity and performance through the provision of high quality, patient-centric services.

Hospital design can impact clinical outcomes. Construction program should be provided with an opportunity to rethink hospital design. The impact of a range of design characteristics, such as single-rooms versus multi-bed rooms, less noise, improved lighting, better ventilation, supportive workplaces and improved layout can help reduce errors, stress, improve sleep, pain and drugs, increase effectiveness in delivering care, improve patient safety, and overall healthcare quality.

In addition to a deteriorating physical infrastructure, India faces a huge shortage of trained medical per-

sonnel. The size of the health workforce (both health professionals and other health workers) has declined in absolute numbers, and this directly threatens patient safety.

Nurses, physicians, and other healthcare employees work under extremely stressful physical conditions.

The design of hospitals often increases staff stress and reduce their effective-

ness in delivering care. While much research in the hospital setting has been aimed at patients, there is a growing and convincing body of evidence suggesting that improved designs can make the jobs of staff much easier. Workplace design that reflects a closer alignment of work patterns and the physical setting can improve work flow and increase patient satisfaction with the service.

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Priority areas for further action Design of healthcare environments Provide single-bed rooms.

Single rooms have been shown to lower hospital-induced nosocomial infections, reduce room transfers and associated medical errors, greatly lessen noise, improve patient confidentiality and privacy, facilitate social support by families, improve staff communication to patients, and increase patients’ overall satisfaction with health care Installation of high-performance sound-absorbing ceilings, and eliminating noise sources (for example, using noiseless paging) Improve ventilation through the use of improved filters Improve lighting, especially access to natural lighting and fullspectrum lighting Design ward layouts and nurses stations to reduce staff walking and fatigue, increase patient care time, and support staff activities such as medication supply, communication, charting, and respite from stress Immediate availability of complete medical record (compiled from all sources) to any point-ofcare Enable use of tools and equipments such as electrical sub-stations, generators, AC plant, kitchen equipment, laundry equipment etc. to facilitate delivery of care Manpower requirement Increasing the operational efficiency of healthcare space Reduce length of stay of patients in hospitals by providing them timely services

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The chronic shortages of equipment and supplies (including vaccines, antibiotics, and other essentials) compounds poor quality of services. Irregular supply of essential drugs at all levels of the health delivery system leads to unnecessary delays in treatments.

Most of health workers highlight a lack of capacity to satisfactorily complete diagnostic examinations at dispensaries and hospitals. These workers often go months without supervision. Inadequate communication between health service providers at the various levels means that provided skills and facilities are not maximised.

There is an immediate need for medical education and training, which could provide additional opportunities for private sector providers or public-private-partnerships (PPP).

Technology should be applied in innovative ways to enhance operational efficiency, enabling care coordination and improving patient outcomes.

Technology that enables telemedicine could also be used to deliver training courses.

These medical professionals cite many concerns common in lowerlevel facilities: low salaries, frequent unavailability of necessary equipment and consumables, inadequate performance evaluation and feedback, poor communication channels between workers and management, lack of participation in decision-making pro-

cesses, and a general lack of concern for workers welfare by the hospital management.

Invariably, it is at this crucial stage that the aspect of maintenance has got neglected without the realisation that this very aspect that determines the efficient delivery of healthcare, results in patient satisfaction.

Over time, senior management staff, healthcare providers and clinicians at various hospitals have realised this oversight and have instituted corrective measures. They are incorporating the costs of maintenance of medical equipment in the procedure of procurement. This makes maintenance the onus of the supplier and ensures that timely checks and actions are taken by the supplier to make sure that delivery of healthcare is uninterrupted and efficient.

Taken together, population growth, too few health workers and their poor morale, lack of equipment and medical supplies, and increasing health burdens from chronic and emerging diseases have overwhelmed the capacity of the health system. The overall performance of health service delivery is unsatisfactory at all levels, especially in the public sector. Commitment by the government and other stakeholders of adequate financial and human resources, together with their efficient and effective utilization, will go a long way to improve the health of its population.

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Clean Care is Safer Care Standard principles for infection prevention and control focusing on hospital environmental hygiene, which is crucial to the prevention of healthcare associated infection (HCAI). Good hospital hygiene is vital to any strategy for preventing HCAIs in hospitals

By Japneet Kaur, Elets News Network (ENN)

I

t is said that “It is easy to make friends but very difficult to maintain friendship”. Healthcare infrastructure is no different. It is not enough to engage great architect, health planner and a very good executing agency offering attractive, pleasing and rich specifications in the construction of healthcare infrastructure. The essence lies in the proper maintenance of infrastructure so that it functions smoothly and aids the sustainable delivery of healthcare.

Though there is a suitable protocol, standard operating procedures should be in place during the design and planning of hospitals but the efficiency and effectiveness of healthcare delivery lies in its maintenance.

HCAI- Causes and Precautions Health care-associated infection (HCAI), also referred to as “nosocomial” or “hospital” infection, is an infection occurring in a patient during the process of care in a hospital or other health care facility which was not present or incubating at the time of admission. HCAI can affect patients in any

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type of setting where they receive care and can also appear after discharge.

In a health-care facility, the sources of infection, and of the preceding contamination may be the personnel, the patients, or the inanimate environment.

The most frequent route of transmis-

sion, however, is indirect contact. The infected patient touches–and contaminates–an object, an instrument, or a surface. Microorganisms can be transmitted from their source to a new host through direct or indirect contact, in the air, or by vectors. Based on data

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The main solutions and perspectives identified for improvement are: Implementing standard precautions, particularly best hand hygiene practices at the bedside. It is recommended as the most important practice to control hospital acquired infection.

Improving staff education and accountability.

Disposables provides the best possible protections for the healthcare professional, i.e the surgeon, the caregiver, the nurse and finally the patient himself/herself. Using disposables during intra-operative procedures provides comfort and convenience to user and also earns the confidence by providing the consistent protections.

Designated proper place for garbage, bio medical waste (BMW) bins and temporary bio medical waste storage with removal facility through separate staircases and lifts and proper segregation, collection and disposal.

Energy conservation must be planned and implemented, and some of the measures are - use of efficient light sources, natural light utilization, effective ventilation and energy recycling.

Air curtains should be installed at entry of patient care areas such as ICU, OT sterile area and delivery suites.

Washrooms should be provided with grab bar with enabled entry of wheelchairs and with provision of emergency call button.

Flooring should be non slippery and abrasion, acid and alkali resistant.

There should be distinct, ideally separate, access for ambulances and ambulant cases.

Corridors should not be less than 2.85 m in width to facilitate the movement of trolley and stretchers.

Provision for separate lifts for the patients, visitors, staff and supplies.

Lifts should be capable of accepting hospital beds with emergency equipment and attendants.

Appropriate traffic flow. Easy movement of patients and staff from one clean area to another.

Critical areas like LR, OT, ICU should be isolated from general traffic and avoidance of air movement from areas like laboratories and infectious diseased wards.

Provision of natural light should be made to the maximum.

Septic and non septic nursery provision to prevent the infection transmission between the neonates.

Right locations and zoning.

Mechanically or electrically operated beds.

Applying technology in innovative ways to enhance operational efficiency, enabling care coordination and improving patient outcomes.

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from a number of countries, it can be estimated that each year, hundreds of millions of patients around the world are affected by HCAI. Every day, HCAI results in prolonged hospital stays, long-term disability and increased resistance of microorganisms to antimicrobials, massive additional costs for health systems, high costs for patients and their family, and unnecessary deaths.

Healthcare services are in a dire need of a paradigm shift in terms of providing care more efficiently.

Many infection prevention and control measures, are simple, lowcost and effective, however they require staff accountability and behavioral change.

Over time, healthcare providers and clinicians at various hospitals have realised this oversight and have instituted corrective measures. They ensure that timely checks and actions are taken to make sure that delivery of health care is uninterrupted and efficient.

Many of these efficient ways of functioning are being practised across the country. Diagnostic and other allied services like laundry, kitchen waste management are already being outsourced. This is called ‘wet leasing’ where, the space is provided within the infrastructure and the cost of installation, running and maintenance of the equipment lies with the vendor. Similarly, facility management is out-sourced and is responsible for looking after the house keeping and engineering maintenance besides the efficient functioning of these out sourced areas of specialty.

This has helped in creating an environment where the clinician and medical staff can attend their clinical services more efficiently and effectively and not worry about maintenance of general running of the hospital.

Infection control is the discipline concerned with preventing HCAI. It is an essential (though often under-recognized and under-supported) part of the infrastructure of health care.

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Controlling HAI is about Saving Life I n today’s era, hospitals have become high-tech centres of healing with state-of-the-art infrastructure and technologies. Doctors have become highly super specialised. Inspite of all this, hospital associated infections (also called nosocomial infections) are one of the critical focus areas for the healthcare industry.

These are the infections obtained by the patients from the hospital. The impact can mean months of additional

Avinash Ojha Chief Executive Officer RG Stone Urology & Laparoscopy Hospital

treatment and cost. India is a high risk potential market for these infections due to factors such as huge population, lack of sanitation procedures adherence; thereby leading to high disease prevalence rate.

Hospitals acquired infections (HAI) can be caused by direct line into veins or catheters; others can result through surgery byproducts or resistant bacteria. Various such infections include pneumonia, blood stream infection, surgical site infection, urinary tract infection, MRSA infection and others. The hospital acquired urinary tract infection holds the maximum prevalence share in this category.

Noscomial infections are a huge burden on the healthcare system, and almost all are preventable! It is indeed a setback for the ailing patient who wants to get better but gets afflicted even more.

The infection control in the hospitals is taken care of by high rate of implementation of healthcare guidelines given by the regulatory institutions, standard treatment protocols, infection control measures, proper biomedical waste disposal mechanisms, and proper sterilization techniques. Hand sanitization is one of the key factors.

Almost all facilities have now installed sanitizer dispensers to allow regular disinfection of hands. World Health Organization (WHO) recommends rewarding employees with great hygiene and penalizing employees with poor hygiene. Medical and surgical patients are to be managed at different areas in the hospital so as to reduce cross infection spread to the least.

Compliance with regulations is to be

strictly monitored. Functional department planning is as important as structural planning. All departments such as Out Patient Department (OPD), Diagnostics, In Patient Department (IPD), Supportive services need to be segregated from each other so as to prevent mixing of patient flow. Critical areas such as Operation Theatres, ICUs need to be isolated from general public. Careful zoning (sequence of increasing clean zones) for OTs is very important. There must be easy movement of staff in clean areas without passing by dirty areas.

Ample wash basins to be provided within patient care and nursing stations.

Separate staircases should be there for waste removal. Proper ventilation of wards is also of utmost importance.

RG Stone Urology & Laparoscopy Hospital focus on delivering qualitative services so as to establish necessary healthcare standards specialized in infection prevention and control.

The hospital employees are required to complete an infection control training program. Routine tasks such as Surgeon wash is monitored even more closely. Operating room temperature, humidity levels that minimize bacterial growth, and minimal traffic in and out of operating rooms are few of many protocols that are adhered well to.

Controlling the hospital acquired infections is of course about saving lives, but it is also cost effective. The hospitals get severely penalized for high rates of nosocomial infections.

This often overlooked concern needs to be given a very serious look at the very start of planning so as to be able to deliver efficient qualitative treatment.

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Hospital Infrastructure and Infection Control

By Dr Parvez Ahmad, Group Medical Director, Rainbow Group of Hospitals, Hyderabad

T

he physical design of Children and Mother Hospital is an essential component for infection control measures to minimize the risk of transmission of any infectious disease in the vulnerable group i.e. newborn, children and pregnant women who are more susceptible to the infection. When historical and traditional hospitals were built, there were minimal concerns of new emerging infectious diseases. Children & mother hospital were designed as any usual general hospital. More progressive outlook and patient expectation made it the fundamental requirement to adopt a holistic view of the design and management of children & mother hospitals. Designing of mother & child hospitals should be focused on patients i.e. newborn, children, pregnant ladies, their visitors, hospital staff and environmental safety.

Spread of infections in hospitals lead to loss of many human lives. These Nosocomial infections, also called hospital acquired infections (HAI) occur in the patient during hospital stay or after the discharge. International average of infection rate is 8.7%, however it is higher in India specially in newborn, children and pregnant ladies due to their weak immunity system. HAI can be minimized due to effective planning & designing of hospital infrastructure as steps of infection control.

can minimize the risk of infection transmission. Therefore, this must be a prerequisite to take these into consideration from the initial conception and planning stages of the building.

Facility planning therefore needs to reflect at the beginning itself to fulfill the infection control criteria.

Designing of OPD OPD should be readily accessible from the hospital’s main entrance & in close proximity of diagnostics services & pharmacy with parking facility.

Children OPD: should have play area for children’s and effective disinfection protocol on regular interval for play area to avoid or minimise the risk of transmission of infection amongst children through play area. Waiting area and sub waiting area for healthy children for periodic health check ups and separate waiting area for sick children. Breast feeding room for mothers with other ancillary and auxiliary facilities like vaccination cum injection room, nebulisa-

Designing The structure and physical design are very essential components of a hospital’s infection control strategy which

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Dr Parvez Ahmad

tion room and blood sample collection room. Drinking water facility along with wash room, with proper provision for changing the baby’s diaper. A provision of small cafeteria can be made. Preferably independent routes are required for women & children OPD. Women (Obstetrics & Gynecology) OPD also should have facility for blood sample collection, drinking water and adequate wash room along with cafeteria for pregnant ladies and special emphasizes should be given to anti slippery flooring.

Designing of IPD

Wards: should be attractive with pictures of cartoon characters/ animals etc which can be displayed, with play area to attract the children. Wards should have feeding bottle sterilization, isolation, blood sample collection and procedure room with all necessary supplies including sufficient hand washing facilities.

Pediatric rooms: two sets of door handles one at a high level and one at low level for use by children. Patient rooms should have windows so that use of natural light could be optimized.

Nurse station: should be located as centrally as possible to the activities of the unit and provide optimal visibility.

Post delivery wards should be little away from the other wards to avoid the disturbance to other patients as generally these wards have happy environment.

Provision of separate rooms should be available for the mothers who lose their babies during delivery to provide them calm and soothing environment and to

avoid emotional stress while listening the voice of other newborn babies. Maternal ICU facility may be available to deal with high risk complication maternal cases.

Designing of OT & LR Standard OT size - 20 x 20x 10 feet Zoning: Infection Control in OT can be carried out by proper planning and correctly designing of OT zoning in four zones i.e. Protective zone, Clean zone, Sterile zone & Disposal zone. Further infection will bring down with proper maintenance of Ventilation, Temperature, Humidity, air changes and use of HEPA filter, laminar flow and protective clothing and infection control programme. While designing the OT the following factors should be considered: • Corridors should not be less than 2.85 m in width to facilitate the movement of trolley and stretchers.

obstetrics unit and to the nursery and should be attached with pre and post delivery wards with all infection control facilities. One operation theatre provision can be given in labor room complex for caesarean section.

Designing of ICU

Location: preferable to have near OT, ER and Imaging Department.

Space: 14 Sqm/bed (Minimum) Lighting: provision of natural light should be made to the maximum. It is recommended to have a 300 lux light illumination for patient areas with antiglare arrangement, 100 lux for corridor and 150 lux for staff area.

Environmental control: humidity: 50 +/- 5, Temperature: 21+/-3c & at least 10 – 12 air changes per hour & positive air pressure.

Beds: Mechanically or electrically operated beds.

room, doctors duty room, utility room, hand washing facility i.e. wash basin between other bed if possible & washroom facility in the ICU.

Designing of emergency Ground level location is best since it avoids access by stairs or elevators, and provides easy access for patients and ambulances. There should be minimum criss-crossing of patients.

A separate entrance and exit may be planned to facilitate unidirectional patient flow. There should be distinct, ideally separate, access for ambulances and ambulant cases. There should be a readily identifiable triage area with expansion facilities for utilization during management of disasters.

It should provide privacy during management of patients. Isolation cubicle facility can be planned.

Designing of cssd

Space: 0.7sqm/bed Proper layout: (Unidirectional flow, zoning) and separation of clean and dirty areas should be as follows : Receiving area, Washing area, Cleaning area, Packing area, Sterilization area (Autoclave & ETO), Sterile store area, Issue area.

Designing of kitchen • Seamless OT i.e. no joints.

• Easy movement of patients and staff from one clean area to another.

• Removal of bio medical waste from the suite without passing through clean areas.

• Taps in the scrub room should be knee/ elbow operated or electronically controlled, activated by infrared sensor. In operating, anesthetic, recovery rooms, holding area, the color of the walls and ceilings should be such that they do not alter the perception of the skin color.

Labor Room The labor & delivery room should ideally be located close to the

Storage/Utility area: space for placing equipments, housekeeping supplies and lockable space for storing drugs.

Isolation room: with negative pressure.

Septic & Non septic Nursery provision to prevent the infection transmission between the neonates.

Breast Feeding room/Pumping room along with feeding bottle sterilization facility and if possible kangaroo mother ward can be created.

Visitors waiting room: This should be provided outside the ICU with seating facility and toilets. Provision for equipment room, Counseling

Design: should be logical work flow i.e. Receiving area, Storage area: (Dry Store & Day to day Sundries store), Preparation area, Production/cooking, Service area, Food distribution, Dish washing area & Garbage disposal.

Other Considerations: Proper lighting, LPG cylinder bank, Hot and cold water outlets, Air lock should be provided between the kitchen and the outside & Provision for equipment of Insect Killer.

Value added services Prayer room, Flower shop/ fruit shop/ book store, Fitness/ wellness center, Guest House, Communication facilities-STD, ISD, FAX, Cyber café, post office, Banking/ATM facilities .

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Special Focus

Oncology

T

he International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization reveals an estimated 14.1 million new cancer cases and 8.2 million cancer-related deaths occurred in 2012, compared with 12.7 million and 7.6 million five year ago. The cause of concern is the geographic spread of cancer, as the re-

port suggests that more than half of all cancers and cancer deaths in 2012 occurred in less developed regions of the world, and these will only increase by 2025. For a developing country like India, the economic burden of cancer is a major hurdle in fighting the disease. There are limited cancer hospitals, lack of specialist doctors and the overall treatment cost is very high compared to other diseases. In addi-

Cancer

tion to these, the prolonged chemotherapy and its side effects take a toll on the patient – physical, emotional and economical.The best foot forward to strengthen our fight against cancer is to create a robust and effective early detection, diagnosis and treatment protocol.

India – High Alert The flagship government initiative of

Emerging as the Biggest Killer Worldwide Latest reports from WHO suggests that there will be 22 million new cases of cancer every year in the next two decades. With more than 60 percent of the cancer cases in Africa, Asia, Central and South America- India is on high alert. Rachita Jha finds out more…

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National Cancer Control Programme states that In India it is estimated that there are 2 to 2.5 million cancer patients at any given point of time, of this 0.7 million new cases coming every year and nearly half die every year. The reason of high mortality rate is that two-third of the new cancers are presented in advanced and incurable stage at the time of diagnosis, thus leaving very little room for the hospital or doctor to help the patient in recovery. Reflecting on the rate of incidence of cancer in India DrAmolAkhade, Medical Oncologist, International Oncology Services at Dr. LH Hiranandani Hospitalsays, “The most important trend in our country is that the number of cancer patients in our country is increasing.

As per the national cancer registry data last published in 2008, in Mumbai city itself there are about 30,000 new cases diagnosed. This was the situation considering past data with limited survey constraints; the status today should be four to five times larger and this is for a single city only. Thus, the numbers of the entire country will be much more.Also,this data does not coverthe remote areas which have not been included till now.

Thus it is evident thatthe numbers are growing manifold.”

The major factors accounting for the rise in cases are changes in lifestyle, pollution, longevityand better medical diagnostic services available fordetection of cancer due to improved imaging modalities.DrAkhade adds, “Many hospitals and diagnostics centres today have MRI and CT, and the future is not far when even PET scan will be available easily. We are detecting cancers much more easily than it was possible few years back and by 2025 cancer will be second leading cause of death from a non-communicable disease.” The speculation of the number of cases being much higher in India also stems from the fact that the awareness on the prevention and

“We are detecting cancers much more easily than it was possible few years back and by 2025 cancer will be second leading cause of death from a non-communicable disease.”

Dr Amol Akhade, Medical Oncologist, International Oncology Services at LH Hiranandani Hospital diagnosis is not high as compared to cardiac ailments. Hence it is necessary to emphasise the importance of screening tests and regular health check-ups in cancer similar to heart diseases.

Integrated Approach Unlike other forms of diseases, for cancer it is preferred to follow a protocol-based treatment in a tertiary care hospital. This ideally involves the team of medical oncologist, surgical oncologist and radiation oncologist. Keeping the status of cancer for a particular patient, a unique treatment plan is drawn out in consultation to follow a protocol-based approach involving all three modalities that ensures consistency and comprehensiveness of treatment leading to better outcomes.

Due to absence of speciality hospitals and trained oncologists in many parts of the country, patients have to either make dowith whatever is available or migrate to cities where cancer hospitals are available. “At least 70 percent of the cases are already in the advanced stage of cancer when they reach any tertiary care hospital.

Although the cancer might be picked up early, due to inappropriate treatment given to the patient, by time it reaches our hospital the case is advanced stage and then we can only control and not cure the patient,”says DrAkhade. Cancer therefore demands a connected line of treatment from

various levels in healthcare delivery chain. He adds, “We need better healthcare which is not on ly at the tertiary access but also is connected by channels via primary and secondary care centers to ensure the patient is taken through the chain of care.

International Oncology Services has taken many initiativesand the aim is to widen the spread of cancer care across tier 2 cities This has been embedded in our plans to ensure that not only is the infrastructure improved across all parts of the country but also to pick up cases early and treat them so as to reduce morbidity and mortality.”

Thus an integrated approach is very important in any strategy that aims to screen, diagnose and prevent cancer, especially for a country like India wherein the healthcare delivery system largely has primary and secondary care available for larger sections of the society

Importance of Protocol Treatment The developed countries are moving towards protocol-based or evidencebased mode of treatment for cancer.

This has proven to be more effective and reduces the side effects of unwanted exposure to radiation as well.

Elaborating on the same Dr Neeraj Mehta, Regional Head, InternationalOncology says, “Treatment has to be comprehensive.The expertise in-

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Special Focus

Oncology

cludes surgical oncologist, medical oncologist and radiation therapist.

This usually involves that following a surgery, prescribed chemotherapy, medication and drugs will start and based on the assessment of the patient condition, radiation therapy will begin. These are steps of a protocol oriented therapy that is critical for patient recovery. Cancer care does not end post operation. For example if there is a tumour or a lump, even post surgeries there are chances that some cells go into circulation and grow.

So after surgery the treatment continues with chemotherapy and times supplemented by radiotherapy, and so the awareness needs to be there.”These protocol based treatment guidelines should be a joint decision taken by medical, surgical and radiology oncologists together. In the developed countries, since last 30 years cancer is treated only in tertiary care centers and only using protocol based treatment.

The reasons for the absence of such a practice in India includes, lack of co-ordination among doctors treating the patient, lackof referrals to comprehensive cancer care hospitals, existence of cross-speciality practice wherein the doctor continues patient care despite his limited expertise. Dr Mehta suggests, “In totality, a specialist treatment costs much less, compared to an unorganized and insufficient treatment which will lead to relapses and more cost and intervention later. The disease has to be diagnosed, so that adequate treat-

“Treatment has to be comprehensive. The expertise includes collaborative team work of surgical oncologist, medical oncologist and radiation therapist.”

Dr Neeraj Mehta, Regional Head, International Oncology Cancer Centre, Dr L H Hiranandani Hospital

ment and medication is planned and providedaAnd the course of treatment is addressed at an early stage itself.

Our assessment is unique for a patient based on his stage of cancer instead of a straight-jacketed treatment for all.”

In malignancy, ,the first line of treatment is the best chance to help the patient. Delays in correct treatment only deteriorates the condition of the patient thus reducing the chances of survival and adding costs. The idea is to take protocol treatment to the grassroots.

“The latest trends in radiation oncology include the arrival of Intensity-Modulated Radiation Therapy (IMRT) and Image-guided radiation therapy (IGRT) technology, the most recent is the RapidArc therapy” Dr Wasim Phoplunkar, Radiation Oncologist, International Oncology Services at LH Hiranandani Hospital

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Decentralized healthcare delivery Many cities in India do not have good treatment facilities available in a government set up. And there should be more cancer hospitals especially in smaller towns and cities to address the growing cases of cancer in these areas. Due to the constraints of distance, travel and cost, taking treatment in a specialized hospital in metro cities is unviable for many patients. “To make cancer care affordable and accessible in a government healthcare model, the key is to bring-in decentralization. The government however has taken many initiatives on cancer care in India, apart from setting-up of new cancer hospitals in tier-2 cities; they also have launched many schemes including the national cancer control programmeto address the growing disease burden of cancer in the country,” says DrAkhade.

The amount of funding done by the government is significant, if implemented

properly it may have a huge impact in treatment of cancer patients in India.

“In the next ten years, we are sure there will be a better balance of cancer care in the rural and urban India,” he adds. This model will be very effective to achieve screening, diagnosis and preventive care initiatives to identify patients in their early stages of cancer itself, thus better coping mechanisms of treatment and cure can be availed.

Trends in treatment modalities Treatment is now becoming affordable with early diagnosis, and there are new drugs which are much more effective and have reduced side effects. “The new advances that have happened in cancer treatment across the world have happened in chemotherapy, whereas surgical treatments have been largely same over the years.

Maximum evolution has been seen in chemo-drugs, where new age targeted

drugs have come up. As the name suggests these are targeted only at cancer cells and not the surrounding cells so the side effects are much less and deliver better results in not just disease control rate but also disease cure rates,” informs DrAkhade.In addition, newer radiation-based techniques that have come up, the beam is now more precise such as the rapid arc machine in which the radiation is targeted so side effects are lower, the results are better and compliance of treatment is improved. “The supportive care in form of growth factor boosters and targeted drug therapy is also a fast advancing field, there has been an improvement in the efficacy of cancer treatment to such an extent that now we are able to offer chemotherapy even to elderly patients that was extremely high risk earlier,” he adds. The latest treatment modalities have tablets available for certain forms of cancer such liver and kidney, for those patients that cannot take injectionable therapy. This helps in compliance and the costs are less.

Dr. WasimPhoplunkar, Radiation Oncologist, International Oncology Services at Dr. LH Hiranandani Hospital says, “The latest trends in radiation oncology include the arrival of Intensity-Modulated Radiation Therapy (IMRT) and Image-guided radiation therapy (IGRT) technology, the most recent is the rapid arc and we were the first hospital to install this facility in Mumbai. The main advantage lies in the precision of the device as usually the patient might move or the organs might move during the treatment and so a larger area is selected for radiation exposure to ensure the tumour is on target. This is not required in the rapid arc as the real time images are being captured during the treatment and overall treatment time is reduced to 2-3 minutes so that the chances of patient motion or organ motion are lessto ensure the results are better and side effects

“More of hematooncological diseases are becoming curable and we do bone marrow transplantation for these malignancies and also treat nonmalignant condition.”

Dr Ashish Bakshi, Medical Oncologist, International Oncology Services at LH Hiranandani Hospital

much reduced.” Overall, cancer care is becoming personalised and unique depending on the stage of cancer.

In addition, there are advanced research studies being conducted to know more on the biology of cancer especially molecular pathways. Elaborating on the arrival of new drugs DrAshish Bakshi, Medical Oncologist, International Oncology Services at Dr. LH Hiranandani Hospital says, “Because of recent advances in molecular research on cancer cells we now know that there are certain targets or there are certain molecular pathways that are involved in a particular cancer and we if are able to block those pathways with the help of newer drugs there are improved outcomes of the treatment. So targeted therapies have become new development and every year there are 8-10 molecules that have proved revolutionary in the way we treat cancer.”

Blood cancer Blood related malignancies although

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Oncology

are not a common form of cancer in terms of incidence; however it is a curable form of cancer. However, most of the times, by the time the patient reaches a tertiary care centre, he has already undergone some form of incorrect treatment as the awareness is absent. International Oncology Services has taken the initiative to launch a blood clinic at Dr. LH Hiranandani Hospital to address these special group of patients. “Haemato-oncologyis a highly specialisedfield because the blood related malignancies are fairly commonly seen in the country and an ordinary physician or a general practitioner cannot handlethese malignancies.

More so because nowadays, the field has specialised so much so that there are targeted genetic tests available for these diseases both in terms of diagnosis as well as monitoring out the disease,� says DrBakshi. There is lack of trained doctors equipped to treat blood cancers. In addition, in cases of lymphoma or multiple myeloma if it relapses requires a stem cells transplant that requires facility of bone marrow transplant. “It was much needed that for any bloodrelated diseases that maybe benign such as low platelets due to idiopathic thrombocytopenic purpura (I.T.P.) or deadly diseases like acute myeloid leukaemia (a form of blood cancer)a single facility should cater to all such diseases. We have therefore launched a blood clinic wherein any patient suffering from any form of blood related disease can approach us and get best-in-class treatment,� informs Dr Neeraj Mehta. The advances and affordability of bone marrow transplant is also an advantage for the patients suffering blood cancer. “More of hemato-oncological diseases are becoming curable and we do bone marrow transplantation for these malignancies and also non-malignant conditions. Because of the increasing affordability of Indian population, more and more people can go for the

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Targeted therapy is the future Type of cancer patients regular at the hospital‌ We at Wockhardt Hospital, Nagpur, mostly see cancer of head & neck due to the rampant use of tobacco and related products in our country; this is followed by cancer of lung, breast, gastrointestinal tract, liver, and blood cancer.

Cancer treatment facilities available at the hospital‌ We offer surgery, chemotherapy, hormonal therapy, management of cancer pain along with help for handling psychological issues. In addition, we also keep our patients in close follow up post treatment, where we closely monitor a patient’s condition without giving any treatment until symptoms appear or change.

Some recent advances‌

With the advances in diagnostic and therapeutic modalities the incidence of cancer is on a rising trend also more and more number of patients is diagnosed at an early stage so that curative treatment can be delivered.

FDG-PET CT Scan: The use of FDG PET-CT scan (2-Flouro-deoxyglucose) in diagnosing the cancer and to know the spread is latest and now the imaging modality of choice for almost all types of cancer except for Leukaemia (Blood Cancer). PET-CT scan can detect primary tumour as well as metastatic sites without any exposure to radiation.

Bone Scan: Fluoride bone scan is also increasingly being used in cancer of solid organs for detecting spread of cancer in bones.

Chemotherapy: There is great advancement in chemotherapeutic drugs over the decade and lot of newer generation drugs called as Targeted therapies are now available Radiation Therapy: As in chemotherapy major advances in radiation therapy also occurred over the decade and now more and more use of advance technologies are being used to avoid harmful effects of radiation to non cancerous part of body.

Dr Amol Dongre Consultant Oncologist, Wockhardt Hospitals, Nagpur

bone marrow transplant and secondly, earlier we used to find difficulty in finding donor but nowadays with donor registry available we are able to identify donorsmore easily and as a result transplants are becoming more common. Similarly umbilical cord transplant are also becoming routine thing in our practice,� informs DrBakshi.

Future Positive Although statistics reveal a grim picture of cancer tide in India, the collaborative efforts among government, hospitals, doctors and organisations

such as International Oncology Services are building groundwork for counter-attack to the disease menace.

Taking a hub and spoke model, International Oncology Servicesplans to extend reach of cancer treatment and diagnosis to smaller towns and cities that lack these facilities in order to fulfill a larger goal of bringing the best of cancer care to India. Empowered by a dynamic team of experts dedicated for the cause, collaboration and partnerships amongst hospitals, doctors and research organisations we will make this vision a reality in near future.

Special Focus

Oncology

Living with

Lymphoma

Dr Anurag Mehta, Director, Laboratory Services, Rajiv Gandhi Cancer Institute & Research Centre and the Organizing Secretary, RGCON 2014 (Lymphoma – Biology to Therapy, Feb 15-16, 2014) discusses the nutritional facts and fallacies with Shahid Akhter, ENN

R

eceiving a cancer diagnosis can be overwhelming and no less complicated. Within a short duration of time, one is expected to learn a lot of things so that he is more familiar with the condition and the treatment process.

Nutrition is one such aspect that fuels appetite for more information.

Following diagnosis, what nutritional strategies would you recommend ?

As a patient, one goes through a lot of emotional and social stress and tries to acquire all the possible knowledge about the treatment, side effect and lifestyle modifications. After some of the dust has settled regarding the treatment plan and chemotherapy, the thoughts of many new lymphoma patients turn to diet and nutrition. They want to know if, in the past, their diet played any part in their development of lymphoma and going forward, can diet play an important role in directing their fight against lymphoma with their survival odds.

Unfortunately, no dietary treatments are available for lymphoma.

Being well nourished will help your body respond better to treatment, and will help you recover more quickly after treatment has ended. Being appropriately nourished means working towards or maintaining a healthy weight and eating five or more serv-

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ings of fruits and vegetables each day, and minimizing your intake of alcohol, salt and processed meats.”

Will the food habit of the past impact the present ?

It’s natural to want to scour one’s past in search of the etiopathogenesis on one’s cancer, but in the vast majority of cases, the cause will never be uncovered—either because it is simply impossible to determine what caused most cancers with certainty, or because that ‘something’ that someone believes they may have done in the past to have brought on this cancer does not in fact exist.

One of the potential dietary causes enlisted by National Cancer Institute is “high meat and fat diet” as being a potential risk factor for nonHodgkin’s lymphoma, which till date has not been proven as in breast and endometrial carcinomas.

Can ones’ diet fight Lymphoma?

Diet and nutrition are easily targeted by quacks and hucksters looking to cash in on the desperation of cancer patients, and since it involves the immune system, this is especially true in lymphomas. However, to date there is simply no evidence that altering one’s diet can play any part in directing beating back one’s lymphoma, however eating fresh fruits and vegetables have mentally and emotionally boosted a psychological sense of well being in the patients will to survive which in turn boosts the immunity of the patient to fight cancer. At that particular point of time anything positive may modify the course of illness and result in a positive outcome due to the enhanced reinforcement of the immunological attributes.

Minerals and Supplements There is a very long list of nutritional products which support a healthy immune system. Many of these immune boosting supplements are antioxi-

dants. The list includes a variety of vitamins, minerals and other routinely used dietary items. Zinc is involved in just about every aspect of immunity and helps support a healthy immune system by increasing white blood cells which increase antibody releases, increasing numbers of infection fighting T-cells, and increasing the number of killer cells that fight off free radicals.

Selenium is an essential trace mineral which functions primarily as an anti-oxidant in the body. It works synergistically with vitamin E in supporting immunity by reducing free radical damage to cell membranes.

Vitamins A, C and E are all well known immune system builders. Vitamin A is a key in maintaining immune cell function and plays a role in the development of T cells and B cells.

to destroy the cancer cells. .Recent studies have shown that vitamin D is also important for proper functioning of immune system.

Beta Glucan enhances immunity by promoting macrophage and neutrophil production and by stimulating natural killer cell function. Beta Glucan is a complex long chained polysaccharide derived from the wall of baker’s yeast. It is also found in mushrooms. Many herbs including, Aloe Vera, Astragalus, Licorice root have been known to affect the immune system.

Other commonly used dietary items shown to boost immunity include, garlic, olive leaf, cranberry. In the future, if any nutritional therapy can significantly alter the disease progression in lymphoma patient, it

“Developing a positive attitude is essential as Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor” It also promotes antibody function.

Vitamin C is a key factor in protecting our cells from oxidative stress and works in conjunction with vitamin E and selenium in enhancing immune response. Vitamin E is a very efficient antioxidant and a modulator of a number of our body’s host immune functions. Vitamin E is also known to cause apoptosis, or programmed cell death, the body’s normal method of disposing of damaged, unwanted, or unneeded cells.

Is non vegetarian food desirable?

Cancer cell walls have a tough protein covering. By refraining from or eating less meat, it frees more enzymes to attack the protein walls of cancer cells and allows the body’s killer cells

will be a big success, but as of now they are under trials.

Based on the individual’s mode of cancer treatment, isn’t there a need for customized diet ?

This isn’t to say that changing one’s diet following a diagnosis of lymphoma can’t be beneficial, especially if one is undergoing modern anti-cancer treatments such as chemotherapy and/or radiation. Because these treatments can take a toll on the body and deplete it of certain nutrients, a diet that is tailor-made to suit the specific needs of the patient can be of great help in maintaining his health during anti-cancer treatments so that they can emerge from them as healthy as possible.

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Oncology

No single food or food component can protect you against cancer by itself. But strong evidence does show that a diet filled with a variety of plant foods such as vegetables, fruits, whole grains and beans helps lower risk for many cancers. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline environment. About 20% can be from cooked food including beans. Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells. Vegetables and fruits are low in calories, which help us get to and stay a healthy weight. Whole grains and beans are rich in fiber and moderate in calories, which also help in weight management efforts.

Besides dietary regulations, what matters most in cancer care ?

Following good food safety practices is always important, but food safety is especially important while going through cancer treatment. Chemotherapy, radiation, blood or marrow transplantation, or removal of the spleen can make people more susceptible to food borne illnesses. Finally developing a positive attitude is essential as Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, unforgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax and enjoy life.

To that end, and since each person is different, lymphoma patients should consult their treating physician and nutritionists and similarly skilled registered dieticians—either in residence where one is being treated, or by referral from one’s oncology team—to determine the best possible diet.

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Is there any standard recommendation?

According to American Institute of Cancer Rresearch (AICR) laboratory studies have shown, many individual minerals, vitamins and phytochemicals demonstrate anti-cancer effects.

Yet evidence suggests it is the synergy of compounds working together in the overall diet that offers the strongest cancer protection.

That is why AICR recommends filling at least 2/3 of your plate with vegetables, fruit, whole grains and beans. The American Institute for Cancer Research (AICR) has enlisted potential cancer-fighting foods.

Is there any nexus between sugar and cancer cells ?

Nutritional Choice Guidelines Maintain weight within normal range Get active, getting the equivalent of 30 minutes of walking per day Consume calorie dense foods sparingly Eat at least 5 portions of non starchy vegetables and fruits per day Consume less than 18 oz of red meat per week Limit daily alcohol intake per day to no more than 2 drinks for men, 1 for women Avoid salty or salted foods Dietary supplements may be recommended by your physician to correct a nutritional deficiency, but are not recommended for cancer prevention. It is usually best to get your nutrients from foods rather than supplements (Source: World Cancer Research Fund’s recommendations)

In general, dietary sugar does not feed cancer cells. All cells do run on glucose, a type of sugar molecule, a small amount of which does come directly from the diet. But, most blood glucose is synthesized in the liver.

The amount of glucose that we have circulating in our blood supply (and thus available to the cancer cells) is tightly regulated under normal circumstances, and is a balance between the amount of sugar produced by the liver and the amount of sugar taken up by the cells through a mechanism that involves the hormone insulin. Cancer cells grow and multiply by taking more of their fair share of nutrients from the blood stream, and by tricking the liver into producing more glucose to fuel their growth.

Blood glucose, rather than dietary sugar, should be the focus for people trying to decrease their risk of cancer or cancer recurrence.� Maintaining a healthy body weight through a combination of regular exercise and avoiding over-eating is recommended and has also been shown in study after study to be associated with lower risk of cancer recurrence and improved survival after a cancer diagnosis.

Special Focus

Oncology

India set to be Cancer Capital Prof. Chintamani, President - The Association Of Breast Surgeons Of India, Vardhman Mahavir Medical College Safdarjang Hospital, in conversation with Shahid Akhter, ENN, discusses the onco challenges.

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Oncology

T

oday cancer has percolated into our daily life, like never before. It is in the air, food and water. Despite cutting edge treatments, cancer figures continue to remain stubbornly high. Cancer seems to be tightening its grip on India.

Cancer is a leading cause of death worldwide, accounting for 7.6 million deaths.

India has nearly 3 million cancer patients.

Despite cutting edge treatments, We are stiil grappling with the high price of cancer care.

Where are we heading to?

How do you envision the Indian onco-scenario?

A million new cases are reported in India every year.

It is indeed a reality and we need to understand that now we live in the midst of disease and preventive oncology is assuming great relevance in developing countries like India. There is great concern about the environmental insult as you mentioned but the major impact has been on account of lifestyle that has changed drastically and is still changing. The so called “burgers cola culture� that we have adapted along with the western lifestyle and element of stress is contributing a great deal. Our rivers are polluted beyond repair; there is a high dose of carcinogens in the food and water that we are consuming, so on and so forth. Even the mother’s milk has been found to have a high percentage of chemicals and metals that are believed to be damaging. This epidemic has already hit India big time. Breast cancer is fast catching up as the most common cancer in the Indian women and tobacco abuse has already made oral cancers the most common cancers in Indian males. This needs addressal at the earliest.

Lung and oral cancer are the most common among men.

Cancer continues to sound like a death knell to a layman in India. More precisely, what exactly does it mean to be a poor and suffer from cancer as well ? How does he cope with the trauma ?

It cannot get any worse than that.

Poor man and cancer is a deadly combination. The management of

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Cancer Today

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Deaths from cancer worldwide are estimated to reach 13.1 million deaths in 2030.

Air Pollution causes lung cancer.

WHO Classifies it as carcinogenic.

Cervix and breast cancer are the most common among women.

Tobacco use is the most important risk factor for cancer causing 22 percent of global cancer deaths and 71 percent of global lung cancer deaths.

Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year.

Cancers such as breast, cervical and colorectal cancer can be cured if detected early and treated properly. cancer is very expensive and the cancer drugs, radiations and surgery are beyond the reach of a sizable majority. India is indeed a land of paradoxes; while at one end of the spectrum there are centers that are at par with the best in the world and at the other end there are still issues with basic health care for the majority of Indians.

How do you compare the diagnostic costs and screening programmes in India with that of the West ? To what extent are the government policies responsible in meeting the onco

challenges that we face today ?

There are no screening programmes in India for any cancer except the cervical cancer and the obvious reason is the cost involved. Screening although now being challenged did play a very significant part in the management of various cancers in the West, especially breast and colorectal cancers.

I am sure the government is doing its bit but we need to do more in health care and especially cancer needs to be given the priority it deserves in a civilized world.

As the President of the Association of Breast Surgeons of India, how do you address the breast cancer epidemic that is set to overtake cervical cancer as the most common cancer in women?

Ever since I took over as the President of this National body “The Association Of Breast Surgeons Of India� we have been conducting various cancer awareness programmes and seminars and conferences to educate the care providers and cancer patients across the country. We are the first breast cancer related National association and it has been our endeavor to deal with basic issues and we are focusing on smaller cities and centers that often cater to the majority of our patients at peripheral levels.

Working at a tertiary cancer care center I have realized that there is more of “bankruptcy of thoughts and training� and we have taken upon ourselves the responsibility to conduct some training courses for basic doctors including imaging, core needle biopsies etc. We are putting in a serious effort to find and share the “Indian solution to Indian problems�.

We are working towards increasing breast cancer awareness (various pink ribbon marches, seminars etc.) and also planning screening programmes that can be in the form of clinical breast examination, self breast examination etc.

study that we had conducted and published that the delays are most often due to the delayed diagnosis by the providers .This therefore would mean that we need to prime and train our doctors into making an early diagnosis. In one case during this study we had observed that there was a delay of 35 days before a classical case of breast cancer could be diagnosed at a tertiary care center.

I am sure the government is doing its bit but we need to do more in health care and especially cancer needs to be given the priority it deserves in a civilized world. Cancer care in India is still struggling to reach all sections of society and is thoroughly disorganized How active and effective is the support service for cancer patients and care providers?

The cancer care in India is still struggling to reach all sections of society and is thoroughly disorganized.

There are very few dedicated centers to have a “holistic view” of the problem and there is too much of red tapism in state run services. Support services and nursing care to these patients is appalling.

How do you compare cancer care in India with that of the West?

Indian cancer has been shown to behave differently. In a study that we had conducted and published it was observed that unlike in the West where the incidence of breast cancer increases with age reaching a peak in 60s, we observed two peaks, one in 30s and 40s and the other one in 50s.The cancer occurring in the younger age groups was found to be more aggressive and associated with a poorer outcome. A special aggressive type of breast cancer (triple negative cancer) has been

found to be more common amongst Indian women occurring at younger age when compared to the western world.

This cancer has been found to have a bad prognosis. The classical “Indian oral cancer” involving the lateral sulcus has been linked to the peculiar habit of consuming the tobacco in the form of “quid” or khaini. The increasing abuse of this smokeless form of tobacco (Pan masala etc.) is a cause of worry. The Indian cancers and Indian patients with cancers behave differently from their western counterparts.

Early detection of cancer is the key to successful treatment.

Unfortunately, in India, patients come for treatment in stage 3 or 4. Why do they present late ?

Who do you think is responsible for the delay?

You are right and the best bet is to get the cancer early. We are struggling on this front as even today most cancers that we manage are advanced at presentation. We often attribute it to the lack of education and awareness amongst our patients, however we observed in a

In Indian perspective, how do you envision cancer detection and management in near future?

We cannot have an American or English solution to an Indian problem. We need to tailor the entire effort to our patients.

India is a vast country with highly skilled health care providers. The need of the hour is to standardize our efforts rather than the “free for all” kind of scenario, as it exists today. The management of cancer patients requires a multimodality approach and we need to bring all these specialties on board to improve the outcome. It is of course easier said than done but I am very optimistic about the future.

Please elaborate on dermatoglyphics in cancer detection?

You are perhaps referring to my study on using dermatoglyphics or finger printing for screening breast cancer.

This, in simple terms is to exploit the understanding that there is a genetic basis to breast cancer and the kind of fingerprints that we carry. One can say that we are carrying our genetic code on our fingertips as the patterns are unique to an individual and these patterns do not change as we grow.

In our study we observed that some finger print patterns are more often seen in breast cancer patients. We had published our study in a leading International cancer journal and are still working to find out if these can help us as a screening modality along with CBE (clinical breast examination).

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Oncology

Education, Awareness the

key to defeat cancer Dr. Nilesh Lokeshwar Medical Oncologist, Global Hospitals, Mumbai

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The theme for the World Cancer Day this year is to raise awareness and debunking the 4 myths about cancer: • We don’t need to talk about cancer • Cancer... there are no signs and symptoms • There is nothing I can do about cancer • I don’t have the right to cancer care Currently, 7.6 million people die from cancer worldwide every year, out of which, 4 million people die prematurely (aged 30 to 69 years). Unless urgent action is taken to raise awareness about the disease and to develop practical strategies to address cancer, by 2025, this is projected to increase to an alarming 6 million premature cancer deaths per year.

Prevention is the most cost effective long term strategy for the control of cancer. Tobacco use is the most common risk factor for cancer and is linked to 70% of cancer related deaths. Tobacco is the single greatest avoidable risk factor for cancer. Inspite of its deleterious effects on health tobacco use is widespread in our society especially among the youth. The society and government has to implement initiative to put in place effective means to combat the tobacco epidemic through education, awareness and legislation.

There is poor awareness about cancer including risk factors, early detection, diagnosis and treatment.

Cancer still remains a taboo in our society and patients fear stigma and discrimination in society. This prevents them from seeking right help at the right time and at the right place. There

is a misconception in our country that cancer is always hereditary and can be contagious. These myths needs to be dispelled by appropriate education and counseling.

Lung cancer is the commonest cause of cancer related death in males and breast cancer in females.

Tobacco related cancers which include lung cancer, head and neck cancer and urinary bladder cancer constitute 38% of all cancers in males and 25% of all cancers in females. In males lung cancer has the highest incidence followed by digestive tract cancers and head and neck cancers. In females the commonest cancer is breast cancer followed by cervix and ovary.

According to 2011 statistics, breast cancer accounts for 30% of all cancers in women in Mumbai. Based on results from a recent study 1 in 28 women develop breast cancer during her lifetime.

This is higher in urban areas being 1 in 22 in a lifetime compared to rural areas where this risk is relatively much lower being 1 in 60 women developing breast cancer in their lifetime.

“Cancer is curable if detected early”, this statement especially applies to cancers that can be detected early by screening methods such as breast cancer and cervical cancer. Early detection leads to diagnosis and appropriate treatment and a higher cure rate. This would be feasible through educating public and family physicians regarding signs and symptoms which can be due to cancer and when to seek opinion of cancer specialists.

It’s through awareness about the disease that we will be able to defeat it.

See. Plan. Treat. Verify.

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Special Focus

Oncology

Shift in Population will lead to

more Cancer Patients More than 23 years of experiences in the field of Medical Oncology and approximately 600 transplants performed for various cancers in India, Dr Vinod Raina, Director Medical Oncology and Hematology, Fortis Memorial Research Institute, Gurgaon, also performed first high dose chemotherapy and peripheral blood stem cell transplant in India. Having considerable research experience, Principal investigator of approximately 50 projects in AIIMS, Dr Raina in an interaction with Ekta Srivastava, ENN

How the scenario has changed since you joined this field and what will happen in next ten years?

I graduated in 1974-75, since that time everything has changed. When I was graduating, there were no CT scanners, ultrasounds, MRI’s, PET scans or molecular diagnostic not even the computers, since then lot has been changed.

Technology has taken the medicine into new era of patient outcome and developing new researches.

Molecular diagnostic and all will be in advance position after 10 years.

Molecular oncology will come into front. Today, problem is that at the under graduate level cancer is not a specific topic but this is the topic or specialty at the post graduate level. At under graduate level they don’t have much information about the cancer.

In next 30-40 years cancer is going to be the major killer. This means it is increasing rapidly but mainly in urban areas not in rural areas and we need more cancer specialists in India.

How molecular diagnostics will helps in patient’s outcome?

Molecular diagnostics is growing rapidly. Molecular diagnostic tests detect specific sequences in DNA or RNA that may or may not be associated with dis-

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ease. Clinical applications can be found in at least six general areas: infectious diseases; oncology; pharmacogenomics; genetic disease screening; human leukocyte antigen typing; and coagulation.

Molecular diagnostic testing usually generates a profit margin that increases as the testing volume goes up. In general, there is greater clinical demand for tests that produce results in less than one day. The infectious disease applications are among the most common area of clinical interest.

What is the difference between medical oncology and surgical oncology?

Medical oncologist: They are the one who specialize in treating cancer with chemicals or medications like chemotherapy (the use of drugs to kill cancer cells) and work with primary care physicians and other medical specialists. Often, the medical oncologist is the coordinator of the treatment team and keeps track of the various tests results and follow-up exams performed by other specialists. A person with leukemia, lymphoma, or other blood-related cancer may be cared for by a hematologist (a doctor that specializes in the treatment of blood disorders). A hematologist also completes a three-year residency in internal medicine followed by a fellowship in hematology, oncology, or hematology/oncology.

Surgical oncologist: One of the main treatments of the cancer is the removal of the particular affected organ and that is done by surgery. This is a doctor who specializes in treating cancer using surgery. Surgical oncologists complete a five-year residency in general surgery and a two-year surgical oncology fellowship. They may choose to specialize even further and devote training to one type of cancer, such as breast or lung cancer.

What is the most challenging part for an oncologist?

Most challenging is the delivery of

cancer care. It’s a very long treatment which goes like for eight nine months.

Then you have to follow up the patient.

The relationship with the patient becomes completely different. It’s not like any other disease. Many cancers have become more like a chronic disease.

Cancer is not getting cured though their life is getting prolonged but they are not getting cured (there are some which get cure but not every cancer has got the permanent treatment)

“Cancer is the disease of the elderly. There is an tremendous increase in number of cancer patients, mainly because of the shift in the population” There are days when things are not going well such as, when patients you have been following up with have their disease progress and you are in a position where there is nothing much you can do. I think everyone finds that a challenging part of their work.

We are hopefully in a position where we can do something to help them. I think that is a good mantra, that you are trying to be there to be helpful to people and improve their situation and you know that you aren’t always in a position to take this away or cure it. But you are in a position where you can give quality time and improve patients’ quality of life. But we do cure them as well, of course.

Challenges arise with people who you’ve worked with for a long time, done multiple interventions for them and they’ve improved and then you get to the end of the line and there isn’t much else you can do.

What is the most common misconception people have

about medical professionals?

Yes they have many misconceptions.

Sometimes they say doctor don’t treat, sometimes they say they over treat, they have scientific mind, and doctors don’t have clear foundation.

Problem is that most of the treatment is done by the doctors who are not scientific, who don’t know what they are giving. Patients sometimes along with the chemotherapy are taking medicines and treatments from local hakeems, ayurvedic doctors and vaids, and since they don’t have much publication, we don’t know what these nonscientific doctors are giving to these patients. The biggest frustration is that sometimes when you are not able to cure them, patient starts going to these sadhu-sants, they believe in so much superstition that they will start saying that particular period will be good for the treatment, now we as the medical persons know what is going inside their bodies but we cannot go against their wishes.

Is there a rapid growth in cancer patients in India? Which age group it is affecting the more?

There is a rapid growth. Cancer mainly is the disease of the elderly. There is an increase in number of cancer patients, mainly because of the shift in the population. If you look at the graph of the India more than 50 percent of the population is under the age group of 30 years. But in next twenty years it will not be like that because in next ten years there are more people who will be elderly. So, in addition to the fact that the reach for the treatment is growing , and there will be less younger people and as I told cancer dominates at the age of 60 years mainly, there will be more case of cancer in next 30 -40 years. It doesn’t means that cancer is increasing but there will be more people who will be vulnerable to the cancer.

Most of the cancers occur after the age of 60, 80 percent of the cancers occurs at this stage only.

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Special Focus

Oncology

Every Life Matters With the purpose of bringing the US standard cancer care and cutting edge technology to India, Pradeep K Jaisingh, MD and CEO, International Oncology Centre, in conversation with Ekta Srivastava, ENN, talks about his commitment to make world class cancer care accessible to the underserved areas through their network of cancer care centers.

What is the Business model of International Oncology?

Our’s is a very collaborative model, where we work with a partner hospital. Partner hospitals have many specialties which are running successfully, but cancer is a derived specialty.

You need to have a successful diagnostic program, internal medicine programme, head and neck urology, etc. So, what we put together is a very innovative model, where hospitals focus on its core strength, and International Oncology brings tremendous amount of strength in the area of cancer care. When you combine them, you can really put together a strong oncology program, and that is the whole idea behind this. So, this model has been received very well across the world. Even in US, the model has received tremendous amount of recognition, and also from the patients point of view it works really well. Because even in dedicated stand alone in cancer centers, we sometimes do not get a very good set up for support services . For example, a cancer patient can get heart attack, and then in those cases you will not get very good support systems, while in our model, because the hospital already has strong cardiology program as well urology, head and neck, ENT, gynecology, with other support services, so we provide all those specialties and support systems from the hospitals and also the entire spectrum of world class cancer care under one roof.

How International Oncology is reaching rural areas in India?

To enhance our reach in rural areas, we primarily focus on two things. We do a lot of educational and awareness events as well as we

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organize cancer screening camps. Earlier we were doing lot of these camps ourselves, and then I found that the need is very large, and there is a limit to how much we can keep doing ourselves, because ultimately we are a cancer care company, and our efforts have to be devoted here. So I set up a non-profit foundation, called OUTCANCER. And it does the entire range of awareness and screening work in the area of cancer care. And it covers lot of rural areas, underprivileged population, and also work as partners with some other organisations, like pharmaceutical companies and therefore we are able to organize lot of these events in smaller towns as well.

Why government lacks in providing the healthcare?

Though they talk a lot about providing healthcare to all, but still what they lack?

Government has many priorities. Cancer as a disease has not received the attention that it deserves. As a country we are still not recognising the problem and the quantum of disease burden.

Cancer is the second biggest killer. It kills more people than TB, malaria and HIV Aids put together. All three combined cause less death than cancer alone. In America, 40 years ago they declared a war on cancer. In India, we are still sleeping through this and not paying the required attention to this.

No a day’s almost every person you talk to knows somebody either in family or friends who is affected with cancer. Our idea on oncology is basically this; our motto is every life matters. So, for every patient, whatever is the best facility, we try and provide. But also cancer is an expensive treatment, so beyond a point we cannot just keep subsidising it. We have our own limitations. We have gone out of our way to subsidise it as much as possible. This is something government should take active role in and government funds allocation’s should be increased multifold which is at present very small.

Your motto every life matters. How are you planning to achieve this?

We are planning to achieve this by treating every patient who comes into our system in the very best possible way. One thing that differentiates us is that in our centre here and in Mumbai is that we make sure every patient is provided the very best clinical care and personal care. Our staff goes out of the way to help patients. What happens after the patient goes home is also equally important. Our people call the patients or their relatives at their home, and find out how the patient is doing and provides necessary guidance as needed. We are also involved with an NGO. Their volunteers also come and they also talk to our patients. Many of

called Tumour board. It’s a mechanism where all the specialists of cancer come together like medical oncologists, surgical oncologists, radiation oncologist and also the nuclear medicine persons. They discuss the case together and decide what the best course for the patient.

What are the key challenges?

In cancer care in India, cost of treatment is one of the biggest challenges for most middle class patients. We therefore offer subsidised rates to many of our patients. All the needy patients get reasonable discounts. Patients sometimes need second opinion, and we appreciate the fact and also make them talk to cancer experts in America to clear their doubts. The other important

“Cancer is a disease, which needs a much better allocation of funds and attention from the government as it contributes double the death rate than malaria, HIV and tuberculosis put together these volunteers were themselves cancer patients. So, they share their stories with the patients.

‘World class cancer care’, how International Oncology is corresponding to the given statement?

International Oncology centers are really state of the art. We provide world class treatment in radiation therapy using Rapid Arc based Image Guided Radiation Therapy (IGRT). Then we have a very advanced bone marrow and stem cells transplant programme that is run by American Board certified oncologists who has worked in America for many years. Then, we also have a team of medical oncologists from top Indian institutions like AIIMS and Tata Memorial as well as from Europe and USA. We send our doctors continuously to America for further training. Then we have Quality Assurance mechanish

thing is that the patient should always avail the entire treatment from one place only. Patients who start the treatment in one centre and keep on going from place to place and mostly end up spoiling the cases.

Please tell us about your role ahead?

For a very successful cancer care programme we need multi areas of support. We need support from government, from the public, from the society at large. We want more participation from all segments of society, be it retired people, housewives, school teachers and students. And tier 2 cities and smaller towns doctors also need to be made aware about the importance of proper diagnosis and improve their own skill sets. For this we have tried to create several satellite centers in areas like Moradabad, Aligarh, Meerut, Agra, in smaller cities.

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Special Focus

Oncology

Cancer of the lung and cervix: A bird’s eye view In India, approximately 950,000 cases of cancer were reported in 2008, of which the top five were cancers of cervix uteri, breast, oral cavity, lung and esophagus; which accounted for a total of about 46% of the overall reported cancer cases in India

By Dr Firoz Ahmad & Dr B R Das

Dr Firoz Ahmad Research Scientist, SRL Limited

S

tatistics describing the spread of cancer paint a disheartening picture. Globally an estimated 12 million cases of cancer were reported in 2008, of which the top five most commonly reported cancers were cancers of the lung, breast, colorectal, stomach and prostate which accounted for a total of about 50%

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Dr B R Das President-Research & Innovation Mentor-Molecular Pathology and Clinical Research Services SRL Limited of the reported cancer cases world wide. As per statistics put forth by the Globocan 2012 report, cancer of the cervix has been reported as the most common cancer among Indian women accounting for about 22.85% of all cancers and 20.69% of nationwide cancer related deaths. On the other hand, cancer of the lung is the

most common cancer among Indian males accounting for about 11.25% of all cancers and 13.65% of all cancer related deaths. On the occasion of World Cancer Day (4th February), it is apt to provide to our readers, a bird’s eye view of two of the most common cancers in India, namely, cancer of the lung and cervix.

Lung cancer is associated with a high death rate and individuals above the age of 60 years are highly vulnerable to the disease as compared to their younger counterparts.

The average 5-year survival for lung cancer is among the poorest of all cancers (16.8%), as the large majority of patients with lung cancer are diagnosed at late stage. Chronic exposure to tobacco smoke remains as one of the major risk factor for causing lung cancer, accounting for 90% of all lung cancers. Radon gas, pollution, toxins, and other factors contribute to the remaining 10%. Clinical studies have demonstrated that smoking cessation notably reduces the risk of lung cancer. Interestingly, death rates from lung cancer have been declining among men since 1984 and among women since 2003. This trend can be attributed to international awareness

Special Focus

Oncology

campaigns regarding the health hazards of tobacco use.

The diagnosis of lung cancer can be elusive as symptoms appear only at late stages of the disease. The most common symptoms includes chronic cough, shortness of breath, chest pain, wheezing, weight loss, bone pain etc. Several researchers and cancer organizations recommend people with an increased risk of lung cancer consider annual computerized tomography (CT) scan screening to monitor for the presence of lung cancer. If you’re 55 or older and smoke or used to smoke, talk with your doctor about the benefits lung cancer screening.

However, for confirmatory diagnosis, a clinician can order a number of tests (CT scans, repeated X rays for monitoring, lab analysis of the patient’s sputum, checking cells from the patient’s body to detect the disease [cytology], or removing a small piece/bit of the suspected tissue from the patients body to check it under a microscope [tissue biopsy]) to look for cancerous cells and to rule out other conditions.

Treatment options typically include one or more treatments, including surgery, chemotherapy, and radiation therapy. In addition, the concept of targeted therapy in lung cancer has gained tremendous attention in recent times– popularly known as personalized medicine- “the right treatment to the right patients at the right time”. Cervical cancer reveals an equally sordid tale.

An estimated 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting to nearly 1/3rd of the global cervical cancer deaths.

Cervical cancer occurs early and strikes at the productive period of a woman’s life. The incidence rises during 30–34 years of age and peaks at 55–65 years, with a median age of 38 years (age 21–67 years). The human papillomavirus (HPV), a sexually transmitted infection, plays a key role in causing most cases of cervical cancer.

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• The average 5-year survival for lung cancer is among the poorest of all cancers (16.8%) • The existing guidelines recommend no annual screening for cervical cancer either by Cytology test or HPV DNA test (Advanced test which detects the DNA of the causative HPV) before the age of 21 years • The importance of regular cervical cancer screening needs to be reiterated among women in the age group of 30-55 years The adverse effect of HPV infection on a woman’s body is influenced by other factors like individual genetic makeup, environmental exposure, sexual activity; smoking and lifestyle choices.

Effective cancer screening has successfully decreased cervical cancer incidence and mortality in various countries. The existing guidelines recommend no annual screening for cervical cancer either by Cytology test or HPV DNA test (Advanced test which detects the DNA of the causative HPV) before the age of 21 years.

For women aged 21 to 29 years, screening with cytology alone every 3 years is recommended. Similarly, women aged between 30 to 65 years should be screened with cytology and HPV testing (“cotesting”) every 5 years (preferred) or cytology alone every 3 years (acceptable). In addition to screening, vaccination is also recommended for disease prevention.

Currently, two vaccines licensed globally are available in India; Gardasil™ marketed by Merck) Cervarix™ marketed by Glaxo Smith Kline. The Indian Academy of Pediatrics Committee on Immunisation (IAPCOI) currently recommends routine vaccination of females aged 11– 12 years with three doses of the HPV vaccine. Vaccination can be given to females as young as 9 years as well as to those aged 13–26 years; who have

not previously completed vaccination.

Pap testing (simply taking a swab sample from the woman’s cervix and analyzing it in the lab for presence of cancer-like cells) and screening for HPV DNA or HPV antibody before vaccination is not needed.

Increased awareness among the common masses regarding the medical hazards of tobacco can play a pivotal role in further curbing the occurrence of lung cancer. Mass media campaigns being aired on national television and in cinema halls issuing warnings against tobacco consumption are great initiatives which have proven instrumental. Similar mass scale campaigns need to be designed and executed at a ground level, for creating cervical cancer awareness too.

The importance of regular cervical cancer screening needs to be reiterated among women in the age group of 30-55 years. Pap testing and cytological screening of women in the productive age group can be promoted at a national level as part of a mass surveillance programme. This World Cancer Day, we re-affirm our resolve to continue spreading awareness among the common masses about preventable diseases like lung and cervical cancer. The bottom-line is in tune with the age old maxim of medicine “prevention is always better than cure.”

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Special Focus

Oncology

Perfint Healthcare Reaches New Milestone The medical technology company, Perfint Healthcare is a world leader in planning and targeting solutions for image guided interventional procedures - with an emphasis on oncology and pain care Kindly share with us the technology, services and benefits offered to patients under the Perfint healthcare.

S Nanda Kumar CEO and Co-founder Perfint Healthcare

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Perfint Healthcare is a world leader in planning and targeting solutions for image guided interventional procedures - with an emphasis on oncology and pain care.

In recent years, Interventional Oncology [IO] has emerged as a new discipline offering effective treatment of many malignant tumors with minimally invasive techniques. IO procedures include tumor ablation using needles or catheters, targeted chemo-embolisation, radio-embolisation etc.

These procedures have the benefits of being image guided, minimally inva-

sive, targeted using instruments, outpatient procedures with survival rates comparable to surgery at significantly lower cost to the patients. And for a service provider, the time to start an IO practice is significantly less.

In numerous cases in the liver and lung, IO offers an opportunity to treat tumors when they are not surgically operable. In several other cases, IO achieves the destruction of tumors with fewer complications and more rapid recovery than traditional methods like surgery. We also see an increasing trend where IO is performed in combination with surgery or Radiation Therapy or Chemotherapy.IO is also used as an effective palliative therapy.

However like other oncology therapies (surgery, chemo and radiation) residual tumor and recurrence are not uncommon in IO. That has probably got less to do with the science of IO and more to do with the way IO is performed today. Inadequate visualization, tumor segmentation, procedure planning, inaccurate needle placement, inadequate verification of the procedure – are all challenges that the practitioners of IO are today faced with, that limit the efficacy of IO. And that’s where we are assisting physicians. For example ancompletely ablating the tumor and the desired margin should lead to lower same-site recurrence .

Our flagship product MAXIO helps physicians acquire CT images, see tumor in 3D, plan to place one or more instruments safely, treat the tumor by accurately placing these instruments (needles) using our robotic targeting system and finally verify the treatment using image registration. This workflow is significant upgrade to current practice - leading to enhanced patient safety and accuracy, while reducing procedure time and reducing radiation, particularly during complex procedures that involve ablation of large tumor(s) using multiple instruments and where complex angulation is involved to avoid critical structures and

Case studies of successful installations of technology India – Global Health City, Chennai Product installed – ROBIO EX No. of procedures done – 100+ Australia – Alfred Hospital, Melbourne Product – ROBIO EX / MAXIO No. of procedures done – 30+ Malaysia UMMC Product – MAXIO No. of procedures done –40+

to achieve adequate tumor coverage.

This helps achieve consistent procedure quality across skill levels.

Our robotic targeting system, ROBIO, is increasingly becoming the preferred choice when it comes to PET-CT guided interventions and for CT guided paincare procedures.

Affordability is a huge factor for healthcare. What efforts has Perfint made to ensure that the cost is not passed to the patient?

At Perfint Healthcare, our vision is to work with physicians to improve quality of life of those fighting cancer and pain. One of the first steps for achieving this vision was to bring affordable technology to both the Doctors and the patient. For this our leadership team made certain key strategic decisions that helped create affordable solutions: A globally renowned KOL panel helped identify, evaluate and select from several clinical choices available for cancer and paincare.

We have set up a globally located advanced technology team while disciplined product development team happens at our product development center and at our partner locations in India.

While these keep the cost of technology development low, the fact that we are helping physicians perform a less expensive procedure better than without assistance is the more important contributor to lower cost of cancer care.

What has the response and demand in India been till now?

Perfint Healthcare’s products are installed in over 100 clinical sites globally. Over the last couple years we were focused on expanding our global foot print. With unprecedented technology investment in the healthcare sector in India and with increasing rate of incidence of cancer in India, we have refocused our efforts to serve patients in India. We work closely with teaching hospitals, oncology Care centers and tertiary hospitals to impact the quality of life of patients.

How does the company plan to expand in the near future?

Perfint Healthcare’s expansion plans can be defined as both Solution perceptive and Market perceptive.

While we continue to increase our focus on facilitating complete treatment, we are targeting a 4-dimensional growth in the field of Interventional Oncology & Pain care, these are – geography, organ, imaging modality and procedures we support. We are awaiting regulatory approvals to enter China, USA and Japan and we hope to be in these markets from 2014. We are working on solutions that would assist Ultrasound, MR guided procedures. We are working on procedures that involve substances like drugs, radioactive material etc. We will work on solutions that target organs in anatomical regions beyond the liver, lung and kidney in the future.

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health watch

Critical care has to be

Comprehensive and Personalised Designed to cater to medical, surgical and cardiac patients and equipped with latest workstations and monitoring mechanisms for intensive care to each patient, Dr Yogesh Velaskar, Consultant Physician and Intensivist, Hinduja Healthcare Surgical, Khar, shares insights on management of critically-ill patients at the hospital What is the first line of action for a critical patient coming to the hospital?

We understand that for patients with severe injury, illness or life-threatening condition each second is crucial for survival. To ensure that the patient receives the correct treatment even before they reach the hospital, we have trained doctors present in the ambulance and they update the hospital and doctors on the status of the patient much before he reaches the hospital. In addition, we have trained our staff and casualty doctors on necessary procedures as in the casualty department they are the first to come in contact with critically ill patients.

Here, 60 – 70 percent of the required medical assistance and care is already given so that the patient is adequately stabilized by the time he reached the ICU. In case of emergency cardiac cases when the patient arrives at the hospital and needs an immediate angioplasty, we shift the patient from the Casualty department directly to the Cath Lab to save on time and stabilize his condition. In addition, at each examination point of the patient, the data

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and parameters of his/her condition is captured at the central workstation of the ICU for the doctor to analyse much before the patient comes to the ICU physically. This ensures that the ICU team is prepared with patient condition and the preparatory work is co-ordinated. Our aim is to deliver on quality with personalized care.

Please help us on the workstations and their benefits?

Workstations are important for monitoring of vital parameters of each patient. We have central table and central monitor that collates all data from various machines and gives us all the information of all patients as it is not possible for the doctor to be at each bedside at one time. However the Consultant can just visit the centre table and take a quick update of all the data and parameters of each individual patient at one place. Even after surgery, all information and data comes to the centre monitor and provides all the vital parameters to be monitored on one screen thus making it convenient for the doctor team. This also gives our ICU team enough time to interact and engage with patients.

What are some exciting trends in critical care that are coming up?

Arrival of non-invasive techniques and

“Today each technique has an evidence based approach and strong support of real time image-guided technologies such as Sonography, X-Ray, Doppler etc. newer technological advances, including gadgets have made way for newer ways of engaging with the patient. Today each technique has an evidence based approach and strong support of real time image-guided technologies such as Sonography, X-ray and Doppler.

Video conferencing with global experts

for conducting live surgeries of complicated cases have become a reality which is good. In the developed world there is a practice wherein they have installed monitoring devices at homes of critically ill patients to capture vital data that is relayed to the hospital ICU. In case of an emergency the hospital can provide immediate care guiding the patient on remedial action or by connecting with a general practitioner located closest to the patient for treatment. This model promises vital expertise and faster response time from available experts at extremely low cost as it cuts away travel time and hospital admission processes. This is something that ICU facilities in India can replicate in the not too distant future. Another trend we see if from a reporting standard is that as people have become more aware of the consumer act hence it is only a good practice for any hospital to follow an evidence based reporting and treatment methodology.

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zoom in

Streamlined Workflow-Key to Infection Control Anuradha Desai, Manager –Academy, Getinge India

C

entral sterile supply departments (CSSD) are known by a variety of names in different facilities. Some go by central service, central processing, surgical supply and processing, or may be sterile supply and distribution. They also serve different customers like the entire hospital or just the operation theatre or even day care centres or dental clinics. While CSSDs may not have the same label, responsibilities or reporting structure, there is one thing that never changes - the fight against infection. This is the common goal of all CSSDs. The foundation towards this goal is laid by a well designed and well equipped CSSD.

East Way Around To make the reprocessing department an efficient production plant and still meet microbiological demands, it is vital that the interior design of the department is adapted to good manufacturing practice and provides good working routines. Our design of a CSSD is generally based on three areas - for soiled, cleaned/disinfected and sterile goods respectively - with products, designed for a pass-through processing flow, serving as barriers between the areas. The first barrier, used in the fight against pathogenic microorganisms, is between the soiled reception area and the clean area where the inspection and packing take place. The physical barrier itself consists of high-capacity, pass-through

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washer - disinfectors. Since soiled cleaned and disinfected goods respectively are handled in entirely separate rooms by separated operators, the risk of cross-infection due to staff and the surroundings is minimized. The second barrier, between the clean area and the sterile storage area, includes passthrough sterilizers. Once again, the operators are physically separated, with one group working in the Clean Area, while the other is working in the Sterile Storage Area.

An effective workflow also requires the use of standardized goods carriers

by and between the various work procedures. While it is recommended to follow the above guidelines to the fullest extent possible, there may be barriers along the way. There are barriers of knowledge or rather lack of knowledge.

Many barriers seem to be financial in nature - whether it’s not enough staff, inadequate space, too few instruments, unreliable equipment or something else. Yet, it is important and also practically possible to follow the concept underlying the designing of a CSSD from the perspective of Infection Prevention.

Quality of Utilities While the foundation for successful reprocessing of medical devices is a well designed and equipped CSSD, it is incomplete unless proper processes are followed and quality of utilities used.

The hospital has to maintain the quality of utilities such as water required for the proper functioning of the equipment, and has also maintained the equipment by regular cleaning and servicing. Records for all processes conducted are maintained which are important from the legal point of view. A CSSD that is operational 24 X 7, has to have well trained staff, and lays emphasis on quality control. Thus a CSSD designed for specific requirements, with state of the art equipment, and proper and well documented processes, is well equipped to handle the challenges that infections pose in hospitals today.

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event report

IRIA 2014 Radiology Frontiers in Imaging

Hospital Architecture Going Green

H

T

he much awaited academic meet was a major draw for eminent radiologists across the country, and in addition there was enthusiastic participation of medical students from various educational institutes as well. The session had been designed to accommodate the various needs and expertise of radiologists, the topics o breast imaging, fetal imaging, organ transplant added new dimensions to the agenda. In addition, renowned radiologists conducted lectures and workshops on head to toe, nerve imaging, and pediatric radiology among many others. Non-technical sessions included social radiology that discussed the safety, legal guidelines and ethics in radiology.

The latest technology in imaging was on display for radiologists to experience as part of exhibition. Fujifilm launched their digital mammography product, BPL medical technology announced their arrival in the radiology & imaging sector, Samsung introduced their 5D ultrasound technology, Fujifilm SonoSite showcased their newly launched X-Porte Ultrasound system among other market leaders in the radiology and imaging industry. India is an important for many of the leading players as there has been significant growth in the number of hospitals, diagnostics centers and clinics not only in cities but also smaller towns and investments on imaging equipments are on the rise. The conference offered them a unique opportunity to meet practitioners from across the country under one venue.

The next edition of the event IRIA 2015 was announced to be held in Kochi, Kerala.

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ospiArch Pune 2014, a two day conference on hospital planning, design and architecture was held on 17-18 January in Pune, Maharashtra and discussed new trends for greenfield and brownfield projects.

Architecture and building design are evolving trends with new concepts and planning techniques available for hospital administrators. The event shared novel ideas and had eminent speakers from diverse field so that the hospital administrators can get a comprehensive knowledge sharing platform for their queries and also delve on imagination and ideation. The event was attended by hospital administrators, planners, architects and doctors.

The key sessions included architectural challenges involved in building a new hospital that addressed the common hurdles faced by hospitals and architects while designing or re-designing a new hospital. The concept of green hospitals was elaborated in a detailed presentation by Dr Rakeev Boudhankar, Vice President, Kohinoor Hospitals as he shared his knowledge on planning a green hospital and discussed topics such as mercury elimination, utilisation of natural light, rain water harvesting, recycling of hospital material and acoustic planning. Critical areas such as fire safety, designing a CSSD, manpower planning, budgeting and financial planning, feasibility study and quality standards were discussed extensively.

Tech Trend

Technological Innovations

in Healthcare Industry Medical technology companies on a path to growth with innovative products that are easy for doctors to use and could improve lives. Wim Michiels, Executive Vice President at Materialise, in conversation with Ekta Srivastava, ENN Tell us something about Materialise.

We have around 900 employees working in 16 offices all over the world. Basically, we started with the historical activity of buying a CD printer machine in 1990, and it was the second printing machine in Europe. The purpose was to help others with typing the applications. Materialise mission is to innovate product development, resulting in a better and healthier world through its software and hardware infrastructure and in-depth knowledge of additive manufacturing.

Second big thing in the initial years was 3D printer in 2 layers. You take the CT Scan and put it in 2D and work on slices. Through this, we made the way to all custom making plans.

Today half of our business is medical.

How were years 1999 to 2014.

Describe your journey?

At that time, we started realizing about the benefits of 3D information.

We started thinking to do surgery with planning in mid 90s. We looked at tempo for implant surgeries. The principle in CT Scan is to reconstruct the 3D. And all the planning, which you cannot see in the normal surgery could be seen with 3D. The tempo industry was somehow accepting it because it was new in a digital way. Later, it became the standard of care in tempology.

Our company found the strategic partnerships for all kinds of reconstructions. We are involved in design-

Are online services helpful?

Wim Michiels Executive Vice President at Materialise ing, printing and endeavoring custom related plants and mostly what we do now is reconstructions and highly complicated hip revisions.

Any new innovations in bio medical researches?

It’s the same as customized plant anatomical model which is a world revolutionary innovation. And the other companies are taking our software to do their innovations.

Do you think India is ready to take this technology?

This technology has become more global and is helping those patients who have complicated medical problems. But, the biggest hazard is the cost. There are lots of people who cannot afford cost for such surgeries.

When we come to India, the surgery would be provided to the patients who can afford it.

If you look at the process of planning surgeries, it’s quite a complicated process. You have surgeon, assistants, people who would do composition of data. We have production centre and there are so many people who are involved. It’s very easy because it’s patient specific. It is quite easy to make mistakes if you don’t have the online system. But we do have an organization, where we know that who is handling what. And we try to keep everything transparent.

There are doctors working from 10-30 years, who are not ready to accept this technology of online process. So what do you think about it?

Talking about the senior doctors, they are very much experienced and they don’t need these kind of tools for their surgical processes. But, the younger generation is ready to accept this as it helps them to tackle difficult and complicated cases.

Being a mechanical engineer, how are you working in healthcare?

I am the MD of the organization, keeping a check on the overall a tivities of the concern and it’s my moral r sponsibility to look after the health department also. Not necessa ily, we have medical doctors but we have whole lot of medical engineers who are working on the healthcare system.

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SonoSite offers Point-of-Care ultrasound education when and how you want it ers’ training, hospitals and medical institutions are encouraging ultrasound training among the practitioners.

Says, Pavan Behl, Director and General Manager - India & Middle East, FUJIFILM SonoSite India Pvt. Ltd “As this advanced and improving technology continues to become popular in diverse medical specialities, FUJIFILM SonoSite strongly believes

Pavan Behl Director and General Manager, India & Middle East, FUJIFILM SonoSite India Pvt. Ltd.

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ltrasound device signifies an important point-of-care (POC) diagnostic modality, which is increasingly being used in several specialties, like musculoskeletal, rheumatology, anaesthesia, pain management, surgery, interventional, and emergency care amongst others. Especially, its use during the critical situations when the physician is able to carry the portable ultrasound system to the point of diagnosis has enabled further expansion of ultrasound use.

Despite its widespread utility into clinical practice, point-of-care ultrasound is relatively a new field and many older clinicians had completed their training before ultrasound use was introduced into their respective specialties therefore for their and oth-

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that imparting training on effective use of point of care ultrasound is vital and that education and training combined with technical talent makes point-of-care ultrasound a lifesaving tool and improves care delivery along with patient satisfaction. With this reason, since its inception SonoSite India has partnered with leading Indian institutions, associations and medical centres to provide point-of-care ultrasound training to physicians, nurses and other clinicians and helping deliver the best possible care to the society.

Going forward, we plan to hold many more similar workshops in various cities to provide education & training to physicians wanting to integrate point-ofcare ultrasound in their daily practice.”

FUJIFILM SonoSite considers physician education and training so critical in the use of POC ultrasound, that it has integrated education and learning in its newest generation of pointof-care ultrasound: the X-Porte™ Ultrasound Kiosk. The kiosk integrates high-resolution ultrasound imaging synchronously with 3D animations that enable “any user, any time of day” to use POC ultrasound in patient management.

Real-time learning on the product enables any and all members of a healthcare team—nurses, midlevel providers, and even a physician-hospital administrator—to be empowered to take advantage of X-Porte’s high-performance visualization.

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The best just got better Barco diagnostic displays with LED backlights With LED diagnostic display system, Barco brings dependable diagnostic imaging to its true potential. Now combining high-bright and low- power LED backlights with a brand-new, stylish design. They define today’s industry standard for diagnostic imaging. See more shades of gray to detect subtle details more quickly. View perfect DICOM images thanks to a unique front sensor for interventionfree calibration. And make confident diagnostic decisions, while reducing footprint and extending lifespan. www.barco.com/healthcare Barco - India A38, B&C, Sector-64, 201301, Noida, UP, India Tel: +91 120 4020000 Mob: +91 99714 41118 Email: sales.in@barco.com

www.barco.com/barcoindia

product launch

Carestream Health India

Showcases Innovative Radiology Imaging Solutions

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ndia’s biggest annual radiology event organized by the Indian Radiological & Imaging Association (IRIA) the 67th Indian Radiology Congress was held between 23rd and 26th January 2014 at Agra. At this prestigious event, Carestream Health India showcased some of its innovative radiology imaging solutions, which attracted attention of several imaging specialists, general medical community and healthcare administrators from across India and several countries from around the world.

Carestream’s booth was one of the best, which was specifically designed around the theme “A Smarter Way Forward”. The booth was strategically located near the entrance gate of the exposition area, where Carestream showcased its latest innovations such as PACS solutions, the DRX-1 System, the DirectView Classic CR System and the DirectView Vita CR System. The DryView 5700 Laser

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Imager and the DryView 6850 Laser Imager were also on the display that attracted many eyeballs.

Another highlight was the demo station of Carestream’s exclusive online journal ‘e-Radiograph’, a bi-yearly clinical publication, an educational initiative by Carestream.

The station was placed at a hard to miss exclusive location, which ensured overwhelming response from customers.

Speaking about

the tremendous response Carestream received from the customers at this prestigious congress, Mr. Nilesh Sanap, Manager Marketing, Carestream Health India, said, “It was a result of the distinctive experience company had been able to create through its booth’s design, personal interactions, demonstration of its industry-leading product range, and the various branding, and media activities conducted during the Congress.”

The event served as a great networking platform for both Carestream and its customer. It provided visitors with the first hand experience of Carestreams’ innovative radiology imaging solutions to perform their job better, faster and most costeffectively.

product launch

SAMSUNG’S First Premium Ultrasound with 5D Technologies

(Left to Right) Priya Joshi (GM-Ultrasound, Health & Medical Equipment, Samsung India Electronics), Dr.Sneh Bhargava (Ex. Director-AIIMS), Mr.Sameer Garde (Sr.Vice President & Head-Enterprise Business, Samsung India Electronics) & Dinesh Lodha (Vice President, Health & Medical Equipment, Samsung India Electronics)

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amsung Electronics has launched the UGEO WS80A, its first premium ultrasound with 5D technology in India. With stylish Samsung design and innovative features including the 5D technologies, MPI and ElastoScan that provides superior image performance, the UGEO WS80A redefines premium ultrasound for women’s health. The device features a 21.5” wide LED imaging screen and a 10.1” touch screen for the controls, as well as a variety of software optimizations that help resolve relevant anatomy and outputs data to 3D TV’s for an even more realistic view.

“As the first premium device, the UGEO WS80A represents the latest ultrasound innovation and leading IT technologies of Samsung,” said Dinesh Lodha, Vice President, Health and Medical Equipment Business, Samsung India. “Samsung will continue to put its best efforts towards developing medical devices that deliver true-to-life images and features that provide faster diagnosis.”

The new UGEO WS80A combines Samsung’s latest technology in display to deliver faster and more accurate di-

agnoses in the field of women’s health.

Its key features are: • The 21.5” Wide LED screen offers users higher quality color image representation as well as higher resolution compared to conventional monitors, delivering enhanced vision of the ultrasound images.

• A 10.1” Touch Control Pad is highly sensitive, allowing for easy input to minimize users’ stress from pressing the buttons.

• FRV + Inversion Mode – FRV (Feto Realistic View) has been upgraded to improve speed and to support inversion mode. Advanced FRV allows for detailed visualization of subtle anatomical features, thereby enabling intuitive diagnosis on the scanned 3D images and enriching patient communication.

• 5D NT (Nuchal translucency)* -Enables realistic visualization of NT images that help detect Down syndrome.

For further information please contact: Rebecca Oommen Samsung India Phone: 0124-4881234 Email: rebecca.o@samsung.com

5D Cine -- Provides images that can be viewed on 3D TV for healthcare practitioners to acquire new clinical value through more accurate diagnoses of lesions and blood vessels. Apart from the clinical benefit, this feature also gives life-like 3D images of the unborn child.

• ElastoScan - applies strain imaging technology which displays the gradient value of tissue displacement via color map, thus making it easier for users to differentiate between benign and malignant masses through acquiring the strain ratio between the target and reference area at a much faster rate than its predecessors.

Simple ROI selection and automatic calculation make breast diagnosis more efficient and intuitive.

Other additional features include the Additional EV Probe Holder, Probe Cable Hangers, Default Gel Warmer and up & down Lift that allows the user to adjust the system to the user’s preferred height without straining.

About Samsung Electronics Co., Ltd. Samsung Electronics Co., Ltd. is a global leader in technology, opening new possibilities for people everywhere. Through relentless innovation and discovery, we are transforming the worlds of televisions, smartphones, personal computers, printers, cameras, home appliances, LTE systems, medical devices, semiconductors and LED solutions. We employ 270,000 people across 79 countries with annual sales of US$187.8 billion.

Reegal Jayani Weber Shandwick Mobile: +91- 9999976533 Email: RJayani@webershandwick.com

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product launch

Philips India Showcases Asha Jyoti A sha Jyoti, Philips Healthcare’s flagship Women’s Healthcare Outreach Mobile program, was being showcased in Delhi as a great example of a public-private partnership to address the issue of accessibility of healthcare in India. The program, run with close collaboration between Philips Healthcare, Postgraduate Institute of Medical Education and Research (PGIMER), and RADAID was launched on 22 April 2012 and has successfully screened more than 4000 women in less than 20 months.

Asha Jyoti is a population-based screening program of women aged between 40 and 60 years, which aims to ensure early detection of breast cancer, cervical cancer and osteoporosis, even before the individual has any signs or symptoms. It was established as a model for preventive healthcare for semi-urban and rural areas in northern India and involved the creation of a special mobile outreach van with imaging technology and clinical referral services to efficiently and effectively address multiple care needs.

The initial goal of this program was to screen 500 women in first six months and 2000 women every year thereafter.

However, it has already successfully achieved its goal to provide breast cancer, cervical cancer, and osteoporosis screening to more than 4000 women.

“Our vision for Asha Jyoti was to develop a high quality, mobile screening facility to provide decentralized primary healthcare on people’s doorsteps, to detect three major diseases effecting women’s health earlier, and to provide diagnostic follow-up and therapy to the community;” commented Dr. N. Khan-

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delwal, Professor and Head, Department of Radio diagnosis, PGIMER. “A multidisciplinary team of health care specialists from PGIMER, formulated this program, and the teams from Philips Healthcare and RAD-AID supported the initiative to make it a reality and ensure that we reached the underserved population in the northern part of India.” To make the Asha Jyoti program work, PGIMER delivers the clinical services, RAD-AID is providing educational training and program planning support to health workers and staff and Philips has donated all the equipment and also donated the entire van which was designed and built in India with local suppliers. Philips India is now working on extending the program to other parts of India as well.

The design of the Asha Jyoti van itself is exemplary, keeping in mind the need to reach the remotest areas of India. Built by Philips Healthcare, the van uses trailer with double axle to meet the tough Indian road conditions.

It has a horse-cart structure so that the truck can negotiate in narrower turns as compared to single bus-like chassis.

The van has been compartmentalized

in radiation area and non-radiation area. The workflow has been optimized through this division such that time taken during cervical examination is equivalent to time taken for breast and bone scans – this allows screening of two women simultaneously.

The van is supported by air suspension to avoid damage to the equipment.

The van has three options of power sources – external power supply, 30kV generator and a set of batteries. The robust van design has allowed use of the van across cities and rural areas around Chandigarh. The mammograph unit on board is a digital mammograph that obviates the need of any film chemistry and provides highest resolution images.

It also provides only a fraction of usual mammography radiation because of special detection technology used in the Philips mammography unit. The cervical cancer screening is being done with a new technique. The usual screening using acetic acid (vinegar) is pictured using a colposcope at various intervals and using green filter. These pictures are cross-checked by gynecologists at PGIMER for validation of the findings of the colposcopy technologist on board.

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