eHealth August 2014

asia’s first monthly magazine on The Enterprise of Healthcare

IVF

Giving hope a

better chance IVD fulfills its promise Managing birth, naturally Insights on organ transplant

Maharashtra

Healthcare Leadership Awards & Summit 2014

Event Report

Dr N C Borah,

Chairman, GNRC Health Crusader of North East

eHealth Magazine

volume 9 / issue 08 / august 2014 / ` 75 / US $10 / ISSN 0973-8959

Contents In Person

12- MCI Looks to Building the Classroom of the Future Dr VP Mishra, MCI

PolIcy

16- One Organ can Save Eight Lives Dr Avnish Seth, FORT

Event Report

20- Driving Innovations for Patient Care

Cover Story

24- IVF Implanting Hope 26- We Love to Handle Complex Issues Dr Aanchal Agarwal, BLK

28- Every IVF Treatment is Customized Dr Duru Shah, Gynaecworld

30- Assisting the Bond

Called Family Dr Beena Muktesh, Miracles Fertility and IVF

32- Infertility is the Growing Problem Around the World Dr Supriya Puranik, Sahyadri Specialty Hospital

34- Bringing Smiles to Childless Couples Dr Vasan SS, Manipal Ankur

36- Emotional Distress Invites Infertility Dr Hrishikesh Pai, Fortis Bloom

38- Managing the Miracle of

Towards New Life Dr Anubha Singh, Shantah Fertility

42- Helping Couples in Their

Journey to Parenthood Dr Rakhi Singh, Abalone Fertility

Special Focus

48- India’s Baby Making Business: The Growth Story

In person

52- Heralding Health

Renaissance in North East Dr NC Borah, GNRC

Birth, Naturally Dr Vijaya Krishnan, Healthy Mother Sanctum

56 -A Truly Indian Growth Story

40- We Help in the Journey

In Focus

Special Focus

58- Growing Big Through

Innovation Dr Harshvardhan Hegde, NOSH

Expert Speak

62- Watching the Industry Grow For Three Decades

Expert Speak

64- A Single Minded Focus on Orthopaedics Dr Harshvardhan Hegde, NOSH

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

09

issue

08

august 2014

President: Dr M P Narayanan

Partner publications

Editor-in-Chief: Dr Ravi Gupta

I C E CO ECT Connecting Technologies,Trends & Business

Infrastructure Construction Engineering

Editorial Team

WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead - Web Development: Ishvinder Singh

Health Sr Assistant Editor: Shahid Akhter Sr Copy Editor: Rajesh Sharma Copy Editor: Subash Deb

Executive-IT Infrastructure: Zuber Ahmed

governance Sr Correspondent: Kartik Sharma, Nayana Singh, Souvik Goswami Research Associate: Sunil Kumar

Legal Officer: Ramesh Prasad Verma

Executive – Information Management: Khabirul Islam Finance & Operations Team

education Sr Correspondent: Mohd. Ujaley Correspondent: Seema Gupta ICE Connect Assistant Editor: Rachita Jha Correspondent: Veena Kurup Sales & Marketing Team West: Douglas Digo Menezes, Mobile: +91-9821580403 North: Vinay Shil Gautam, Mobile: +91-9910998066 South: Vishukumar Hichkad, Mobile: +91-9886404680 Subscription & Circulation Team Manager Subscriptions: Mobile: +91-8860635832; subscription@elets.in Design Team Sr Graphic Designer: Om Prakash Thakur Sr Graphic Designer: Pramod Gupta Sr Graphic 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 - Dr 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.

In our story titled ‘Putting Human Touch Before Technology’ for the July 2014 edition of eHealth, the photo and the accompanying article incorrectly identified Mr Shrikant Soman, CEO, Bhatia Hospital as Dr PD Potdar, its Medical Superintendent. The error is deeply regretted.

ehealth.eletsonline.com | egov.eletsonline.com | education.eletsonline.com | iceconnect.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

Implanting Hope

Dr Ravi Gupta ravi.gupta@elets.in

august / 2014 ehealth.eletsonline.com

7

news

Satisfied at polio-free India, but can’t be complacent

U

nion Health Minister Harsh Vardhan says that he is happy about India being polio-free for three years and receiving WHO certification, but warned against becoming complacent and neglecting steps to save the country from getting reinfected by the polio virus.

“I feel so happy and satisfied…

We are talking to each other in a polio-free India which has been certified polio-free by World Health Organization and in the last three years we have not seen any case of polio. I think the credit for all this goes to the whole country. A part of me is satisfied but we can’t afford to be complacent.

Unfortunately, we have cases of polio in Pakistan, Afghanistan and Nigeria,” he said at a function her to mark India being certified polio-free.

“And we have the horror story of 2009 and 2010 where 23 countries which were being declared as polio-free actually had once again been infected by polio virus because people travelled from one place carrying polio virus to the other place,” he added.

8

Two lakh Anganwadi Centre Buildings approved for construction in 12th Plan

T

he Government has approved construction of two lakh Anganwadi Centre Buildings during the 12th Plan under the programme of ‘Reconstructing and Restructuring ICDS’.

The Units will be constructed at the rate of Rs. 4.5 lakhs per unit in the cost sharing ratio of 75:25 between Centre and States against the North Eastern Region where it is 90:10.

So far States have been given approval for Construction of 44709 AWC Buildings (including 5556 AWCs building for Odisha) in their Annual Programme Implementation Plan.

First installment of Rs.72334.01 lakhs has already been released to States / UTs in 2013-14.

The States have also been advised to leverage funds from several schemes such as MPLADS, MLAL-

ADS, Backward Region Grant Fund (BRGF), Rural Infrastructure Development Fund (RIDF), Panchayati Raj Institution (PRI), Multi Sectoral Development Programme (MSDP) of Ministry of Minority Affairs, Finance Commission, Additional Central Assistance under State Plan etc. for Construction of AWC buildings.

Ministry of Rural Development has also included Construction of AWC buildings as an approved activity under MGNREGA.

Non-invasive tools for liver fibrosis

L

iver fibrosis and cirrhosis have long been considered a prelude to certain death. Besides alcoholism, chronic viral hepatitis B and C infections are the most common causes of liver fibrosis.

Presently it is estimated that about 20 million Indians are Hepatitis B carriers and around 8 to 10 million have HCV infection. At SRL close to one lakh patients are annually screened for hepatitis. Current trend indicates highest seropositivity for HEV (45 percent), followed by HBV (~ 19 percent); HEV and HCV seroprevalence has been comparatively low (below 10 percent). In chronic viral hepatitis cases, liver fibrosis rates are not predictable or linear therefore assessing the prevalence as well as progression of fibrosis is difficult.

It is estimated that some 15 – 33 percent of HCV infected patients may ex-

hibit mild or moderate liver fibrosis over the course of 40 or more years, whereas 20 to 33 percent have disease that progresses to severe cirrhosis or hepatocellular carcinoma (HCC) over 20 or more years. However some patients may have liver fibrosis that progresses to severe disease in as little as three or four years. Thus from clinical point of view two timelines need attention particularly when considering progression of viral hepatitis related liver disease.

The first timeline begins when a patient becomes infected with either HCV or HBV, marking the onset of liver injury and a course of progression (in the absence of successful treatment) that varies from several years to as long as 50 years. The second timeline begins at the onset of cirrhosis. Successful management of fibrosis is possible through early screening and intervention.

TECH TRENDS

Palash Healthcare Systems A bouquet of Healthcare IT solutions

P

ALASH Healthcare Systems (PHS) is specialized Healthcare Information Technology organization offering software services and solutions to healthcare providers. PHS offers a complete range of IT solutions viz. HIS, LIS, PACS and Healthcare Dashboards by leveraging healthcare domain expertise and a global deliv-

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ery model. It provides frameworks for automating their processes in verticals such as multi-specialty, diabetes, ophthalmology, dental, IVF, cardiology and much else. PALASH provides enterprise wide solutions to clinics, polyclinics, specialty clinics and small and medium hospitals.

PALASH Healthcare Systems was incorporated in 2006 by a team of Information Technology experts having more than 15 years of experience providing Software Solutions and Information Technology Consulting to various domains.

PALASH for IVF Clinics was first designed and developed in 2009 with help of a team of world-renowned IVF providers in addition to our software development team.

The goal of PALASH IVF for Fertility Clinics is to assist the provider in this filtering of information. The system highlights important trends and offers single-screen dashboards to view relevant data in a single glance.

PALASH IVF is a web based software solution to help Fertility clinics to manage all fertility procedures electronically. It helps to get the information about the patient on practitioner’s finger tip. PALASH IVF helps to keep the fertility clinic paperless

with powerful analytics and reporting tools which is useful to find out the performances of Fertility clinics.

Modules of PALASH IVF: n Appointment / scheduling, Patient Management (Single / Couple / Donor / Surrogate), Billing, IVF EMR; n Procedures: Hysteroscopy, Laparoscopy, Ultrasound, OPU, ET, TBPCR, PCT n Investigations: Female (Hormones), Male (Semen) n ART Cycle Management: Planning, Execution, Drug Management, Follicle Study, Luteal Support, Outcome of Cycle n Embryology, Cryo bank, Inventory / Pharmacy, MIS, Statistical, Dashboards, Files/Images/Video attachments, SMS/Email alert notifications, Audit Trail of users

Benefits of PALASH IVF: Easy to use, local Implementation/ SaaS, security to patient data, increase efficiency, 24x7 support, helps to build relationship with patients ART CTechnology: Microsoft .Net Framework 4.0; Silverlight 4.0, WCF, C#.Net, ASP.Net; MS SQL Server; SAP Crystal Objects

TEGRIS REDEFINING OR INTEGRATION

The TEGRIS solution from MAQUET unites video routing, recording and transmission, data management, device control and more in a single, user-friendly unit. Allowing hospitals to boost efficiency, enhance patient safety and create seamless workflows. n Highly intuitive user interface n Workflow-oriented navigation area n Compact and lean design n Simultaneous recording of two video signals in HD quality n High expandability and upgradability n High degree of patient safety n Time-shift Recording

MAQUET — The Gold Standard.

MAQUET Medical India Pvt. Ltd. SURGICAL WORKPLACES II & III Floor, “Mehta Trade Centre” No.1, Shivaji Colony, Plot No. 94, Sir M V Road, Andheri (East) Mumbai - 400 099, India Phone: +91 22 40692100 Fax: +91 22 40692150 info.india@maquet.com www.maquet.com

in PERSON

MCI Looks to Building the

Classroom of the Future Dr VP Mishra is Director, Academic Committee, at the Medical Council of India (MCI). In a conversation with ENN’s Rajesh K Sharma, he explains the MCI’s push to make medical education relevant by incorporating technology Please explain MCI’s vision.

MCI is a statutory body created by a parliamentary enactment with three important mandates. Its primary mandate is to maintain a registry of doctors through the Indian medical register, set the standards of medical education, monitor them and ensure they are followed in the medical schools. It is also required to regulate the opening of a new medical college, increase in the intake in existing medical colleges, opening of new post graduate courses, increase in the intake of on-going post graduate courses, recognition of medical schools and renewal of their courses.

What are the duties of the Academic Committee at MCI? The Academic Committee is a recommendatory committee constituted by the MCI President for advising competent authorities on all academic concerns. It is MCI’s think-tank. The Academic Committee assists vari-

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ous authorities in decision-making through its recommendations. It does not make any decisions; it makes recommendations based on the existing and future academic concerns, challenges and limitations.

In your opinion, what is the state of medical education in India?

If you consider the number of medical institutes in the country, we have made huge strides. Today, India has 389 medical schools with an intake capacity of nearly 50,000 seats for MBBS and 25,000 seats for PG courses, perhaps the largest for any country. But there is still scope for augmentation of the quantity.

More than that, the quality concerns need to be addressed and focused upon. In this, there are two important aspects. Firstly, we do not have a mechanism for accrediting medical institutions. MCI recognizes, approves and permits medical colleges. For operational purposes, we think that

recognition is accreditation, which it is not. Recognition by MCI is being worked against the regulations, the title of which is self-speaking: minimum requirements to be fulfilled for the purposes. You are prescribing minimum requirements which are required to be fulfilled, but they do not guarantee quality sustenance, enhancement and enrichment. These three have to be addressed, so accrediting mechanism for medical education is a must.

The Academic Committee suggested that the Indian Medical Act should be amended to give MCI the authority to create an accreditation body for medical education.

The other important concern is the academic concern. The Academic Committee regulates the curriculum, how it should be updated and the minimum requirements are notified by MCI under Section 33 of the Indian Medical Council Act. But the preconditions are that MCI cannot notify even the regulations on academic matters without

the prior approval of the government.

In our experience, this takes up a lot of time. If a curriculum that is formulated but not notified for four years, then it loses its relevance. We have proposed that this Section should be amended since Academic Committee is an expert body taking an expert decision based on inputs from all members and from the relevant stake holders, so that things are executed in a timely manner.

Also, while we talk of authority and autonomy of medical colleges, MCI has no authority to prescribe service conditions for medical teachers. It does not even have the authority to prescribe pay scales for the medical teachers. The University Grants Commission (UGC) has it. The Academic Committee’s contention is that the authority to prescribe the service conditions and pay scales of teachers in higher education should be vested with MCI instead of UGC. If the ambit of the jurisdiction of the Indian Medical Act is made on par with UGC for the purposes of higher education, a huge gap can be closed.

Though the number of colleges have increased, the quality is still lagging?

Quality has to match the international standards. In a borderless world, you are not preparing your doctor for a small time local situation. The Indian medical graduate should be a global medical practitioner. That competency cannot be brought without catering to the quality centricity of medical education.

But western countries have adopted technology in medical education in the form of digital learning centers. Does MCI have a similar vision?

Yes. Ultimately, you have to think about the role of medical education in national development, quest for excellence, incorporation of medical technology, in terms of linkages with global competencies, and with ethical

medical practices incorporated with morality and values. The Academic Committee has ventured into creating a competency based, integrated curriculum for the MBBS course.

Through various expert committees, things have come to a very advanced stage, and we will be putting up for the consideration of the competent authorities at MCI. But what about tools like digital learning aids and virtual classes?

Ultimately, virtual component o learning has to be brought into place, and the Academic Committee is alive to this requirement, be it virtual library, virtual learning, incorporation of technology. Therefore, a realistic assessment of the requirement standards is being worked out in the context of advent and incorporation of technology.

India has an abysmal teacher to student ratio in medical education...

A lot of thinking has gone into it, and the ratio has been appropriately worked out, where we cannot say it is abysmally poor.

A paucity of teachers could be there due to their non-availability, and that is because people are not interested in taking up teaching as a profession now. The reasons could be pay scales, incentives, working conditions etc.

We have to look into all this. Teachers

The Academic Committee assists various authorities in decisionmaking through its recommendations

cannot be manufactured in a factory.

We have to create conducive working conditions for them.

Faced with the paucity of teachers, can the digital learning tools aid in teaching?

They can. Even in the modified and updated regulations, technology has found its place. But technology has to find its place in a larger context, and the Academic Committee has taken that exercise - how IT results in various virtual formats of teaching and learning, how it can be incorporated, and what will be its impact on the minimum standard requirements.

Do you foresee any roadblock in the adoption of IT in medical education?

All implementations have to be made in the form of regulations. Presently, the Academic Committee’s findings are put before an Executive committee, which takes it to the MCI’s General Body Council. The General Body in turn sends it to the Government of India for approval before it is notified for implementation. What we are saying is, in academic matters, MCI be given the authority to implement the recommendations. This will shorten the process.

Is the delay in implementing the decision the only roadblock you foresee?

It is timely implementation of the policies which are required to be routed in the form of regulation. Regulation making and regulation notifying as an exercise should not be time consuming which, as of now, it is.

We have a new government, which has promised to do improve governance, does that give you confidence?

We have a well meaning President at MCI, and a well meaning Health Minister. Their timely interactions over time should be in a position to take things forward in a positive and pragmatic manner, and I’m optimistic about it.

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13

focus

BIACH & RI: A monument of hope

for terminally ills

Sri Nandamuri Balakrishna, Chairman and Dr T S Rao, Medical Director, Basavatarakam Indo-American Cancer Hospital and Research Institute, in their conversation with Shahid Akhter, ENN, hold forth on the genesis of this magnificent cancer institute, talk about its education and research programmes and its future plans Please tell us about the genesis of Basavatarakam IndoAmerican Cancer Hospital and Research Institute.

BIACH & RI is a culmination of dream of legendary Sri N T Rama Rao to have a full-fledged cancer hospital in Andhra Pradesh providing quality treatment at affordable cost to the people as his wife Smt Nandamuri Basavatarakam was herself an unfortunate victim of cancer. Many likeminded people from various walks of life and philanthropists in India and USA took his call, joined hands and formed Smt Nandamuri Basavataraka Ramarao Memorial Cancer Foundation in India and Indo-American Cancer Organization in USA to promote BIACH & RI. Though the foun-

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Nandamuri Balakrishna,

Chairman, Basavatarakam Indo American Cancer Hospital & Research InstituteHospital & Research Institute

“Onco scenario in India is quite grim and present number of cancer patients in the country is estimated to be around 2.5 million and about 7.50 lakh cases are being reported every year�

dation stone was laid in the year 1989, the Institute could start functioning only in June 2000 with 100 beds and has gradually developed into a major cancer treatment centre in the country with over 500 beds.

What is the core strength of BIACH & RI in cancer care?

Comprehensive and scientific treatment is provided to all patients rather than luxury to just a few people. We are stressing on advancement of technologies and techniques in cancer diagnosis and treatment.

What technological advancements have been introduced lately?

The Institute has been continuously

bed during surgery. This advanced technology may help kill microscopic disease, reduce radiation treatment times or provide an added radiation boost.

>>

Does Basavatarakam Indo American Cancer Hospital and Research Institute play a role in mentoring the next generation in cancer care?

Basavatarakam Indo-American Cancer

Hospital and Research Institute, Hyderabad

introducing the latest technological developments in the treatment of cancer and it was the first cancer hospital to install a Linear Accelerator in India for radiation treatment. Presently, it has six linear accelerators, the largest number in India and four of these including the Novatis Rapid Arc with V Mat supported by Brain Lab are IMRT capable. The Institute also has Real Time Position Management (RPM) and Acute Breath Coordination (ABC) facilities for SBRT. It is the only facility in India to have Lantis, ARIA and Mosaiq networks with three independent servers and common RT network for radiation planning. Besides, it was the first centre in India to introduce Cone beam CT based IGRT, breath control system for IGRT and All in One (AIO) immobilization system for conformal radiotherapy.

Any technology that is exclusive to Basavatarakam IndoAmerican Cancer Hospital and Research Institute in India?

Intraoperative Radiation Therapy (IORT). It delivers a concentrated dose of radiation therapy to a tumor

The Institute has very active mentoring and training programme for future surgical, medical and radiation oncologists as well as pathologists and has been accredited by the National Board of Examinations (NBE) to conduct their DNB programme for surgical, medical (post MS/MD) and radiation oncologists as well as pathologists (post MBBS). It encourages its doctors to actively participate in in-house as well as external academic programmes, CMEs and workshops/ seminars. The Institute also regularly organizes national and international programmes on latest advances in cancer treatment and related issues.

Being one of the largest laparoscopic surgery centers in India, it provides opportunities to young surgeons to

DR. T S Rao

Medical Director, Basavatarakam Indo American Cancer Hospital & Research Institute

“Accreditations are of immense value because they sensitize the health care professionals and other staff towards consistently ensuring quality and safety in patient care�

be trained in laparoscopic surgery through observer programmes.

What facilities are offered in blood and marrow stem cell transplantation for patients without fully matched family donor?

There are three options: Matched unrelated Donor (MUD) search, Haplo identical sibling transplantation and Umbilical Cord Blood transplantation.

What other supportive care and oncology services do you offer?

Palliative care, blood and components, alternative care systems like Naturopathy, Ayurveda and Physiotherapy.

Basavatarakam Indo-American Cancer Hospital and Research Institute is reckoned one of the best cancer hospitals in India.

How about the influx of patients from neighbouring countries?

Number of International patients coming to the hospital is increasing. Hospital is receiving patients mainly from Africa and Middle East and there are patients from SAARC nations also.

Is BIACH & RI working in collaboration with other organizations, particularly in molecular tumour profiling?

BIACH & RI is working in collaboration with Tata Memorial Hospital in the fields of cancer treatment, education and research.

What are your future plans? Where do you see Basavatarakam Indo-American Cancer Hospital and Research Institute five years from now?

With the optimization of capacity in the Hyderabad facility, the future plans are to open satellite hospitals in other parts of Andhra Pradesh particularly due to division of the state into Telangana and Andhra Pradesh.

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15

policy

‘1 Organ Donor can Save 8 Lives’ Dr Avnish Seth, Director, Fortis Organ Retrieval and Transplant (FORT), in conversation with Shahid Akther, ENN, holds forth on FORT programme and shares his insights on organ donation

Where do we stand in organ donation map of the world today?

Awareness on organ donation is increasing in our country, albeit slowly. Over the last few years, the organ donation rate in India has increased from 0.05 to 0.26 per million population. This is still a far cry from more than 30 per million in some Western countries.

Why are people so unwilling to donate organs?

That is a myth. The fact is that there is not much awareness on organ donation at all levels, be it doctors, paramedics or the general population. The government needs to step in with resources to increase awareness from school days onwards. Those of us who have tried sincerely for organ donation by increasing awareness amongst hospital staff, providing training for transplant coordinators, liaising with police, making easy access to documentation etc., have found an acceptance rate amongst families of over 40 percent, which is as good as the Western world.

How do we define organ donation?

It is important to understand that organ donation is possible only after brain death. Brain death occurs due to an injury which can be caused

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either by a stroke or a head injury. In fact, when the brain dies, the heart still continues to beat for a few hours or days so that the vital blood supply to the organs is maintained. The basic difference between brain death and death is that the heart continues to beat for sometime even after brain death. Tissue donation is possible up to 48 hours after death.

Do all brain-dead patients need certification?

The diagnosis of brain death is based on clinical tests carried out at the bedside by four doctors and repeated after six hours. There is no requirement for any expensive tests like MRI or Angiography. Earlier, certification of brain death and organ retrieval were allowed only from large hospitals with transplant centers. The Transplantation of Human Organs and Tissues Rules 2014, now, allows for certification of brain death and organ retrieval from any hospital with intensive care unit. Also, the presence of neurophysician or neurosurgeon is not mandatory if the hospital does not have the facility. Of course, all hospitals have to apply for the approval of brain death committee and sanction for organ retrieval centre from the appropriate state authority.

The new rules now make it mandatory to certify brain death and counsel the family for organ donation.

Who can be an organ donor and which organ is in most demand?

One can pledge to donate one’s organs with various organizations during lifetime. We, at Fortis Organ Retrieval and Transplant (FORT) offer the same (fort@fortishealthcare.com ; helpline +91-8447743868). However, the organ donor card has no legal standing. It is an only an expression of one’s desire which the family

members should be made aware of.

Organ donation is possible in patients with stroke or head injury who develop brain death while on ventilator.

There is a huge gap between requirement and availability of organs. It is estimated that we need about 1,75,000 kidneys, 100,000 livers, 50,000 hearts, and 20,000 lungs in a year. Besides these, the pancreas and small intestine can also be transplanted. In 2013, a total of 815 organs were transplanted following deceased organ donation across the country.

We do not have to be at par with Spain which has an organ donation rate of 35.1 per million population. We need to establish shortterm goals.

Our awareness in organ donation is so low. What efforts have been made by FORT or NGOs in this direction?

There are several NGOs working in this field, and we have reached where we are today. This has happened largely due to their efforts, most notably MOHAN Foundation. Fortis Organ Retrieval and Transplant (FORT) has been established with an aim to promote and streamline the process of organ donation following brain death.

We provide organ pledging facility and arrange awareness drives with schools, corporate and media.

We have interacted with Gurgaon police to facilitate the process of organ donation in medico-legal patients.

Each organ deserves a different treatment by way of retrieval, processing, storage and forwarding. Where do we stand here in this domain?

Organ retrieval is the easy part. We have transplant surgeons who have worked in the best centres in the world. Organ retrieval is carried out in the operation theatre as per wellestablished protocols. It is important to remember that organs cannot be stored. We pack organs in sterile ice and special organ preserving fluids, but there is no shelf life. Heart and lungs have to be transplanted in four hours, liver in six to 12 hours and kidneys in 12 to 18 hours. Thus, the challenge lies in having a robust and transparent organ allocation system along with regulated traffic corridors for rapid movement of ambulances.

What has been the role of FORT in organ donation programme?

Fortis is the largest private healthcare provider in Asia. We are currently carrying out organ transplantation in 15 of our hospitals, and have established deceased organ donation facilities in most of them. We are also in the process of getting non-transplant hospitals recognized as retrieval centres.

FORT provides 24-hour referral service for organ and tissue donation and assistance with documentation and procedures related to organ and tissue donation. We recently held a fiveday training workshop for transplant coordinators from across the country.

How good is our organ harvesting protocol as far as clearances from law enforcement authorities are concerned?

The process of organ re-

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17

focus

The new rules now make it mandatory to certify brain death and counsel the family for organ donation

trieval and transplantation has to be completed swiftly before the heart comes to a standstill. At the same time, police clearance is mandatory for organ retrieval in medico-legal patients with head injury. Very often a patient has been transferred from a smaller hospital close to the site of an accident to a tertiary care facility where brain death occurs. Tamil Nadu police has passed instructions that police clearance will be accorded on priority and by the police station closest to the hospital and it is not essential to approach the police station under whose jurisdiction the accident took place. Recently, 70 personnel from Gurgaon police, pledged to donate their organs with FORT. Mr Alok Mittal, the police commissioner, leading from the front in pledging his organs, has also promised full cooperation. Similar positive attitude by police forces from all states will go a long way in promoting organ donation in the country. Recent amendments in Transplantation of Human Organs & Tissues Rules 2014 have made postmortem requests easier by allowing post mortem beyond office timings for organ donors.

What should be the government’s role in promoting organ donation?

Increasing awareness takes years and decades of constant endeavour. The government needs to step in by introducing chapters in school books, media campaigns, creating pledging facility at the time of issuing driving licence, ration cards, ADHAAR cards etc.

Has there been an amendment to the Human Organs Transplant Act of 1994?

The most recent amendment is the Transplantation of Human Organs & Tissues Rules 2014. Families of patients with brain death were

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not being approached for organ donation as there was no mandate. But now, brain-dead patients, irrespective of their previous pledge, near relatives have to be approached for organ donation by the treating doctor.

Organ retrieval was not permitted in hospitals which were not approved for organ transplantation. However, now, organ retrieval is allowed from any hospital having ICU facility. The process of organ donation after brain death in medico-legal cases has been simplified. Post-mortem authorities may be requested to do post mortem beyond office timings. Also, appointment of a transplant coordinator is made mandatory

How do you see the future of organ donation in India? Can India be at par with Spain some day?

Organ donation in India is poised for takeoff. We, as a nation, believe in giving to others and in altruism.

Awareness on socially relevant issues is rapidly increasing. We have campaigns on educating the girl child, save the tiger, global warming and so on. It is the younger generation which is going to make a difference. We do not have to be at par with Spain which has an organ donation rate of 35.1 per million population. We need to establish short-term goals. I would suggest goals like organ donation rate of 1 per million population by 2020. With our population, that translates into huge numbers. We should aim to follow the example of Croatia or Brazil. Croatia was able to increase their organ donation rate from 2.7 to 35 per million population over 10 years, and today they are second in the world. This was achieved by recognizing organ donation as a priority area, earmarking requisite funds, sustained awareness campaign, training of transplant coordinators and appointing a key donation person in each hospital.

Event REPORT

Driving Innovations

for Patient Care

Maharashtra is witnessing a silent revolution in the healthcare sector. The recently concluded Maharashtra Healthcare Leaders Forum held on July 11, 2014 in Pune unveiled the vision and initiatives of healthcare stakeholders across the state.

W

ith a population of more than 115 million, Maharashtra is the second largest state in India. Healthcare delivery to this widespread and diverse population has always been a challenge for the state. A proactive public and private sector dominant in the state is driving new models of healthcare delivery. Thus, the healthcare sector in the state has seen a growth curve year on year. The contribution of private players has been primarily in strengthening the quality healthcare in the metro cities, whereas the government has introduced many schemes and extended support programmes to uplift the public healthcare pyramid in the state. The state has also seen adoption of new technologies and IT as a tool for bringing quality and efficiency in healthcare. The smaller towns and cities are also emerging as investment and excellence centres This progressive healthcare sec-

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tor was represented at Maharashtra Healthcare Leaders Forum that aimed to provide a platform for hospitals across Maharashtra to engage with government, corporate, academia and key decision-makers to engage in knowledge sharing and dialogue on best practices, opportunities and challenges in healthcare delivery.

Mapping State Initiatives The inaugural session MaharashtraTransformation of Hospitals and Healthcare Delivery illustrated the many initiatives taken by government, hospitals and organizations. The keynote address was delivered by Mrs Meeta Rajivlochan, Secretary, Department of Public Health, Government of Maharashtra where she elaborated on the vision and strategies adopted by the government to put patients first in the healthcare ecosystem. “If we wish to transform the hospitals be it either the public or the private, we have to put

patients first. The objective of making investments in healthcare be whether in terms of infrastructure or technology is to ensure that patient care is delivered in delivered better and patients outcomes of treatment is much better,� she said. Pune Municipal Corporation has taken significant efforts to make healthcare for all a reality. She elaborated on schemes to support medical expenditure and make quality care affordable for the lower income groups admitted in hospitals of the city. The city corporation has also taken extensive measures to make women and children better healthcare facilities.

Dr KK Kalra, CEO, National Accreditation Board for Hospitals & Healthcare Providers (NABH) in his special address said, “Patient Safety is a global concern across many countries. International studies across developed nations indicate that one in every ten patient gets hospital-acquired infection and one in ten suffers from medical

Meeta Rajivlochan, Secretary, Department of Public Health, Government of Maharashtra

Protocols Precedes Quality

issues such as over charging for the treatment, the patients also complained of not being informed of the treatment plan, did not issue standard operating protocols, follow-up of patients was not there. Also, the hospitals pressurized doctors were given billing targets for prescribing certain medicines and many such malpractices were challenges. Standard operating protocols are taught throughout his education, however, when he joins hospitals, there is no institutional mechanisms to keep systematic record of data. And this is an important to ensure treatment plan and procedures that hospitals are best suited as per the patient needs. Contrary to the perception that doctors are the most important parameter for rating a hospital, we find that a patient ideally spends maximum time in the hospital, with the paramedics and nurses etc. And it is here that we should see that operating protocols are followed. However, except few hospitals, most of them do not make sufficient institutional arrangements to see that standard operating procedures (SOPs) are followed. Although, most of the hospitals have HMIS systems, but the focus of these systems in entirely on the back office, the ability to record patient data, treatment outcomes are very limited.

Today, when we reflect on the state of healthcare in the country, the patient is missing from patient care.

The most important parameter of quality of service, patient medical records that details the ailments, treatment protocol, follow up at the hospitals is not followed by most of the hospitals. When we visit hospitals we find that the patient medical records are incomplete. That is a serious problem and pose challenges for our department to execute medical studies and make treatment plans. The hospital should update the records regularly with the treatment plan. When hospitals maintain data and they keep records as they function as an enterprise.

They do keep the operational data and data of the entire inventory. However, when it comes to treatment data that is not maintained, be it statistics of death or even at the individual patient records, there are many flaws. Thus it is the responsibility of the hospital institution to enable sufficient institutional arrangements are made to ensure that patent data of this kind is recorded.

We need to document and record the patient and treatment related information, how can we take corrective action. The most important issue today is that are we delivering quality healthcare to our patients, reduce the period of stay, better healing. And these can only be if we are documenting and following-up with patient well-being as he is getting treated. It is a myth that quality healthcare requires huge investments. It only requires attitude, I urge hospital to become proactive and these are not discussed and little pressure on hospitals to make necessary institutional arrangements and ensure that higher quality healthcare is delivered.

We in Maharashtra have started a novel insurance scheme in which we cover 75 percent population of the state and we had huge issues with the hospitals to ensure the success of the scheme. Apart from major

We are a prosperous society. And healthcare will attract investments, but unless we utilize that money to improve the quality of services which we deliver. We need to invest for the future of our children.

error. These numbers are far greater in India with limitations. These medical errors increase the length of stay and incur higher costs to patients and even death. If there is a safety culture adopted in hospitals, most of these medical errors are preventable. Patients are becoming more aware and have knowledge of medical condition and treatment modalities. They want to be involved in decision-making.” He added, “The most common reason for medical error is lack of communica-

tions. The medical education has not yet imbibed the concepts and implementation of patient safety and soft skill development in its entirety. On one side we are witnessing very high growth in private healthcare sector, but still patient safety still remains a concern in addition to accessibility, affordability, inequity and quality of care.” Representing the not-for profit organization, Dr Dilip Murlidhar Sarda, President, Indian Medical Association Maharashtra said,”We have taken

up the issue of consumer protection act wherein we are demanding for a tribunal that will be at local level, state level and national level that due their expertise in medicine will be able to take better decisions in medical negligence related cases. The association has taken a new initiative on antibiotic resistance to bring more awareness on the issue to use antibiotics very safely.”

Healthcare Infrastructure Dr Manisha Bobade, CEO, Jehangir

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Event REPORT

Hospital said,” Best clinical outcomes cannot be achieved without excellent infrastructure. Extensive planning with co-ordination with end-users is important. Manpower should be trained with standard protocols and guidelines. She emphasized the need to upgrade the government hospitals at par with private hospitals and elevate the level of quality offered at these hospitals. New ideas on sustainable and affordable infrastructure were shared by Tarun Katiyar, Principal Consultant, Hospaccx Healthcare Business Consultancy. He said, “High operational costs take a toll on the overall sustainability of the hospital.

Intelligent building and going green is best way to go forward, the capital cost will come close to 3 percent of the total cost and in the long run the operational costs come down and the return on investment is achieved.” The diagnostic industry was represented by Dr A Velumani, Chairman, Thyrocare and he shred his experiences in bringing operational efficiencies for conducting tests and making each test profitable and at the same time deliver customer satisfaction.” Biomedical waste is an ignored aspect in operational planning; GH Trivedi, Senior Environmental Engineer, Gujarat Pollution Control Board provided insights on the importance of planning for management of biomedical waste. There is rapid change in advancement of technology as new equipment are coming and new treatment guidelines are being set-up, are we upgrading ourselves to the latest was a concern raised by many. The dignitaries discussed the state-of-art

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infrastructure of public and private hospitals that supports high efficiency and customer satisfaction for patients.

Technology Mantra With complex operational systems and medical ecosystem, to keep patients at the core of the hospital information system, technology is a transformational tool that poses huge opportunities in healthcare. The key technologies that were discussed included EMR, medical imaging, mobile health, tele-medicine and many others. Speaking on government initiatives, Bhudeb Chakravarti, AVP and Region Head, National Institute of Smart Governance discussed the new models of healthcare delivery via kiosks wherein all technologies will be available with tele-health facilities and real-time technology or location based technology that can be used by the healthcare community. Archana Samudra, VP, Palash Healthcare Systems illustrated the role of technology in making the entire process management of hospitals electronic and a click away.

The doctors should have accessibility with ease of all patient data on various smart devices such as smart phones and tablets. Patient can easily be at the centre of care if he is connected to his hospital and doctor anytime anywhere.

This was well supported by Dr Sandeep Salonkhe, Medical Director, JJ Mahanagar Blood Bank who detailed on the extensive efforts of state blood transfusion council over the years and their latest service of blood on call across the state.

Insurance in Healthcare Health insurance can be a means for

reaching universal healthcare; many global countries have followed this. In the Indian scenario, the governmentsponsored schemes have reached penetration across many villages, however the private insurance companies still have limited reach and penetration. “If we want health insurance to become more generalized, two important needs that the sector needs to do if they are servicing the government or private sector as a client, then they must bring down prices and introduce transparency in their functioning.

The sector today is valued at 23,000 crore per annum and the government contributes one-third of the contributor. There are no package rates in the health insurance industry and the healthcare industry that services the insurance sector. The third party agencies have not take desired initiatives and there no general standards and policies for ailments even today. This is important as general protocols help in bringing in transparency in insurance cover and re-imbursement of procedures,” said Meeta Rajivlochan, Secretary, Department of Public Health, Government of Maharashtra. The session also had presentations from private insurance companies and hospitals to provide a holistic approach. Innovation will reduce cost and affordability through collaboration. Maharashtra Rajiv Gandhi Jeevandayee Yojna is an innovative scheme under which the department of health of the state has developed entitlement criteria for the participating hospitals and these have been finalized by consultations with NABH and Quality council of India. Initially some criteria have been based in the infrastructure parameters considering the constraints and ground realities in hospitals.

Collaborations is the way forward to ensure progressive growth and success in healthcare sector in India.

Thus public private partnership and collaboration will strengthen the services and quality of care offered to the patients in hospitals.

cover story

In vitro fertilization or IVF has come a long way since its inception in 1978. With technological advancements and breakthrough in research, IVF has gained momentum with a wider appeal, grater applicability and unquestioned success rate. Shahid Akhter, ENN, explores the evolving IVF centers across India

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VF

Implanting

Hope

Denmark In Denmark, IVF is widely accepted, publicly subsidised and waiting times for treatment are comparatively shorter.

This has helped to ensure Denmark’s high birth rate at 1.9 children per woman, close to the 2.1 babies per woman required to maintain population levels.

Global IVF Senario

Sweden

In Sweden, where IVF is well reimbursed, succeeded in reducing multiple birth rates from 34% in 1991 to 5% in 2004 thanks to single embryo transfer policies.

ENGLAND IVF Clinics must be licensed by the Human Fertilisation and Embryology Authority (HFEA), the regulatory body in the UK. The use of hybrid embryos for medical research has been approved recently. Allows IVF treatment for lesbians and single women as well as married women.

Czech REPUBLIC

Spain Since sperm and egg donation in Spain is anonymous, there are many egg donors and virtually no waiting lists.

Only six children can be born from the same donor. A maximum of three embryos are allowed to be transferred.

Sex selection and surrogacy is not recognised.

T

he World Health Organization describes infertility as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after twelve months or more of regular, unprotected sexual intercourse. Infertility, whether male or female, is “the inhability of a couple to achieve conception or to bring a pregnancy to term after a year of regular, unprotected intercourse”.

According to WHO approximately 8-10% of couples experience some form of infertility problem. On a worldwide scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region.

The prevalence of infertility has been stable for the past decade but there has been a shift in aetiology and age bar. It is not just the pollution and pesticides that have infiltrated our lives but equally responsible are the lifestyle choices like addiction to smoking and alcoholism, late marriages ( quality of egg sharply declines after 35), charting out the career growth in precedence to child, mental and emotional stress and similar factors have resulted in malfunctioning of the human body by way of reproductive activities.

India, with around 180 million women in the reproductive age group, is home to the world’s largest young population.

The Czech laws ensure that woman who gives birth to a child is legally the mother. In case of egg donation, the recipient who carries the child and gives birth is lawfully the child’s mother.

Around 30% of infertility is attributed to female factors.

Another 30% is labeled as male problems, 20% is combined male and female while 20% rests as unexplained infertility.

Around 1/10 of the population is believed to be in the grip of infertility and this sums up the country’s fertility market.

According to Manish Banker, President of ISAR ( Indian Society for Assisted Reproduction), the Assisted Reproductive Technology (ART) market in India is estimated to be worth $1 billion (Rs 5,000 crore) in the next three to five years.

To cope up with the spiralling infertility graph, we have a plethora of fertility clinics, said to be more than 3000 across India. Amidst scant and liberal guidelines laid down by ICMR ( Indian Council of Medical Research), the infertility clinics continues to be unregulated, leaving doctors free of legal and ethical constraints. To begin with, the guidelines say nothing about who or how to open an infertility clinic. Just like any other commodity in a shopping mall, these ingredients of life are available on the shelves for shopping, including online!

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We Love to Handle

complex issues Dr Aanchal Agarwal, Head Consultant IVF and Reproductive Medicine, BLK Super Speciality Hospital, in conversation with Shahid Akhter, ENN talks about the grim infertility scenario and the complex IVF issues

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Could you please throw some light on the prime reasons for escalation in fertility?

More people are focusing on their careers and are marrying late. The very process of planning a baby is delayed.

Even today, most women are unaware of the exponential decline of fertility after the age of 35.

Latest research indicates that 10 percent urban Indian couples in their reproductive age are infertile. However, among women of 35 years of age and above, it is as high as 30 to 40 percent, because women are born with a fixed pool of eggs: one to two million at birth, 3,00,000 to 5,00,000 at puberty, which reduces to about 25,000 when a woman turn 37, and further goes down to 1,000 by the time she hits menopause.

We also see an increase in numbers now-a-days because of late marriages, corporate culture with high stress and targets to be met. With westernization, come smoking, alcoholism and junk food.

What are the risks involved in IVF or any other ART treatments?

The only risks involved are multiple pregnancy and Ovarian Hyper Stimulation Syndrome (OHSS). There are no risks to health or life associated with IVF attempts.

Please tell us something about the embryology lab at BLK. The embryology lab at BLK Super Speciality Hospital is a modular lab built according to ESHRE guidelines. It has all the modern equipments required with a very strict quality control.

What is the IVF success rate at BLK and your USP? Any example of extraordinary IVF treatment.

The success rate at IVF centre of the BLK Super Speciality hospital is approx 45 to 50 percent per cycle. There have been months when the success rate touched even 80 percent. We have given results in multiple failed cycles at other centres.

Of late, we have handled many complicated cases of multiple IVF attempts. I could recall of two unusual cases. First, a lady who was affected with polio virus since her childhood and was recommended at many centres that she could not conceive. Her desire to have a baby never ended until she came to our center and tried for IVF. Hers was a complicated case but with the techniques that we use and personal attention, she was able to conceive and deliver a healthy baby.

Secondly, a patient from Haryana has been trying to conceive through various means and had already tried 14 IVF attempts. Her hopes were still alive and that gave her courage to try for another IVF attempt at BLK SSH. She conceived in the 15th attempt and gave birth to a healthy baby at full term.

We expertise in handling such complex cases and bring smile on the face of the couples.

To what extent does IVF contribute to medical tourism?

Indian is an economical market when it comes to egg or embryo donors. In India, it is easier to get donors and surrogates which makes it lucrative for the foreign patients to get donors that too at much economical price as compared to European market. In Britain, there is acute shortage of eggs resulting in a long wait for years. Also, globally there is a cap on number of embryos being planted in the womb.

In India, it is different. Here, market rules, donors are available easily, and we have expertise in IVF. It is a market of ut-price genetic material from a pool of highly trained, English-speaking doctors who can address the concerns of a lot of foreigners who travel here in want of children.

What makes India a fertile option for IVF treatment?

India is high on technology and medical expertise, and IVF treatment in India is three to five times less expensive as compared to Europe. Also, as mentioned

earlier, donors are easily available.

What services you offer by way of surrogacy?

Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person.

This woman may be the child’s genetic mother (called traditional surrogacy), or she may carry the pregnancy to delivery after having an embryo, to which she has no genetic relationship, transferred to her uterus (called gestational surrogacy). If the pregnant woman received compensation for carrying and delivering the child (besides medical and other reasonable expenses) the arrangement is called a commercial surrogacy. BLK SSH IVF Centre offers all kinds of IVF services including IVF-ICSI, egg donation, embryo donation and surrogacy.

Surrogacy is commercial and legal in India but getting tainted.

As you offer surrogacy services, what do you think is the biggest challenge that the surrogacy industry facing in India today?

India has too many IVF centres many of which are not even registered or approved. The biggest need of this hour is a strict control and regularization on mushrooming of IVF centres in every street and corner of the city so that domestic as well as international patients get genuine and quality services.

How do you envision the future of IVF in India?

IVF facility has a lot of scope in India.

Research is going on to further increase the success rate so that more and more couples can fulfill their dreams of having their own child. Personally, I feel this is a very noble profession and extremely gratifying. But, the authorities need to exercise strict control over mushrooming of small centres and malpractice by untrained professionals so that in future, only trained specialists are allowed to practice this noble profession.

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Every IVF Treatment is

Customised

Dr Duru Shah, Scientific Director of Gynaecworld and Gynaecworld Assisted Fertility Centre and a Consultant to the Breach Candy Hospital, Jaslok Hospital, Mumbai, talks to Shahid Akhter, ENN, about the struggle and solutions faced by the infertile couples How have aids such as ovulation kit helped/harmed the modern couple?

The ovulation kit is a very useful method which helps couples to time ovulation and plan a pregnancy.

The kit has made it easier for infertile couples to plan a pregnancy in the comfort of their homes, without any invasion from doctors and clinic staff, especially in women with irregular periods, as it helps them to time their ovulation. The kit detects the rise in the luetinising hormone in the body which is responsible for the final maturation of the egg and its release leading to ovulation. In this busy world, where men and women are both struggling to build their careers are so stressed that they have no time for sex. Getting pregnancy in such couples is not spontaneous, but dictated by the kit which tells them “today is the right day.”

Please tell us something about the embryology lab at your centre.

The embryology lab is the heart of any ART Centre. It is a state-of-the-art laboratory with well-equipped Laminar Air Flow, the latest incubators, ICSI Manipulators, culture media, Laser Assisted Hatching machines, freezers for embryos, sperms and eggs for future use with a high level of quality control. The embryology lab is converted into a space like the womb of a mother--adjusted at the same

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Success rates vary from situation to situation with the women’s age being the most important factor

temperature, clean environment, humidity and atmosphere of the womb, so that the sperms, eggs and embryos thrive and give positive results.

What is the success rate of IVF at your centre, and your USP? IVF success rate will always be a

variable. It depends on the age of the woman you are treating. Besides that, there may have various other complications. The average success rate is approximately 30 percent per embryo transfer. But, if we select the couples based on the age of the woman, the pregnancy rates go as high as 47 per-

cent per embryo transfer in women below 30 years of age, and go lower as the age advances. On the other hand, when we use donors’ egg in older women, the pregnancy rate rises to 53 percent per embryo transfer. In women, where we have used donors’ egg and surrogacy, it goes up to 65 percent per embryo transfer. So, success rates vary from situation to situation with the women’s age being the most important factor.

How do the cost and services of IVF in India compete with other competitive markets?

In India, the cost per IVF cycle is approximately 25 percent of the cost in Western countries, even though most of the culture media and consumables such as petri dishes, etc., are imported with a heavy import duty being levied. The cheap labour and the cost of medical expertise help to make it more affordable here. Our USP is that we offer all services under one roof so that patients do not have to travel all over the city for all the services needed. Every couple’s treatment is customized, and individualized care is given to every couple. We do not believe in having assembly lines.

Can you think of any government initiative that can make IVF more cost effective?

IVF is totally unaffordable by the lower socio-economic strata of society because of its high cost. The government can definitely assist by setting up their own IVF services at government hospitals. It can collaborate with private IVF centres for treatment at subsidized rates, and also manage basic infertility in rural areas. The Government of India has been aware of this, and has initiated a process to address the issue of infertility management, which does not exist, at all, in the rural areas. I have been a part of this process during the development of the basic guidelines by the ICMR.

Globally, IVF seems to have become the first choice, especially in women as they get older What they need to do is to bring infertility under the purview of the insurance companies so that more people can afford IVF treatment.

What is the biggest challenge facing the surrogacy industry in India today?

India became the capital of surrogacy in the last few years mainly because of the high-end services available in India with proven results and English speaking doctors. Because of its high monetary value, many businesses which came into being went into extremes, and started creating babies for trafficking. The Government of India, however, clamped down on them, and created guidelines which made it possible for couples who truly needed surrogacy to avail themselves of this facility. Visa rules for international clients were tightened, and a lot of documentation came into existence. This has put off a large number of potential international clients from coming to India due to these bureaucratic difficulties.

The entire business of international surrogacy has now moved to Thailand and Mexico, away from India.

Please dwell upon some of the most revolutionary reproductive therapies that can aid in curing infertility.

The most revolutionary reproductive therapies that can aid in curing infertility are: Intracytoplasmic sperm injection (ICSI) for those men in whom not even a single sperm is obtained

through the semen. In such men, the sperm is aspirated from the testes directly, and used for ICSI. Besides, there are times when women from other countries or cities can live in Mumbai for their treatment, and husbands can freeze their sperms and leave. The frozen sperms can then be utilized for the next few cycles whilst the woman is in Mumbai. She can still get pregnant with his sperm, even though he is away.

How do you commence the treatment of unexplained infertility?

It involves a lot of psychological counselling as the cause of infertility is not known. Unexplained infertility is a situation wherein the doctor is unable to determine the cause of infertility even after all the relevant investigations are done. We induce ovulation in patients with ovulation inducing agents and perform Intrauterine insemination (IUI) -- a procedure where husbands semen is deposited within the uterus). After three to four attempts, if this process also fails, then IVF is the best option.

How do you resolve the chances of multiple births?

Multiple pregnancy is an important complication of IVF. Careful stimulation of the ovaries after proper patient selection and single embryo transfer can help to reduce the multiple pregnancy rates. Most of the IVF centres transfer three embryos at a time, so that the chance of pregnancy increases, because it is well known that only one out of three embryos is usually normal, and will lead to a pregnancy. However, sometimes all three are normal, and we end up with triplets. Hence, today, in order to reduce the chance of multiple births, we grow the embryos to Day 5 in our labs, and they represent the best of the lot of embryos. And a single of those Day 5 ones is transferred, hopefully leading to a single pregnancy.

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cover story

Assisting the bond

Called FAM LY Dr Beena Muktesh, Head, Miracles Fertility & IVF, Gurgaon is poised to create a niche in infertility care and cure. She shares her IVF expertise and experience with Shahid Akhter, ENN What are the cutting-edge advancements in IVF? IVF science has advanced very rapidly in recent years. Today, we have an array of break-through techniques that has outpaced the traditional IVF. We are equipped with Embroyoscope, Blastocyst, Cytoplasmic inclusions, Mitochondrial repairs and replacements, Lasers, Genomics and things are still on the move. We are not too sure where we will land tomorrow.

Things are evolving.

Desperate couples seeking fertility solutions often seek help from ovulation kits? How helpful or harmful are they?

It sounds to be a very useful kit that may assist couples in planning their pregnancy, but in reality the couples end up totally confused. It is certainly not indicated for all infertility patients, and in some cases it is simply a waste of time, and may even prove counter-productive for many.

When should a couple consult an IVF centre or an infertility specialist?

Experts suggest at least one year.

Women aged 35 or older should see their doctor after six months of trying. A woman’s chances of having a baby decrease rapidly every year after the age of 30. But a fertility check

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is recommended for women as early as possible.

Some health problems also increase the risk of infertility. So, women should speak to their doctors if they have irregular periods, or no menstrual periods, very painful periods, endometriosis, pelvic inflammatory disease, more than one miscarriage.

How important is counselling for an infertile couple?

We need to consider the fact that those who have turned up to us are couples who have failed in their initial attempt to conceive. We need to answer their queries, clear their doubts and help them understand the new treatments that are venturing into. Before the treatment commences, during the treatment and finally post treatment, there are so many issues that need to be addressed to the satisfaction of the patients.

What services are offered by Miracle IVF? We offer a wide array of infertility treatments. They include: Follicular Monitoring – used to identify the maturation status of eggs.

I.U.I – Intrauterine insemination (IUI) is an infertility treatment where the woman is injected with specially prepared sperms.

IVF – In Vitro Fertilization is the most popular and advanced treatment in reproduction.

ICSI – Intracytoplasmic sperm injection (ICSI) is part of an IVF treatment.

Donor Egg Cycle – A need for egg donation arises for a number of reasons.

Embryo Transfer – After ovarian stimulation, egg retrieval and embryo development in the lab, it’s finally time for the embryo to be transferred back into the patient’s uterus.

Embryo Cryopreservation – It is the process of preserving an embryo at sub-zero temperatures.

Laser Assisted Hatching – This is used to soften the shell of the embryo which helps to increase pregnancy rates by improving implantation rates, since embryo hatching is facilitated.

P.E.S.A/T.E.S.A – These procedures are done to retrieve sperms from the male testes and epididymis.

Testicular Biopsy – It is a test to remove a small sample of tissue from one or both testicles.

Semen Cryopreservation – It is a procedure to preserve sperm cells that can be used successfully indefi-

nitely after cryopreservation.

Why should one consider Miracles Fertility over others?

We strongly believe in evidence-based fertility treatment. Our state-of-theart facilities include Lykos lasers, High-tech Laminar air flow to name a few. We ensure that the patient is well aware of the entire treatment, and prepare herself/himself accordingly.

Your expansion plans?

We are planning to create over 100 sub-centres in North India. At present, we have them at Aligarah, Pataudi, Rewari and Gurgaon.

Does Miracle Fertility cater to overseas patients?

Today, we have an array of breakthrough techniques that has outpaced the traditional IVF. Yes, we have a very good clientage among overseas patients. One third of our patients are foreigners, they are mostly from neighbouring nations and Central Asian countries. We provide facilitation services for international patients, and our services are customized.

To shorten their stay in India, we have online reporting and counselling, cycle is planned, and at an average it takes fifteen days of stay to allow things to take shape.

Once a centre (IVF) gains popularity by way of good work, it receives acclaim and people share the news with others when they return. This induces and prompts others seeking infertility treatment to come to us.

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Infertility is the growing problem

around the world, says Dr Supriya Puranik, IVF Expert, HOD Obstetric & Gynaecology, Sahyadri Speciality Hospital, Nagar Road, Pune, in conversation with eHealth Who is an ideal candidate for IVF or ART, and should this be the first choice in the line of treatment?

Couples who cannot have children due to unknown reasons, or repeated failure of IUI (Intra Uterine Insemination) or due to specific reasons like lowsperm count and obstruction in fallopian tube, severe endometriosis have a viable and excellent solution in the form of In Vitro Fertilization (IVF).

How difficult is it to convince couples seeking IVF treatment?

With the increasing awareness, infertility treatment is now becoming more acceptable across all the communities in India. The infertility treatments require the patients to follow a strict schedule in all the procedures, and many of them fail to follow because most of them come from distant places, some have strict work issues, etc. Patients are reluctant to take multiple injection pricks. The late decision of starting with the IVF treatment is one of the major challenges because success rate of IVF sharply falls from 30-40 percent in women aged below 35 to 2 percent in women aged over 45.

Is IVF the only option available? How do you resolve the chances of multiple birthss?

While majority of the patients require fertility enhancing laparoscopic surgeries and basic procedures like IUI, few of them require IVF and ICSI. Although major efforts are warranted to reduce the risk of multiple births with IVF, but it is also clear that single-embryo transfer is not the solution in all the cases.

What are the risks associated with ART? Possible risks associated with ART include those inherent to pregnancy and delivery, those associated with the infertility itself, and its causes and risks iatrogenic to ART e.g. OHSS i.e. hyper stimu-

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lation of the ovaries. Although there are there are many potential risks associated with ART, it has become clear that the major risk is multiple pregnancy and its consequences.

vitro and not transferred in vivo, religious leaders opinion on the fertility treatment, infertility caused by DNA defects on the Y chromosome is passed on from father to son in particularly ICSI.

Please shed some light on embryology lab at Sahyadri Hospital

What is your contribution towards fertility tourism?

Along with the most modern fertility centre, providing end-to-end fertility solution, we have our embryology laboratory following internationally accepted IVF protocol and global practices. We have invested in technology and expertise to perform complex fertility procedures. We have experienced, and highly-accomplished team of IVF experts, embryologists and support staff. We offer individualised fertility treatment with warmth and compassion. We respect confidentiality and patients’ rights.

What is the success rate of IVF at Sahyadri Hospitals? How different is it from others?

Our hard work and continuous efforts have helped us succeed in IVF cases with a good success rate. Our results are competitive, and are par with the best known. It is important to remember that the maximum you can expect per cycle of treatment would be 8 to 10 percent with IUI, 30-40 percent with IVF and ICSI, 50-60 percent with oocyte donation, embryo donation and surrogacy.

However, the good statistics is that the cumulative pregnancy rate with three cycles of the selected treatment would be in the range of 60-70 percent.

We at Sahyadri are committed to transforming the ART technology by ensuring fertility treatment made accessible, available, accountable and affordable.

Are unethical practices on the rise?

There are several ethical issues associated with the infertility treatment. Highcost treatments are out of financial reach of some people, allocation of the medical resources that could be used elsewhere, the legal statues of embryos fertilized in

The form of medical tourism, i.e. fertility tourism is the practice of traveling to another country for fertility treatments. Israel is the leading fertility tourism destinations for IVF procedures, having the highest number of fertility clinics per capita in the world. In turn, India and other Asian countries are the main destinations for the US women seeking IVF, and 52 percent seeking IVF with donor eggs.

Hence, a huge growth in fertility tourism is foreseen.

as uterine damage owing to genital tuberculosis, the couple can hope to have their own genetic offspring by IVF with transfer of embryos to surrogate mother who carries the child for nine months, and then hands over the baby to the biological parents.

As you offer surrogacy services, what do you think is the biggest challenge facing the industry in India today?

In addition to possible complications from ART procedures, using a gestational carrier is expensive, controversial and legally complex. It often involves intricate contracts and arrangements. You will not only experience the usual suspense, and the anxiety of waiting for a pregnancy to safely reach full term, you will have to worry about the legal snags,

Today, India’s expertise and technology is being recognized worldwide and the country has emerged as one of the most favoured destinations for IVF How does the cost and services of IVF in India compete with other nations?

The affordable IVF treatment cost in India has given a lot of hope to infertile couples who cannot bear exorbitant bills of this treatment in their own countries. Significantly, costs are saved compared to North America and UK. In these years, along with the cheaper treatment option, India has internationally accredited medical facilities using the latest technologies and easy accessibility to facilities such as no waiting lists, etc.

What services you offer by the way of surrogacy?

In cases of end organ failure, such

and the possibility that your gestational carrier will change her mind.

What is the future of IVF in India?

Today, India’s expertise and technology is being recognized worldwide.

The country has emerged as one of the most favoured destinations for IVF. In these years, the country has built very sound and state-of-the-art technologies. Moreover, Indian doctors are noted for their expertise and capabilities.

The healthcare system is also very cost effective bringing it to the doorsteps of a large global middle-class population. Hence, we at Sahyadri Hospitals provide high-quality treatments in a transparent manner. We believe in satisfaction of the patients.

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Bringing Smiles to

Childless Couples

Dr Vasan SS, CEO & MD, Manipal Ankur, in conversation with eHealth holds forth on the recent developments at Manipal Ankur and shares his insights on the sudden spurt of infertility in India Please tell us something about Manipal Ankur.

Manipal Ankur is a joint venture between Ankur Healthcare and Manipal Health Enterprises Pvt Ltd, Bangalore. At Ankur we are focused both on male and female fertility issues as well as special dysfunctions, meaning erectile dysfunction or premature ejaculation. We also have an emphasis on male health in terms of men’s vascular. The organization has panIndia presence, having 11 centres in India across different cities such as Bangalore, Mangalore, Ongole, Raichur, Indore, Jaipur, Salem and Goa.

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We will soon be functional in Surat ,Jabalpur, Delhi, bhuvaneshwar & Kolkata.

If you look at fertility centres, most are tilted towards addressing only female fertility or IVF alone.

What research has established is that male infertility is equally a pertinent issue and it is extremely under-served in India. Therefore, we have been constantly addressing fertility comprehensively – both male and female. It is our firm belief that addressing this comprehensively is the only way to be effective in the treatment that we are eventually offering to our patient.

What are the reasons for spurt of infertility in India?

People tend to associate fertility as an urban phenomenon which is untrue.

The problem of infertility is multi-layered. Infertility is an equally rampant phenomenon in rural areas.

Historically, in India, a lot of infertility was undetected. Culturally, the females were to be blamed for infertility. Now, with our thought processes being more open, people are resorting to take medical help. It has helped us capture the problem of infertility.

What are the major technologies

that you have implemented in Manipal Ankur?

We have constantly invested in the latest technologies. We have been pioneers in advanced diagnostic capabilities of andrology. Some of the tests we do like DNA Fragmentation Index (DFI), Reactive Oxygenation Species (ROS), Caspase 3, Annexin V Binding, Sperm Proteomic analysis, we are the only ones in the country to be doing this. We have invested in time lapsed imaging system for embryo monitoring that helps in deciding the best embryo for implantation. This has helped us significantly improve success rates in females with recurrent IVF failures.

We would be the first to be using flow cytometry technology in male infertility diagnosis. Along the way we have partnered with various equipment vendors globally and are now focussing in assessing endothelial dysfunction in male, manage the reproductive health of a male and therefore proactively identifying males who show signs of developing CVD eventually.

What are the steps you have taken to make IVF treatment affordable to the masses?

Our presence across the country has helped us in standardizing our infrastructure and treatment protocols.

Due to this there is consistency in what we do across all these centers. Over time, this has enabled us to focus on automation, thereby improving clinical accuracy and reducing costs. Further, we are constantly looking for ways to bring in new tools/technologies that will help us in reducing cost to patient. Testimony to this is the fact that our prices would be one of the lowest in most of the locations we are present and still manage to deliver success at international benchmarks

In India, around 1,000 IVF centres are there. How are you different from them?

Traditional infertility centers focus on IVF / female infertility only but we focus on addressing male and female infertility comprehensively. Considered pioneer in the field of Andrology having a strong lab conducting advanced tests to help maximize success of an IVF. Some tests like DFI, ROS, Caspase 3, Annexin V Binding, Sperm proteomic analysis were initiated by us and have helped in developing clinical strategies for patient care.

We have incubated a set of services in the area of early vascular ageing detection and management of male and

Seven Orthopaedic patients being available on-site gives a lot of comfort to the patient

have seen tremendous success.

Research collaborations with institutes like IISc, Biocos, Achira labs, RGTU constantly help us in pushing the bar on treating fertility. Our time tested QA-QC processes ensure consistent SOPs across all centres across all clinical services therefore consistent patient care and results. We offer fellowship courses in Andrology and Reproductive Medicine that are certified by Manipal & RGUHS university. This has helped us in spreading awareness and going beyond our centers to ensure people get benefited. Innovation is at the core of this all and our efforts in deploying time lapse imaging system for embryo monitoring & flow cytometry in Andrology diagnosis is testimony to this.

What is the normal success rate of these treatments?

If you look at the international standards, success rate is categorised by age. By international standards, it has been benchmarked at around 3536 percent. Indian standards do not publish any standard for India. We also come out with our own researches, and we have kept it as 45 percent, as we like going beyond standard benchmarks.

Convincing people for IVF technology, how difficult is it?

We are here to explain the right approach, to diagnose their problems, tell them why pregnancy is not happening and give them a scientific explanation. The decision is completely the patient’s.

Please tell us about Medical Tourism at Manipal Ankur.

Although our focus has been primarily on the domestic patients, we have seen a steady increase in patient flow from a few international markets like Maldives, Africa, Middle east and Bangladesh to our centers across.

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Emotional Distress

Invites Infertility Dr Hrishikesh Pai, Consultant Gynaecologist, Fortis Bloom IVF Centre, New Delhi, is one of the pioneers in the field of infertility treatment with a variety of innovations to his credit. In an interaction with Shahid Akhter, ENN, he discusses the IVF issue in India.

At Fortis IVF Bloom, how do you address infertility?

Consultation with a fertility specialist is the primary step before going for the treatment. We at Fortis Bloom IVF Centre understand that infertility problems can be emotionally distressing for patients, and hence we respect their situation and help them overcome it. First step of consultation leads to the understanding of the problems and a brief guided outlook of the right treatment procedures available. We also explain the fertile period to the couples. Besides that, we prefer to conduct some investigations to track the couple’s reproductive health. The investigation procedures include routine blood tests, specific test to assess ovarian reserve, ultrasound for the wife and semen analysis for the husband.

The best way to deal with stress due to infertility is through counselling, which is suggested as a solution to the patients. We understand what patients are going through, and we put forward the best way to reduce emotional stress over the subject. Counsellors deal with patients to take out their fears and help them to relax beforehand.

Who is an ideal candidate for IVF or ART, and should this be the first choice in the line of treatment?

In case a couple is unable to conceive after one year of unprotected inter-

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course, they should seek treatment for infertility. IVF is not the first resort. Couples are counselled for timed intercourse cycle, followed by IUI (Intra Uterine Insemination) depending on their test results. Occasionally, couples with wife’s low ovarian reserve, bilateral tubal blockage, some developmental abnormalities or severe male factor infertility are taken directly for IVF.

What difficulties do you face in convincing the IVF couples?

Couples facing infertility are emotionally distressed. We need to clarify to them that the children born through ART are as normal as other babies.

Over more than three million babies have been born after IVF treatment has been found to be safe worldwide, and the risk of any abnormality in such babies has not been found to be any more than other babies.

They also have apprehension regarding the child being their own. During the IVF procedure, the egg of the genetic mother and the sperm of the genetic father are used to create the embryos in the laboratory. These embryos are then transferred into the womb of the genetic mother or surrogate – where in both cases the child is of the genetic parents. In case,

the couple decides to go for a donor egg or sperm programme, the child still remains of one genetic parent.

Some couples may not find the IVF treatment affordable. As a part of our CSR initiatives at Fortis Bloom IVF Centre, we do have economy packages for the under-privileged patients.

Is IVF the only option available?

How do you resolve the chances of multiple births?

IVF is a treatment option for couples with various types of infertility. It has been successfully used to overcome infertility due to blocked or damaged tubes, endometriosis, repeated IUI failure, unexplained infertility, poor ovarian reserve, poor or even nil sperm count (through sperm retrieval techniques like TESA/PESA) IVF can be normally performed for counts which are more than 5 million per ml. For counts less than 5 million per ml, ICSI is a better option. At Fortis Bloom IVF Centre, the success rate of IVF is in the region of 40 to 50 percent for women less than 35 years, which are comparable to the leading units in the world.

For patients with repeated IVF/ICSI failures, we have even better techniques like Assisted Laser Hatching, IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) and Embryoscope.

Assisted Laser Hatching - A cut is given to the zona using an 8 micron laser beam when the embryos are at 4 cell (Day 2), 6-8 cell (Day 3) stage or blastocyst stage and embryos are placed back in the womb. The cut (called Assisted Hatching) weakens the zona and helps in the hatching process which results in better pregnancy rates.

IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) - Patients with low-sperm count can opt for IMSI technique in which sperms are magnified to 6,600 times which gives us the option to choose good sperms from the bad ones.

Embryoscope - Embryoscope technology contributes to improving success rate by monitoring the development of embryos and identifying the healthiest embryos to be implanted in the womb for achieving pregnancy.

This helps in preventing the chances of multiple pregnancy as only single best embryo is transferred per cycle.

What are the risks of ART? Most of the procedures now-a-days are simple, of short duration and patient friendly. IVF/ICSI cycle needs a maximum hospital stay being restricted to four to six hours for egg pickup. Sometimes the ovaries swell up excessively, leading to fluid collection in abdomen and lungs. This is called ovarian hyperstimulation syndrome (OHSS), and may need hospitalization and sometimes removal of the fluid from the abdomen by a procedure called ‘Paracentesis’.

Occasionally the pregnancy may lodge in the fallopian tubes (ectopic pregnancy), and may need medical treatment or surgery for its removal.

Complications may occur during the egg retrieval procedure as the removal of eggs through an aspirating needle entails a slight risk of bleeding, infection, and damage to the bowel, bladder, or a blood vessel.

Please tell us something about the embryology lab at Fortis.

Laboratory environment: HEPA filters, Japanese Nikon SMZ 2 B stereo zoom and Nikon Diaphot 300 inverted microscopes within laminar

As a part of our CSR initiatives at Fortis Bloom IVF Centre, we do have economy packages for the under-privileged patients

airflows, Hera cell CO2 incubators from Germany, Cook bench top incubators for embryo culture, disposables imported from Australia and UK, culture media Medicult and Vitrolife from Denmark and Sweden

State-of-the-art facilities: Embryo freezing (Cryologic - Australia) & Micromanipulation ICSI (Narishige, Japan & Research Instruments, UK), Assisted Laser Hatching (Fertilase Laser), IMSI and Embryoscope

What is success rate of IVF at Fortis Bloom IVF and your USP? At Fortis Bloom IVF Centre, the success rate of IVF is in the region of 35 to 40 percent for women less than 35 years, which are comparable to the leading units in the world.

Our team of doctors has been practicing and specialising in infertility treatment for the past 20 years. We are one of the biggest chains of IVF centres in India

How do you see the growth of medical tourism by way of IVF? Medical Tourism is growing rapidly including fertility treatments. The costeffective treatment options along with latest technology make India a desirable medical tourism destination.

How does the cost and services in IVF in India compete with other competitive nations?

The technology in fertility treatment in India is now at par with the West including the high success rates. The affordable costs enable couples all over the world to choose India for their choice of treatment.

Can you think of any government initiative that can make IVF more cost effective?

Government initiatives that can be of help are to provide subsidized treatment options where only cost of drugs and consumables are charged to patients.

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Managing the Miracle

of Birth, Naturally Dr Vijaya Krishnan, Certified Professional Midwife (CPM), USA, co-founder and Director of Healthy Mother Wellness & Care and Healthy Mother Sanctum, Hyderabad, India’s first Natural Birth Centre based on Scientific Midwifery Model of Care, in conversation with Shahid Akhter, ENN advocates the need and practice of natural birthing Healthy Mother is known for Scientific Midwifery. Can you please elaborate more on this model of care?

The core tenet of Scientific Midwifery is that midwifery is woman-centered.

Scientific Midwifery encompasses the full range of primary healthcare services for women from adolescence to beyond menopause, with emphasis on a woman’s child-bearing period. The word “Midwife” means “With Woman”. The midwifery model of care considers pregnancy and childbirth as normal life events, and encourages mothers to trust their bodies’ unique wisdom to go through labour and birth their babies under the personalized, continuous and unlimited care from their midwives. Midwives are experts at normal birth – their education, clinical and hands-on training make them the best source of physical and emotional support for expecting mothers who are healthy and are at low risks – in effect for the vast majority of women around the world.

You believe in empowering women but decision making should be in the doctor’s domain?

The midwifery model of care is very different from the hospital and doctor-centric medical model of care practiced in almost 99 percent of Indian hospitals. We believe in giving

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the factual, unbiased and evidencebased information and knowledge to mothers, their husbands and family who are the best people to make the right decision. Today’s progressive, confident, independent women are yearning for alternatives to the kind of maternity care practiced in Indian hospitals which consider them as diseased patients to be subjected to numerous, often unnecessary tests and procedures. We are bringing informed decision making back to where it should be – in the hands of expecting mothers, their husbands and their family.

How do you handle emergency or situations where caesarean may be the only solution?

Part of the training for midwives is to recognize when there is a need for medical intervention like Induction, Assisted Birth or C-Section. We have pioneered a unique collaborative model where we follow the scientific midwifery model for most normal birth situa-

tions, but bring the emergency care expertise of the medical model in case there is a true emergency. This means having in-house Operation Theatre, SICU, NICU, emergency medical personnels and equipments available 24 hours.

Modern life and lifestyle seems to prompt and promote the new caesarean as the way forward.

How do you evaluate its impact and outcome?

Yes, we agree that some modern lifestyles introduce stress in our lives as couples juggle multiple roles and responsibilities in their daily lives.

This stress and the accompanying health implications can cause problems in reproductive health too. However, we do not agree that this is the cause of increased caesarean sections in the country. There is a lack of true, evidence-based information about the physiology of pregnancy and birth among couples. This lack of information feeds on the natural apprehension among expecting parents for the health of their baby, creating a panic-like situation for them, and forces them to agree to often unnecessary procedures like C-sections at the urging of their hospitals. This is a worrisome trend, and society will be in danger of giving rise to a generation of women who don’t know what it is to give birth naturally.

Caesareans come under fire for being too quick and too clinical but don’t you think it is essential and life saving at times?

There is absolutely no doubt that caesarean operations can be life savers for mothers and babies. In fact, at our Natural Birth Centre, The Sanctum™, we have had to perform C-sections on a few mothers where the health of babies or mothers was looking to be compromised. However, what our midwifery model of care does is not judgemental – mothers who have had

to undergo C-sections received the same level of physical and emotional care and support as those who give birth naturally. In fact, in line with WHO recommended guidelines on breastfeeding, even while a mother is being sutured after undergoing a C-section, we put her baby on skin-toskin contact with her body, and initiate breastfeeding within the first hour of birth.

supreme”. Most attribute this to the healthcare system where midwives are entrusted with care for the expecting mother and her baby. Midwives care for the mother and her unborn baby all throughout her pregnancy, and the doctor while being available, stays in the background, and only comes into the picture when there is a medical problem or when the mother has to or opts for epidural.

Are you apprehensive about the sudden spurt of the IVF industry?

What is the success rate at Health Mother and your road ahead?

No, there is place for IVF wherever it is truly required. We are concerned at the intense marketing to snare customers by employing gimmicks.

We often see full page Ads from various IVF clinics offering goodies and discounts to couples to get the treatment. Because wanting a baby is a highly emotional and aspirational feeling, many couples are taken advantage of by some unqualified people

We have had high success rate of natural births at Healthy Mother. In 2013, our natural birth rates were 92 percent. We routinely help women who have had a previous C-section, try for a full trial of labour and give birth naturally. Our VBAC rates in 2013 were 86 percent. Because of the personalized, continuous and unlimited care, our midwives give to moth-

We are bringing Informed Decision Making back to where it should be – in the hands of expecting mothers, their husbands and their family who play on their minds. We also wish that the cost comes down so that good IVF care can be more affordable to a larger cross section of people.

When do you suggest one should opt for IVF treatment?

This is left to experts to answer, but in our opinion, we believe the choice for IVF should come after all other infertility treatments are exhausted.

What makes Sweden the second-best country in the world to become a mother?

As they say, “In Sweden it is the mother and not medicine who reigns

ers during labour, we have been able to help mothers with so-called ‘highrisk’ conditions such as Gestational Diabetes or Pregnancy Induced Hypertension and many others, have an empowered natural birth. 99 percent of our mothers and their husbands are young, professionals and want an alternative to the hospital and doctorcentric model in maternity and infant care. We are getting increasing wordof-mouth referrals and other customers enthusiastically refer their friends and relatives to us for their maternal and infant care. We have plans to open similar centres in other metros and later in Tier II cities as well.

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We help in the journey

towards a new life Dr Anubha Singh, Medical Director, Shantah Fertility Centre, discusses the infertility issues and the IVF scenario in India with Shahid Akhter, ENN

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How common is male infertility today, and what are the underlying reasons?

It is a widely prevalent myth that infertility is synonymous with female problem. Almost 40 percent of infertility cases concern men. A good many obstacles to conception stem from male issues like low-sperm count, sperm motility, erection issues, ejaculation, passage of sperms which may be blocked, or damaged due to bacterial infection that cause scarring or blockage of tubes. At times, infertility is the outcome of both male and female factors.

How do you take care of the first visit by infertile couples?

We always recommend couples coming together so that both of them understand the issues, and be a partner in our approach leading to the solution. The tests are explained to them in detail, and the outcomes are discussed. We begin with the detailed history, followed by investigations. Next comes counselling session where we invite all questions and doubts that the couple may be dwelling upon. In fact, counselling is a part of treatment, and is offered at all stages – prior to the treatment, during treatment and post-treatment. This is very important to erase the doubts and make the couples feel positive about the progress of the treatment.

We also make them understand that stress is a big fertility robber and can even hurt the relationship.

Diagnostic tests begin with Baseline 3C Ultrasound to do AFC (Antral Follicel Count) and also to check endometrial cavity.

What difficulties do you face while convincing IVF couples?

Following all tests and investigations when we are convinced that IVF is the only solution, we share this with the couples but still they look out for alternative minor treatments including medication. The cost factor is another impediment that makes the couple think again before they invest the amount. Some patients even turn up to us for some sort of guarantee or assurance that the child is assured, following the investment. Some look out for second opinion which is certainly a healthy thing to do but often people fall prey to unscrupulous IVF centres.

Some of the couples are too stressed, they need to relax and think of togetherness and time out. Some couples overread the internet, assess themselves, and arrive at their own conclusion which may be riddled with flaws. Ovulation kit is not recommended for the simple reason of mis-

reading and misinterpretation which impacts the performance level.

What primary investigations do you recommend?

We begin with an ultrasound to check early stage developing follicles called Antral Follicles. Low count indicates low ovarian reserve, and thus treatment plan done accordingly. Other tests include – AMH (Anti-mullerian hormone), it is the hormone released by small Antral Follicles; Immunological Tests – if indicated, other tests may include screening for Rubella, Viral, HIV, Hepatitis B and Syphilis.

In males, the initial tests begin with semen analysis, WHO has set a reference value, like semen volume needs to be 1.5 ml or more with pH – 7.2 or more, sperm concentration should be 15 million sperms/ml or more, total motility is supposed to be no less than 40 percent, progressive motility should be 32 percent or more, vitality should be 58 percent and the sperm morphology is supposed to be at least four percent.

Our quality of service is at par with the best in the West, and we charge a fraction of the IVF cost Who is an ideal candidate for IVF? IVF should be your treatment option if you have been diagnosed with unexplained infertility, or your fallopian tubes are blocked, or you have been unsuccessful with other techniques like using fertility drugs or intrauterine insemination (IUI). Add to this some extent of male sub-fertility

– more severe problems are treated with Intracytoplasmic Sperm injection (ICSI).

How would you sum up a typical IVF treatment?

Normally, it begins with the suppression of the natural monthly hormone cycle. This is induced through a drug via routine injections. The next step is to boost the egg supply by giving a fertility hormone (more precisely Follicle Stimulating Hormone – FSH in short, again a set of routine injections for about two weeks. This will lead to enhanced number of eggs and with more fertilized eggs, the chance of getting pregnant increases. During the process, ultrasound scans, blood tests are conducted to monitor the progress. To ensure that the eggs mature, a hormone injection is given 34-38 hours prior to egg collection.

This happens under sedation by ultrasound guidance and the eggs are harvested through a needle.

Finally the eggs are mixed with sperms and cultured in the laboratory for about a day to ensure fertilization.

The fertilized eggs or embryos are grown in the incubator for few days and the best ones chosen for transfer.

What is the USP of Shantah Fertility Centre and its success rate?

Our success rate is 40 to 50 percent, and we take pride in patient satisfaction at every stage. We encourage them to ask questions, so that they get the feeling of participation in the entire process. We love to adhere to the British protocol as I have spent 11 years in IVF centres in UK where things are so well-regulated, reported and documented which is in the interest of both, the IVF centre as well as the couples seeking treatment.

At Shantah Fertility Centre, we strive to maintain highest standard of clinical work, and we have a well-equipped, state-of-the-art lab which is the driving force behind the IVF centre.

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focus

Helping Couples in their Journey

to Parenthood

Dr Rakhi Singh, Medical Director, Abalone Clinic, Noida, in conversation with Shahid Akhter, ENN shares the infertility treatment protocols in achieving pregnancy rate at her centre To what extent infertility has affected us, and why is it on the rise?

Infertility is becoming increasingly common and affects approximately one in 10 couples. To become a mother is a dream of most of the women for which sometimes you need a little helping hand. The problem could be either in wife or husband, or it can be unexplained infertility where the underlying cause of infertility cannot be found in the couple which is on the rise these days.

Infertility can also be the outcome of increased stress which has almost become a norm today. Add to

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this, competitive work, environmental pollution, obesity, erratic lifestyles, delayed marriages, prolonged family planning and priority to the career advancement over planning

of pregnancy. High pressure jobs with erratic long-working hours and sleeping schedule adversely affects the hormones, thus increasing infertility in these segments. It is required to identify and manage the lifestyle habits which adversely affect the outcome of pregnancy.

Please spell out the revolutionary reproductive therapies that can come to the rescue of the infertile couples.

Today, there are various options available, and the course of treatment is based on initial diagnostic tests which reveal the lacunae in reproductive system of the husband or the wife or both. Some of the most prominent Assisted Reproductive Techniques (ART) services are: In-Vitro Fertilization (IVF) is a wonderful solution to infertility. This involves putting the eggs and sperms together. Following fertilization, the embryos grow for a short period of time before being

placed into the uterus. This leads to a successful pregnancy which can be confirmed about two weeks later. IVF is offered to the couples, if the patient has not conceived even after IUI cycles, tubal block and severe male factor.

Intra-Cytoplasmic Sperm Injection (ICSI) is all about a single sperm cell being injected directly into an egg.

This helps in initiating the fertilization process and is best suited when the problems are evident in the sperm.

Intra-Cytoplasmic MorphologicallySelected Sperm Injection (IMSI) is akin to ICSI with the added advantage that more attention is paid to the quality of the sperm to be injected into the egg. In IMSI, the man’s sperm sample is examined under a high-definition microscope, and only those sperm cells which appear to have good genetic characteristics are selected for injection into the female partner’s eggs.

The selection of only good-quality sperm makes IMSI a more successful fertility treatment than ICSI. Other therapies include Superovulation & Intrauterine Insemination, Blastocyst Culture and in-vitro maturation of oocytes, Laser Assisted Hatching and there are even software that help in the identification of sperm and eggs, resulting embryos and other materials used in IVF treatment cycles.

Add to this, the surge in endoscopic surgery and advancements in ultrasound that has revolutionized the face of infertility treatment.

What diagnostic tests you consider before suggesting IVF? Basic general health check-ups with tubal patency test, diagnostic laparoscopy and hysteroscopy, ovulation induction documented by transvaginal USG for monitoring and detailed semen analysis.

When should one consult an infertility expert?

If the couples fail to conceive even after one year of not using contraception and cohabitation, they should consult earlier by six months, if the woman is of more than 35 years of age.

What difficulties do you face in convincing IVF couple?

In India, infertility is still considered as a taboo, and women are usually considered as the cause of infertility, and males not coming forward for their check-ups. The couple usually suffers silently emotionally, financially with the pressure from the society growing thus making infertility a social taboo. Many patients don’t even know the options available. A good detailed counselling is required to solve all their queries, so that they are more convinced to take their treatment with daily injectables. The success rate and the myths involved with IVF like: • IVF is associated with complete bed rest for nine months which is not true as once conceived it continues as a normal pregnancy.

In India, infertility is still considered as a taboo, and women are usually considered as the cause of infertility, and males not coming forward for their check-ups

•

It is also not a painful procedure involving long admissions.

How will you resolve the chance of multiple births?

We have very less multiple pregnancy rates, as we practice to transfer single or twin transfers only, depending upon the age of the patient, and the quality of the embryos. With the controlled ovarian stimulation and the surplus embryos, which if are available can be frozen.

Please tell us about the embryology lab at your centre.

We have the state-of-the-art embryology lab with all the latest equipments required as per the ICMR guidelines.

What is the success rate of IVF at your centre, and your USP? At Abalone IVF centre, we have a good success rate and promising results. We treat each couple as separately with the tailor-made protocols for each of the individuals based on the hormone evaluation, ovarian reserve and semen analysis.

Abalone clinic’s doctors and staff give the patients a homely feel so that they are well counselled and answered to all their queries.

We have well-equipped state-of-theart facilities available under one roof set as per the ICMR guidelines. Our centre offers all the facilities from evaluation of the infertile couples, IUI, IVF, ICSI, embryo freezing, egg donation, donor insemination, PESA, TESA and surrogacy.

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I see India as the ART

Capital of the World in Coming Years, says Professor Kuldeep Jain, Program Director, ASIAN –KJ IVF ART Centre, Faridabad, in conversation with Shahid Akhter, ENN Please dwell upon some of the most revolutionary reproductive therapies that can aid in curing infertility.

In the last three decades, mainly three high-tech advances have taken place which had revolutionised the management of infertile couples. Apart from ART (IVF), endoscopic surgery and ultrasound have made significant contribution to the treatment of infertility and providing parenthood to so many couples.

What are the treatment options, and who is an ideal candidate for IVF? Treatment options are many depending on the causes of infertility ranging from ovulation induction with drugs to surgical correction of endometriosis and tubal factor to IUI for male and unexplained factors, and finally IVF and ICSI for difficult cases who cannot conceive with simpler techniques.

What diagnostic tests do you consider before suggesting IVF? Basic tests like TVS, hormonal profile, semen profile, test to rule out STD, hysteroscopy to evaluate endometrium, AMH for ovarian reserve are various diagnostic tests before proceeding for IVF.

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How do you commence the treatment of unexplained fertility?

If we don’t find any obvious abnormality after routine evaluation but patient is unable to conceive she is grouped as unexplained infertility. Many of these patients can be benefitted with

a simple procedure called SO- IUI. Drugs are given to increase the number and quality of eggs and processed sperm are inseminated in the uterine cavity. It is a cost-effective method to achieve desired outcome. It may take at least four cycles to give full benefit of IUI before moving on to more advanced procedures like ICSI.

What difficulties do you face while convincing IVF couples?

There are a lot of myths related to IVF. It is believed by most of the people that IVF is unnatural, and always done with donor semen. Another concern of many couples is that it is having a lot of side effects, painful and children are born abnormal. Cost is another concern which takes a lot of time in counselling. IVF is usually considered as

the last resort by most patients, which is not true. In fact, for tubal and male factors, IVF may be the first choice.

Then there are religious issues which need to be addressed. Thus, counselling is an important part at our centre.

Have aids such as ovulation kit, helped or harmed the modern couple?

Ovulation kit is Okay for initial phase for self monitoring. However, if there is no conception within a reasonable time-frame, one must consult infertility expert as time is precious in infertility management.

How do you resolve the chances of multiple births?

Multiple birth is an unwanted complication of infertility treatment. One has to observe a balanced approach to minimise this complication. In India, acceptance for twins is quite high. In fact, many couples prefer twins. Policy of single embryo transfer in selected cases helps in reducing multiple birth.

Please tell us something about the embryology lab at your centre.

Our IVF lab at ASIAN -KJIVF ART centre is a hi-tech ultra-modern lab fitted with Coda Aero and HEPA filters with dedicated AHU for cleanest atmosphere for developing embryos.

The lab is equipped with Supraclean Laminar workstation, Nikon dissecting, Stereozoom Microscope and 4th generation Nershighe-Nikon manipulator for advanced procedure like ICSI. We are providing advanced facilities like ICSI, Blastocyst Culture, Assisted Hatching, Sperm Bank, egg donation programme, surrogacy programme, PESA/ TESA and other advanced procedures.

What is the success rate of IVF at your centre, and your USP? Our IVF team is consistently provid-

ing success rate at par with the best of centres across the globe. Our success rate has crossed 47 percent for people below 35 years of age. Cumulative pregnancy rates for three cycles are up to 70 percent. Our USP is transparency, individualised approach and in-house expertise with all facilities under one roof.

How do you see the growth of medical tourism by way of IVF? India is a favored destination for IVF and surrogacy for overseas patients because of great infrastructure, lowcost and world-class expertise. Projected growth of medical tourism in IVF sector is phenomenal

How does the cost and services of IVF in India compete with other competitive nations?

Low cost combined with at par results and world-class infrastructure is India’s USP. We can beat any nation on that front.

Can you think of any government initiative that can make IVF more cost effective?

Yes, government needs to be more proactive. Low taxes and low-import duty will go a long way in cost reduction. Also, Indian Pharma industry should be encouraged to put in more efforts in research so as to bring out

Our USP is transparency, individualised approach and inhouse expertise with all facilities under one roof

more indigenous products of international standards. That will certainly reduce the cost of treatment. Another important area is insurance sector.

This is must for making advanced services available to the masses. The government has got an important role there too.

What services do you offer by way of surrogacy?

We offer surrogacy to genuine couples who are having problems in there uterus. We do observe all legal and ethical obligations. Our surrogacy programme is very transparent and the most sought-after programme.

Surrogacy is commercial and legal in India but getting tainted.

As you offer surrogacy services, what do you think is the biggest challenge facing the surrogacy industry in India today?

At present, the ART scenario including surrogacy is self regulated as there is no law governing the segment.

Though there are ICMR guidelines to follow, however, there are issues related to agencies providing surrogates which is fractured at present, and controlled by people who may not be well aware of various issues related to legal and ethical aspects.

How do you envision the future of IVF in India?

As far as future of IVF is concerned, it is quite bright. This is a challenging time for industry. The whole world is looking at us with curiosity to see how we evolve ourselves. We require a strong regulatory authority which will help prevent mushrooming of ART centers, regulate third-party reproduction, help service providers, promote research and education, and take along all stake holders. Role of societies like the Indian fertility society and ISAR is very important in shaping the future of ART sector. I see India as the ART capital of world in coming years.

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cover story

Special Focus

The

India’s baby making business:

Growth Story The IVF industry in India is on a growth path. However, the industry is largely unregulated which can prove to be pernicious in the long run. ENN’s Subash Deb charts the scenario

F

or almost all Indians, the family is the most important social unit. Till as recently as a couple of years ago, infertility was a glaring phenomenon that proved to be a shattering experience for many couples. In the Indian family milieu, mothers-inlaw and intrusive relatives would cast aspersions and make sly innuendoes on couples for not being able to have kids in the first few years of marriage.

Irrespective of their socio-economic status and the caste or community they belong to, infertile couples are outcaste and discriminated against.

However, with the advancement of science and technology, a lot of things have changed for the better. Right from changing our old mindsets to motivating us to explore newer, more successful ways to live our life, technology has made things possible which weren’t so before.

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The wonder of IVF is one such example which has come as a boon to millions of couples who face the scourge of infertility like a thorn in the flesh.

History of IVF - a tale of two cities The concept of IVF came into being with the birth of Louise Joy Brown, the world’s first-ever, successful ‘testtube’ baby, on July 25, 1978 in Great Britain. Two British doctors, who created history by performing this world’s first In-Vitro Fertilisation (IVF), were Robert Edwards and Patrick Steptoe.

They eventually won the Nobel Prize in 2010 for the development of human IVF therapy.

Simultaneously, an Indian doctor, Dr Subhash Mukhopadhyay, brought glory to India for the same reason. Durga alias Kanupriya Agar-

wal, India’s first test-tube baby and the world’s second test-tube baby was born on October 3, 1978, just 67 days after the birth of Louise Brown.

Unlike his British counterparts, Dr Mukhopadhyay’s work was barely recognised, yet his feat proves the country’s ability to deliver top-notch medical excellence.

The technology that made this fertilization possible is applauded and celebrated as an achievement for medical excellence. The In-Vitro Fertilization technology and its usefulness in the treatment of infertility have spurred immense interest among researchers and medical professionals.

Consequently, numerous IVF clinics have sprung up all over the world.

The Growth Trajectory Over the last two decades, there has been an exponential growth of infertil-

Special Focus

ity clinics around the world. The concept of IVF has gained popularity at a swift pace in India over the last decade. Currently, India’s fertility market is witnessing double-digit growth which is driven by proliferating infertility rates amongst married couples and availability of competitive treatment procedures.

IVF, Intrauterine Insemination (IUI) or artificial insemination by husband or donor sperm, egg freezing, Intra cytoplasmic sperm injection (ICSI), donor egg treatment, donor embryo treatment, endoscopic diagnosis as well as surrogacy are all practiced widely in India with new techniques being evolved and developed on a par with international standards. Sperm donation is a recent development in Indian fertility market. It requires a kind of a medical expertise that is being expanded and spread throughout.

Today, India stands at the forefront of reproductive medicine and is touted as a MECCA for all the IVF treatments.

Booming baby-making business in India India is fast becoming the hub for IVF and surrogacy as the country’s market value is expected to touch INR 14.2 Billion and register a CAGR of 14 percent approximately over the next five years.

India has witnessed an unprecedented and unregulated growth of IVF/Infertility/Assisted Reproduction Technology (ART) clinics and hospitals. With the estimated number of around 700 clinics across the country and new clinics being added every day, India has occupied a place of prominence on the world IVF map.

The present boom, witnessed by the IVF segment, is a

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result of various factors. From increasing number of infertility cases in the country, to a relatively low-cost high-end treatments that attract a lot of foreign patients, to skilled doctors, to plentiful supply of surrogates, to increased awareness, to no regulations, all these factors have contributed well to the growth of the IVF sector in India. Also, easy availability of surrogate mother, gamete donors and low-cost infertility treatments have made India a favoured destination for reproductive medical tourism or better known as fertility tourism.

In India, IVF treatment is available at an affordable cost which is nearly one-quarter of the cost in developed nations. Fertility clinics in countries like UK, Israel, Australia, France, Spain, and Denmark are finding it more and more difficult to fulfill the demand for donor eggs and hence turning to India. Furthermore, India is also home to some of the finest international IVF centres and top-notch IVF doctors. Most of the major global IVF stakeholders have recognized the size of this opportunity, and some have already entered the market.

For instance, a renowned UK IVF operator, Bourn Hall has established its two clinics in Gurgaon and Kochi.

Despite this monumental growth and expansion, the IFV sector is not without a catch. There are glitches, pitfalls and dilemmas which can prove to be deleterious for its growth in the long run.

No rules in place In India, the IVF market is largely monopolized by small niche players and sole-practitioners, as the loose regulatory environment is promoting constant mushrooming of such players. The IVF industry in India is completely unregulated. Anyone can open an infertility or Assisted Reproductive Technology (ART) clinic and start performing procedures the same day, as there is a lack of centralised regulatory body with complete visibility over

the whole market.

Although the Indian Council of Medical Research (ICMR) reports 3,000 clinics around the country, certain market forecasters estimate that there could be as many as 15,000 solepractitioners who focus on surrogacy only.

Currently, the industry stick to guidelines set out by the ICMR that includes when, and by whom IVF can be performed. The guidelines do not lay down any rules for the setting up of ART clinics.

Need of the hour On the whole, there is an urgent need of a binding law which will allow the Indian IVF industry to enter some form of consolidation. Small clinics that fail to meet regulatory standards will close. Barriers to entry will be higher which will make harder for small clinics to launch in the first place The present situation is such that the Indian Council of Medical Research hardly cracks the whip on the IVF industry. Its guidelines are effectively optional as there is no legislative backing.

The Assisted Reproductive Technology (Regulation) Bill which is currently making its way through the parliamentary rounds has been significantly delayed. The Bill has been originally scheduled to become law in 2012. The original bill was drafted in 2008, and has been altered and reframed in 2010.

The ART Bill 2010 provides a national framework for married and unmarried couples as well as single parents seeking surrogacy in India.

Its objective is to regulate and supervise the ART procedure happening throughout the country.

There is no doubt that new regulations will help formulate the Indian IVF industry. This will also be a positive step for potential investors and eventually provide an impetus for increased foreign investment.

in person

Heralding Health

Renaissance in North East Born in Dubia, Sonitpur district in Assam in 1950, Dr Nomal Chandra Borah started out with next to nothing. Hailing from a poor peasant family, Dr Bora faced many odds in life to become a doctor and later, a successful entrepreneur. With little financial backing, Dr Borah set up Guwahati Neurological Research Centre (GNRC) in 1986-87. Today, GNRC stands tall with state-of-the-art facilities and is one of the best hospitals in eastern region.

In an interaction with K S Narayanan of Elets News Network, Dr Borah recalls how he turned into an entrepreneur with the aim of providing Quality Medicare at an affordable rate, and holds forth on his future plans on changing the healthcare landscape in North-East India. GNRC, a super-specialty hospital, is spreading across Assam, other North-Eastern states and neighbouring south East Asian countries.

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Recently, the GNRC Hospitals launched a special facility to provide emergency medical care to accident and emergency patients. Could you please elaborate on this?

The scheme will cover patients suffering from stroke, heart attack and other medical emergencies also. The free facility will cover doctor’s consultation, bed charge, essential medicines, oxygen, CT Scan, ECG, X-Ray and limited blood tests. We are concerned over the spurt in fatal road mishaps in Assam, accounting for thousands of deaths and injuries every year.

Accidents are one of the most common causes behind the untimely and sudden loss of life. In such a situation, the sooner they are treated, the better their chances of survival. Keeping this in view, and for the overall well-being of the society, GNRC has taken a bold step towards providing free treatment within the first 24 hours of an accident. We are setting an example by treating 50 to 60 patients daily free of charge.

It is just two months since we launched. I hope we can sustain and expand it.

India is notorious for road accidents and the numbers have risen sharply in recent times. What’s your take on that?

Indians do not follow basic traffic rules. Road conditions are very bad. This is the reason why India has the highest rates of road accidents in the world. Both the government and the private sectors should sit together and chalk out a strategy to prevent these accidents as early as possible.

Do all the stakeholders like hospitals, government, police and community realise the importance of ‘Golden Hour’ in saving a life in a road accident?

Slowly, the sensitivity is developing. People are talking about it. But, we are yet to work to find a solution. We had promoted the concept of air ambulance in this region. Authorities are thinking of having helipads along the national highway.

You started GNRC after you gave up a secured job in a government hospital.

What is the GNRC’s footprint?

There were no super-specialty hospitals in Assam or anywhere in the North East before we started GNRC in 1986-87. We were the first to

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set up Neurosurgical facilities, Cardiovascular, Angioplasty facilities.

Currently, we have three hospitals in Assam. We have plans to set up facilities in neighbouring states like West Bengal, Jharkhand and Bihar. In Assam, all the three hospitals are in Kamrup only.

process protocol and how to create low-cost hospital. Most of the hospitals to be created outside Assam will be based on this cost model. The World Bank is advocating us to take the model outside India.

Any further plans to foray into foreign soil?

We are planning to initiate air ambulance and medical outreach programmes using helicopters to remote areas of North-East India. The service will regularly ferry doctors from GNRC to difficult-to-access locations across the region and provide doorstep medical support to the population across the North-eastern states of Arunachal Pradesh, Assam, Meghalaya, Manipur, Mizoram, Nagaland, Tripura and Sikkim.

We are planning to go to Bangladesh, Myanmar, Bhutan and Nepal and also explore African countries. We have developed a model which is very suitable for the developing world where affordability is the issue.

Why is GNRC not expanding to other North-Eastern states before expanding to other places?

We will expand to other parts of North East also. It will be done in a phased manner. Our expansion plan is within the North East, outside the North East and outside India, where need for lowcost health services and solutions is high. At least, ten new centres will come up by next year in all these regions I mentioned.

For a healer, it’s a huge and unenviable task. How will you find finance to fuel such ambitious project, as setting up healthcare facilities is a costly issue?

We have different models. For some, we will look for local partners. It would be based on franchisee model where GNRC will offer technology,

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How do you plan to serve the rest of North East?

Bank money would be used for scaling it up.

When building a health care system, we should avoid polluting air, water and environment and conserve energy while offering health services to people.

In all our hospitals, we strictly follow the energy conservation principles.

The GNRC, formerly known as ‘Guwahati Neurological Research Centre’, works on this eco-friendly sustainable model. This is first of its kind.

What is GNRC model and what is unique about it?

Could you tell us more about GNRC ultra low-cost model?

GNRC’s uniqueness is in many areas. It is one of the world’s eco-model hospitals. To limit expenses, bamboo cladding is used extensively in the building’s exterior. That acts as a natural insulator and allows the hospital to do away with air conditioning in common areas such as lobbies and reception. This resulted in saving electricity and reducing maintenance cost. We asked local contractors to tailor-make hospital beds instead of ordering them from pricier multinational manufacturers. The result: beds have no frills but meet the needs of the patients. Both bamboo and water are recycled.

This is affordable to common people.

It is primary, secondary and tertiary care. All combined together, it is quality care. This facility should be available to many more communities. The challenge is scaling it up. The World

It has gone for gold standard certification by rating agencies. We plan to patent. The National Institute of Design has been given the mandate for this. We will patent all the process

How are the talks with the World Bank progressing?

We had preliminary talks with them.

Some positive results will come. They are also keen benefits of this model is made available across the globe. That is why, the World Bank Group (WBG), through its India Development Marketplace (IDM) initiative, chose GNRC to receive a grant of US$150,000.

protocol and procedure model. It will be known as GNRC Model.

people and their needs matter. So, norms should be relaxed. That is why, along with Health Sciences University of Assam, we have created innovative two-year courses and training in areas like Neurology, Cardiology, Critical Care and Head Injury.

We have drawn up plan for Rs 300 crore over the next two years for scaling it up.

We have a nursing institute which is affiliated to SNDT Women’s University, Mumbai. We also run Assam Health Science University and conduct post-MBBS courses in Clinical Neurology, Critical Care, Head Injury and Trauma. About seven candidates were registered for Neurology and they successfully completed the course.

Are you in talks with corporate for you expansion plans?

What about a full-fledged medical college in Guhawati?

Tata Sons hold equity in GNRC. We definitely will approach Tata, ONGC and State Bank of India and Ministry of Development of North Eastern Region (DONER).

The kind of model we are creating now with a 300-bed hospital, there is an ample opportunity to start a medical college. The hospital has to be run for three years before we can start a medical college and 80 percent occupancy -- that is the requirement.

The GNRC is empanelled by the Bhutan Government. Many Bangladeshis and Nepalese are treated at GNRC.

What is the state of neurology in India?

That is one of the challenges. Doctors are willing to join us. We have all kinds of specialists. Besides affordable health services, GNRC has also ventured into grocery retail. We have ten GNRC Medi Shops which house grocery, FMCG and personal care. They are sort of neighbourhood stores. We are planning to scale it up in coming years.

The World Bank award money is a trickle compared to the kind of mission you have set for yourself?

What needs to be done to set up more super specialty hospitals like GNRC in North-eastern states and Central India?

Innovative solutions in infrastructure -- build, operate and transfer mechanism should be introduced in healthcare system too. Several multi-lateral institutions like the World Bank will come forward to finance them.

How does the GNRC initiative, ‘hospitals on wheels’ work?

We have examined 1,00,000 patients so far. Last year, we began dispatching ‘Hospitals on Wheels’ buses, re-purposed as mobile hospitals equipped with X-Ray machines, sonogram equipment, and a patient exam room. These buses, along with a group of doctors, visit several remote parts of Assam to screen and treat patients free of charge. The new hospitals, we are planning now, will have ‘Hospitals on Wheels’ as an extension service.

Do we have BOT mechanism in India?

Not yet. But, definitely, we can make a beginning. The new government can encourage it.

Any plans to encourage medical education?

Currently, we have 1,500 neurologists in India. They are too few in numbers.

In developed world, for every 18,000 people, there is one neurologist. But, in India it is one neurologist for one million people. We need critical number to provide good care. And mind you, not all the 1,500 are working in India. About 20 to 30 percent are settled abroad. And the rest are working in metropolitan cities.

What is the way out?

The Neurological Society of India wants to restrict the numbers to maintain quality. I don’t agree completely. What is more important is that

GNRC Swasthya GNRC publishs a monthly health magazine called ‘GNRC Swasthya’. They also bring out health and medical encyclopedia in Assamese, besides health columns and health capsules every day.

You have heralded a health renaissance in North East. Do you see Assam emerging as a hub for the region and the neighbouring countries?

How are you able to attract and retain talents to work in North East with doctors who have done their super specialisation?

Who is Dr Nomal Chandra Borah? A doctor or an entrepreneur?

Practicing medicine is my passion.

At the same time being an entrepreneur, I am able to create more healthcare facilities for people and wealth for the nation. That is also another responsibility.

Nothing came to my plate so easily. To provide neurological care, I need equipments and services and this forced to become an entrepreneur.

You are an inspiration to the North East and India. You have been featured in the university text books.

I feel humbled. It has increased my challenges to do more and leave better world for them.

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Special Focus

A Truly Indian

Growth Story The Indian IVD industry has ably delivered on its promise, growing at an admirable rate. It is now a sector that has both Indian and foreign players competing to provide diagnostic tools to an ever hungry medical sector. As the industry looks to grow beyond the urban centers and grow into rural sectors, ENN’s Rajesh K Sharma takes a critical look at the industry.

A

s Indian healthcare industry grows, the associated industries that assist it get an opportunity to grow as well. The IVD industry in India was, till very recently, a largely unorganized sector, populated by local players as well as multinationals, but with little to no interaction between them. While the local players were mostly involved in the servicing segment by making the reagents, the multinationals devoted themselves to building the IVD machines. But now, things are hanged, and Indian manufacturers have also entered the equipment side of the business.

The Indian IVD industry has seen double digit growth in the past few years. It is expected to grow at a CAGR of 20 percent and will be valued at $1.5 billion by 2018 according to MarketReportsOnline.com. Others like Carl McEvoy are more optimistic, pegging it at $760 million in2014 itself. The optimistic outlook cast by them is a clear indicator of the tremendous of the IVD sector in India.

The IVD sector, which encapsulates both, the equipments and the reagents, is vast in scope. It includes segments like immunochemistry, bio-

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chemistry, haematology, microbiology, blood gas and electrolyte, molecular diagnostics, urinalysis and coagulation analysis. This tends to be confusing to most people, as the breadth of the sector seems to cover all aspects of diagnostics, having a footstep in multiple medical disciplines. In India, biochemistry has the

largest share among all the diagnostics, but this too is changing as competition among the players rises. Another reason for other streams getting more attention

is the changing lifestyles that have brought forward newer medical conditions that require diagnosis.

The changing fortunes of the IVD industry have been duly noted, and the industry is now raring to go.

More multinational companies have entered the Indian marketplace and even the Indian companies have expanded their portfolios. They are now producing more types of reagent as well as equipments. This frenzy in the IVD space is producing companies that are pushing Indian manufacturing further. To compete with foreign manufacturers, they are stressing on quality.

The multinationals, in turn, have to price their devices lower to match the price advantages that the Indian manufacturers enjoy. This is ultimately benefitting the patient, who can now get affordable treatment at a fraction of the cost. The technological advancements and higher efficiency systems are taking the market to new heights. Use of advanced and cutting-edge technologies in understanding a disease prognosis has further strengthened the sophistication level of participants in the sector.

Rapidly rising automation needs along with the rising incidence of diseases are consistently driving the growth of the Indian diagnostics market. The increasing number and complexity of tests, coupled with a shortage in laboratory staff, is leading to a greater level of automation in laboratories. Labour accounts for around 65 percent of operating expenses in a typical laboratory, and automating a laboratory can expand its capabilities while achieving significant savings.

Till now, most of the growth driving the IVD industry has been in the metro cities. But manufacturers are now looking at Tier II and Tier III cities to grow. India is the home to over 100 cities with enough population size to generate demands for diagnostics centres catering to a wide range of requirements. Several healthcare giants are seeking to tap into this market.

Lifestyle and communicable diseases

More multinational IVD manufacturers have entered the Indian marketplace and even the Indian companies have expanded their portfolios

are no longer restricted to urban centres and are spreading to rural areas as well. As a large portion of rural areas do not have even the basic healthcare facilities, several cases remain undiagnosed. The changing disease patterns, rising incidence of diseases, higher healthcare spending, and untapped markets create abundant opportunities for IVD manufacturers in rural and semi-urban areas.

But despite this positive outlook, the industry has some roadblocks to overcome if it has to live up to its reputation. Due to low entry barriers, the IVD industry still remains fragmented.

There is not standardization among the players. Also, a well-defined regulatory pathway for diagnostics industry is missing. Due to lack of regulatory framework, there is no clarity on the classification and requirements for approval of diagnostics products and novel medical devices in India. If the industry is to venture into smaller towns and villages, then there have to be some common standards to be adhered to, so that the sector does not become a confusing mess of competing standards that are often in contrast to each other.

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IN focus

Growing Big Through

Innovation

Rajesh M Patel heads the business operations at Meril Diagnostics Private Limited.

In an email conversation with ENN’s Rajesh K Sharma, he talks about how the young company is making a name for itself in the IVD space, both nationally and internationally, as well as the challenges that he foresees Please give us a brief description of Meril Diagnostics’ presence in the IVD space? What areas in this space do you service?

Meril Diagnostics is a part of the Bilakhia group. It entered the IVD space in a planned manner; the company setup a research and development facility in 2009 to ensure development of quality indigenous instruments and reagents. Before its commercial launch in early 2013, the company was fairly successful in designing several indigenous instruments and reagents. In order to serve laboratories of all sizes, from small to medium size and up to large sized chains hospital-based laboratories, we invested heavily in technology, getting a wide range of products ranging from semi-automated to high throughput fully-automated analyzer.

Currently, we serve the Biochemistry, Immunology, Hematology, Coagulation, Critical Care, Diabetes Management and Rapid range segments of the IVD industry through our products.

Has the Indian IVD market delivered on the promise that it held? How do you think the market will grow in the future?

At present, there are very few Indian IVD companies that have research and development facilities to bring new products to cater the existing and changing needs of laboratories in In-

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focus

dia. In fact, more than two-thirds of IVD required in India is still catered by foreign products, including the raw materials required for making the IVD products. Indian companies have produced products that have been well appreciated by the industry for their Quality and affordability. Indian IVD sector has attracted the MNCs to set up their operations here, however the Indian economy sometimes becomes a barrier when we try to bring new products in the market.

What is the status on innovation happening in the IVD industry?

Please tell us about the R&D taking place at Meril.

The emerging technologies like Molecular techniques, Multiplex, Allergy, Quantification of Syphilis, Point-ofcare texting (POCT) are leading the growth in the IVD segment. Perhaps most interesting innovation for this industry is the way these new technologies are finding their way into traditional testing segments.

At Meril, we have associated ourselves with some international partners in developing new tests for Syphilis quantification, allergy, Infectious Rapids and Chemiluminescence analyzers.

The IVD manufacturing space is crowded, with MNCs as well as

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Indian manufacturers. Has this made the IVD segment price sensitive?

There are certain new products like smaller throughput automation, differential kit sizes, more pocket friendly products to laboratories that are a direct result of this crowding of the IVD segment. However, any overall impact on prices in IVD has not been observed in the last few years. The result of the increased competition has been that most companies have compromised on their bottom lines further and the margins have narrowed down due to the price sensitivity.

The entry of foreign IVD companies from countries such as China, Taiwan, and Korea has also made the

At present, there are very few Indian IVD companies that have research and development facilities to bring new products

sector more competitive, thereby making it more price sensitive.

How has been the response to your products outside India?

Given your exposure to foreign manufacturing, how does Indian manufacturing match up?

Meril Diagnostics is a fairly new entrant in IVD space and therefore we do not have anything substantial to share currently. However, we have presence in many countries and our products have been appreciated for their quality and performance. In the IVD space, there is no shortage of talent in India. India has done fairly well in the Biochemistry segment as well. However, there is no substantial contribution from Indian manufacturers in segments like Hematology and Immunochemistry. We at Meril have setup a state-of-the-art 300,000 sq foot plant which is Asia’s largest manufacturing research and development facility as a testimony to the commitment and vision to cater to the global IVD market in the future. We plan to fill the gaps that currently exist in Immunology, Hemostasis, Rapid tests and several other disciplines of this sector. We strongly believe that in the next five years, Meril Diagnostic will bring several innovative products that will be world class and compete with the best.

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expert Speak

Watching the Industry Grow

For Three Decades Transasia Bio-Medicals Limited has had a long presence in the Indian IVD industry for more than three decades. It has seen the industry grow, and has been a pioneer in this growth. ENN’s Rajesh K Sharma talks to a Transasia representative about the state of the IVD industry today and what the future holds.

What is the current state of innovation in the IVD market in India? Is the increase in IVD techniques pushing the current innovation?

The last decade has been very progressive for the Indian healthcare industry, which is on a growth trajectory.

A patient today plays a primary role in deciding his/her healthcare needs.

Sustained efforts by the government and the private healthcare institutes have led to an increased awareness amongst the rural and urban population. Moreover, new initiatives from the public and private sectors, have encouraged the setting up of primary and secondary healthcare setups in the rural areas and specialized corporate setups in the urban areas.

Though the life expectancy has gone up, nowadays an increased population is detected with lifestyle conditions. This in turn has emphasized the need for preventive and curative diagnosis. As a result, the demand for diagnosis is at an all time high. With the easy availability of global products and solutions, there is a surge of competition from foreign players.

As a result, the onus is now on indigenous innovation.

Continuous technological advancements in diagnostics and an increased healthcare awareness

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Transasia Bio-Medicals Limited is India’s leading in-vitro diagnostic company. We have been offering our quality instruments and reagents in different segments

have made in-vitro diagnostic testing an indispensable tool in current medical practices. The Government is also supporting new initiatives for promoting the growth of the Indian IVD. Public-Private Partnerships (PPPs) prevail in Tamil Nadu and parts of West Bengal (especially for radiology). Now the Government is encouraging the same in other states as well in order to pass on the benefit to the citizens. Moreover, the Government has encouraged indigenous research thereby promoting the sector. There has been a rise in the number of players entering the sector and offering quality products and after sales services.

There has been a paradigm shift resulting in adoption of technology and automation. This in turn has led to the introduction of high end products for in-depth analysis.

All in all, the Indian IVD Industry is on an exponential growth track!

What is the current size of the Indian IVD market? How much growth do you see in it in the next five years?

The IVD market in India has seen dou-

ble digit growth in the last few years.

According to a market research done in May 2014, the Indian IVD market is currently pegged at $500 million, and is expected to surpass $1.5 billion by 2018 growing steady at a CAGR of 20 percent.

Please tell us about Transasia’s products in the IVD segment in India. What are the products it makes?

Transasia Bio-Medicals Limited is India’s leading in-vitro diagnostic company. We have been offering our quality instruments and reagents in different segments such as Biochemistry, Hematology, Immunology, Diabetes Management, Critical Care, Microbiology, Clinical Electrophoresis, Urine Analysis, Molecular Diagnostics and Coagulation.

Over the last three decades of its existence, Transasia has been recognized for its products and services.

And our commitment is not restricted to serving only the Indian healthcare industry. Transasia Bio-Medicals is a part of the global ERBA Mannheim Group. Through our strategic alliances with some of the best names

across the world, we have spread our network in more than 94 countries.

The biochemistry range of instruments and reagents are manufactured indigenously. Moving further, we plan to expand our manufacturing base to include other segments as well. At the same time we intend to continue bettering our best and offering latest technologies and innovations. We soon plan to venture into new product lines such as POCT and markers for hemoglobinopathy and cancer.

Currently, how do the Indian manufactured IVD devices measure up to the foreign manufactured ones?

Indian IVD products are recognized for their quality. The latest technology is used for the development of the products. Indians enjoy the reputation of developing and offering advanced softwares and IT solutions. And so, we have an edge over others,as most of the analyzers are technologically advanced, incorporating the latest softwares.

Moreover, the Indian IVD products are also recognized for their cost effectiveness.

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expert Speak

A Single Minded Focus

on Orthopaedics Dr Harshvardhan Hegde, Medical Director, Nova Orthopaedic and Spine Hospital (NOSH) has been instrumental in the introduction of robot-assisted surgery. A singlespecialty hospital devoted only to Orthopaedic cases may seem ambitious, but he feels that the time is right for such hospitals in today’s modern times. In a conversation with ENN’s Rajesh K Sharma, he explains why he thinks so

T

he modern lifestyle is characterized by extremes: one the one hand, technology has made our lives sedentary through automobiles, computers, elevators etc, thereby turning us into couch potatoes; while on the other hand, we join gyms for exercises that stretch out bodies to their limits, often causing injuries. In absence of moderation, our bodies are pushed to the extremes of a sedentary lifestyle and extreme workouts. As a result, incidents of Orthopaedic cases are on the rise.

“The commonest injury today is neck pain and back ache. It is also the most common reason for layoff from work”, says Dr Harshvardhan Hegde, Medical Director Orthopaedics at Nova Orthopaedic and

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Spine Hospital (NOSH). Also, injuries and death on road are very high, and very common. In fact, India has the worst record in road accidents, he says. The rise in the number of Orthopaedic cases is also being attributed to the overall rise in life expectancy.

Dr Harshvardhan leads a team of seven doctors specializing in the various Orthopaedic disciplines at NOSH. In a market flush with multi specialty hospitals of all sizes, NOSH is a part of a growing trend of single specialty hospitals.

Explaining the thought behind a hospital devoted solely to Orthopaedics, Dr Hegde says that the benefits are tangible. “Everything, right from consultation to deciding whether a patient needs surgery or not, to actually doing the surgery to rehabilitation is done here,” he says. The hospital has taken the best in Orthopaedics from hospitals around the world, like transparency, archiving, equipments, OT space, infection control, processes, and used it here.

Being a single specialty hospital, the Operations Theaters (OTs) at NOSH are more focused. Unlike multi-specialty hospitals, the staff is trained solely for Orthopaedic matters. Also, since the OTs are used only for Orthopaedic cases, the amount of infection control needed is lesser than what would be required for a multi-purpose OT. “A focused center like ours reduces the chances of infections,” says Dr Hegde. “Even the nurses, anaesthetists and ICUs are trained to manage Orthopaedic patients. So everything is very super specialized in that area. We can give a focused attention to our patients,” he adds. Cost-wise too, Dr Hegde feels that single specialty hospitals help in keeping costs down.

“We don’t need

to send our nurses for different trainings. Orthopaedic needs are different from cardiac or neurological needs. If you are a focused hospital, you don’t need to meet with the demands of other specialties,” he says. Instead of creating large monoliths with lots of nurses and lots of managers, he feels, it is better to create small verticals which deliver healthcare at their best The focus on Orthopaedics also extends to sports medicine, which has become a specialized area within the discipline. Contrary to what its name implies, it is not just sportspersons that require sports medicine. Even overzealous gym goers who pick up

any images during the surgery. This helps the surgeon immensely, as he can have images ready in real time for viewing.

The Mazor Robotics’ Renaissance is a machine created especially for spinal surgeries. The spinal region is a mesh of tiny nerves, Dr Hegde explains, and a slight error in judgment can damage the nerves, possibly causing grave complications. The Mazor Robotics’ Renaissance assists the doctor while placing screws in the spinal cord for its straightening. “If you want to position screws to correct a deformity to stabilize a spine, then positioning a screw can be dangerous

Seven Orthopaedic patients being available on-site gives a lot of comfort to the patient heavy weights without expert supervision and end up injuring their joints and tendons end up needing it.

NOSH is taking Orthopaedic surgery in India to the next level by introducing two new machines – a Spinal Surgery Table and Radiolucent Wilson Frame, and the Mazor Robotics’s Renaissance. With these installations, it aims to provide better services in the field of Orthopaedic surgeries. In fact, Mazor Robotics’ Renaissance is the first machine that is commercially available only for Orthopaedics. Its relevancy lies solely in spinal surgery and that too, in spinal instrumentation.

Explaining their significance, Dr Hegde says that the Spinal Surgery Table and Radiolucent Wilson Frame facilitates a 360 degree view of the spine during surgery. It allows the surgeon to access the anterior and posterior part of the anatomy without having to physically lift and turn the patient. The table does not inhibit the use of X-Ray and C-arm machines, allowing the surgeon to easily obtain

because potentially, you can injure the nerves. That injury is reduced almost to zero because of these robots, because it makes things very accurate,” he says.

Together, the two instruments give NOSH an edge over other multispecialty hospitals that offer Orthopaedic surgeries. That, coupled with the fact that the chances of Hospital Acquired Infection (HAI) are lower in single specialty hospitals has Dr Hedge optimistic of the entire enterprise. In the future, he plans to open more single specialty hospitals in other cities, citing the positive response he has received for the current one, and also get into pain management.

He is not too worried about competition from the multi-specialty hospitals, pointing to the fact that even the multi-specialty hospitals are specializing in a particular discipline at their branches, making them look like a single-specialty hospital. “Seven Orthopaedic patients being available on-site gives a lot of comfort to the patient,” he concludes.

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medic Expo 2014

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Tech trends

Carestream DRXEvolution system offers optimised workflow and high image quality for enhanced patient care at Ruby Hall Clinic

Optimising

Workflow

for Enhanced

Care

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T

he Radiology Centre at Ruby Hall Clinic, Pune has been at the forefront of technology, patient convenience and quality healthcare for over a decade. A trendsetter in healthcare, it was amongst the first healthcare facilities in the country to install a Carestream Health CR (Computed Radiography) system in 2001.

In recent years, as hospitals in India are beginning to see the value of the then advanced Computed Radiography technology, Ruby Hall Clinic had taken the lead with the installation of Carestream Health India’s Carestream DRX- Evolution System a digital radiography technology powered by the revolutionary Carestream DRX-1 System, the world’s first wireless DR detector. This was the first installation of this versatile, compact fully automatic DRX-Evolution suite in south-east Asia.

Dr Joshita Singh, Consultant Radiologist at Ruby Hall Clinic elaborates on the unique features of this system says, “We found the Carestream DRX-Evolution System to be dependable, reliable, and offering the best technology suited for our needs.”

Given the high number of examinations conducted every day, the department works continuously to improve its systems, processes and practices in order to improve the organisational throughput and deliver enhanced patient care. The Carestream DRX-Evolution has helped Ruby Hall Clinic’s Radiology department improve its departmental efficiency and increase its throughput by reducing patient waiting time and providing an improved accuracy in examining results. Used extensively in a multitude of diverse real-life cases, the DRX- Evolution suite has shown unmatched operational flexibility for general radiology and trauma exams.

Speaking about the experience after installing the DRX-Evolution, Dr Singh says, “The DRX-Evolution system offers excellent image quality, ease of use and reduction of patient examination time by almost 5-7 min-

utes per patient compared to CR. In addition, it has also provided us the flexible positioning we needed for urgent trauma cases. More importantly, this system reduces radiation exposure by over 40 percent, making it the most highly preferred technology for women and young children.”

The Carestream DRX-Evolution is an integrated, automated digital radiography suite powered by the revolutionary DRX-1 detector that offers high quality images, far superior to those offered by other CR systems. According to Dr Joshita Singh, equipped with enhanced visualizations options that provide greater latitude and depth, the DRX-Evolution system delivers images of improved accuracy, enhancing diagnostic confidence and reducing the need for repeat exams.

In addition to inpatients, the Radi-

convenience of patient repositioning due to the limited flexibility of equipment.,” said Dr Singh “Designed with highly configurable, modular components and a unique auto-tracking technology that eliminates the scope of human error in examining, the DRX- Evolution system helps ensuring patients’ comfort and expedite examining in prime focus,” Dr Singh adds.

In addition, the x-ray equipment operates within an image capturetime of about 5 seconds and transmits the imaging exams to the facility’s database over a wireless network, decreasing the imaging time by 5-7 minutes per patient compared to CR. Problems in patient positioning can be verified immediately after the raw image appears on the computer screen, and immediate diagnosis

Carestream DRXEvolution is an integrated, automated digital radiography suite that offers high quality images ology department at Ruby Hall Clinic also handles a large number of outpatients. “The Radiology department at Ruby Hall Clinic is used for multiple exam types, from elderly patients in traction with broken limbs who have to be lifted onto the table, to multitrauma victims. The DRX-Evolution system offers an unmatched positioning flexibility for both general radiology and trauma exams. Available in three configuration options, fully automated, hybrid and standard, the DRX-Evolution system has been particularly helpful to improve both workflow and patient care with its unique system designed to move around the patient, eliminating the in-

can be made in cases of emergency.

The DRX- Evolution has definitely helped streamline patient positioning, speed up our workflow in between patients and improved the overall patient flow, particularly for outpatients. Moreover, a major benefit in patient care stems from the fact that the DRX-Evolution delivers a higher quality of images while lowering the patient’s exposure to radiation by over 40 percent when compared with CR systems. On concluding note Dr Singh says, “The DRX- Evolution System has offered us benefits such as compatibility and scalability helping us meet today’s needs while positioning for tomorrow’s growth.”

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RNI NO. UPENG/2011/38140

UP/GBD-140/214-16