Express Healthcare (Vol.9, No.10) October, 2015 Issue

VOL.9 NO.10 PAGES 84

www.expresshealthcare.in OCTOBER 2015, `50

Sometimes I’m blunt.

But never pointless.

Creativeland Asia

The Indian Express.

For the Indian Intelligent.

#IndianIntelligent

CONTENTS MARKET Vol 9. No 10, OCTOBER 2015

Chairman of the Board Viveck Goenka

19

Sr Vice President-BPD

Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das

20

WHO SEEKS INVESTMENT IN EMERGENCY PREPAREDNESS MEASURES

20

HLL INSTALLS SANITARY NAPKIN VENDING MACHINES AT NIRMAN BHAVAN, MOHFW

Bangalore Assistant Editor Neelam M Kachhap

21

SHIV NADAR, SANJAY KALRA START NEW INVESTMENT FIRM

22

YOUNG INDIANS DRAWN TOWARDS HEALTHCARE APPS: BRANDCARE SURVEY

22

HIRING GREW 13 PER CENT IN AUG, TO PICK UP FURTHER, SAYS NAUKRI.COM

23

US-BASED HCENTIVE TO INVEST RS 750 CRORES AT ITS INDIA R&D CENTRE

26

AMERICARES INDIA ANNOUNCES WINNERS FOR THE 6TH SPIRIT OF HUMANITY AWARDS

Pune Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr Raghu Pillai - South Harit Mohanty - East & West Marketing Team Douglas Menezes G.M. Khaja Ali Ambuj Kumar E.Mujahid Arun J Ajanta Sengupta

Visitors from across the world are coming to our shores in pursuit of affordable and quality healthcare services. Yet, it is imperative to mitigate inadequacies like regulatory deficiencies and infrastructure challenges to propel India's growth as a leading destination for medical value travel | P42 P13:INTERVIEW:

MEDICALTOURISM SPECIAL: 42- 56

RAJIT MEHTA MD & CEO, Max Healthcare P24:INTERVIEW: DR DEBRAJ SHOME Co-Founder & Facial Plastic Surgeon, MediAngels

PORTEA MEDICAL RECEIVES $37.5 MILLION SERIES B FUNDING LED BY ACCEL

LIFE KNOWLEDGE

33

ADVANCES IN INTERVENTIONAL NEUROLOGY

35

EVOLUTION OF NEUROSURGERY

Scheduling & Coordination Ashish Anchan

37

MYTH VS REALITY OF STEM CELLBASED PRODUCTS

74

DR KK AGGARWAL RECEIVES VISHVA HINDI SAMMAN

CIRCULATION Circulation Team Mohan Varadkar

39

DE-ADDICTION WITH TECHNOLOGY

74

MCOA FELICITATES DR HUZAIFA KHORAKIWALA

PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia

39

Express Healthcare® Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express (P) Ltd. by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021.

(Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright © 2015 The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

The tipping point?

T

he ongoing dengue infection has

to be first resolved before the country can truly

become fodder for the political

claim to be the 'first' destination of choice.

mill in Delhi and while we all

Outbreaks like the dengue infection in

mourn the loss of lives, there is

Delhi prove that healthcare facilities are not

hope that at least now, the

accessible for the economically weaker sections

centre and state health functionaries will be

of society. While laying out the red carpet for

forced to cooperate and work together.

overseas patients and their families who flock

Unfortunately, public memory is short, and

to India for more affordable healthcare, the

that of politicians even shorter. Why else would

government should also look at revamping our

we not learn from our experiences of past years?

public healthcare system to provide the same for

With the winter season around the corner, the

the millions of patients who migrate to the cities

situation is bound to get worse not better in

for treatment.

Delhi, and yet we see no real signs of change.

Today, the Indian Medical Association's April 21 release on vector borne diseases to mark World Malaria Day on April 25, like writing on the wall, remain stark reminders that all the awareness drives and media coverage is just not working. Have we, as citizens, become adept at tuning this out, as long as it happens to someone else, some place else?

And might I humbly add that the media too is guilty on this count. Why else would journalists ask, sometimes politely and most times not, to be taken off the daily news feed from IMA? There is no doubt that the present dengue deaths are getting covered only because of the location, with each side milking the situation for political gain.

It is indeed ironical that the capital hosted the Medical and Wellness Tourism Summit 2015 on August 27 and will be hosting Advantage Healthcare, another event highlighting India as a destination for medical value travel.

While laying out the red carpet for overseas patients and their families who flock to India for more affordable healthcare, the government should also look at revamping our public healthcare system to provide the same for the millions of patients who migrate to the cities for treatment

market points to the obvious fact that with low government healthcare spends (public spend on health is just 1.3 per cent of India's GDP), the largest growth will come from countries like (16 per cent CAGR) and China (20 per cent CAGR).

With a bed penetration of just 1.3/1000 people against the global median of 2.5, India is tipped to see the strongest growth with the report projecting that the India private hospital market would reach $120 billion by 2020.

While growth in the private sector is required, simply to increase the number of beds and choices available to the patient community, what will it take to increase beds in the public healthcare sector? Public-private partnerships (PPPs) with hospitals could have been an option but most of these have run into glitches and are today not seen as the way forward.

While the government's intentions are good, implementation is the bug bear. For instance, the

Express Healthcare's October issue too will

much needed mental health policy is progressive

carry a section on this section of the healthcare

and even radical in some areas but certain

delivery sector, (See story, Journeying for good

loopholes can destroy the purpose of safeguard-

health, pages 42-47) but we hope that in the hopes

ing mental health in India. Without adequate

of attracting foreign patients, the stakeholders

implementation guidelines, the policy can end

lay out a roadmap for the sustainable develop-

up doing more harm than good. With World

ment of medical tourism.

Mental Health Day coming up on October 10, our

India has still not got its act together on the

cover story in the October issue looks at the

medical tourism front. A host of issues, ranging

issues in more detail. (See story, Safeguarding

from lack of coordination between government,

India’s mental health, pages 28-33) VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

hospitals, hotels, airline and tour operators to taxation and medical insurance anomalies need

10

A Bank of America-Merril Lynch report on the emerging market (EM) private hospital

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LETTERS QUOTE UNQUOTE

SEPTEMBER 2015

BEAUTIFULLY WRITTEN

C

ongratulations for the beautifully written interview of Dr Naresh Trehan. It helped us know this amazing personality much better as a person.

(Read: The Sapient Surgeon, EH September 2015) Vijay Kumar Head - Strategic Accounts Johnson & Johnson Medical India Email: vkumar2@its.jnj.com

Poonam Khetrapal Singh Regional Director,WHO South-East Asia Region

HEAD OFFICE Express Healthcare® MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.com

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Health is critical to development. Access to safe, affordable and good quality health services enables people to be more productive and active contributors to their families, communities and nations

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MARKET I N T E R V I E W

‘In three to five years’ time we want to become the most trusted name in healthcare’ With the recent acquisition of Pushpanjali Crosslay Hospital, Max Healthcare has become the biggest healthcare network in NCR in terms of number of beds. In addition, an influx of funds of Rs 766 crores from South Africa's Life Healthcare, has propelled the company’s growth. At the helm of this new development is an astute leader, Rajit Mehta who recently took charge as MD & CEO, Max Healthcare. In an interaction with M Neelam Kachhap, he outlines the company's expansion plans and unique initiatives to increase efficiency and improve patient care

From COO of Max Life Insurance to DMD and promotion to MD & CEO Max Healthcare, congratulations!

How are you liking your new role at Max Healthcare?

Thanks. I have spent 14 months in this sector and I'm really loving it. Having worked in life insurance I used to feel that my work there was touching peoples life. But here, now what we do impact lives everyday. This is really different from my previous work and it is heartening to know how small decisions taken impact patients’ lives. For example, a simple training programme for nurses can bring about a change in patient care so can the clinical pathways we follow. I find this very encouraging and humbling.

How has your journey been for the past 14 months?

It has been very interesting , rewarding and learning. It is fantastic to learn a new domain and how it works. While I have had over three decades of experience, I really had to customise and adapt to the healthcare domain. For instance, there are different communities you deal with in healthcare; there is a nursing community, clinician community, administration and patients. So, you really have to understand the business ex-

tremely carefully. Indeed has been a learning experience, very rewarding and I have enjoyed seeing the change happen.

Were there any preconceived notions about the industry that changed while you started work here?

I had to relearn. See, there is a corporate management way of dealing with the organisation; defining strategy, aligning the people, disseminating communication, holding dialogues in town halls. Now you have to customise it to the healthcare sector. Here you cannot do a town hall dialogue with all employees as the hospital will come to a grinding halt. So, you have to innovate. In fact, the nurses response to different motivators, clinicians engage differently. Perhaps it's the admin part which is close to the corporate world.

For example; let's look at performance appraisals. How do you appraise a cardiac surgeon vis-à-vis a nursing supervisor? So really you have to adapt and customise at every step, be it the way of communication or the way management process work, implement technologies, etc. So, a lot of learning has taken place on how to make sure that you adapt what you have learnt to this sector.

Indeed, quite a few para-

digms have changed. I had to change my own perception of how this sector works. This sector is so sensitive to patient needs that I'm very conscious of the changes I make. My favourite quote is 'get your DNA right'. You can only deliver care to the patient if doctors, nurses and admin come together.

How do people inside the organisation perceive you?

I think it should be a mixed feeling. You don't become a favourite leader within 14 months, it takes many years. Having said that, the buzz I have heard is both positive and negative. The clinicians are happy that somebody is listening to them. They have the freedom to do what they do best. They feel that somebody is putting patient at the centre. I believe financial outcomes are the only outcomes. What you really can influence is the input matrix and patient safety. Revenue is just an outcome. Hence, now a lot of quick decisions are happening which were pending for a long time, such as decisions on upgrading the equipment, decision on new facility and growth. We have launched seven centres of excellence and just acquired a new hospital which is the first acquisition of the company. Pushpanjali Crosslay Hospital (PCH ) just four km from

EXPRESS HEALTHCARE

13

October 2015

MARKET

You don't become a favourite leader within 14 months, it takes many years

QUARTER ENDED KEY BUSINESS DRIVERS

UNIT JUNE'15

a) Financial Performance

JUNE'14

Y-O-Y GROWTH

472

401

18%

Contribution

%

63.8%

63.7%

10 bps

EBITDA

Rs. Cr

45

40

12%

EBITDA

%

9.5%

10.0%

(50 bps)

Cash Profit

Rs. Cr

32

19

72%

Profit

Rs. Cr

10

(5)

-

b) Financial Position Net Worth

Rs. Cr

760

422

80%

Net Debt

Rs. Cr

418

644

(35%)

Fixed Assets - Gross Block

Rs. Cr

1,462

1,395

5%

c) Patient Transactions (No. of Procedures)

UNIT

QUARTER ENDED JUNE'15

JUNE'14

Y-O-Y GROWTH

Existing Hospitals*

Rs. Cr

Revenue

KEY BUSINESS DRIVERS

a)Financial Performance Revenue

Rs. Cr

331

293

13%

Contribution

%

65.4%

64.1%

130 bps

EBITDA

Rs. Cr

42

37

13%

EBITDA

%

12.7%

12.8%-

Profit

Rs. Cr

19

5

296%

b) Average Inpatient Operational Beds

No.

1,095

1,072

2%

c) Average Inpatient Occupancy

%

72.8%

77.2%

-

d) Avg. Revenue/Occupied Bed Day (IP)

Rs.

34,026

29,261

16%

Revenue

137

105

31%

Contribution

%

60.6%

63.2%

(260 bps)

EBITDA

Rs. Cr

3

4

(25%)

EBITDA

%

2.3%

4.0%

-

Profit

Rs. Cr

(9)

(8)

-

b) Average Inpatient Operational Beds

No.

660

526

25%

c) Average Inpatient Occupancy

%

68.1%

75.8%

-

d) Avg. Revenue/Occupied Bed Day (IP)

Rs

29017

25,055

16%

New Hospitals^ a)Financial Performance

No.

Inpatient Procedures

35,721

31,894

12%

Day care Procedures

6,750

6,204

9%

Outpatient Registrations

12,58,371

10,82,130

16%

d) Average Inpatient Operational Beds

No.

1,755

1,598

10%

c) Average Inpatient Occupancy

%

71.0%

76.7%

-

d) Average Length of Stay

No.

3.18

3.50

10%

e) Avg. Revenue/Occupied Bed Day (IP)

Rs.

32,221

27,894

16%

*The above results are for MHC Network of hospitals and includes results for Max Super Specialty Hospital, Saket, unit of Devki Devi Foundation and Max Super Speciality Hospital, Patparganj, unit of Balaji Medical and Diagnostic Research Centre

*The above results are for MHC Network of hospitals and includes results for Max Super Specialty Hospital, Saket, unit of Devki Devi Foundation and Max Super Speciality Hospital, Patparganj, unit of Balaji Medical and Diagnostic Research Centre ^ Only results for Mohali, Bathinda, Dehradun and Shalimar Bagh hospitals

REVENUE ◗ Revenue across network of hospitals for Q1FY16 grows 18% y-o-y to Rs. 472 Cr. ◗ Avg. Occupancy** across healthcare facilities in Q1FY16 at 71% against 76.7% as ALOS and operational beds improve/increase by 10% each ◗ Improved business mix and efficient ALOS result in 16% increase in Average Revenue per Occupied bed day* as it crosses to Rs. 32K PROFITABILITY ◗ MHC turns profit of Rs. 10 Cr. in Q1FY16 against a loss of Rs. 5 Cr. in Q1FY15 ◗ Cash Profit for the quarter at Rs. 32 Cr., grows 72% y-o-y ◗ Q1FY16 EBITDA at Rs. 45 Cr., grows 8% and EBITDA Margin at 9.5% against 10.0% mainly because of steep revenue growth of 31% in new hospitals caused by significant hiring in later part of FY15 to build new programs. EBITDA Margin for existing hospitals maintained at 12.7% OTHERS ◗ MHC acquires 77.4%*** stake in 340-bedded (expandable to 540) Pushpanjali Crosslay Hospital in August through Primary Investment & Secondary Acquisition for a total investment of Rs. 258 Cr. ◗ Average length of stay improves 10% to 3.18 days in Q1FY16 ◗ 2,276 Physicians on roll vis-à-vis 2,056 as at June 30, 2015 * Average Revenue per Occupied Bed Day = Inpatient Revenue/ Occupied Bed Days**Occupancy has been calculated on average operational beds*** Stake to further increase to 77.9% with an incremental investment of Rs. 2 Cr.Max Healthcare

14

EXPRESS HEALTHCARE

October 2015

MARKET

This is really different from my previous work and it’s heartening to know how small decisions taken impact patients’lives

Max Super Speciality Hospital in Patparganj. On the other hand, the feeling may be negative because of too much pressure on execution, and lots of follow-up.

There has been a lull phase at Max Healthcare in the past couple of years?

I think that the healthcare model for Max has evolved over a period of time. They started off with a small day-care outfit in Panchsheel and then expanded further. They slowly evolved over time. Over the past few years, there have been challenges of frequent management changes. Also, there have been challenges in going from a day care model in the Panchsheel unit to a tertiary care hospital in Saket and a PPP model in Mohali and Bhatinda. So there have been quite a few changes and we looked at what worked for us.

But now, I think we are hopefully coming out of it. Last 12-18 months have been extremely good in terms of stabilising operations and getting the required financial outcomes. We have been building new teams, new clinical programmes and the clinician bench strength. So, I think we are on the right path and our journey has just begun.

What has been your focus after joining Max Healthcare?

As I mentioned before, has been 14 months since I started work here. There have been a couple of focus areas. The first objective was to stabilise the operations because the financial performances was not up to the mark. The cultural values were not what we wanted and the clinician engagement was wanting. Therefore, my focus was really to a) stabilise the operations b) increase positivity and engage with clinicians for them to contribute their best c) look at what

16

EXPRESS HEALTHCARE

October 2015

processes we could strengthen specifically in execution.

My experience in building business in India is that India is always an execution challenge and not a strategic challenge.

Today I can proudly say that I have built this business brick by brick. We really strengthened execution, looked at patient centricity. Under the new Clinical Director we modelled a new era of clinical quality. We invested a lot in clinical data analytics to make sure we follow the right clinical practice. Also, we looked at progressive medicine, molecular medicine or disease patterns. We started investing in listening to patients more through IMRB surveys. We implemented a very comprehensive listening mechanism so we really know what the patients want and what we should improve as we go along. Finally, building a new team, both on the unit side and executive committee has kept me occupied. We have a very simple, 5C model for focus to happen. It is clinical excellence, patient care, meeting our commitments, compliance and cohesion. We are following this 5C framework to guide thought and action and we are working to align the entire organisation to 5Cs. You are known for turning around Max Life Insurance.

Do you think turning around MH is a similar feat?

Let me first point out that no one person can do a turnaround

alone. At Max Life Insurance, I was privileged to have a fantastic team which I built over the years. We had superb culture which held the organisation together. It was this strong fabric which helped in the turnaround.

Max Life was a superb journey for me. Today, expectations are that one should turnaround Max Healthcare and believe me they weigh very heavy on my shoulders. I believe that one can only do their daily job to the best of their ability and the rest falls in place. So our focus has been to build a right team, the right culture, focus on clinician and let them have a free hand to do what they do best. I perceive that's how slowly we will win the game and that's exactly what we are doing.

You have charted a success plan. How has the progress been? What have you achieved in the span that you have been here?

The team has been built. We are putting strong processes to monitor execution. We have hired 100 + revenue adding clinicians in the last year and added new facilities. We have just put execution back on track, therefore the results are there for people to see. Last year, we grew about 24 per cent in terms of revenue with 50 per cent growth in EBIDTA. In FY2015, Max Healthcare had revenues of Rs 1,740 crores from over 2,000 beds across 12 hospitals in North India, as compared to Rs 1,407

crores in FY2013-14. This year we perceive similar growth of about 19 per cent in revenue and 40 per cent EBIDTA. So far the first few months have gone pretty well. If you have the right culture and the right focus you can achieve your targets.

Tell us about some of the steps undertaken to bring about changes at Max Healthcare Let me tell you about nursing at Max Healthcare. Lot of people in our industry neglect nursing in terms of basic hygiene. We want to establish ourselves as a preferred nursing employer, so as a first step we changed all the nursing hostels. I personally visited all the sites and took note that the facility was hygienic for our nurses. In addition, we are building state-ofthe-art nursing hostel for 200 nurses in Greater Noida. It's air conditioned, hygienic and a place where people would like to stay and feel welcomed. Further, we changed the medical policy to accommodate nurses.

They couldn’t examine the patients or recommend diagnostics tests as the case is in the developed countries. We put some money on the table, covered them through medical insurance and allowed them to work with patients. These are some examples from the many engagement activities currently running to empower them.

Technology again is a big enabler. It is a huge leverage, both

We have a very simple, 5C model for focus to happen. It is clinical excellence, patient care, meeting our commitments, compliance and cohesion. We are following this 5c framework to guide thought and action and we are working to align the entire organisation to 5Cs

for efficiency and cost, more importantly to make sure that patient safety is secure. For example, we have a bar coded medical administration system which reduces medical errors. We have just piloted the system of e- prescriptions and appointments where patients can take appointments online. These patients come to the hospital, in the lobby there is a kiosk where they put their appointment number and get a token number which is displayed in the consultant chamber. You can then facilitate the patients’ experience through technology. Wherever they are in the hospital they will get a message that their turn has come. Then they will get an eprescription and their diagnostic requirements will be sent to the respective departments such as radiology or pathology.

When they step out of the consulting room, they would go to the pharmacy where their medicine bag is ready. Then they would pay and move on. This is bringing about huge patient convenience. We are further committed to investing in technology for patient quality and for efficiency.

How is Max Healthcare positioned in the market today?

We believe that we should position ourselves as a tertiary and quaternary care provider over the years. At Saket, Patparganj, Shalimar Bagh and Mohali, we are moving towards being a tertiary provider. That's the way we want to go. Further, we want to create centres of excellence. For example, oncology is big for us .

Actually in North India we are bigger than Rajiv Gandhi Cancer Institute and Research Centre today both in terms of revenue and number of oncologists. We have a huge vision for that and we want to get into disease management groups now. Similarly, in orthopaedics we have

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The team has been built.

We are putting strong processes to monitor execution

launched the Musculoskeletal Institute of Excellence in Saket which deals with joints, spine, rheumatology, pain management, chiropody, sports injury and creating centres of excellence right around these areas.

Our belief is that we should do more and more high end quaternary and tertiary work. We have inherited small centres by legacy like Panchsheel that's fast becoming a day care centre; Gurgaon has become a surgical centre with about 70-80 beds.

Inevitably, we are converting what we have inherited into some kind of specialised centres, to go the tertiary-quaternary route.

What is your plan for the next year?

We are clear about our plans for the next year as we just had a meeting on that. We have just started to look at what should the next three years look like, work on next three years’ strategy. Our first objective is to maximise what we have to make it very efficient and build on that.

In addition, we are looking at building on existing assets, create centres of excellence. We also want to look at brownfield acquisitions.

Tell us your plans for enhancing existing capacity.

Will you be adding more beds at this centre (Saket)?

We have the capability to expand bed strength because the floor area ratio (FAR) addition allows us to do so. We can expand in Mohali, Shalimar Bagh, Saket and Patparganj We have just added 400 beds to Pushpanjali and we will build 200 more there. In addition, we have land banks in Malanpur, Greater Noida. At present, our preference is to look for a mix of brownfield and greenfield projects because greenfield always dilute earnings and has long gestation periods. So, we are look-

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ing for the right combination.

Why are your efforts limited to North India?

Our expansion plans are primarily in North India because we have the benefits here. First of all healthcare is very local. Your manpower and other inputs have to be local. Besides, there is a lot of advantage in continuity, you can share assets and management control is better. Another plus point is that Max Healthcare is a well known and respected brand and we can leverage the brand here. Max is pretty big in North India.

Are you looking to dilute more equity?

Not really. The year we got additional investment by Life Healthcare Group (LHC), as it raised its shareholding to attain 46.4 per cent shares through additional investment of Rs 766 crores in Max Healthcare. We

also acquired a controlling stake of 76 per cent in NCR-based Pushpanjali Crosslay Hospital (PCH) through a combination of fresh investment and acquisition of shares from the existing promoters for Rs 260 crores. As we move forward we will invest more to add more beds there.

So far equity has not been a constraint for us.

Today, LHC and Max Healthcare have equal shareholding pattern in the company. Do you think LHC would try to takeover in future?

LHC is Max India’s joint venture partner in Max Healthcare and a leading healthcare provider in South Africa. Both partners are very bullish on the healthcare market. But, as I said earlier healthcare is a local business and I don't see Life Health taking over operational

control in the near future.

Tell us about your growth plans.

Growth will come to us in several ways. We will grow both organic ally and inorganically. We will add new clinical programmes and will sub segment existing programmes. In addition, we could be looking at alternate models, which we have just started talking about, but not finalized yet. In three to five years we want to become the most trusted name in healthcare, known for medical excellence service as well as excellence scientific education and research.

Besides hospitals, we also have Max Institute of Health Education and Research (MILER) where we have academic and skill building programmes and I'm proud to say that the first batch of 50 nurses are ready to graduate from the institute. Besides we also have 128 DNS stu-

At present, our preference is to look for a mix of brownfield and greenfield projects because greenfields always dilute earnings and have long gestation periods. So, we are looking for the right combination

dents with us.

Will you be expanding it to a medical college?

No, I don’t think we have thought about a medical college as yet. However, lack of clinical talent and nursing talent, both are constraints for growth and we are looking at several solutions to retain and attract talent.

We are looking at building a leadership pipeline. We have set up a full clinical recruitment facility under the new clinical director. we are looking at several retention schemes. We have a clinical scholarship policy, we also conduct several clinical training programmes to upgrade technical knowledge allow clinicians to go for national and international conferences.

We even have an employee stock ownership plan (ESP) for select people. We are working on more tools for retaining clinical talent.

What do you think of the existing private healthcare environment in India?

India really needs to look at the healthcare sector very carefully. My biggest worry is will the regulation be progressive or will they just put burden and kill the sector? Hopefully not.

We are going to dialogue with the government, I think they are open to dialogue. Secondly, clinicians should come together to look at how to close the trust deficit. There is a trust deficit between doctors and patients.

We owe it to patients to do good, honest work. We need to step up advocacy, reach out to more and more people. In fact, we must be proactive to take ownership of fixing what truly is not going right. The level of transparency and communication with patients has to be of a much higher order than what it is currently. mneelam.kachhap@expressindia.com

MARKET NEWS

Portea Medical receives $37.5 million Series B Funding led by Accel IFC, Qualcomm Ventures and Ventureast also co-invest in this round PORTEA MEDICAL has received $37.5 million in Series B funding led by Accel. International Finance Corporation (IFC), a member of the World Bank Group, Qualcomm Ventures and Ventureast also participated in this round.

Reportedly, Portea will use the latest investment to fuel the company’s expansion in India where it currently operates across 24 cities. It will also utilise the funding to grow in other markets elsewhere in the region including Malaysia.

Portea also plans to recruit an additional 5,000 employees over the next 18 months.

“This investment from marquee investors recognises the rapid strides Portea has made as well as points to our prospects as we build the company into India’s leading consumer healthcare brand in the coming years,” said Meena Ganesh, MD and CEO, Portea.

Arun Mathew from Accel has joined Portea’s Board of Directors. “Portea’s service actually improves health outcomes for patients because it combines highly trained physicians/ nurses and technology, making the healthcare process more efficient and accessible,” said Mathew.

Pravan Malhotra, IFC’s venture capital lead for South and Southeast Asia, said, “ Our investment in the company will also help them create jobs and a skilled workforce, thus creating opportunity in tier II and tier III cities in India. This is our third venture capital healthcare investment in India and part of IFC's strategic approach to improve access to quality health services in Asia.”

Portea had previously received $9 million Series A funding from Accel, Qualcomm Ventures and Ventureast in December 2013.

EH News Bureau

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October 2015

MARKET

WHO seeks investment in emergency preparedness measures urged the countries to scale-up their emergency management capabilities, expedite efforts to prepare for epidemics and make health facilities safe and functional during disasters THE WORLD HEALTH Organisation (WHO) has asked South East Asian nations to invest in emergency preparedness measures to effectively respond to natural disasters, infectious diseases and radiological disasters in the future.

WHO also urged the countries to scale-up their emergency management capabilities, expedite efforts to prepare for epidemics and make health facilities safe and functional during disasters.

“The region is prone to disasters. Every disaster is a reminder of the need for better risk reduction and preparedness, an essential public health function that needs to be prioritised,” Poonam Khetrapal Singh, Regional Director for

A WHO statement said that countries need to accelerate compliance to the International Health Regulations (2005) by building capacities to detect, report and respond to public health events WHO South-East Asia said at 68th regional committee meeting which was held at Dili, the capital of Timor-Leste. WHO’s South-East Asia Region comprises Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and TimorLeste.

A WHO statement said that countries need to accelerate

compliance to the International Health Regulations (2005) by building capacities to detect, report and respond to public health events. “Preventing and responding to health emergencies is an issue of global health security. Every country must invest in emergency preparedness measures to effectively respond to natural disasters, infectious diseases, chemical

and radiological events and any other emergency with health implications," the statement said.

The South-East Asia Region has witnessed a series of major public health emergencies over the years including the outbreaks of SARS and Avian Influenza, the 2004 tsunami, earthquakes, cyclones, floods and flash floods.

WHO is supporting coun-

tries in the region to build core capacities required of them in the International Health Regulations such as good practice in infection prevention and control, effective surveillance and others.

"The earthquake in Nepal demonstrated the effectiveness of emergency preparedness.

Hospitals in Kathmandu, that had been retrofitted and its manpower trained in contingency planning and mass casualty management as part of Nepal's emergency preparedness measures, withstood the earthquakes on April 25 and May 12 and continued to function and provide healthcare to the affected population," Singh said.

EH News Bureau

HLLinstalls sanitarynapkin vending machines at Nirman Bhavan,MoHFW The VENDIGO machines will dispense a pack of three pads CENTRAL GOVERNMENTOWNED HLL Lifecare has installed four sanitary napkinvending machines in women’s washrooms at Nirman Bhawan which houses the Union Ministry of Health and Family Welfare (MoHFW) in the national capital. The machine dispenses ‘Happy Days’ sanitary napkins manufactured by HLL at its Kanagala factory in Belgaum.

Aimed to benefit the female employees of the ministry, these VENDIGO machines will dispense napkin (pack of three pads) on the press of a button.

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Priced at Rs 10, a pack can be available on inserting a Rs 10 note or coins of Rs 1, 5 and 10.

The state-of-the-art machine was inaugurated by Additional Secretary and MD National Health Mission CK Mishra in the presence of CRK Nair, Additional DG, MoHFW, Dr Rakesh Kumar, Joint Secretary, MoHFW, Vikas Arya, Director, Procurement, Department of Health and Family Welfare and Dr M Ayyappan, Chairman and MD, HLL Lifecare.

Mishra described VENDIGO as a bold step in the right direc-

tion for health and hygiene for women. “We need to install more of them in schools, offices and hospitals,” he added.

Dr Ayyappan said the VENDIGO machines are a ‘noble way’ of making napkins available to women without any intervention. “We have ensured round-the-clock availability of the product—at the right time and right place,” he said.

Dr Ayyappan, while explaining the machine to the top ministry officials and other dignitaries, said that HLL is specially working towards pro-

moting menstrual health and hygiene with a vision to increase usage of quality sanitary napkins amongst adolescent girls and women of the country.

Their not-for-profit organisationHindustan Latex Family Planning Promotion Trust (HLFPPT) has been organising sanitary napkin awareness programmes all across the country, besides supplying it for the Government of India’s national programme.

He also added that the current production capacity of sanitary napkins at their factory at

Kanagala Belgaum is 400 million pieces per annum.

Reportedly, HLL is already working with various state governments to install VENDIGO machines in schools, colleges, offices, hospitals and hostels for women and girls.

Currently, the PSU is working with various departments in Madhya Pradesh, Maharashtra, Haryana, West Bengal and Kerala among other states to promote this concept and provide complete solution.

EH News Bureau

MARKET

Shiv Nadar, Sanjay Kalra start new investment firm To invest up to $500 million in the US healthcare IT product and platform firms SHIV NADAR AND SANJAY KALRA have launched Shiv Nadar & Sanjay Kalra Associates (SNSK), an investment firm. The firm will focus on healthcare technology investments in the US. Reportedly, SNSK will invest up to $500 million to buy-out IT product and platform companies across providers, payers, pharma and life sciences, which are either disrupting or being disrupted by the confluence of regulatory changes, evolving consumer attitudes, changing demographics and emerging technologies.

SNSK's investment thesis favours creating an integrated portfolio of mature businesses.

The firm will also invest in select early stage US and Indian companies, where product, platform or talent will accelerate portfolio objectives.

The focus areas include hospitals, ambulatory, long term acute care, physician practice, information exchanges, ACOs, self-funded and commercial insurers as well as insurance exchanges.

Shiv Nadar, Chairman, HCL and Mentor, SNSK, said, "Over the next five years, SNSK aspires to be an engine of accelerating digital solutions that would make patient care more accountable, efficient, predictable and effective. I am delighted to join hands with Sanjay and Mahesh in this exciting journey.�

Sanjay Kalra, SNSK Chairman said, "We will support management teams to unlock value in their companies through our entrepreneurial passion, engineering heritage and global operating experience."

EXPRESS HEALTHCARE

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October 2015

Mahesh Nagaraj, MD, SNSK added, "The firm intends to realise synergies

across its portfolio and rigorously explore growth in new markets. SNSK's operational

expertise, cost discipline, India based R&D capability and cutting-edge technology adoption

will support businesses in achieving their potential."

EH News Bureau

MARKET

Young Indians drawn towards healthcare apps: Brandcare survey It reveals men to be the majority users BRANDCARE COMMUNICATION recently conducted a survey in India which draws light on the health conscious Generation Y. The survey on popularity of healthcare apps was conducted in major cities like Mumbai, Delhi NCR, Bengaluru, Kolkata, Chandigarh, Chennai, Pune, between men and women ranging from the age of 18-45.

The survey found that 46 per cent users of healthcare apps are between the age group of 2635 years; 33 per cent between 18-25 years, 19 per cent above the age of 35 and only two per cent user are below 18 years of age. Majority of the healthcare

app users are found to be men.

The study suggests that mobile app stores play a major role in influencing people to download the apps followed by word of mouth, online/TVCs and the doctors. Among these health app users, Fitness apps occupy the top download spot with 54 per cent users followed by diet management apps and disease education apps. It also throws a light on a fact that only one per cent of the doctors influence app downloads among the users exposing the need to create awareness about health apps among doctor's community.

Talking about the survey,

Rashmi Thosar, CEO, Brandcare Communication said, “With the current lifestyle, one hardly gets time to keep a tab on their health due to hectic schedules. Such apps allow people to keep track of their health related issues on the go. As a communication agency, our endeavour is to understand the customer’s mindset and not only suggest effective solutions to our customers but also share these insights with the industry.”

Healthcare apps popular amongst young Indians include Fitbit, Calorie Count, Heart Rate Monitor, Runtastic, amongst others.

EH News Bureau

Hiring grew13 per cent in Aug,to pickup further,says Naukri.Com Sector-wise, the healthcare sector comes in the second position while hiring HIRING ACTIVITY witnessed a rise of 13 per cent in August over the corresponding period last year, with banking and financial services industry leading the pack, a Naukri.Com survey reveals. Sector-wise, banking and financial services (BFSI) recorded the maximum increase in hiring activity, followed by healthcare, pharma, software, telecom and media and entertainment industries.

Naukri Job Speak Index for August 2015 recorded a 13 per cent increase in hiring activity over August 2014 and stood at 1,665.

"Job market seems to be

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moving north, sustaining the momentum gained over the first four months of this financial year with an impressive 13 per cent year-on-year growth in August," said V Suresh, Executive VP and Chief Sales Officer, Naukri.Com. Meanwhile, hiring activity in auto and ancillary stabilised while the insurance sector saw a decline.

"This growth is led by sectors like IT, banking and pharma and we can expect other sectors to pick up in the next few quarters. Looks like exciting times are ahead for job seekers," Suresh added.

The report further noted all metro cities registered an increase in hiring activity in August 2015.

Among the metros, Hyderabad topped the chart with 24 per cent increase in hiring activity on a year-on-year basis, followed by Mumbai (19 per cent) and Pune (15 per cent).

Bengaluru saw a growth of 13 per cent and Chennai and Delhi recorded an increase of 10 per cent each for the same period.

On the other hand, hiring activity in Kolkata remained stagnant in August 2015 from last year, the report said.

EH News Bureau

UAE readyto take strategic relationship with India to newlevel: UAE Minister UAE, India healthcare providers should leverage strengths: Shobana Kamineni, VP, CII ADDRESSING THE India – UAE Business Meet organised by the Confederation of Indian Industry (CII) in cooperation with the Government of India and the Government of the UAE in New Delhi recently, H.E. Reem Ibrahim Al Hashimi, Minister of State, United Arab Emirates (UAE), stated that the UAE is ready to take the bilateral relationship with India to a new strategic level. In his address, Anil Wadhwa, Secretary (East), Ministry of External Affairs, Government of India stated that the visit of the Prime Minister of India to the UAE last month led to several significant announcements like the setting up of the UAE-India Infrastructure Investment Fund and the commitment made by the two sides to step up bilateral trade by 60 per cent over the next five years. He also mentioned that at the India-UAE 11th Joint Commission Meeting for Economic and Technical Cooperation, the UAE team reiterated their commitment to undertake extensive investments in India.

Addressing the participants, Shobana Kamineni, VP, CII stated that India and UAE need to step up their cooperation in the services sector.

She highlighted the case of healthcare in which she stated that the two countries could cooperate in areas such as

disease prevention, joint research on lifestyle diseases such as heart disease, hypertension and diabetes, low cost delivery of healthcare as well as quality and cost efficiency of pharma and medical devices.

Kamineni, who is also Executive Vice-Chairperson,

Recently the two nations announced setting up UAE-India Infrastructure Investment Fund and stepping up bilateral trade by 60 per cent over the next five years Apollo Hospitals Enterprise Limited (AHEL), stated that healthcare providers from both countries can leverage their strengths and set up hospitals in third countries in the greater region of Middle East, West Asia and North Africa (MEWANA).

EH News Bureau

MARKET

US-based hCentive to invest Rs 750 crores at its India R&D centre Expects to ramp up its India team by about 25 per cent over the next 12 months A HEALTH insurance exchange solutions provider, hCentive has announced ambitious investment and hiring plans for its R&D centre in India. hCentive has R&D centres in the US and India (Noida) and employs over 750 people with about 600 based in the India R&D centre.

It plans to invest Rs 750 crores in India over the next five years at its R&D centre and expects to ramp up its India team by about 25 per cent over the next twelve months. hCentive provides cloudbased/Software-As-A-Service (SaaS) solutions to the US government agencies, carriers, and brokers to offer health insurance and benefits to consumers and businesses.

VJ Bala, Senior VP and Head of Marketing, hCentive said, “As our research and development hub, our India office will see continued investment for hiring and scaling the infrastructure and facilities to support our aggressive growth plans. We are committed to hiring top talent with competitive compensation and benefits in the IT industry. Aswe become a leading healthcare technology company in the US, we will continue to nurture a skilled talent pool in India to bring innovative solutions to market. We are looking at talented software product developers, engineers and business analysts to build next generation skills in SaaS/ cloud-based products and Agile methods for healthcare.” hCentive recently conducted 50 plus learning and development sessions with over 600 participants to hone the professional skills of its employees and prepare them for the future.

The sessions, which covered technical, soft skill and leadership topics, were well received with participant rating of 4.5 out of 5.

EH News Bureau

EXPRESS HEALTHCARE

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October 2015

Smart, Simple, Versatile Smart design • Compact footprint instrument of less than 1m2 (10.76 square feet) • First results in 3.5 hours, then 5 results every 5 minutes Simple operation • Install, train and test in less than a week • Touch screen interface featuring step-by-step guidance of tasks Versatile capabilities • Continuously load, test, and release results • Process and obtain STAT results for high priority samples without delay

For more information, contact Grifols India Healthcare Private Limited at mahesh.kulkarni@grifols.com or visit www.procleix.com.

©2015 Grifols Worldwide Operations Limited. Procleix is a trademark of Grifols Worldwide Operations Limited; Panther is a trademark of Hologic, Inc. This material may only be used in jurisdictions where the product(s) and/or indications mentioned in the material are approved. For a complete list, visit www.procleix.com/approvals.

MARKET I N T E R V I E W

‘eHealthcare is poised to revolutionise healthcare delivery in India’ MediAngels, founded in 2011, enables patients to get in touch with medical specialists from around the world. Dr Debraj Shome, Co-Founder & Facial Plastic Surgeon, MediAngels explains the venture’s business model and talk about its vision for India, in an interview with Raelene Kambli

What does MediAngels have to offer to the Indian healthcare sector? What is its USP? The objective of MediAngels is to have the best doctors for every disease empanelled on one global platform, so that the consumer can seek an online consultation and the best second medical opinion, at a click.

At MediAngels, we match a patient's case to the best medical expert. Our medical team ensures that patients are directed to the right doctor who specialises in that area.

One gets to access the best global medical experts from within the comfort of their home or office.

MediAngels.com aims to do to healthcare, what e-commerce is doing to products all over the world. The purpose of this e-healthcare venture is to have the best doctors from across the world on a cloud-based platform and match the best doctor for every single disease with the help of technology, in the form of phone and the internet, to make them available across the world.

It seems strange and surreal in a way that in India, you can buy the best phone or camera whether you are in the most remote area or Mumbai, but you still can’t have access to the best doctors. Today, one cannot have access to the best doctors and I am sure the same would be the case 30 years later, as best doctors are a rare resource, and it would be very difficult to have them in every city or town or village or even in every multi-specialty hospital.

We, therefore believe, Medi-

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Angels, the world’s first online hospital, is the business of tomorrow, wherein we connect global medical experts, diagnostic laboratories and other types of medical requirements, to patients, using technology.

How is MediAngels different from other e-hospital facilities?

At MediAngels, we have 350+ superspecialist doctors belonging to 93+ specialities from India and 15 other countries such as the US, the UK, Germany, Australia, Singapore, etc. Empanelled specialists are the most important part of any hospital, therefore, MediAngels follows the most stringent criteria to empanel physicians.

Physician empanelment is by invitation card and we make sure that we work with only the top one per cent specialists in the world. These are doctors handpicked from their speciality and associated with the best hospitals in the world, including the Mayo Clinic, MD Anderson, Harvard, Stanford, Apollo, Fortis and many others.

Our doctors are the ones who are writing the textbooks and conducting research that determines future medical protocols and practices. It has been proven repeatedly that there is a big difference in medical outcomes when the best doctors are involved in treatment. Our objective is to ensure that the best medical decisions are taken globally by doctors and patients alike, across the world.

We offer online consultation services by means of email

MediAngels was voted as the most innovative startup in the Asia Pacific region in 2012,

by Intel and the Department of Science & Technology, Government of India, from amongst 8,000 companies (eConsult), telephone (DialMD) and video chat (Video Consult).

In addition to this, we also provide online investigation services, doorstep blood collection services - wherein you the consumers can book the tests online from MediAngels.com and get the blood collection done from their home. We have about 21,000 diagnostic centres across India. MediAngels.com is an integrated online hospital providing medical second opinion services in the form of online consultation, video consultation, telephonic consultation and also online investigation services.

What about its creditability?

How do you measure it?

The strength of MediAngels can be ascertained by the fact that it has been voted as the most innovative startup in the Asia Pacific region in 2012,

by Intel and the Department of Science & Technology, Government of India, from amongst 8,000 companies. The strength of this social enterprise can also be deciphered from the fact that MediAngels has been funded by diverse entities, like

the India’s largest private equity fund – HDFC Holdings, the Department of Science & Technology, Government of India and by a renowned venture capital fund – VenturEast.

All the doctors who get empanelled on MediAngels, are chosen by invitation only. At the time of empanelment, all the doctors profiles get verified by our Medical Advisory Board.

Our doctor criteria are extremely stringent and rigorous.

Below are the criteria for choosing our doctors: ◗ Physician recruitment by invitation only ◗ Post-graduation and recognised clinical fellowship from top institutes ◗ Minimum five years of experience post training in the chosen speciality ◗ Position of consultant and above in top international hospitals and universities ◗ Minimum five research publications in peer reviewed journals How do you plan to reach out to your audience? How are you planning to reach to the

grassroot level where language is a barrier?

The target audience is being reached by a combination of the following techniques: ◗ Directly to the consumer, through the Internet ◗ To the consumer, through their doctors ◗ To the consumer, through their corporate affiliations Yes, language is a big barrier in a country like India and we are looking at multiple language supported websites to assist people in every language.

What is MediAngels’ revenue and CAGR in India? When did you start?

We started in 2011 and are growing rapidly, showing a growth of 25 per cent or so every month.

What are your future plans and what will be your strategy to achieve them?

Internet penetration in India is growing at a very rapid rate, leading to all sorts of services being delivered to the rural Indians, as they become more aspirational. Healthcare services are no different. We must figure out a way to deliver healthcare in our country equitably and make it affordable and accessible across India. The only way to do this is to use technology. In my opinion, eHealthcare is poised to revolutionise healthcare delivery in India. It is a good time to be in this sphere and achieve good health for all Indians. raelene.kambli@expressindia.com

MARKET PRE EVENT

Musculoskeletal Ultrasound Society to organise MUSoc 2015 Aims to spread knowledge about the vast scope of musculoskeletal ultrasound in clinical practice MUSOC 2015, an international conference on musculoskeletal ultrasound is being from held 8-11 October, 2015, at the Taj Vivanta, in Dwarka, New Delhi. It is being organised by the Musculoskeletal Ultrasound Society, dedicated to the application of ultrasound to the entire range of musculoskeletal imaging. The event's objective is to teach the anatomy, techniques and

interventions applicable to the musculoskeletal system using ultrasound, while constantly defining its role as a major modality in musculoskeletal imaging.

The highlights of this conference would be: ◗ Over 20 international faculty apart from renowned national faculty ◗ Dedicated, single focus

educational programmes ◗ Live demonstrations on all joints following each session ◗ Interventional techniques on animal models ◗ Hands-on-workshops each day ◗ One to one interactive session between faculty and delegates to help step into the international arena of teaching and learning ◗ Introduction to world class

authors of various books ◗ International accreditation of the conference from America, Europe, UK and India ◗ Companies' support to showcase the best tools to help delegates get introduced to optimal technical resource ◗ Assurance in form of information on many training programmes for future

growth and hand holding Thus, MUSoc 2015 intends to spread knowledge about the vast scope of musculoskeletal ultrasound in clinical practice, teach the right techniques and learn to use the modality judiciously.

Apart from radiologists, it is also pertinent for rheumatalogists, pain management consultants, sport medicine experts, orthopaedicians etc.

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October 2015

MARKET

Transforming Healthcare with ITconference to be held in Bengaluru It offers an opportunity to meet, discuss and disseminate the latest happenings in the field of healthcare IT THE SIXTH International Conference on Transforming Healthcare with IT promises to be an exciting confluence of minds from the field of healthcare and information technology. It offers an opportunity to meet, discuss and disseminate the latest hap-

penings in the field of healthcare IT. Organised by the Apollo Hospitals Group, the conference is being held on 1617 October, 2015 at The Lalit Ashok, Bengaluru, India.

This edition of the conference will focus on the impact of information technology in

healthcare, on the theme ‘Today & Tomorrow’. It will reportedly bring together 60 speakers from different countries addressing over 750 delegates. The conference attracts a focused audience which includes leaders from hospitals, CEOs of healthcare

units, CIOs and CXOs, senior healthcare professionals, domain experts from IT companies, start-ups and venture capitalists among others.

THIT-2015 intends to spark a breakthrough in collective thinking on usage of Smart IT for smarter health-

care delivery across the globe.

This conference is being held along with “The 5 th International Congress on Patient Safety” at the same venue.

For more information on the event check: www.transformhealth-it.org

POST EVENT

AmeriCares India announces winners th for the 6 Spirit of Humanityawards This year, the impact sectors include – Child health, Diabetes, Disability, Eye Care, Education, Livelihood, Water & Sanitation, and Women empowerment

SPIRIT OF Humanity Awards, an initiative by AmeriCares, announced its winners in eight categories recently. It was a culmination of three levels of short listing with ended with a grand awards evening. Reportedly, the programme, in its sixth year, received 400 registrations from NGOs across India of which 28 made it to the finale. The top eight were chosen after a live presentation in front of an eminent jury.

Until last year, the awards were predominantly focused on NGOs in healthcare; this year, it has extended to other categories namely - Disability, Livelihood, Education and Water & Sanitation. Only one best from the four zones (N-EW-S), for each category have

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Sr. No.

Category

Organisation

Zone

1

Child Health

Mahan Trust, Melghat, Maharashtra

West

2

Diabetes

Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai

West

3

Education

Sevalaya,Tamil Nadu

South

4

Water & Sanitation

Jal Bhagirathi Foundation,Jodhpur

West

5

Disability

Tamana, Delhi

North

6

Eye Care

Samarthanam Trust for the Disbaled, Banglore

South

7

Livelihood

RMD Pain And Palliative Care Trust, Chennai

South

8

Women's Empowerment

Drishtee Foundation , Delhi

East

made it to the finals, through a process monitored by KPMG in India.

Spirit of Humanity, is organised in partnership with

Abbott, Allergan, Castrol, Novartis, State Bank of India, Bharat Serums and Vaccines, Ericsson, The Hans Foundation, SPJIMR, Idobro,

Guidestar and JW Marriott.

AmeriCares is also associated with Bristol-Myers Squibb Foundation for significant projects on public health.

Talking about the change in awards this year, Shripad Desai, MD & Country Director, AmeriCares said, “It gives me immense pleasure to bring the 6th edition of The Spirit of Humanity Awards this year. Over the years, this platform has evolved for better. This year, apart from recognising the healthcare NGOs we have extended nominations to other impact sectors as well. We are thrilled to receive such an encouraging response from all the participants. We only hope and thrive to grow this platform further and encourage services of many in the future.”

The winner of the award received the prize amount of Rs one lakh, a certificate of excellence from the organisers and a trophy.

EVENT BRIEF OCTOBER 2015 05

ADVANTAGE HEALTH CARE - INDIA 2015

ADVANTAGE HEALTH CARE - INDIA 2015 Date: October 5-7, 2015 Venue: New Delhi Summary: Jointly organised

by Ministry of Commerce & Industry, Govt of India; Federation of Indian Chambers of Commerce and Industry (FICCI); and Services Export Promotion Council (SEPC), Advantage Health Care - India 2015 is an international summit on medical value travel. It aims to showcase India and its immense pool of medical capabilities as well as create opportunities for healthcare collaborations between the participating countries.

Contact Federation of Indian Chambers of Commerce and Industry Federation House, Tansen Marg New Delhi - 110001 Tel : +91 11 2370 5468, +91 11 2348 7579 Fax : +91 11 2335 9734 sandip.mukherjee@ficci.com

08

conference aims to bring together experts from both healthcare and IT to meet, discuss and disseminate the latest happenings in the field

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE of Healthcare IT. This conference is being held along with the 5th International Patient Safety Congress Contact

www.hmdhealthcare.com

16

Suresh Kochattil Conference Secretariat, Transforming Healthcare with IT, ATNF, 9th Floor, Health Street Building,

TRANSFORMING HEALTHCARE WITH IT Apollo Health City, Jubilee Hills, Hyderabad Ph: 040- 23606868 / 09849011006 E: mail@transformhealth-it.org

TM

Safety I.V. Cannula with

While you take care of patient safety, We wish your safety.

INTERNATIONAL MUSCULOSKELETAL ULTRASOUND CONFERENCE Date: October 8-11, 2015 Venue: Vivanta by Taj, Dwarka, New Delhi, Summary: It would focus on the application of ultrasound to musculoskeletal imaging. It would dispense information on the anatomy, techniques and interventions applicable to the musculoskeletal system using ultrasound, while defining its role as a major modality in musculoskeletal imaging Contact Conference Secretary , Dr Nidhi Bhatnagar, E-7, East of Kailash, New Delhi Mobile: +91 - 9810884378. nidhibhatnagar63@gmail.com

TRANSFORMING HEALTHCARE WITH IT

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for harp njury revention

Date: October 16-17, 2015 Venue: The Lalit Ashok, Bengaluru Summary: Organised by te Apollo Group of Hospitals, the

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Reduce the chances of Infections from Used Cannulas

cover )

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F O C U S : M E N TA L H E A LT H

SAFE GUARDING INDIA'S MENTAL HEALTH India's mental health policy is progressive and radical in its approach, yet may falter without effective implementation RAELENE KAMBLI

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India needs to have a system where everyone has easy access to a trained mental health professional Dr Priyaranjan Avinash Senior Psychiatrist, ePsyClinic.com

Strategies to fight mental illness call for a complex array that will deal with its multifaceted effects Dr Prashant Goyal Consultant Psychiatrist, Sri Balaji Action Medical Institute

The policy has tried to bring in benefits for mentally ill people and their families and has decriminalised attempted suicide Dr Neeta Sawant Consultant Psychiatrist, Global Hospitals Mumbai

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ack in October last year, it was felt that mental health, ignored for decades in India, has finally got the deserved attention.

The then Union Health Minister, Harsh Vardhan unveiled the Mental Health Policy on the occasion of National Mental Health Day organised by the government. This marked a significant shift with the introduction of access targets for mental health services, emphasis on early interventions and standards for the provision of liaison and registration of psychiatry as well as the announcement of more money.

While launching the policy Dr Vardhan said, “The bi-directional relationship of mental ill health and poverty is evident in many reports, including the World Disability Report, 2010, that places persons with mental disabilities at the bottom of the pyramid.

This alerts us to what could become a health crisis with damaging consequences for society. He also pointed out that earlier laws governing the mentally ill, the Indian Lunatic Asylum Act, 1858, and Indian Lunacy Act, 1912, ignored the human rights aspect and were concerned only with custodial issues. Hence, the government introduced the Mental Health policy.

Express Healthcare seeks to understand the need for the policy, its impact on the industry and patients and its implementation, one year down the line.

Firstly, let us understand the need for a policy as such.

Demand-supply gap Globally, mental disorders account for about 160 million lost years of healthy life. Of this, atleast 30 per cent can be easily averted with existing interventions. However, in India, experts see a growing incidence of mental illness which need urgent attention.

India has

ONLY about 3,500 psychiatrists

160 20 million

%

Globally, mental disorders account for about 160 million lost years of healthy life. Of this, atleast 30 per cent can be easily averted with existing interventions

World Health Organisation had predicted that about 20 per cent of India’s population would suffer from some form of mental illness by 2020.

Moreover, the country has only about 3,500 psychiatrists.

“Seven per cent of India’s population suffers from mental disorders and over 90 per cent remain untreated. There

of India’s population would suffer from some form of mental illness by 2020- WHO

>

90

%

remain untreated

is less than one psychiatrist available for every four lakh people. The scene is worse in rural areas. India’s allocation for mental healthcare is less than one per cent of the health budget,” informs Dr Prashant Goyal, Consultant Psychiatrist, Sri Balaji Action Medical Institute.

The National Mental

Globally, the median number of mental health workers is nine per 100,000 population

■

The median number of mental health beds per 100,000 population ranges below five in low and lower-middle income countries to over 50 in high-income countries

■

Health Program, MoHFW, GOI lists down some stats on the mental health scenario in India (See table on page 32).

Consequently, there is a compelling need for good governance of mental health in India that is backed by a radical policy framework. Now, let us understand how the mental health scenario is dealt

(

F O C U S : M E N TA L H E A LT H

A progressive policy

with, worldwide.

The global scenario As stated in WHO's Mental Health Atlas series 2014, 68 per cent of WHO Member States have a stand-alone policy or plan for mental health; 51 per cent have a standalone mental health law. In many countries, however, policies and laws are not fully in line with human rights instruments, implementation is weak and persons with mental disorders and family members are only partially involved. Levels of public expenditures on mental health are very dismal in low and middle-income countries (less than $2 per capita). A large proportion of these funds go to inpatient care, especially mental hospitals. Globally, the median number of mental health workers is nine per 100,000 population, but there is extreme variation (from below one per 100,000 population in low-income countries to over 50 in high-income countries). The median number of mental health beds per 100,000 population ranges below five in low and lowermiddle income countries to over 50 in high-income countries; equally large disparities exist for outpatient services and welfare support.

Such is the global scenario for mental health governance.

What about India? Is the Mental Health Policy 2014, justified in its provisions?

Some experts are of the opinion that India Mental Health Policy is a blend of various global principles, put together to suit the Indian context. They state that the policy is progressive and sensitive to the social impact of mental illness, like

stigma and poverty.

Dr Neena Sawant, Consultant Psychiatrist, Global Hospitals Mumbai, says, “The policy has tried to bring in benefits for mentally ill people and their families and has decriminalised attempted suicide. It has emphasised on improving the

Mental Health Policy provisions

mental healthcare facilities in the country.”

Dr Priyaranjan Avinash, Senior Psychiatrist, ePsyClinic.com, elaborates, “The policy is going to benefit people with mental illness, in ways that the current act could never do. Advance directives

Step into digital imaging,

The draft policy calls for recognition of mental disorders and a more accessible and holistic treatment of mental illnesses.

It also pushes for decriminalisation of attempted suicide.

Taking a fresh look of the available health services for mental illnesses, it lays down the guidelines for mental healthcare and recommends changes in the law that criminalises suicide, now considered a major cause of death among people with mental illness. The policy additionally spells out specific roles to be played by the Central Government, the state governments, local bodies and civil society organisations.

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and nominated representatives are some of the provisions which will bring a sense of autonomy to patients. Also, the approach of the policy towards inclusion of psychiatric illnesses in the list of illnesses for the purpose of insurance, may take the finan-

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cover ) cial burden off the shoulders of already disadvantaged people with mental illnesses.”

Another notable provision under the policy is the recognition that a caregiver should receive monetary and tax benefits. This shows that the policy also draws attention to the largely-neglected need to support caregivers, who are almost always family members in India.

Dr Avinash further lists down some of the provisions that will be proved beneficial to patients: ◗ Advance directives: Capacity to make mental healthcare and treatment decisions, shall have a right to make an advance directive in writing, specifying the way the person wishes to be/not to be cared for and treated for a mental illness. ◗ Nominated representatives: Right to choose a nominated representative, who can take mental health treatment and care decision on behalf of the person with mental illness. ◗ Mental Health Review Commission/Board ◗ Mental health professionals: The definition has been widened to include psychologists, psychiatric social workers, psychiatric nurses, etc.

Harini Ramachandran, Co-founder, School of Excellence, an organisation for Neuro-Linguistic Programming, mentions that the policy also has provisions that recognises alternative therapies like yoga etc, as a treatment method for mental health, which according to her is certainly a good move toward dealing with mental illnesses.

Giving a perspective on regulating the industry to bring a positive change, Dr Avinash feels that the provision of delicensing the mental health establishments that do not comply with the norms will go a long way in making the system a less corrupt one. On the same lines, Mrinalini Ellen Shinde, Clinical Head, 1to1Help.net informs that this new policy has made stringent rules for gaining license and

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registration of psychiatric clinics and practices which is indeed a good move by the government. She goes on to say that this move will regulate the industry and also prevent malpractices.

Well, if there are interesting benefits for patients provided in the policy, there are some drawbacks too.

MENTAL HEALTH SCENARIO IN INDIA Treatment gap in even Severe mental disorders (SMDs) is approx 50 per cent. In case of Common Mental Disorders (CMDs) it is over 90 per cent.

Six per cent of Kerala’s population has mental disorders. One in five have some sort of emotional and behavioral problems.

Almost 60 to 70 million Indians suffer from SMDs and CMDs

Scope for improvement “There are several deficiencies beginning with a very broad definition of mental illness to the surveillance system to regulate psychiatrists.

'Mental Health Review Commission' for the whole nation and 'District Mental Health Review Boards' for each revenue district would be the review boards who would be vested with powers to regulate the professional conduct of psychiatrists. This would definitely make the psychiatrists uncomfortable. In section 90, it is laid down that the Commission will appoint an expert committee, who would prepare a 'guidance document' to tell psychiatrists regarding assessment and treatment decisions. This would mean that psychiatrists would have to take lessons from the expert committee,” informs Dr Sawant.

“Some of the loop holes include no financial provision for upgrading of resources and the implementation of the provisions. Mental health establishments are still under the scrutiny of many authorities and commissions which will discourage private sectors from getting into mental health delivery. Admissions at a mental health establishment are still going to remain vastly involuntary, with the provision of supported admissions,” adds Dr Avinash.

Moreover, Dr Vasant Mundra, Consultant Psychiatrist, PD Hinduja Hospital & Medical Research Centre informs that certain areas such as unclear process for gaining license to set up psychiatric wards within hospitals is very detrimental to healthcare providers. Similarly, Shinde points out that there isn't

State-run mental hospitals/mental health institutions – only 43 all over the country 289 departments of psychiatry in medical colleges includlingapproximately 85 PG departments Approximately 30000 psychiatric beds is provided in govt mental hospitals.

3800 psychiatrists available as against requirement of 11,500; 898 clinical psychologists as against 17250; 850 psychiatric social workers as against 23000; 1500 psychiatric nurses as against 3000.

Burden of these disorders is likely to increase to 15 per cent by 2020 (World Health Report, predicted in 2001 )

enough transparency in the process for registration and licensing. “If the government can make the process more transparent then we can eliminate middle men and avoid corruption”.

So how do we plug these loopholes?

Learning lessons Industry experts suggest that there should be a multifaceted approach to deal with this problem. “Strategies to fight mental illness call for a complex array that will deal with its multifaceted effects and civil society must do its part as much as the government. Mental health and its ramifications affect every country and section of the society. Unfortunately, official recognition of the incidence of the same in India has been more on paper than in practice,” believes Dr Goyal.

Laying emphasis on the importance of the mental health policy, Professor Dinesh Bhugra President, World Psychiatric Association stresses, “It is important that mental health policies are taken seriously. Patients with mental

illness have the right to services which are equitable and fair and need appropriate resources. The mindset needs to be changed, bearing in mind that one in four adults in their lifetime will develop mental illness. Furthermore, there is evidence that more than half of the mental illnesses in adulthood starts below the age of 15.

Schools need to teach children at an early age on how to identify and manage stress and pressures. Rapid urbanisation and globalisation have increased rates of mental illness and also changes in family and social support. Hence, there is a need for better awareness.”

Furthermore, he goes on to cite an example from Gujarat which can be replicated in other states as well. ”There is an unusual example in Gujarat where nurses and doctors attend a dargah where patients with mental illness and their families go to pray. So, there are models of good practice and they need better exposure and application elsewhere. The state has better training facilities for medical students and also for stu-

dents doing BAMS and homoeopathy courses, elaborates Bhugra.”

Dr Avinash gives some recommendations to improve the scenario in four major areas: ◗ Capacity building: The shortage of trained mental health professionals in India is huge.

As long as we don’t have enough of them, no policy or bill is going to make the mental health situation in India better. ◗ Funding: The government needs to hike the allocation of funds for health in general, and mental health in particular. ◗ Medical education: The medical education curriculum needs to be modified to be more inclusive. There is a need for exhaustive training of medical graduates in the field of psychiatry and mental healthcare. ◗ Approachable: A country as vast in size and diversity as India, needs to have a kind of system where everyone has easy access to a trained mental health professional providing evidence-based, quality mental health services. With increase in Internet connectivity, cyber consultation, can definitely fill the vacuum that we have.

Lastly....

Well, the Mental Health Policy has been radically drafted in many areas, yet its implementation won't be a cake walk.

Also, there are some glitches that cannot be ignored and needs immediate attention.

Nevertheless, the move to consider mental health as an important healthcare need reflects the government’s willingness to overhaul the non-existent mental healthcare system, at least on paper. Yet, the delay in tabling the policy in the Parliament also raises questions on the government's commitment in this area.

Looking at the urgent and genuine need for an effective policy on mental health, it is to be hoped that all the stakeholders come together and ensure that the policy comes into effect as soon as possible. raelene.kambli@expressindia.com

KNOWLEDGE INSIGHT

Advances in interventional neurology Dr Vikram Huded, Head of Neurointervention and Stroke, Narayana Hrudayalaya Institute of Neurosciences, Narayana Hrudayalaya Hospital, Bengaluru, elucidates on the evolution of interventional neurology and the various methods that have proved beneficial in handling strokes, a major health concern STROKE, ALSO called as 'lakwa' or 'paralysis', is a medical emergency. Broadly, strokes can be divided into two types: ischemic stroke, where blood supply to a part of brain is blocked by clot in the vessel; and haemorrhagic stroke where blood vessel ruptures in the brain. Stroke has been among one of the leading causes of death and disability worldwide. Just in the US alone, one stroke happens every four seconds and one person dies of stroke every four minutes. According to WHO, stroke was the most frequent cause of death worldwide in 2011 with more than 40 per cent of death occurring in South East Asia. With increase in longevity, urbanisation and sedentary lifestyles the occurrence has further increased.

Stroke can happen to anyone at any point of time.

Importance of recognising the symptoms at the earliest can be judged by the fact that for each minute a stroke goes untreated and blood flow to the brain continues to be blocked, a person loses about 1.9 million neurons. Sudden onset change in voice, inability to speak or understand; sudden onset face dropping, arm or leg weakness or numbness especially on one side of body; sudden onset imbalance in walking; sudden onset severe headache; or sudden onset loss of vision in one or both eye may suggest a stroke. An easier way to remember it is ‘FAST’ where

'F' is face drooping, 'A' is arm weakness or numbness, 'S' is speech difficulty and 'T' stand for time to rush to hospital which has facilities to perform thrombolysis. Only by increasing the awareness about stroke symptoms we can make sure

that people reach the hospital in time and can be treated appropriately.

Till recently, there was not much to offer for treatment and management of stroke, with more emphasis being laid on rehabilitation. In the last 20

years, this scenario has changed with rapid advances in medical science, especially for treatment of ischemic strokes.

The first major aspect was intravenous thrombolysis in which the medical professional attempts to lyse the clot by

giving drug through injection into the vein.

Interventional neurology offers the best minimally invasive treatment for a wide range of conditions involving the brain, the head and neck region as well as the spine and spinal

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KNOWLEDGE cord. It has taken the treatment of stroke one step ahead so that now we can go into the artery and take out the clot, thus restoring the blood flow immediately, by procedure known as mechanical thrombectomy. With the new generation clot retrievers the chances of complication have come down as well as the success rates have gone up. Also, with the advent of newer procedures, the time window in which a procedure can be performed has gone up from 4.5 hours in case of intravenous thrombolysis to six hours in case of mechanical thrombectomy. We have been doing both intravenous thrombolysis as well as mechanical thrombectomy with the help of a dedicated stroke team and a very efficient stroke protocol for the last six years. Narayana Hrudayalaya Institute of Neurosciences is the first centre in India to do mechanical thrombectomy for acute ischemic stroke. The youngest patient treated by mechanical thrombectomy by us was six years of age, which is first in Asia. Our assessment of patient data suggests the most important reason for inability to offer the treatment to patients is late arrival, mostly due to unawareness about the availability of treatment options and thus wasting

STROKE SYMPTOMS AN EASIER WAY TO REMEMBER IT IS FAST is face drooping

FAST is speech difficulty and

is arm weakness or numbness

crucial time.

Carotid stenting is rapidly becoming an effective non-surgical method of choice to open the blocked vessels in neck. By doing so the chances of recurrence of stroke can be effectively reduced. Stenting has also been proved to be method of choice for those who have associated diseases such as coronary artery disease or patients having arterial narrowing in neck after radiation therapy. The development of embolisation protection devices have made stenting procedures much more safe.

These are sieve like devices which gather the debris formed during stenting and thus prevent occurrence of stroke during procedure.

is time to rush to hospital which has facility for thrombolysis

The indications for endovascular neuro-interventions in neurology have been increasing rapidly.

Subarachnoid haemorrhage (SAH) is another such disease wherein interventional neurology is fast becoming the treatment method of choice. SAH occurs due to rupture of a bleb in the brain leading to haemorrhage. Of all the haemorrhagic strokes, 50 per cent are due to SAH. The seriousness of the disease can be gauged from the fact that about 10-15 per cent patients die before reaching hospital. The mortality rate reaches almost 40 per cent within first week and up to 50 per cent in first six months.

Advances in technology has made it possible to treat the

aneurysms rapidly and effectively. Using this approach, aneurysms can be cured with the help of platinum coils, even in those areas of brain were surgical access is difficult. This abolishes the chances of rebleeding and helps providing the established line of treatment to the patient. Through endovascular injection of drugs complications of SAH, namely vasospasm, can also be treated at the earliest. With the help of stents, some difficult to coil aneurysm can also be coiled.

Flow diverter stents are the latest in treatment of unruptured aneurysms.

A frequently missed but not uncommon subtype of stroke is cerebral venous sinus thrombosis wherein clotting happens in vessels which drain blood out of brain called veins.. This kind of stroke is frequently seen in women in their last months of pregnancy or in early weeks after giving birth.

Another group of people at risk for this are young males with habit of chronic smoking or alcoholism. Its symptoms are also somewhat different as it presents with headache with or without fits. The other characteristic symptoms of stroke may or may not be there thus, the diagnosis becomes even more difficult. Using blood thinners have been the accepted treatment protocol in this

condition but it provides little benefit in those situation where the disease is in its particularly aggressive form. In such cases, we have been doing in-situ thrombolysis with very good outcomes. With the help of a microcatheter, high potency blood thinners are given directly to the clot thus reducing the need for amount of drug and potentially avoiding complications of the drug. Apart from these major indications, some rather infrequent conditions for whom neuro-intervention is the preferred method of treatment includes intracranial and spinal dural AV fistulas, arterio-venous malformations, and carotico-cavernous fistula.

In the end, it all comes down to improving the awareness of the public about the symptoms of diseases like stroke, importance of time for treatment and the availability of the newer neuro-intervention methods for treatment of those diseases.

We can expect to pass on the benefit of these advances to the public. The best thing would be increasing awareness about stroke risk factors such as sedentary lifestyle, obesity, alcoholism, smoking, hypertension along with timely recognition of stroke symptoms at some point of time among school going children along with various community education programmes.

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Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare

KNOWLEDGE INSIGHT

Evolution of neurosurgery Dr Venkataramana NK, Vice Chairman & Chief Neurosurgeon, BGS Global Hospitals, speaks on the advancements in neurosurgery over the last three decades, the role of technology in its progress and the growing implementation of the speciality to offer better patient outcomes

BRAIN, BEING the most complex of all organs, continues to be an intriguing subject of scientific curiosity and is, therefore, a focus of massive research efforts around the world.

Also, despite the development of incredibly powerful imaging and other technologies, there are several key aspects of the brain's functions that remain inscrutable and beyond our understanding. The brain, in short, is simultaneously the most pursued and elusive organ in the living world.

Neurosurgery was said to have begun as trephination wherein crude instruments made out of stone and metals were used to open the skulls.

In fact when I joined neurosurgery, skull opening was done by mechanical means. Therefore it used to take several hours for opening and closure and the instrumentation was not as robust as it is today. Hence the famous statement that neurosurgeons operate by the calendar has completely gained speed to minutes by clocks and advances have come a long way indeed, to levels of highest sophistication that could not have been imagined. Technical advances in the last few decades, however, have dramatically swung the balance in favour of doctors, bringing mortality rates down to extremely low levels making neurosurgery as the best and elegant speciality .

Significant advances in anatomy, physiology and neurochemistry have

DR VENKATARAMANA NK Vice Chairman & Chief Neurosurgeon, BGS Global Hospitals

without doubt paved the way for rapid progress in neurosurgery and neuro pharmacology, helping doctors to deal effectively with a host of diseases that afflict the nervous system.

However, though our understanding has advanced from the gross to the molecular and genetic levels there continues to be a considerable lag between diagnosis and treatment— that is, between our capability to detect a disease and treat it efficaciously. This area warrants immediate and concerted attention.

With imaging tools like CT Scan and MRI, which are boons to make accurate diagnosis, surgeons are now armed with a battery of cutting edge tools that provide three-dimensional information and help them plan their surgical strategies. Technologies like structural imaging, FMRI, tractography (diffusion tensor imaging) and integrated navigation are reshaping the paradigm of neurosurgery, enabling neurosurgeons to achieve unprecedented levels of precision with minimally invasiveapproaches.

The advent of the microscope has

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KNOWLEDGE heralded a new era of microneurosurgery, oriented to microsurgical anatomy and microinstrumentation.

Meanwhile, new illumination and magnification technologies have lit up even the darkest and remotest nooks of the brain, making them accessible to the surgeon. Advances in developmental optics have made neuro-endoscopy possible and this is now being used for intraventricular and pituitary surgeries.

Stereotactic surgery is based on the principle of approaching a target with planned co-ordinates. CT and MR-guided stereotactic surgery has now evolved into functional neurosurgery, neuro modulation and minimally invasive neurosurgery. Such breakthroughs have taken the concept of micro-neurosurgery to an all-new plane of refinement.

Microelectrode technology has made instant intra-operative physiological verifications possible and new therapies like deep brain stimulation (DBS), vagal nerve stimulation (VNS) and sacral nerve stimulation (SNS) have had a profound impact on successful treatment and management of extremely serious brain conditions.

With technology adoption, modern operation theatres are beginning to look like a scene from a science fiction movie— loaded with large arrays of gadgets including the neuro navigation system, ultrasonic surgical aspirator, lasers, highspeed pneumatic drills, micro dopplers and intra-operative electro-physiological monitoring systems. Neuro navigation has enabled computer-assisted neurosurgery with real-time feedback. Intra-operative ultrasound and intra-operative MRI are also available, in addition, to assist the surgeon. Micro Electro Mechanical Systems (MEMS) have spawned a new era for micro devices and implants.

Invasion of such technology revolutionised spine surgery, from paediatric to geriatric groups offering solutions that enhance quality to life tremendously. Variety of implants are now available to strengthen, stabilise and keep the spine as flexible and agile as possible.

Moreover, these sophistications

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Although transplantation is now a reality for all organs, as far as the brain is concerned it has never gone beyond the realms of science fiction. Brain is a crown jewel in creation and evolution.

In spite of several advances over the century, it continues to be an unfathomable organ, holding several mysteries in its depths not only improved the quality of spine surgery but also dispelled many myths and misconceptions about spine surgery.

Modification of receptors, genes, neural proteins and transmitters will be the key therapeutic interventions in the future even as nano technology, new drug delivery systems, and targeted therapies emerge as weapons of super-selective choice for precisely targeting neurological disease. Thus neurosurgery entered into nanosphere – nano neurosurgery.

Similarly, although transplantation is now a reality for all organs, as far as the brain is concerned it has never gone

beyond the realms of science fiction.

The knowledge acquired from the progressive research on stem cells promise to resolve several issues that hinder effective therapeutic neuronal transplantation for disorders like Alzheimers, Parkinson’s Disease and brain and spine injuries. The identification of adult hematopoietic mesenchymal derived stem cells have several unique characteristics and hold the potential to form and regenerate neural cells. This has stirred new hope for several complex neurological diseases, which have been labelled as incurable. The secretomes from the stemcells

are potential hope for future treatments. Extensive research is on to use the technology to regenerate the brain and modify the course of major neurological diseases – molecular and cellular neurosurgery.

A phenomenal progress has happened in the field of neurovascular surgery with the development of micro catheters and the coils.

Endovascular neurosurgery has become the order of the day for many neurovascular diseases. Major advances in the precise and safe delivery of radiation has made possible to shrink some of the small brain tumors without opening the

skull - radioneurosurgery.

Neuro critical care has made a big leap forward, improving the post operative outcomes.

Multi-modality monitoring has facilitated brain protection and promotional recovery improving the quality of life. Microdialysis offers an inner eye that reveals the brain metabolism in physiological and pathological conditions real time, allowing suitable modifications time to time.

Neurosurgical training has now become a mixture of all these specialities offering clinical, technological, operative and research skills. Sub specialisation is being encouraged to improve focus, quality and research. Concepts like brain death are getting established, facilitating organ transplantation.

Brain is a crown jewel in creation and evolution. Inspite of several advances over the century, it continues to be an unfathomable organ, holding several mysteries in its depths.

I am fortunate to be a neurosurgeon working with the human jewel and to be a witness for such phenomenal developments. It has been a fascinating journey of three decades to watch the progress and development. The experience is something exceptional.

It has been a fantastic experience and an incredible journey of learning. Neurosurgery has moved steadily up the ladder from trephination to a stage when transplantation does not sound completely out of bounds, on a series of pathbreaking steps from macro neurosurgery and micro neurosurgery to endo neurosurgery, nano neurosurgery, molecular neurosurgery and currently cellular neurosurgery, which has made neural regeneration a reality. The progress in the future promises to be even more exciting, marked by the emergence of new, integrated, remotely-driven and miniaturised technologies which may open up possibilities that are currently beyond our imagination.

Nothing can be more fascinating than to be a part of this exciting journey that may fuse science and fiction into a new super reality.

KNOWLEDGE EXPERT SPEAK

Myth vs reality of stem cellbased products With stem cell therapy set to become an acknowledged treatment alternative globally for unmet medical diseases, BN Manohar, MD and CEO, Stempeutics Research, opines that it has become increasingly crucial to improve the level of knowledge among doctors

THE TRADITIONAL science of medicine has evolved exponentially.

Today, there is a pill for almost everything that could possibly plague a human body. But, when it comes to critical and life threatening or debilitating/degenerative diseases like diabetes, arthritis, muscle degeneration or organ disease, are these medicines offering complete treatment? Or just slowing down the progression of the ailment and creating an illusion of improving quality of life? Most often than not, the latter scenario is true.

This is when an innovative arm of medicinal science walks into the picture – stem cell treatments. This non-traditional approach is much more than just an intervention to give patients temporary relief or delay the effects of the condition.

Research so far gives hope that in addition to possibly completely halting the progress of specific medical conditions, it may also be possible to actually reverse the degeneration of tissues/organs, giving birth to the term ‘regenerative medicine.’ The world over, scientists and researchers are working aggressively towards unlocking the true potential of stem cell therapies and treatments. Clinical trials are suc-

BN MANOHAR MD and CEO, Stempeutics Research

cessfully proving the efficacy of stem cells in repairing damaged tissue. Regenerative medicine, is a novel multi-disciplinary field that relies on cell therapeutics and bioengineering techniques to enhance the functionality of organs and tissues. In technical terms, regenerative medicine as defined by the US NIH is the process of creating living, functional tissues to repair or replace tissues or organ function lost due to age, damage or congenital defects.

Stem cell research is continually advancing knowledge on how an organism develops from a single cell and how healthy cells are derived from precursor cells to replace damaged tissue. All this knowledge and data is then used in developing stem cell treatments for diseases that do not have a cure yet, with an aim to replace/regenerate damaged cells with healthy cells.

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KNOWLEDGE Stempeutics Research, which is a group company of Manipal Education & Medical Group and a joint venture with Cipla Group, has invested in ground breaking research in this space. The company has spent the last nine years developing innovative stem cell products that could provide a cure for chronic and degenerative diseases. Stempeutics’ stem cell based technologies and products, are under various phases of clinical trials which will put India firmly on the global medical innovations map and potentially revolutionise the treatment protocols for a number of unmet medical conditions.

The most significant breakthrough has been the successful completion of phase II clinical trial of Stempeucel – a novel stem cells based medicinal product, designed to treat Critical Limb Ischemia (CLI) due to Buerger’s disease. Buerger’s Disease is a rare and severe disease affecting the blood vessels of the limbs. It is characterised by inflammation and occlusion of the vessels of extremities resulting in reduced blood flow to these areas, thus leading to severe rest pain and ulcers or necrosis, which finally leads to amputation of the limbs.

Buerger’s Disease is a major unmet medical need in India and globally. Stempeucel treatment is designed to enhance the body’s limited capability to restore blood flow in ischemic tissue by reducing inflammation and improving blood flow to the affected limbs.

The phase II trial conducted by Stempeutics is the largest ever phase II trial in no-option patients with Buerger’s disease in the world. In the trial Stempeucel demonstrated statistically significant results in ulcer healing, rest pain reduction, increased ankle brachial pressure index (indicator of increased blood flow due to neoangiogenesis) and improvement in quality of life.

Stempeucel is developed from allogeneic pooled mesenchymal stromal cells extracted from the bone

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COMMON MYTHS ABOUT STEM CELL TREATMENTS Myth

All stem cells are from embryos

Reality

Stem cells can be derived from the different tissues including bone marrow, umbilical cord, umbilical blood and dental pulp.The cells are often more effective in developing treatments for major unmet medical conditions

Myth

Stem cell research is illegal and unethical

Reality

This is not true.All research and treatments using stem cells are legal and are always authorised by governing bodies.There were number of controversies revolving around embryonic research earlier, but nowadays research in these areas have been made legal and few clinical trials using Embyronic stem cells are approved by US regulators and are ongoing

Myth

Stem cells are a magic cure for every disease

Reality

Researchers believe that stem cell therapy has the potential to radically change the treatment of human disease. But the practical application of this technology has only just begun and is in a very nascent stage, especially in India.We are hopeful that one day we might be able to cure any disease. However, initial clinical trials are focusing on specific conditions which are major unmet medical needs of the community like Critical limb Ischemia, liver cirrhosis and different heart diseases. Globally, testing in the areas of treatment for macular degeneration, neurological diseases and heart disease are promising, but stem cell companies refrain from making claims until they have hundred percent results

Myth

Stem cells automatically migrate to injuries

Reality

This myth revolves primarily around the homing of stem cells by any route of injection in regenerative medicine to the site of injury.While research and clinical trials do suggest regenerative properties, but homing of stem cells to specific injury site is believed to be very limited due to the environmental cues that exist within the body. Hence, to be more effective, it is ideal to inject stem cells as close to the site of injury as possible.

Today, in cases of critical conditions of organ defect or degeneration, donated organs and tissues are often used to replace ailing or destroyed tissue, but the need for transplantable tissues and organs far outweighs the available supply. Stem cells offer the possibility of a renewable source of replacement cells and tissues to treat diseases which has no treatment by standard existing therapy.

marrow of healthy, adult voluntary donors. The drug works by increasing blood flow which is the root cause of diseases and just does not give symptomatic relief, thus proving to be much more effective agent of treatment. Stempeutics’s proprietary pooling technology allows an efficient manufacturing process with minimum wastage of resources in order to provide the product at an affordable cost to patients. Stempeucel has a strong patent protection with 18 patent applications filed across the globe. The core patent has been granted in the US, Australia, New Zealand, Singapore, South Africa, China and Japan. In addition, Stempeucel has been given the Advanced Therapeutic Medicinal Product designation by the European FDA and Buerger’s disease has been granted the Orphan Drug Designation (ODD) by the same agency.

Challenges Stem cell related research is in its infancy in India, similar to the IT/ITES industry two decades ago. Stempeutics has faced several challenges including having to convince policy makers about the importance of aggressive R&D including clinical research in this area, ensuring that the company is self-regulated and works to the highest global standards and to invest in a technology that is not even understood well by most people.

As with any new or innovative treatment method, there are a number of myths and misconceptions surrounding stem cell research and treatment. These are mainly due to lack of knowledge among professional doctors as well as end consumers.

With stem cell therapy set to become an acknowledged treatment alternative globally for unmet medical diseases, it has become increasingly crucial to improve the level of knowledge among doctors about the importance of stem cells. This in turn will help doctors guide their patients better, give them complete and accurate information and secure a patient right to informed decision making.

KNOWLEDGE OPINION

De-addiction with technology

DR NAVIN SAXENA Chairman, Rusan Pharma

On the occasion of World Mental Health Day, October 10, Dr Navin Saxena, Chairman, Rusan Pharma opines that substance abuse/addiction is a mental illness. With 270 million Indians addicted to tobacco, the country needs the right combination of technology (newer delivery systems like transdermal patches) to offer more effective ways of dealing with the addiction

THERE WAS a time when mental health meant just one diagnosis – mad. Those creatively inclined scraped through by calling themselves inspired, the rest were packed off to madhouses. These were spaces where ill-informed and an insensitive lot of people inflicted pain and misery on a misunderstood lot of people.

The end result was a gaping hole in the understanding of the human psyche, a lack of recognition of pattern and behaviour that would have enabled diagnosis. People were written off as 'mad', ‘hopeless’ cases whose lives were forever lost, their families to mourn them prematurely. In India, lack of information, education and research had created the dark ages and we lived within those times, uneasy of our actions, but unable to change our ways.

Until a handful of people recognised the patterns, started attributing behavioural anomalies to personalities and circumstances. They started looking at the complexities of the brain, only beginning to grasp the entire universe that the human brain is capable of producing. Chemical imbalances were first recorded, and ‘mad’ started to fade into clear categories with relatively evolved diagnoses. Mankind was moving into the age of enlightenment and his brain

was finally taking the lead.

Freud and Jung’s theories helped to establish the rudimentary beginnings of psychology and eventually became the foundation on which numerous doctors later added theories to help navigate through human experience.

Today, mental health is far removed from the past. Every moment of our lives can be explained, and often our personalities and predispositions predict the trajectory of our lives. Personality tests are available online, and within seconds you can delve into the details of your life and yourself. Self improvement is a career, with life coaches and armies of psycho-analysts out there determined to help. And yet, mankind falters in the face of new illnesses, new diseases.

Addiction as a mental health illness Disease teaches mankind to be stronger, more prepared, eventually evolving us into a better species. Illness, physical or mental, gives us an opportunity to look further into ourselves and find out what’s not making us tick. One of these illnesses is addiction. And yes, addiction is a mental illness. It changes the brain in a number of ways, turns priorities upside down, changes the very nature of our physiological and psychological selves. And like all illnesses,

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KNOWLEDGE there is a cure; there are ways to overcome it.

The mental health situation in India has not always been at par with the more evolved standards and methods in other countries.

However, there are pockets where practices and concerns have led to innovative treatments and research.

Addiction can range from from teens being addicted to smoking and drinking to hard core drug addiction. The best way to tackle these problems would be catch them early on.

The upheavals in a teenager’s environment and body during adolescence make him or her an easy target. Peer pressure, and nowadays pressure from external social media can lead them down paths that are difficult to return from. But, not impossible.

The pitfalls of addiction have been detailed ad nauseam. High blood pressure, liver damage and Type II diabetes are just some of the ill effects of excessive smoking and drinking. In India, studies have shown that teens have started consuming alcohol before they turn 15 and are five times more likely to develop alcohol dependence or abuse in a later stage in their life.

One of the most basic ways of tackling this is for parents to maintain open communication with their teenage children. Children should feel comfortable enough to approach their parents to engage them and sound them out on issues that disturb them. It’s imperative that parents instil a home of trust, confidence, comfort and nurture so that children never feel threatened to approach them on issues that might be troubling them. The ability to bring up a confident child, who can not only remain unaffected by the habits of his or her peers, but also influence his friends to follow his example, is not an impossible task.

The onus of this of course lies entirely on the parents. There are counselling services now available in India that help guide parents at every step and also act as mediators to help explain the benefits of

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conil. The product has been introduced in India for the first time as a form of Nicotine Replacement Theory. The pharma company has created a more effective way of weaning people off cigarettes, working with advanced formulations and smart time-release technology that ensures a steady deliver of a therapeutic and sustained delivery of Nicotine into the body to curb the patients craving for tobacco. The therapy aims to reduce the physiological craving over a period of time, which enables the patient to focus on their psychological implications.

addiction treatment to the patient.

In a lot of cases, addiction needs more help that just nurture. Addiction in its most aggressive form creates chemical imbalances in the body, and while a clear and strong mind can help the healing process, often the body itself needs some outside help.

Technology in healthcare We live in a world driven by technology and therefore it is only natural that this time too, technology steps in to save the day. The application of technology in this sector is simple enough. World class laboratories around the world work tirelessly around the clock to develop clever drugs, potent mixes of chemicals to help those who want to help themselves.

The first step towards cure is acceptance of the problem which will drive the need to seek treatment and desire a better quality of life. This is often a combination of therapy, counselling, medicines and an equally controlled environment. Bad habits cannot be stopped overnight as the body needs to heal after a prolonged period of trauma.

Within this space, the Indian healthcare industry is a veritable giant. Innovative treatments and potent drugs are being churned out of laboratories every day. These are easily accessible and the services are only improving day to day. A playing field of both private and public players is levelling out problems and making transitions from lab to shop much easier.

Conservative estimates have pinpointed the Indian healthcare industry at $65 billion that includes healthcare delivery, which includes hospitals, nursing homes and diagnostics centres, and pharmaceuticals, all of which constitute 65 per cent of the overall market.

By 2017 it’s been predicted to grow to $160 billion and to $280 billion by 2020.

One of the main reasons for these numbers is the whole hearted acceptance of technology. It enables patients to instantly find a doctor nearest to them in just a few seconds

Addiction in its most aggressive form creates chemical imbalances in the body, and while a clear and strong mind can help the healing process, often the body needs some outside help through a website or an app.

Technology is bridging the gap between the doctor and patient and making treatment provider’s information available at our fingertips. It enables the development as well as availability of healthcare services across the country, making it cost effective and consumer friendly.

Simple but effective measures include systematised storage of patient records, measuring progress and enabling speedy and effective drug administration. Aggressive diseases like cancer require minute monitoring, tracking a patient’s progress over days, weeks, months and even years. This is

where technology steps in, making it a seamless and easy process, requiring minimum effort from hospitals or care givers. Sharing records between doctors and hospitals help consultants work to the best of their abilities, making diagnoses and treatment that much more efficient.

For higher patient compliance Technology helps in the smallest ways possible, to have major positive ramifications. To help the 270 million Indians addicted to tobacco, Rusan Healthcare recently launched India’s first 24 Nicotine Transdermal Patch, 2ba-

With six trillion cigarettes being smoked a year in India, the company’s vision vision has been to bring products into the Indian market which will be not just quality driven but also bring convenience to users, through newer delivery systems like the transdermal delivery systems, which ensures higher patient compliance and ease of use. If we are in knowledge of the fact that there are millions of Indians going to die, especially the youth, then our efforts need to be intensified and focused on saving their lives.

From the local chemist maintaining private patient files to doctors monitoring everyday movements and lifestyle of their patients, technology is breaking new barriers everyday. From a simple diagnosis of mental health to a detailed manystepped programme to recovery, it’s difficult to imagine a scenario where this was not always the case.

Healthcare in general has to evolve with or even faster than human beings. As the world changes around us, we are racing to catch up.

Within that sector, mental healthcare occupies a more specialised seat. The degree to which this segment needs to develop and stay ahead of the race is much higher.

However, with the right combination of technology and critical thinking, it is evident that this is not just possible, but is already happening.

MEDICAL TOURISM SPECIAL

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MEDICAL TOURISM SPECIAL

M

edical tourism or medial value travel, which refers to the “practice or trend of patients seeking cross border healthcare”, is nothing new.

Sumerian health complexes built around hot springs in circa 4000 BC, the Asclepia Temples in ancient Greece, named after their god of medicine, Asclepius; and the hot water baths of Rome which claimed to enhance and preserve good health; etc attracted people from across the world even during those times to find a cure for their illnesses. Thus, history reveals that mankind has always transcended boundaries and travelled to different places to improve their health and sense of well being.

So, could India, the womb of another ancient civilisation be unaware and ignorant of this concept? Not likely. Yoga and Ayurvedic medicine have been bringing foreign travellers to India's shores since as early as 5000 years ago.

Medical travellers and spiritual students came to this land to seek the benefits of these alternative healing methods. The chronicles of Chinese travellers, Fa Hien (CE 405-411) and Hiuen Tsang (CE 629-645) also mention and describe the hospitals and hospices in India at that time. They are referred to as vaidyasalas or punyasalas.

The medieval ages too saw the Arabs playing a significant role in promulgating India's knowledge in science, medicine, mathematics and other spheres to different parts of the world. Sanskrit texts of Indian medicine like Caraka Samhita and Susruta Samhita have been translated into Arabic. There are several mentions of learned vaidyas or doctors like Dhanvantri, Manaka, Kanka etc in the Arab texts.

These are very concrete

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evidences that medical value travel has been in practice since a really long time in our country as well.

The present day With the advent of technology and shrinking borders, alongwith the rising need for healthcare services, the concept has gained more prominence and pertinence over the last couple of decades. A Federation of Indian Chambers of Commerce and Industry (FICCI) report on medical value travel, released in 2014, along with KPMG, pegged the medical value travel industry globally at $10.5 billion and estimates it to grow to $32.5 billion over the next five years at a CAGR of 17.9 per cent.

Today, it comprises two segments i.e. people who travel to other countries for rejuvenation purposes which is a part of the wellness industry, and people who travel for curative care.

Another report released this year by the ICAI-CMA & PHD CHAMBER, titled, ‘Destination India - Evolving Medical and Wellness Tourism Hub’, reveals, “Services typically sought by the travellers include elective procedures as well as complex specialised surgeries such as joint replacement (knee/hip), cardiac surgeries, dental surgeries, cosmetic surgeries diagnostic tests, multi-speciality care, infertility, haematology or diseases related to blood and blood vessels etc. It also encompasses dental implants and orthopaedic care, laser hair removal, hair transplant and lastly spa and beauty treatment. On the other hand, wellness tourism is about to travelling for the primary purpose of achieving, promoting and monitoring maximum healthcare and a sense of wellbeing.”

Explain the growing trend for medical value travel, Nilaya Varma, Partner and Head of Government and Healthcare, KPMG in India states, “On one hand, rising cost of healthcare services has compelled patients from developed nations to seek low cost healthcare services in other countries. On the other hand, lack of healthcare infrastructure and expertise for complex surgeries has compelled patients from developing nations to seek quality healthcare services in other countries. This cross-border movement is also triggered by rising noncommunicable diseases such as cardiovascular, oncology, diabetes etc. which require specialised treatments and has high treatment cost.”

Thus, growing global demand for healthcare services, changing demographic factors like increased longevity of life and rise in birth rates, skewed ratio of healthcare facilities in different parts of the world, rise in disposable income, changing disease patterns etc are some of the factors behind the spread of medical tourism. The pursuit for high quality healthcare, specialised treatment options, instant service prospects for travel teamed with affordability have also aided the growth of this sector.

Asian countries like India, Malaysia, Singapore, Thailand, Sri Lanka, and South Korea; Brazil, Costa Rica, Mexico, Cuba from Latin America; and United Arab Emirates have emerged

as major hubs for medical value travel. European destinations for medical tourism include France, UK, Hungary and Poland and Turkey.

India’s story India, as a destination for medical value travel, is among the top three destinations in Asia and welcomes visitors from across the globe. Its traditional forms of medicine like Ayurveda, Siddha, and Yoga have attracted a lot of people looking for rejuvenation while the mainstream areas offer quality healthcare at affordable rates to those looking for curative care options in our country. States like Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, Maharashtra, New Delhi and others have emerged as

preferred medical tourist destinations. As per statistics given by the India Tourism Statistics 2013, Ministry of Tourism, 2014, around 230,000 patients from all over the world came to India in 2013, with a majority coming from developing and under-developed economies.

Another healthcare report released by FICCI, in collaboration with consultancy firm KPMG, titled, ‘Healthcare: The Neglected GDP Driver’, reveals that the medical travel market in India is set to triple from $2.8 billion in 2014 to $10.6 billion in 2019, registering an increase of 30 per cent annually.

Let’s take a look at the factors driving this segment’s growth in India.

Dr Nandakumar Jairam, Chair, FICCI Health Services Committee and Chairman & Group Medical Director, Columbia Asia Hospitals, informs, “People from different parts of the world are travelling to the country to capitalise on the comparative cost advantage and quality services offered by medical facilities here. Additionally, rising costs of healthcare in the developed world, along with rising disposable income and healthcare awareness among the global population, is forcing patients to explore cheaper options in other countries.”

Reiterating this view, renowned bariatric surgeon, Dr Ramen Goel from Wockhardt Hospital elaborates, “High-end hospitals in India are offering advanced and life savings health services like open transplants, cardio-vascular surgeries, bariatric surgeries, eye treatment, knee/hip surgery, cosmetic surgeries – all under one roof. Among the many Asian countries, India is one of the most preferred destinations for medical treatment. Patients from both the US and the UK travel to India for various types of healthcare treatment and surgery. One of the major reasons for choosing India is the cost factor. India provides

COST OF MEDICAL PROCEDURES: A COMPARATIVE ANALYSIS PROCEDURE COST (USD)

US

THAILAND SINGAPORE MALAYSIA

SOUTH KOREA

INDIA

Heart bypass

1,30,000

11,000

18,500

9,000

31,700

7,000

Heart valve replacement

1,60,000

10,000

12,500

9,000

42,000

9,500

Hip replacement

43,000

12,000

12,000

10,000

10,600

7,020

Knee replacement

40,000

10,000

13,000

8,000

11,800

9,200

Source: “Indian Healthcare Services”, J.P. Morgan, 12 March 14; MSE Monograph 26/ 2013, Medical Tourism in India: Progress, Opportunities and Challenges; “Global Health and Travel”, July-Aug. 13 cited from “Medical Value Travel in India”, KPMG, September 2014

some of the most affordable treatment options for surgery like heart surgery, weight loss surgeries, knee or hip replacement or various orthopaedic treatments and surgery. The doctors in India are highly qualified; many of them have work experience and training in Western countries. Indian doctors are wellknown globally for their research and medical skills.

They understand the requirements of international patients well and treat them appropriately.”

Dr Pradeep Gadge, Consultant Diabetologist, Breach Candy & Seven Hills Hospital, also informs, “The main source market of our medical tourism patients is low GDP countries of Africa and Middle East. India is known mostly for its cost-

India, with its pool of talent, alternate medical therapies and its ability to offer quality healthcare at affordable rates, is well positioned to become a hub for medical value travel

effective medical treatments along with high standards in cardiology, orthopaedics, nephrology, oncology and neurosurgery and we need to bank on this. Also, our country is also known for its alternative treatment options such as Yoga and Ayurveda.”

Varma elucidates further, “On one hand, medical value travel offers huge opportunities for India to provide healthcare services to regions such as SAARC, Africa, Gulf countries, South-East Asian countries due to less developed healthcare infrastructure and low availability of specialists. On the other hand, with its inherent strengths and burgeoning healthcare costs worldwide, India stands a great chance of exporting its healthcare serv-

ices in the form of medical value travel to the patients in developed countries as well.”

The FICCI-KPMG report also mentions that the SAARC countries have been an important source of medical tourists for India.

Physical proximity and similarity in culture, food and language makes India a convenient option for these nations.

Regional cooperation treaties between India and other countries to promote each other as preferred medical tourist destinations have also played significant roles in strengthening India’s position as a sought after destination for medical value travel.

Thus, high quality treatment combined affordable care has aided India’s rise a medical tourist destination.

As per KPMG in India analysis, 2014, “A person coming to India for his/her medical treatment can have savings anywhere in the range of 30 to 70 per cent. Even if we consider the ticket expenses and accommodation expenses along with the treatment cost, the overall expenditure would be lower than the treatment cost in the UK or the US or many other countries.”

India has several benefits in terms of geographical diversity as well, thus travelling for medical care can also be combined with seeing new places and gaining new experiences.

Metamorphosing for progress Thus, it is undeniable that India, with its pool of talent, alternate medical therapies and its ability to offer quality healthcare at comparatively affordable rates, is well positioned to become a leading destination for medical value travel. Looking at the huge oppurtunities available in this sphere, Dr Jairam further predicts, “Indian hospitals are poised to host around 2.4 million medical tourists by 2020 and 4.9 million tourists by 2025.”

Healthcare providers in India have also woken up to the

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MEDICAL TOURISM SPECIAL potential of medical tourism to drive growth. The burgeoning opportunities in this sphere have impelled them to transform themselves and become set ups that offer services that are at par with global standards. Many of them are also accredited with the National Accreditation Board for Hospitals & Healthcare Providers (NABH) and Joint Commission International (JCI). The FICCI-KPMG report on medical value travel reveals that currently there are 21 JCI accredited healthcare facilities in India.

Naresh Kapoor, Director, BLK Super Speciality Hospital, points out, “Healthcare facilities in India are quite aware of quality perceptions of medical tourists, especially those coming from the West and is fully geared up to not only meet the global standards but in many cases set its own global benchmark. Basic healthcare infrastructure and services in India are growing fast and with the support from the government in reducing barriers for tourists visiting the country for medical purposes, further private investment in healthcare will be seen in the coming years.”

Apart from quality healthcare, these set-ups also offer a host of other services such as an interpreter or translator, free Internet access, facility for offering prayer, pick up and drop from the international airport, international cuisine, assitance for Visa and documentation etc to name a few.

Apollo Hospitals, Fortis Healthcare, Aster Medcity, Asian Heart Institute, Medanta – The Medicity, Manipal Hospitals etc are among some of the leading Indian hospitals where people from across the world throng to seek healthcare services that are cutting-edge yet affordable.

India's traditional forms of medicine like include yoga, meditation, ayurveda, allopathy, naturopathy, unani, etc also offers a varied range of medical services and rejuvenation facilities to patients. India

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also has a dedicated department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in India to focus on the development of this segment. DevaayaThe Ayurveda and Nature Cure Centre, Somatheeram Ayurveda Resort, Ananda in the Himalayas, Kairali Ayurvedic Health Village, The Leela, Udaipur, etc. are some of the leading centres for people seeking alternative forms of treatment.

Kerala, Goa, Uttarakhand, Rajasthan etc are some of the leading states in India offering great options in the AYUSH segment.

Initiatives of the government The government has also taken several pivotal steps to make India attractive to medical tourists. Some of the major intitiatives include: ◗ Market development assistance scheme: Fiscal support is offered under the Market Development Assistance Scheme (MDA)46 to medical tourism service providers who are approved by the Ministry of Tourism ◗ Quick clearance and simplified visa procedure: The government has introduced a separate category of medical visa: M-visa for medical tourists. They can be extended for 12 months beyond the one year issue period. A nohindrance-clearance has also been provided at the airports ◗ Tourism circuits: The current government has promised to build 50 tourism cir-

cuits, including a medical circuit whih would connect centres of allopathy and ayurveda ◗ Improving connectivity: The government is creating infrastructure for transport services, especially, air transport and road transport to facilitate medical tourism ◗ Healthcare events: Health expos, medical tourism seminars are being organised regularly in foreign locales to showcase India's offerings in the field of medical tourism

Hurdles to cross Thus, medical value travel segment in India has seen a lot of activity in the past few years. Yet, all's not hunky-dory.

India is only at the third position in Asia when it comes to medical tourism, lagging behind Singapore and Thailand. The industry experts also feel that there are lot of areas where urgent attention is needed to leverage the full potential in this arena.

As Dr Jairam highlights, “In spite of an impressive growth in the Indian medical tourism industry, India attracted only one per cent of global medical tourists in 2012, whereas nearby countries like Singapore, Thailand and Malaysia received around eight per cent.”

Elaborating further, he says, “The Indian medical value travel industry is presently at a nascent stage as compared to its counterparts. It is evident that most of the countries, be it the US, Turkey, Japan or

smaller ones like Jordan, Croatia, Costa Rica, and Malaysia, are extremely organised in promoting themselves for medical travel and are further organising themselves in regions. However, in contrast, India is fragmented in its approach where individual hospitals have been promoting themselves as hospital destinations. Although Indian government is taking steps to deal with infrastructure problems that obstruct medical tourism in India, they further need to increase efficiencies in terms of visa, airport documentation and coordination among various agencies to boost this sector.”

Dr Mohan Thomas, Senior Cosmetic Surgeon, Cosmetic Surgery Institute opines, “India may be losing out on the opportunity to become a hub for medical care due to poor infrastructure, regulatory mechanisms and a mechanism to address patient complaints or discontentment. A long waiting period for adjudication further negates the desire to experience Indian medicine.”

Dr Harish Pillai, CEO, Aster Medcity also shares his concerns and says, “The lack of public policy, adequate uniform infrastructure and policy will cause long-term harm; we should learn from the enormous damage caused internationally to our national brand equity in the pharma sector due to a few unscrupulous players exporting counterfeit drugs. Similarly, there

is a alarming trend of growing dissatisfaction and concerns regarding the trend to over investigate; perform unnecessary procedures; prolong length of stay from a few domestic players. The cost in brand erosion due to short term gain and gold diggers will be catastrophic in a highly competitive market. The best regulatory norm should be self driven by the healthcare stakeholders.”

Varma gives a detailed outline of the areas that need focus and the challenges that need to be tackled to further our progress. He says that to become a leader in medical value travel industry, India needs to overcome the following glitches: ◗ Poor infrastructure: India needs to invest in infrastructure such as road, airport, etc. especially in medical value travel hubs. This is expected to streamline the logistics related to handling medical tourists. ◗ Low coordination among stakeholders: Low coordination between various stakeholders such as hospitals, hotels and airlines is hampering the growth of this sector.

All the stakeholders need to collaborate and bundle their services to patients for a rich experience of medical tourist. ◗ Low transparency in pricing: Hospitals need to increase transparency by providing cost of various surgeries online/on their website.

This is expected to help international patients in choosing the right hospital with the right price. ◗ Low government support: Government needs to support and facilitate medical value travel in India. It can take a cue from Thailand, where the government is promoting medical value travel through online e-marketing campaigns, easy visa policy, support to high technology and it also showcases its medical and wellness treatments to various global news agencies via organising familiarisation tours.

◗ Low PPP models in healthcare: India has very few PPP models in healthcare and it needs to promote PPP models for upgradation and expansion of medical facilities. This is expected to help India in establishing more quality hospitals that can attract more international patients. ◗ Low transparency in role of facilitators: India needs to develop guidelines to streamline the role of facilitators and increase transparency.

KEY PARAMETERS NECESSARY TO ENABLE AND PROMOTE MEDICAL VALUE TRAVEL IN INDIA Parameter

Definition

Metrics

Amenable legal framework

A legal framework refers to the policies that the host country has in place in order to encourage medical tourism; a less restrictive policy is better for international patients seeking medical care

1. Ease in facilitation of visas 2. Lucidity in the regulatory process 3. Stakeholder feedback

Cost effectiveness

This is one of the primary drivers behind people crossing borders for medical care. Healthcare providers need to develop innovative solutions in order to sustain lower cost models

1. Cost per surgery 2. Stakeholder feedback

Quality of healthcare

A major factor behind patients repeatedly visiting a particular country for its services, especially in areas that require advanced medical care and life saving surgeries

1.Availability of skilled doctors/ specialists 2.Availability of nurses 3.Accreditation 4. Stakeholder feedback

Hospitality

Hospitality includes accommodation options, languages similarity, cultural adaptability, and logistics. Other basic infrastructure such as road connectivity and airport can also enhance the medical tourist experience

1. Logistics’support 2.Accommodation 3. Cultural adaptability 4. Number of international airports

Healthcare infrastructure

Infrastructure would include medical infrastructure in terms of hospitals, number of doctors, modern treatment options, etc

1. Number of hospitals 2. Number of doctors 3. Modern treatment options

Beyond allopathy

Availability of alternative treatment options such as ayurveda, yoga and unani etc

1. Number of alternative treatment centres 2. Stakeholder feedback

Government initiatives

The government needs to take appropriate measures in order to promote medical tourism at international platforms and support the industry through investments and liaisons with other countries. It includes online campaigns and other promotion initiatives for the medical tourism industry

1. Number of campaigns/promotions done by government 2. Stakeholder feedback

Macroeconomic factors

Factors that impact medical travel such as political stability, terrorism, pollution, sanitation standards, quality of drinking water, etc

1. Global benchmarking indicators

The way forward So, what are the steps that these experts recommend to tackle these challenges?

Dr Pillai lists down some measures that would help us boost medical tourism. ◗ The quality mantra should be mandatory; it’s time that we emulate models seen in nearby countries like Singapore or UAE, especially Dubai, wherein a quality accreditation is mandatory to establish a practice. The oft repeated excuse of us being a poor country will not do us any good. QCI and NABH is God send for India and all states should build roadmaps to get all public and private centres accredited ◗ Trade bodies and the government incubate a neutral entity to list down minimum criteria and grade hospitals/providers on a matrix score covering quality systems; clinical outcomes; staffing; infrastructure on a model similar to star hotels and publish them annually ◗ Design specific courses to sensitise staff on the specific needs of medical value traveler’s; more healthcare-oriented language courses to be certified and available ◗ Create a GoI and trade body-owned healthcare portal listing all eligible hospitals and access to their websites ◗ Run national campaigns similar to Incredible India hosted by Bollywood star Amir Khan on the need to treat them well ◗ A national task force representing all regions need

SOURCE: ICAI-CMA & PHD CHAMBER KNOWLEDGE STUDY REPORT: Destination India - Evolving Medical and Wellness Tourism Hub

to be constituted by GoI involving ministries of health, commerce, tourism, home and external affairs – call a national workshop that will create a policy document which can eventually become a law ◗ Declare health sector as a priority area and incentivise stakeholders to attract more investment in infrastructure and human resources ◗ Develop a 10-year strategic roadmap, looking at year 2025 to be the consistent leader in medical value travel Dr Goel suggests, “The Indian government needs to promote India as the new emerging medical value travel destination abroad. Private and public hos-

pitals need to synergise their efforts to promote India as the healthcare destination worldwide. The healthcare industry will also have to standardise their processes and make its functioning more transparent and accountable. Indian healthcare sector should ensure that they provide good quality and affordable healthcare to all. For this, there is a need to reduce inequalities, imbalances that exist between regions, cities and villages and different socio-economic groups.”

Promoting medical tourism on digital platforms, encouraging more PPPS, signing MoUs with other countries etc, creation of a Single Consultative Platform (SCP) with a unified

agenda of promoting medical travel, etc are some of the other steps recommended to pave the way for further progress. The government is also mulling the introduction of a new tourism policy which would also focus on promulgating medical tourism. This too would be a positive step as in an exclusive interview to Financial Express Online, Suman Billa, Joint Secretary, Ministry of Tourism, Government of India, informed that they will be creating a Medical Tourism Promotion Board to create synergy between tourism and the healthcare sector. The board will work with the industry to action out a clear gameplan to work upon. The board will

have representations from the Ministry of Health, the medical industry including hospitals, AYUSH as well as from tour operators who deal with medical tourists.

(See: http://www.financialexpress.com /a r t i c l e / l i f e s t y l e /t r a v e l tourism/new-tourism-policy-toset-up-national-tourism-authority-and-medical-tourism-promotion-board-2/81751/) If these measures are implemented effectively and monitored to ensure constant quality, India would definitely be able to ensure a better travel experience to medical tourists and rise about its competition to become the top player in this segment. lakshmipriya.nair@expressindia.com

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MEDICAL TOURISM SPECIAL INSIGHT

Hospital care:

PK MOHAN KUMAR MD & CEO, Comfort Healthcare and Tourism

Cue from hospitality PK Mohan Kumar, MD & CEO, Comfort Healthcare and Tourism, explains the trend of integrating the values of the hospitality industry into hospitals to enrich patient experience, in the backdrop of rising medical tourism and India's growing importance as a destination for medical value travel

WHAT DOES it take to match up to world class standards within hospitals in India?

At a time when healthcare is seen as potential business opportunity and many domestic and international brands or either consolidating or investing into smart hospitals, among the challenges are meeting rising expectations in terms of sensitive patient care, strengthening non-medical aspects of facility and service, integral to a seamless hospital experience.

It is becoming increasingly evident that Indian doctors or medical care are comparable to the best in the world. Many of the specialists are trained overseas and have international experience in the best of hospitals and clinics in the US or Europe. Coupled with this intellectual and highly skilled assets, is the fact that India is an affordable healthcare destination as compared to the West. The success rate and the ease with which admissions are recorded (with less waiting period) is again a testimony to our potential for becoming the most attractive medical tourism destination.

However, in order to make India a sustainable healthcare destination, this new emerging sector with its huge learning curve so far as the posi-

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tioning and management of brand, service deliverables have to be leveraged.

Recent trends clearly indi-

cate an increasing awareness to identify, understand and adopt many facets of the hospital industry vis-Ă -vis the

brand standard, managing customer expectations with a sharp focus on non-medical logistics, facility up-keep and

customised service. Herein comes the challenge for the companies and leadership teams of branded hospitals on

MEDICAL TOURISM SPECIAL how to structure and develop a concierge team with the required competency, skill, attitude while inculcating a patient/escort friendly work culture. Hospitals need to reposition themselves reflecting extreme sensitivity, efficiency to deliver sustainable service time and again. The patients and their families coming in contact at all the frontline touch points must experience positive moment of truth at all times.

On a broader framework, the transformation is all about focusing on experience and perception created the minds of end user from the interaction with the frontline staff.

Therefore, it is extremely important and critical that the brand promise, image is always at the back of

the mind of each and every associate while dealing with every query or interaction with the end user. A broad range of customer and frontline associate engagements occur during the time of reservation and the subsequent processes involving finalisation of non-medical logistics and support facilities. Subconscious evaluation and assessment goes on while the patient/family completes all the formalities, even long before the actual arrival of the patient. Similar to a hotel, checking into a hospital also needs to be managed by a preplanned and seamless process. This could be in the case of appointment with physician/surgeon or arrival and registration formalities.

The frontline team at the hos-

pital needs to be sensitised to handle these early arrival and settling experiences very professionally albeit a hotel reception and escort to the room.

Technology and property management software that monitors and manages every activity in a hotel be it in front of the house, heart of the house or the back of the house need to be positioned in a hospital to facilitate smooth access to medical records, faster treatment process etc.

The talk line between nonmedical concierge team and the patient’s family has to be streamlined process driven to ensure communication. In a hospital environment standard protocol in terms of communication be it on purely medical aspect or non-med-

ical guideline, rules governing safety and security have to be on similar lines as how it has been done in a premium hotel.

The overall organisational culture is tuned towards providing “total care and seamless flawless care experience to the patients and their family in terms of basics (hygiene, safety, security, food etc.) as also out of the way requests and emergency situation” One of the redeeming features of world class service is the ability of the staff to go beyond call of the duty and travel their extra mile to accommodate unexpected but doable little things that matter. Customer research clearly indicates that it is always the little things and warmth and the positive attitude of the down the line touch point

staff that creates the impact and generate an everlasting affinity towards the instruction and the brand. Hospitals in India have a great opportunity to wake up to this reality and seriously look at outsourcing to specialists in the hospitality space who could come on board as specialised concierge vertical providing solid support to the medical team. In today’s time and age, business is all about focusing on your core competence and outsourcing the support services to competent specialists.

At the end of the day, medical expertise and infrastructure for treatment being more or less similar given the access to knowledge and technology, it is the service and the experience that matters to differentiate brands.

PRE EVENT

NewDelhi to host Advantage Health Care - India 2015 in October To promote India as a premier global healthcare destination INDIA IS emerging as a preferred healthcare destination for patients across the globe.

Growing at a compounded annual growth rate (CAGR) of 27 per cent, the inflow of medical tourists in India is likely to cross 3.2 million in 2015.

‘Advantage Health Care India 2015’ aims to showcase India and its immense pool of medical capabilities as well as create opportunities for healthcare collaborations between the participating countries.

Slated to be held from October 5-7, 2015, in New Delhi, the objective of this summit is to promote India as a premier global healthcare destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration

of the ‘5 – Ts’ - talent, tradition, technology, tourism and trade.

The event features are: ◗ Reportedly, first ever international summit on medical value travel being organised in India for promoting services exports from India ◗ Exhibition with focus on hospitals, healthcare centres, AYUSH hospitals, educational institutions, medical devices and electronics, pharma companies, pharma machinery and packaging, and associated infrastructure – medical tourism facilitators, hotels, airlines, tour and travel companies and TPAs ◗ Present and promote exclusive medical services and expertise

◗ Opportunity for state governments to showcase their healthcare and wellness industry ◗ Provide excellent brand visibility to the exhibitors ◗ Knowledge sharing programme where renowned Indian doctors and AYUSH experts will deliver lectures on different topics ◗ International conference on medical value travel ◗ Reverse Buyer Seller Meeting and planned B-2-B sessions with hosted buyers from more than 60 countries ◗ Visitors and hosted buyer delegations from 60 countries ◗ Organised hospital visits by state governments for the visiting foreign delegations to provide exposure of the Indian hospital infrastructure

◗ Health Ministers’ round table session, with Health Ministers invited from the selected 60 countries to discuss issues encompassing medical value travel and formulating a way forward. ◗ Indian healthcare providers and global healthcare stakeholders on one platform ◗ B2B meetings and tie-ups with hospitals and healthcare centres ◗ Showcase medical devices sector - opportunity to encourage foreign companies to start manufacturing in India with local partners ◗ Showcase pharma sector bulk drug manufacturers, pharma machinery and packaging industry strengths for the opportunity to tie up with pharma manufacturers

for JVs, services exports and export of machinery ◗ Showcase training capabilities of India in medical, pharma and nursing sector. Engage with international partners for imparting training courses and short education programmes ◗ Training and development of programmes for allied medical staff through Indian medical universities and skill development missions ◗ Opportunity to get into business tie up for clinical research and trials ◗ Establish global business contacts and connects ◗ Sign business cooperation agreements with international stakeholders sending patients to India.

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SRMC International Patients Care and Services The hospital provides the best services while consciously meeting the expectations of patients SRI RAMACHANDRA Medical Centre (SRMC) is a tertiary care multispecialty university hospital. The medical centre was founded in 1985 with the intention of translating the experience and expertise in medical education into tangible and affordable health care practices suitable for the community.

SRMC is located in Porur, Chennai, right at the intersection of the busy Chennai-Bangalore Expressway and the Chinglepet Chennai toll way. It is 8 km from the international airport and 12 km from the city.

It is easily accessible with good roads and a slew of public transport options.

Mission ◗ Sri Ramachandra Medical Centre will actively promote and preserve the higher values and ethics in education, healthcare and research and will pursue excellence in all these areas while consciously meeting the expectations of the people it serves without prejudice and in all fairness stay socially meaningful in its propagation of the various arts and sciences to enrich humanity at large.

Vision: International Patients Care and Services Department International patients care and services department aims to provide quality care and valuable health services at reasonable cost.

Objectives: ◗ Quality care to patients ◗ Increase flow of patients ◗ 100 per cent patient satisfaction ◗ Identify potential areas and maintain possitive relations with

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external bodies

but within the hospital campus. ◗ IPCS department is available to meet and coordinate other needs like arranging interpreters, accommodation for the companion, assistance in shopping, currency exchange etc. A trained medical assistant can also be provided to take care of the patient during and after the treatment until full recovery.

Inpatient facilities ◗ SRMC is the largest single healthcare facility in Chennai in the private sector with 953 inpatient rooms. Rooms are designed aesthetically and with particular emphasis on patient safety and privacy. Elegantly designed suites and deluxe rooms adorn the seventh floor overlooking the scenic campus and are available for patients who value luxury. Budget accommodation ranges from shared cubicles to single rooms all under one roof. ◗ Cardiology and interventional cardiology; paediatric cardiac surgery; cardiothoracic and cardiovascular surgery; orthopaedic surgery and joint replacement surgery. ◗ Spinal surgery; arthroscopy and minimally invasive surgery; neurology and neuroradiology, neuro surgery; nephrology and renal transplantation; urology; cleft lip, palate and craniofacial surgery; interventional radiology; infertility and reproductive medicine; ENT surgery and gastroenterology, besides preventive master healthcare programme executive healthcare programme

IPCS This centre is headed by the Dr Balaji Singh, Chairman with an excellent team of an executive, Jetty Thampi, Coordinator/ Translator, Murganantham, office assistant and secretary. The hospital have catered to almost 10000 patients as out patient and inpatient since 2008.

Services offered ◗ Trained specialists: A large percentage of SRMC doctors

Testimonials Tina Dovellos (US) and surgeons have been educated, trained or have worked in leading medical institutions around the globe including the US, UK and other countries in Europe. Their commitment to providing top class medical care has won several national and international awards and recognitions. ◗ New age equipment: State-ofthe-art equipment (manufactured by world leaders like GE, Toshiba, Medtronic, Philips, Siemens etc) for all diagnostic and therapeutic procedures is available under one roof at the medical centre adding to the efficiency of diagnosis and treatment and also adding to patient comfort and convenience. ◗ Estimations and visa invitations: Complimentary medical opinions and treatment estimates are provided against medical reports provided to SRMC. ◗ Price value equation: Advanced western technology at Asian prices is what one gets at Sri Ramachandra Medical Centre. The total cost of the treatment at Sri Ramachandra Medical Centre and all other expenses including travel is significantly lower than for similar services in the US, the UK, Eu-

ropean countries or even competitors in India without compromising the quality of treatment or the standards of facilities. ◗ No waiting period: There is no waiting period for treatment at Sri Ramachandra Medical Centre. The international patient services department ensures that appointments for consultation and surgeries are confirmed even before they leave the country. Also, the ready availability of a large pool of specialists across several medical disciplines assures immediate access to top consultants. ◗ Excellent patient-care facilities: Cutting-edge medical treatment and services apart, Sri Ramachandra Medical Centre also goes out of its way in making sure that the patients have a comfortable and hassle free stay.

Airconditioned private rooms with attached washrooms, cable televisions, beds for companions, room service, laundry service etc add to the convenience. Free high speed WiFi is also available for international patients to communicate with their kith and kin. ◗ Guest house: There is a provision for in-house guest house, serviced apartments for patient and companion’s stay outside,

Warmth and professionalism, comfort and care. What more can any one ask for?

Saleh Shaibany (Oman) Good service, polite doctors and very hardworking nurses. The hospital is at a very quiet place which is good for patient recovery. It has a good, serene surrounding.

Dr Bryco Angelo (France) Very interesting hospital with high technical performance.

Very reassuring for patients.

Thanks a lot to the doctors for their visits and help.

Udesh I W Seneviveka (Sri Lanka) The service rendered by the staff is exceptional. All in all, it is an excellent service and I will never hesitate to recommend SRMC for any of my relatives and friends.

Issa Saif (Iraq) We would like to congragulate SRMC for a good service. Everyone has been just fantastic including the doctors, nurses, international department and all other non-medical staff. SRMC will always be in our hearts.

Again, thank you so much.

MEDICAL TOURISM SPECIAL VALUE ADD

Treating Morbid Adherent Placenta Previa successfully A case study of an elderly patient with IVF induced twin pregnancy who survived a concurrent aberrant placenta previa and morbid adherent placenta induced massive bleeding by coordinated team approach at Satguru Partap Singh (SPS) Hospital, Ludhiana

PREGNANCY IN ELDERLY patients is always associated with more risk because most of them have had artificial methods of conception with a physiology which barely supports the dynamics of child birth.

Placenta previa which means placenta at the outlet of uterus and morbid adherent placenta are two other conditions which are considered to be associated with significantly high complication rates independently.

Morbid Adherent Placenta Previa (MAPP) - when both the conditions of placenta occur together is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, it is highly recommended that all such cases should be managed in properly equipped centres. Calling for extra help early should be encouraged and not seen as ‘losing face’. Uterine artery embolisation (UAE) has been a beneficial alternative procedure for the treatment of postpartum haemorrhage. Prophylactic arterial catheterisation before delivery and, if necessary, selective embolisation are effective ways to stop bleeding.

Report This is the case of an elderly mother who had a surge of desire to have more babies.

Since in vitro fertilisation is available in many centres now she chose a centre and conceived twins after multiple attempts. But nature did not support her fully. As her pregnancy progressed she was de-

tected with a morbid adherent placenta praevia, which meant that her placenta was lying right at the outlet of her uterus and was tightly embedded and would not separate after the delivery causing fatal bleeding.

She was told about the consequences of the complication and was referred to SPS Hospital, Ludhiana for management.

The medical team at the hospital knew about the nature of disease interfering with the childbirth and have had the experience of similar cases which needed skill, speed and superspeciality teamwork.

It was decided to deliver her babies in the peak working hours to avoid emergency situation after discussing the case and deciding the management protocol in the team.

She was delivered with full blood and blood component back up using modified caesarian section technique to avoid injury and handle anticipated bleeding.

Babies were quickly handed over to paediatrician and were resuscitated easily, the mother nevertheless started bleeding torrentially. All surgical ma-

noeuvres like buttressing sutures, packs were applied, but in vain. The uterus could not be removed because whole disease was in lower segment.

This was the time for anesthesia team to apply their skills to allow the patient sufficient time for intervention by other teams. Massive transfusion was started and the interventional radiologist who was kept as a back up informed every progress. The patient was immediately shifted to the cath lab with blood transfusion on and active bleeding happening.

Percutaneous access to both sided uterine branches of pelvic vessels were embolised within minutes. The blood pressure which was barely kept pumping with support stabilised, the pulse started beating again.

The urine started pouring, the bleeding stopped and the vital parameters normalised and all this happened within a period of two to three hours.

The anesthesia team had informed a stable situation by now. The patient was awake and was witnessing the whole procedure barring some minutes when her vitals were low

and she was half conscious.

She was allowed full diet the next morning and was declared ready for discharge along with her babies after four days. The family was anxious and had a question to ask. The doctor nevertheless told them that her reproductive organs were fully functional and her fertility is still maintained and she could conceive if she desires to do so.

Postpartum haemorrhage is the most serious complication encountered by obstetricians during routine patient care and is the leading cause of severe maternal morbidity and death.

The incidence of maternal mortality due to postpartum bleeding varies in countries. In developing countries, the incidence of maternal mortality is approximately one in 1,000 deliveries, whereas in developed countries, the incidence is only around one in 10,0000 deliveries. This large difference in maternal mortality is primarily attributed to country-specific differences in management capacity. Recommended procedures for management of postpartum haemorrhage have been well published. The first

step in common management of postpartum haemorrhage is the use of uterine stimulants (uterotonics) such as oxytocin, ergot derivatives, prostaglandins and misoprostol, and bimanual compression of the uterus. Recommended operative procedures for the management of postpartum haemorrhage include surgical repair of lower genital tract lacerations, uterine hypogastric artery ligation and hysterectomy.

More recently, the relative benefits of uterine artery embolisation (UAE) versus cesarean hysterectomy (CH) have been debated. Uterine artery embolisation has been practiced over more than 20 years for controlling haemorrhage following delivery/abortion, in ectopic or cervical pregnancy, gestational trophoblastic disease or carcinoma cervix.

The technique was first reported as an effective intervention for fibroids in 1995, when Ravina et al noted that several women with symptomatic leiomyomata who underwent UAE as a pre-hysterectomy treatment had significant clinical improvement to an extent that hysterectomy was no longer required.

UAE is generally accepted to be a safe and reliable procedure. If a patient is generally stable or the bleeding is anticipated and interventional radiologist is present, UAE is a safe first-line treatment for postpartum bleeding.

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A ray of hope Dharamshila Cancer Hospital and Research Centre,Vasundhara Enclave, New Delhi presents a case study of successful haploidentical (half matched) family donor stem cell transplantation in a patient with anti-donor antibodies: mix and match in the family

AN 18-MONTH-OLD child was diagnosed with acute myeloid leukaemia with abnormal cytogenetics. She was treated with standard induction chemotherapy, but failed to achieve a complete remission (CR). Further, high dose chemotherapy also did not produce a complete remission. In addition, she was found to be refractory to platelet transfusions due to high titre of anti-HLA antibodies (> 10,000 MFI). She was the only child and there were no suitable HLA matched unrelated donors in volunteer unrelated donor registries. Two cord blood units were 4/6 HLA matched with the patient, but the patient had antiHLA antibodies against the mismatched HLA antigens. In fact she had the same against her own parents as well.

Although bone marrow transplantation (BMT) was the only option for the child, there were no matched donors within the family or in VUD registries.

BMT from mismatched unrelated cord blood units was not possible due to anti-HLA antibodies. Haploidentical (half matched) family donor transplantation is considered as an option in such situations. However, the patient had anti-HLA antibodies directed against parental HLA antigens as well.

Graft from haploidentical family donors in patients with such high titre of anti-HLA antibodies invariably results in failure.

Treatment to reduce the antibody levels was not successful either.

Options were extremely limited in this case. Further, chemotherapy with high dose cytarabine and cladrabine resulted in reduction in the burden of leukaemia, but it was

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The 18-monthold girl child was free from leukaemia with 99 per cent donor cells at an assessment at 30 days

very clear that a cure was not possible with chemotherapy alone. Innovation was the need of the hour. The team of BMT physcians at the Dharamshila hospital, Dr Sarita Jaiswal and Dr Suparno Chakrabarti decided that the uncle of the child can be the donor, who was HLA-

matched with the father of the child, despite high levels of antidonor antibodies. Peripheral Blood Stem Cells (PBSC) collected from the uncle were depleted of T and B cells and only CD34+ stem cells were infused at very high numbers, after conditioning with high dose chemotherapy. Two weeks later there was no sign of engraftment. The child was extremely sick with gram negative sepsis and the bacteria isolated was resistant to carbapenems. The only thing that kept the child going was regular granulocyte infusions from the relatives.

Despite the apparent setback, the result was anticipated by the doctors and one of the reasons for using the uncle as a donor and not the father was clear when the HLA antibodies against the HLA antigens against the father were no longer detected. High dose of CD34 cells from the uncle had mopped up the antibodies. Stem cells from the father were infused to the child after minimum amount of conditioning.

The graft from the father started working after 10 days and the child was free from leukemia with 99 per cent donor cells at an assessment at 30 days.

Haploidentical BMT is the only resort for patients without a fully HLA matched donor.

Yet, many patients who are transfused with blood products which are not leucodepleted can develop clinically significant HLA antibodies. BMT from these donors is bound to fail in these circumstances. Yet, this unique and innovative approach using a double transplant approach might be useful in selective cases.

MEDICAL TOURISM SPECIAL VALUE ADD

HBG Medical Assistance Pioneering the distribution model for medical assistance business

“THIS INDUSTRY needs a distribution model,” says Abhik Moitra, the man behind HBG Medical Assistance, a five-yearold company, which has undoubtedly become one of the most famous medical travel and medical assistance companies of India. His passion for his work comes through very clearly while he speaks about the future of the medical tourism industry in India.

Moitra says, “ If you see industries like FMCG or consumer durables, their whole business is dependent on how fast they can reach to the consumer. From a factory in Himachal Pradesh to a household in Chennai, FMCG companies have built a successful distribution model. They work through the clearing and forwarding agents to distributors from distributors to retailers and retailers to consumers, in a most effective way.”

The question, however, remains that is it possible to do so within the medical tourism industry? Can we create similar chain in the medical tourism industry? Moitra, having a background in FMCG and banking, is confident and says that it is possible. “We at HBG have done it,” he answers affirmatively. “We have created country-specific distribution for our services and we have well defined their roles. The model has big advantages; It helps us to connect better with our retailers, namely those people who connect with patients more often than us. It helps us to communicate better with these referral points and thus derive better business from them,” says Moitra The obvious question that pops up is whether this model is relevant to hospitals for which each and every referral

Abhik Moitra, Co-Founder HBG Medical Assistance

Nandita Gupta, Co-Founder HBG Medical Assistance

point is important? How secure is their business, if hospitals stop looking into the markets directly and remain dependent on a distributor to do the job?

Moitra answers, “It is not a matter of mere dependence. It is a practice of making your distribution chain work. Making them do what you do and making them do in a much larger fashion, simply because their reach will be much larger. We are not saying that hospitals should stop promoting themselves, but rather should do it through the distribution chain.”

When a hospital personnel visits another country, he may only have limited number of days with him. He may still need to do follow ups with potential clients but that may happen only after weeks or months when he returns. Instead, he can make his distributors do the follow ups. Thus,

each doctor to compare. We will provide them with those choices under one roof, thereby extending the distribution concept. As we will have access to a strong distribution set up already, the hospitals will be left with the only effort of using our already created network.”

Gupta continues, “Currently, we are promoting all major brands and at the same time we are competing with them directly. We are also competing with other medical travel companies and companies promoting other destinations. With distribution model in place, our focus will change towards adding value to the consumers travelling. We will stop competing directly with hospital brands that we promote, instead we will focus more on acquiring more business for us and for the hospital brands.”

he will be building business for himself and also for his distributin partner. The hospital personnel can work on strategic relationships, look into marketing initiatives and instead spend time in managing the existing relationships and continue to create more retail presence.

Thereby he, will be maximising the returns from his visit, minimise costs and create a deeper brand presence.

When asked on what will be the role of companies like HBG in this larger distribution game, Nandita Gupta, Co-Founder HBG Medical Assistance says, “We will play the role of ‘A Shoppers Stop’ or ‘A Home Store”. Today’s consumers wants choices. They may not want just to take opinion from one hospital and travel. They want to understand the strengths of each hospital and

Moitra adds.” Currently, as the hospitals scout for new referral points, they lose focus from the old and the strong ones. As these strong ones are those which are wanted by most of other hospital brands, with less importance given to them, they are lured to the next hospital. Thus, even if a hospital may be getting new partners to work with, with the loss of old partners, the growth rate of business remains retarded.”

Gupta, on being asked on how practical this is to implement, says, “HBG is known for creating trends. It has been contributing a lot to the industry by providing consumer insights, geographical knowledge and more importantly trained manpower. We are sure, that in days to come, the industry will understand the importance of organising itself. The change has already begun.”

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Advanced micro neurosurgery to the rescue Kovai Medical Center and Hospital, Coimbatore presents case studies where advancements in neurosurgery helped relieve patients suffering from defective vision due to optic nerve compression WITH RECENT development of advanced technology in the field of neurosurgery, challenges in the management of defective vision due to optic nerve compression can be easily overcomed to cure the disease.

Two such case studies are given below: Case Study 1 A 35-year old female from Ethiopia contracted a rare disease known as Idiopathic Intra cranial Hypertension with worsening vision. As its name suggests, its cause is usually obscure and difficult to diagnose. The management of the disease is also complex.

She faced difficulties in getting the problem treated properly in Ethiopia, however good destiny brought her to Kovai Medical Center and Hospital, Coimbatore, one of the largest superspeciality hospitals in India. She started treatment under Dr JKBC Parthiban, Senior Consultant Neurosurgeon. After evaluation, it came to light that both optic nerves need to be decompressed from the increased cerebro spinal fluid pressure that had built in her brain over a period of time.

Through a unique surgical procedure that cut open the orbit's lateral wall, the sheath covering the optic nerves were incised and the cerebrospinal fluid was let out in both sides in a single operative sitting. The procedure is called lateral orbitotomy and optic sheath fenestration. The

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Dr JKBC Parthiban, Senior Consultant Neurosurgeon, Kovai Medical Center and Hospital

headache that affected the patient disappeared in the immediate post-operative period and patient could see better with both eyes at the time of discharge. This surgery is challenging since it was carried out on both eyes at the same time. Microsurgical techniques and soft tissue handling are the cardinal rules for safe surgery and better outcome.

Case study 2 Another case is that of a 70year old male from Ethiopia, who also suffered from worsening vision combined with psychiatric disturbance as his

Kovai Medical Center and Hospital is a teaching centre for neurosurgery in India and has advanced technologies for neurosurgery

disease was a tumour of the pituitary gland, the master gland of the human body. He was symptomatic since nine months, and was evaluated and diagnosed with giant pituitary adenoma. He was operated at Ethiopia through the nostrils but with no significant recovery. He came to Kovai Medical Center and Hospital, Coimbatore, India for treatment and under Dr Parthiban, was reevaluated, wherein it was found that he had a huge tumor causing compression of optic apparatus. He underwent craniotomy and tumour excision with special

focus on optic apparatus decompression. As expected, his vision improved and his psychiatric disturbance also lessened.

Kovai Medical Center and Hospital, Coimbatore is now a teaching centre for neurosurgery in India and has advanced technologies in the Department of Neurosurgery.

The latest Pentero 900 microscope helps in excising the brain tumours to near total with its fluroscent dye technology by illuminating the tumour cells. Micro neurosurgery is essential in dealing with such extremely challenging cases.

MEDICAL TOURISM SPECIAL VALUE ADD

Manage your lifestyle with preventive healthcare PSRI Hospital has established a full fledged department of preventive healthcare and lifestyle diseases THE WORK culture as well as the environment impact our health greatly. Stressful working conditions, polluted air we inhale and chemically treated food we consume are showing up in the form of certain diseases labelled aptly as ‘lifestyle diseases’. They are diabetes, hypertension, obesity, hyperlipidermia, ischemic heart disease and fatty liver disease. All of them carry tremendous morbidity which burdens the patients and their families with huge medical costs. Preventing them and promoting healthy living standards are accepted as the most important steps in stymieing this trend, yet few hospitals have taken up the task seriously. PSRI Hospital has taken up this initiative of establishing a full fledged department of preventive healthcare and lifestyle diseases.

We have all the materialistic goods for our pleasure and recreation like TV, car, washing machine, refrigerator. All these come with a maintenance manual. They are supposed to last

SPINE: THE BACKBONE Spine or the backbone is the main pillar of our body,which is essential to support and function of our upper limbs (hands for a layman) and lower limbs.

For better understanding,it is as essential to our body as the strong concrete and iron pillar for a strong and durable building.

But in the present scenario with a

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for a few years. Yet each of them comes with an instruction note that tells you how to handle it. As a human body, we do not have any maintenance manual. You work in your office for eight to 10 hours. You sleep in your bedroom for six to seven hours, in your drawing room for one to two hours but still you take care to maintain and beautify the above places where you reside only for a few hours. Every 24 hours, an adult heart expands and contracts 100 thousand times pumping about 2000 gallons of blood through the body’s 60,000 miles of arteries and brains.

Do you take care of your human body to the extent you look after the place where you reside for only a few hours?

People visit healthcare providers only when they fall sick or injured but they also need to visit the physician when they are well for a preventive health check up. A majority of costly and disabling conditions can be prevented with proper interven-

stressful and restless life,it has to bear a lot of stress,wear and tear,jerks, which also affects ageing.

Apart from these,our body may suffer from a lot of other conditions such as neck pain,back pain especially low back with or without radicular pain (as sciatica in the lower limbs),fractures of the spine with or without spinal cord injury,inflammatory arthropathies (as rheumatoid arthritis,ankylosing spondylitis etc.),infection (TB etc), various types of spinal tumours, various types of spine deformities as scoliosis (s shaped spine),kyphosis (kubar in layman),kyphoscoliosis and

Dr Rakesh Tandon, Medical Director & Head of Gastroenterology, PSRI Hospital

tion and many of their complications can be avoided or at least delayed.

Who should have preventive health check up? ◗ Family history of hypertension ◗ Obesity ◗ Smoker ◗ Alcohol abuse ◗ Family history of diabetes ◗ Family history of premature cardio vascular disease. ◗People who become angry, hostile. ◗ Family history of cancer PSRI Hospital has created a preventive health programme

Dr Amit Narayan, ASSI Spine Surgeon, MNAMS, Ortho & Spine Consultant, PSRI Hospital spondylolisyhesis etc.

In the spine,both bone and soft tissues like disc etc.are important for

Dr Anil Chaturvedi, Senior Consultant Disease & Life Style PSRI Hospital

towards achieving balanced excellence in physical, intellectual, emotional, material, social and spiritual well being of an individual. The PHC programme has been designed to cater to the needs of every segment of the society.

Preventive strategies for healthy life ◗ Quit smoking ◗ Eating five servings fruits and vegetables daily ◗ Eat 30-50 gms nuts per day ◗ Know your numbers: checking and remembering the results of blood pressure, blood sugar, to-

harmonious biomechanics.As bone gives strength,disc acts as a shock absorber and maintains the balance of the body.But our body can suffer from disc prolapse (PIVD) and canal stenosis as lumbar canal stenosis (LCS) due to various causes.

These problems may affect our dayto-day activities,our quality of life and may lead to depression in many people.You can face difficulty in walking,tiredness in buttocks and legs,pain in lower limbs and in a few cases involvement of bladder and bowel also known as cauda equina syndrome.

tal cholesterol and HDL levels are more important than you realise. Approximately one-third of the general population do not know their numbers another third do, but then do not know the specific numbers. Only a third find out and remember these values as well as what they mean.

Please do remember, prevention is better than cure, prevention is the medical miracle of 21st century.

PSRI has set up many healthcare check-up packages for early detection of lifestyle diseases and advising appropriate timely interventions. To complement these preventive healthcare efforts, PSRI has already in place an integrated system of counselling for diabetes, obesity, heart diseases and gastrointestinal diseases. Psychological counselling and dietary advice are additional features.

A comprehensive management of obesity, including liposuction and bariatric surgery is also available at the hospital.

Management of all of these problems is not very difficult in the present era.

If such problems persist,one should consult a good spine surgeon and discuss all yours problems in detail.

Most of the problems can be managed conservatively with the help of life style changes,some physiotherapy and if required,medication.

Though treatment may be lengthy and in many cases surgical intervention is required,then one should go for it.

In the 21st century,people are scared of spine surgeries,but in expert hands, they are safe and give fruitful results.

IT@HEALTHCARE INSIGHT

Is the connected healthcare industry safe enough?

BRENTON SMITH VP & General Manager, Dell Software Group, APJ

Brenton Smith, VP & General Manager, Dell Software Group, APJ highlights the risks to data security in healthcare and recommends measures to mitigate them

TODAY, WE function in a highly connected world and there is no vertical that is left untouched by technology. Look at the healthcare sector. Healthcare is a key area where technology can potentially innovate monitoring, diagnostics and delivery of treatment at every step. With increasing Internet of Things (IoT) proliferation, it has become exceptionally easy to remotely monitor a patient’s health with the use of network of sensors, actuators and other internet connected medical equipment. In fact, we will soon have smart beds that will inform other devices about a patient’s movements, or medicine bottles that will alert the patient when a daily dose has been missed.

While we talk about connected medical equipment, another benefit that it offers doctors is allowing them to monitor patient’s vital readings and reports without having to visit him personally, thus giving the patient and his family their own space. Usually we dread staying in the hospital but with such technological developments occurring in the healthcare sector, doctors can stay vigilant of their patient’s developments and also provide the best possible care.

Medical equipment connects to a central station by sending out data using the IP address built into its software, enabling devices to be added on to the hospital network. This essentially means that the hospital has put the device online. By doing so, there are many bene-

IT managers need to look at security from a holistic perspective. While looking at deploying solutions to protect the corporate network, it is always advisable to go for a connected security infrastructure as this is where all of the individual security solutions are able to communicate with others which are deployed

fits that can be achieved, such as cutting down the amount of time a duty nurse needs to spend with each patient, to being immediately alerted if a patient requires urgent attention (such as when any administered intravenous fluid is running low, for example).

If handled carefully, connected medical devices are extremely beneficial and safe, however, healthcare professionals are still uncertain of the

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IT@HEALTHCARE safety aspect of these devices.

Customers across sectors such as education, healthcare, energy, etc. have stated the potential risks that connected infrastructures bring along with benefits, such as a 100 per cent increase in attacks in SCADA Networks. Having said that, there are also solutions available to keep these networks safe thereby ensuring patients’ well-being.

Let’s take an example of diabetic patients. Doctors and nurses continually need to monitor patient’s insulin levels to ensure that they are within the ‘safezone’. Traditionally, teams in medical wards have to manually check the levels with each individual patient, however, with connected equipment, nurses can monitor all patients from afar- confident that the data they are receiving is accurate, allowing them to quickly respond to any alerts that may be raised on their system.

For networks to keep safe from any potential threat, it becomes imperative for companies to work with a trusted security vendor who understands their business completely. There are many security vendors in the market place that offer solutions which can protect individual areas of the network, however, often, these solutions cannot communicate with others deployed across the network, potentially leaving certain areas of the network unprotected.

IT managers need to look

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at security from a holistic perspective. While looking at deploying solutions to protect the corporate network, it is always advisable to go for a connected security infrastructure as this is where all of the individual security solutions are able to communicate with others which are deployed.

When these solutions are allowed to communicate, the

IT team can stay assured of network protection from a variety of malicious threats.

Next Generation Firewall (NGFW) is a fitting solution for such requirements as it majorly helps in blocking latent threats, ensuring hospital network is safe and patients are well protected too.

Imagine a scenario where hospitals were to implement

connected medical devices without deploying proper network safety solutions. Nowadays, it is easy for hackers to attack hospital networks than you and I can imagine. If these cyber-criminals get access to the network, some of the dangerous consequences that can occur are tampering with settings, silence notifications and even switch machines off. Along with

this, there also needs to be effective management of privileged access on a remote level.

The system needs to ensure that third party engineers managing pieces of equipment (such as MRI scanners) are controlled through the gateway and don’t have access to patients’ files.

For instance, Sakra World Hospitals wanted to deploy a scalable, cost-effective IT platform with built-in data protection to support its stateof-the art facilities and safeguard the data. They decided to deploy an end-to-end IT solution comprising of PowerEdge servers, PowerVault storage, and NetVault Backup software which enabled clinicians at the hospital to work with a comprehensive IT system where they had fast, robust and seamless wired and wireless access to data at all times. The hospital was also able to ensure data safety with quick and reliable daily and weekly backups. In fact, since going live, the hospital has been delivering information-driven healthcare at low cost in a secure environment.

In a sensitive sector such as healthcare, it is highly crucial for each link to be secured against delay, disruption, and data loss. Initially, security was considered as an additional layer of technology but with cyber-crimes getting alarming day by day, it has now become an essential aspect of any technological deployment regardless of the industry.

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LIFE PEOPLE

Dr KK Aggarwal receives Vishva Hindi Samman Receives the award from Home Minister Rajnath Singh at the 10th Vishva Hindi Samelan hosted by the Ministry of External Affairs, Government of India in Bhopal

RECOGNISING HIS contribution in the field of modern scientific and medical writing, the Ministry of External Affairs – Government of India conferred the Vishva Hindi Samman to Dr KK Aggarwal. The award was given to Dr Aggarwal at the ongoing 10th Vishva Hindi Samelan in Bhopal for his book Alloveda by the Home Minister, Rajnath Singh.

Others present on the dais included Dr Harshvardhan, Minister of Science & Technology and Earth Sciences, Govt of India; Shivraj Chouhan, Chief Minister of MP; Mohan Lal Khattar – Chief Minister of Haryana; Raman Singh, Chief Minister of Chhattisgarh; Mridula Singha – Governor of Goa; Keshari Nath Tripathi, Governor of West Bengal; General VK Singh – Minister of

State for External; Anil Wadhwa, Secretary East MEA; Leela Devi, Minister of Social Security Mauritius and Anil Mahav Dave, MP, Alok Sanjar, MP A consultant cardiologist, President of Heart Care Foundation of India and the Honorary Secretary General of the Indian Medical Association, Dr Aggarwal has worked extensively towards explaining Vedic medicine in a scientific manner. He has also played an active role in streamlining the procedure of handling medical negligence cases and creating guidelines that all doctors must follow through his books and writings.

He is also the MD of the IJCP Group of Medical Communications through which he has contributed immensely in the field of medical scientific writing. Dr Aggarwal also works tirelessly

for the upliftment of the lower sections of the society with the basic belief that every person irrespective of their gender, caste or social standing deserves proper medical care.

Dr Aggarwal is the recipient of three other national awards namely the Padma Shri, Dr B C Roy National Award and National Science Communication Award. He is also a Limca book of World Record holder for the maximum people trained in the life-saving technique of hands only CPR. Commenting on the occasion, Dr KK Aggarwal said, “I am honoured to receive such a prestigious award from the Ministry of External Affairs, Govt. of India. Vedic Scientific knowledge incorporates science behind rituals, religion, and festivals. As per the Vedic

philosophy incorporating parasympathetic breathing and exercises in one’s everyday life can reduce the disease duration, requirement of modern medicine drugs and help prevent most lifestyle disorders."

Alloveda is a book that Dr Aggarwal has authored on Vedic knowledge in allopathic language. The book, in Hindi, explains how Vedic knowledge can be synergistically used in modern practice. For example; chanting of vowels produces interleukin 2 and chanting of

nasal consonants produces delta activity in the EEG and hence all sounds with a mix of a vowel and a nasal consonant will produce mental and physical relaxation. Dr Aggarwal also explains Adwait Ramayana in modern science language, linking mind, body and soul concept. He emphasises the role of parasympathetic lifestyle and breathing. Any activity, which can bring one from a sympathetic to parasympathetic mode, can help healing.

MCOA felicitates Dr Huzaifa Khorakiwala for contribution to education and learning Wockhardt Foundation’s e-learning projects have been implemented in more than 150 schools CELEBRATING TEACHERS’ Day and seven years of its inception, Maharashtra Class Owners Association (MCOA) honoured and felicitated senior teachers in Mumbai for their outstanding contribution to the field of education and nation

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building. There were 10 teachers across Mumbai who were felicitated by the Guest of Honour, Dr Ramakrishna V Hosur, Indian biophysical scientist and former Professor at Tata Institute of Fundamental research in presence of Prof Jagdish

Walawalkar, President, MCOA. MCOA is a The Maharashtra Class Owners’ Association, an outfit of coaching class owners that was founded in the year 200 and has approximately 575 members.

Speaking at the occasion, Dr Huzaifa Khorakiwala, Trustee and CEO – Wockhardt Foundation said, “It is an honour to be appreciated for the work we do in the field of education. Initiatives like these en-

L-R - Dr Huzaifa Khorakiwala accepting the memento from the guest of Honour, Dr Ramakrishna V Hosur

courage people to contribute their bit and help build an educated nation – which is the need of the hour. Our e-learning projects have been implemented in more than 150 schools. So far we developed

State Board Curriculum for Maharashtra, Rajasthan and Haryana, with more in the pipeline. Our aim is to promote fast and easy learning to the under privileged people of the society.”

TRADE & TRENDS

Carestream DRX-Evolution Plus launched Advanced features help expedite complex X-ray exams, support future applications

CARESTREAM HEALTH’S newest DRX digital imaging system, the Carestream DRX-Evolution Plus, offers major software and hardware enhancements to help expedite complex medical imaging exams and support future advanced imaging applications. The new system is now available for order in many countries across the globe.

“The DRX-Evolution has been embraced by radiology professionals around the world who appreciate its ability to combine ease of use with features that boost productivity and help technologists capture complex exams that previously required greater effort,” said Helen Titus, Carestream’s Worldwide Marketing Director for Xray Solutions and Ultrasound.

“The DRX-Evolution Plus includes new capabilities to further enhance workflow and offer improved visualisation of anatomy.”

The DRX-Evolution Plus offers: ◗ A sleek new design with LED lighting for enhanced function-

optimised viewing of soft tissue ◗ Fast, secure log-in process using RFID badges ◗ A transbay option enables fast tube movement across multiple trauma bays, which helps expedite treatment while minimising movement of critically ill or injured patients ◗ Automatic acquisition and stitching for long-length and supine imaging exams; and ◗ IHE Dose Reporting to facilitate data sharing with a facility’s dose management system.

Platform offers modular components and configurations

ality and aesthetics ◗ Greater flexibility in high-ceiling rooms via an extended tube column ◗ A new high-performance generator ◗ An optional table to accommodate patients up to 705 pounds (320 Kg); and ◗ Forward-looking design specifi-

cations to embrace new advanced imaging applications as they become available.

Additional capabilities of the DRX-Evolution Plus include: ◗ An innovative wall stand Bucky-angulation feature expedites cross table and other com-

plex X-ray exams ◗ Tube touch screen allows a technologist to change techniques and view images from the tube ◗ Paediatric capabilities including automatic technique and image processing for seven paediatric body size categories ◗ Bone suppression software for

The DRX-Evolution Plus offers modular components and configurations. For maximum productivity, the system can be configured with a fixed detector in the wall stand, and one or two additional wireless detectors that can be used for table Bucky and tabletop exams. Like other members of the company’s portfolio of DRX systems, the DRXEvolution Plus enables each DRX detector to work with all other DRX systems within a provider’s environment.

Transasia buys UK-based Lumora for Rs 250 crores The acquisition will see ERBA-Transasia Group add advanced molecular diagnostics testing to its comprehensive suite of clinical testing products MUMBAI-BASED Transasia Bio Medicals has acquired Lumora, a Cambridge, UKbased patented molecular technology company for Rs 250 crores. Thus Transasia becomes one of the select few global companies with its own

patented technology for molecular testing.

The acquisition will see ERBA-Transasia Group add advanced molecular diagnostics testing to its comprehensive suite of clinical testing products and make them

available worldwide for testing of diseases such as HIV, respiratory diseases, dengue, malaria, etc. Global market for molecular tests is estimated to be about Rs 35,000 crores per year.

Alongwith the specific di-

agnostic technologies, the Transasia Group will have the opportunity to further commercialise Lumora’s patented technologies such as BART, RapidMag, and other sample preparation technologies. In addition, Lumora, has a num-

ber of ongoing commercial partnerships which will continue following the acquisition.

Dr Laurence Tisi, Chief Executive Officer, Lumora, said, “The ERBA-Transasia Group is an excellent home for Lumora’s technology. The

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TRADE & TRENDS company has a strong global presence and is well established in a number of key market segments. With the acquisition of Lumora and its novel technology, the Group is now well placed to expand the utility of the technologies globally.”

Suresh Vazirani, Chairman and Managing Director, ERBA-Transasia Group said,

“The acquisition of Lumora enhances and completes our existing portfolio of instruments and test kits, to make ERBA-Transasia a global IVD leader. Lumora has a strong portfolio of molecular technologies which will help us develop molecular testing for emerging country specific diseases such as HIV, TB, malaria, dengue, etc.”

Transasia opens new vistas at 8 Medical Technology Conference of CII th

Transasia was one of the participants at the conference TRANSASIA BIO-MEDICALS has been providing accurate, reliable and affordable diagnostic solutions for over thirty five years now.

‘Make in India for the World’ has been Transasia’s credo all along. With its total solutions in Clinical Diagnosis, Transasia has spread its global footprints, serving millions across hundred countries. The ERBA-Transasia Group has been at the forefront of engineering and crafting indigenous products and solutions of international standards.

Medical Technology Conference is the annual flagship event of Confederation of Indian Industry (CII). The 8th edition of the conference was recently held at New Delhi. The event saw the congregation of the best names driving the Indian healthcare industry. The theme ‘A $50 Billion Medical Technology Industry: Making it Happen in India’ set forth a platform for a plethora of ideas and opportunities.

Suresh Vazirani, Chairman and Managing Director, ERBATransasia Group addressed the delegates on ‘Making India a Manufacturing and Export Hub- translating dreams into reality’. A strong apostle of the Make in India ideology, he advocated the need for indige-

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nous manufacturing of healthcare products. While highlighting that the Indian healthcare market is on an upward growth track, Vazirani remarked, “Indigenous manufacturing is picking pace. At one point of time, the ratio of indigenous manufacturing to imports was just five per cent. However, tables have turned today. Many companies are now involved with in-house manufacturing.

Indian companies have been manufacturing kits for blood grouping, serology, clinical chemistry, pregnancy detection, HIV detection and other rapid tests that are accepted globally. Today, imports of such products are negligible in fin-

ished form.”

He said, “Today, the diagnostic business is mainly based on technology. The drive or thrust for smaller, faster and easily accessible devices is increasing.

Emerging markets have different needs with respect to test menus, technologies and operating procedures. Thus customised solutions need to be developed depending on the need.

Indian companies with their R&D facilities have developed a range of good quality products for the local market amidst fierce competition.”

While talking about the steps to be taken to boost further innovation, he said, “Though the government has

introduced many policies for in-house production, there is still scope for more. The government and private players need to join hands to promote innovation at reasonable prices. The government needs to initiate policies to encourage indigenous manufacturing.

This can be done through availability of funds, land demarked for setting up manufacturing units, tax relaxation, encouraging research and development, etc. Encouraging foreign players to set up manufacturing units in India can help further.”

Vazirani alongwith other honchos of the industry offered useful insights to place India as a world leader on the global

healthcare map.

Sudhanshu Pandey, Joint Secretary, Ministry of Commerce, Government of India, graced the occasion and underscored the need for enhancing the medical device industry.

He referred to the new legislation which will help to regulate and harmonise the segment, which is presently covered by the Drugs and Cosmetics Act. Pandey said, “Since the legislation might take some time, certain short-term measures also can be bought to address the immediate problems of the industry such as labelling requirements, etc.” He called the transfer of technology to give a leg up to the medical device industry by taking up contract designing, research leading to manufacturing. He also referred to better brand building of Indian medical device products to command higher prices in the international market. Products sourced from India at cheaper prices are sold at higher prices abroad, denying the Indian industry the benefits.

On a closing note, Pandey exhorted industry to evolve a pragmatic pricing policy for equipment. Product pricing should be transparent, predictable and economical to make the medical treatment affordable to the common man.

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