A Week in Paradise-II

Gulmarg

On a bright morning full of promise of a glorious day ahead, we bid our hosts Bilal Hakroo and his father adieu and headed towards Gulmarg, a hill resort approx. 52 kms from Srinagar. We drove in the valley for about 40 kms to Tangmarg and than found ourselves winding our way through a beautiful pine and fir forest. As we drove up, magnificent vistas of snow covered mountains loomed before us and the drive soon took on a dream like quality.

In Gulmarg, we found our hotel amidst rolling meadows dense woods of fir and pine. The weather in Gulmarg we discovered is very fickle. By the time we settled in, it had turned chilly with clouds hanging low and a drizzle making us stay indoors. Later in the evening we went horse riding on the meadows. Chatting with the locals, we discovered that in the winters, these meadows turn into fabulous ski slopes for, which Gulmarg is famous the world over.

The next day we set off on a walk in the woods and later rode up to Khilanmarg. From Khilanmarg, on a clear day one can see snow covered peaks in a huge 360 degrees ring. The distant hills look almost etheral, floating on air. Gulmarg’s greatest attraction these days is a Gondola ride, a ropeway linking Gulmarg to the Kongdoori Hill in two stages. The first stage transfers from the Gulmarg resort at 2,600 m (8,530 ft) to Kongdoori Station. The second stage of the ropeway, which has 36 cabins and 18 towers, takes skiers to a height of 3,747 m (12,293 ft) on Kongdoori Mountain, a shoulder of nearby Afarwat Peak 4,200 m (13,780 ft)). We rode on our horses till the Kongdoori Station through lovely woods and than boarded the Gondola  for the stage 2.

The Gondola ride is an amazing experience. As the Gondola moved out from the station the snow covered mountain fell away beneath us. We slid by quietly on the rope, an elaborate system of metal ropes and pulleys kept propelling us higher and higher. The Gondola eventually disgorged us at the Kongdoori peak. Stepping out of the station we were mesmerised by the expanse of soft snow, stretching over mountain ranges as far back as the eye could see. We walked on the soft snow, sinking into it to our knees and keeling over and than pulling ourselves out to stumble on for a little more. A local Kashmiri youth informed us that right behind the snow covered hill in front of us is the Line of Control, the de-facto Indian border with Pakistan. The Indian Army patrols these mountains round the clock and the Gondola is also used to ferry supplies to them.  

On our way back, we rode the Gondola right down to Gulmarg. It was indeed one of the most memorable day in our sojourn, a day one is unlikely to forget in a long long time.

Sonamarg

The drive to Sonamarg is more enchanting than the ‘golden meadows’.  The river Sindhu (not to be confused with Indus) rumbles along the road all the way. The road too surprisingly does not wind its way up, it gently slopes up along the fast flowing river. We drove to Sonamarg on a bright sunny day through the Kashmiri countryside, along the river. Sonamarg is breathtakingly beautiful, with huge snow covered mountains, slopes densely covered with fir, pine and birch trees and the river Sindh flowing by. Nearby is the Thajwas glacier, accessible on foot or on ponies. As soon as we drove to the village square we were virtually assaulted by a crowd of pony owners inviting us to go to the glacier. As we were making up our minds, we spied an inflatable raft. Enquiries revealed that we could go river rafting in the Sindh. We immediately signed up and drove a few kilometres further up and on the banks of the Sindh.

River rafting on the Sindh in grade 2 and 3 rapids amidst huge mountains on either side is a uniquely exhilarating experience. Off we went on a 3 kms stretch, with expert guides directing the raft. The river flowed fast and furious and the water was ice cold. We shouted and screamed as we plunged into vicious rapids and came out drenched to the skin. Being on the river and flowing with it creates an illusion, where with a start one realises that the mountains too seem to be moving with the river!  

We dried ourselves on the bank of the river in the hot sun that beat down on us. Driving back we took a detour and went towards Sumbal and than crossed Jhelum, driving along it to reach Srinagar by the nightfall.

Pahalgam

Kashmir is perhaps one of those places, where getting lost on the roads is a pleasant diversion. We set off from Srinagar on our way to Pahalgam and turned left towards  Bijbihara. Soon we found ourselves in a village, where we asked for directions and headed on a narrow road, which soon turned into a dirt track.  We went past tiny somnolent villages set in the valley amongst beautiful hills. Eventually we came across an old lady, working in the fields alongside, who told us to go back  and take a right turn  Soon we crossed the Lidder and found the highway to Pahalgam, with the river flowing besides us.

Pahalgam is located on the junction of the Aru and Sheshnag rivers, which form the Lidder. There is something completely enchanting about Pahalgam, which is so hard to define. If ever one was to conjure up a perfectly beautiful landscape, than it has to be in Pahalgam. The snowcovered peaks, the river, the forests, everything in Pahalgam is magical. . In Pahalgam we just sat around the river and enjoyed the natural beauty, so generously spread around us. We went for walks and roamed the markets, buying gifts and souvenirs for family and friends.

Pahalgam was our last port of call in Kashmir during this sojourn. After having spent these days in the valley, I can only say that I can not agree more with emperor Jehangir. Even 500 years on, if there is a paradise on earth, it is here in Kashmir.

 

A Week in Paradise-I

The Mughal emperor Jehangir loved Kashmir and traveled often from his capital of Agra in the North Indian planes all the way to the valley beautiful. So much was he in the thrall of the valley  that he called it the ‘paradise on Earth’.

Now having driven from Delhi to Srinagar in the Kashmir valley, I can only wonder at the difficulties he must have faced 500 years ago and yet he couldn’t resist the allure of the valley. Today, Srinagar is connected to Delhi (and Agra) by a modern 6 carriage highway all the way upto Jammu (the work is still on between Jullandhar-Pathankot and Jammu). From Jammu to Srinagar, the road is a 2 lane carriageway, well maintained by the Border Roads Organisation and is the lifeline of the valley.

We drove from Delhi to Jammu, a distance of approx 630 kms in about 11 hours, stopping twice at roadside dhabas for refreshments. The next day after breakfast we set off for Srinagar a distance of approx. 300 kms. Soon we were in the hills, passing by quaint towns, ascending to Patnitop at 2024 m and than coming down to Ramban, where we crossed the Chenab, flowing swiftly to our left. We than climbed to Banihal and crossed the Jawahar Tunnel to enter the Kashmir Valley. The Jawahar Tunnel is an engineering marvel. Opened in 1956 and named after Jawahar Lal Nehru, the tunnel connects the valley to the rest of the country and allows India round the year access to the valley.

Once across the tunnel we swiftly descended into the Kashmir Valley and drove to Srinagar approx 80 kms away. The first views of the snow capped mountains ringing the valley, the magical greenery and free flowing springs everywhere made me switch off the car air conditioning, lower the windows and breathe lungfuls of the clean air of the valley. The drive on the road leading to Srinagar is an exhilarating affair, the accumulated fatigue of the earlier days drops off, the road is lined with clusters of beautiful, erect tall trees, locally called safeda (they have white bark) and the green paddy fields on either side of the road are filled with water fed by small streams flowing from the mountains. We reached Srinagar by the twilight hour and settled down in our hotel on the Boulevard, on the Dal.

Srinagar

Srinagar, lies on the banks of the river Jhelum a tributary of the mighty Indus. Srinagar is an ancient city with a recorded history of more than 2500 years. In the 3rd century BC, the city was a a part of the Maurya empire and Asoka the great is credited to have introduced Buddhism in the valley. Subsequently it was ruled by the Gupta Kings, the Kushans and the Huns. The valley came under Muslim rule in the 14th century and Akbar the great assimilated it in the Mughal empire. in 1814, Maharaja Ranjit Singh conquered the valley after the fall of the Mughals and the valley came under the influence of  Sikh rulers. In 1846, a treaty was signed at Lahore with the British, providing them control over the valley, a dogra king by the name of the Gulab Singh was installed as the ruler of the valley. Gulab Singh and his progeny ruled Kashmir till the Indian independence, when the princely state was absorbed in the Indian union.

Srinagar today is a bustling city. Lal Chowk, its main market has shops full of exquisite Kashmiri handicrafts and dry fruits. Big malls are yet to arrive and the entire market has a quaint, old fashioned charm about it. The old city boasts of grand mosques, traditional eatries and a rich and vibrant culture of  Sufiana Music. The shrine of Hazrat Bal on the shores of the Dal Lake attracts devotees from across the valley and beyond. We too visited the shrine and paid silent obeisance.

The Dal

The Dal is a mesmerising sight. The stately victorian era houseboats, the beautiful shikaras, the hawkers selling Kashmiri handicrafts, saffron, trinkets and baubles all add to its magic. The boulevard around the lake is lined with huge safeda trees casting a deep shadow on its placid waters and the reflection of the hills surrounding the lake gives it an aura of immense depth and tranquility. In the evening as we went on a Shikara ride, the setting sun bathed the lake in its golden glow, and all the world seemed to be at peace with itself.

We soon moved into a Houseboat called Shah Parie and spent a few days with Bilal Hakroo and his family the owners of the Houseboat. The houseboat has a balcony in the front, a living room, a dining room and four rooms along a narrow corridoor. It has exquisite teak wood carvings, embroidered curtains, linen and soft wall to wall carpets. My father spent a lot of time chatting with Bilal’s father on the balcony, watching the shikaras go by and enjoying the sounds and the sights of the beautiful lake. Bilal hesitantly talked about the turmoil of the last two decades and how it has ruined the valley, he blamed fellow Kashmiris and their Pakistani masters for fomenting trouble and driving away tourists. Bilal also talked about the humiliation of living under the shadow of the gun. The Indian Army seemed to be omnipresent in the valley and even on the Boulevard, every 500 metres or so one would see an alert soldier, armed to the teeth keeping a sharp eye on things.    

While on the houseboat we discovered that the Dal also sustained a unique way of life. The kids go to school on the shikara, the faithfuls go for prayers to the mosques located on the lake, there is a busy market floating on the lake selling everything from vegetables, to groceries, toiletries, Kashmiri handicrafts, saffron, and flowers. We also saw a hotel now being used by the Central Reserve Police Force, restaurants offering Kashmiri and North Indian cuisine,  nice houses with vegetable gardens at the back- all floating on the lake.

The Mughal Gardens

The world famous Mughal gardens in Srinagar are a sight to behold. Shalimar, Nishat and Chashm-e-Shahi are all located on the shores of the Dal, along the boulevard. Shalimar Bagh, was built by the Mughal emperor Jehangir in 1616 for his beloved wife Noor Jehan. The garden is symmetrically laid out along a stream, which flows into the Dal. The stream has beautiful fountains and each terrace is punctuated by a ‘baradari’. We visited the Shalimar on a glorious morning, with the sun playing hide and seek with candy floss clouds in an azure sky. The garden was a riot of colour with flowers in full bloom. (I counted at least 9 different colours and shades of roses, each flower the size of my fist or more). The massive chinars gradually recede into the hills at the back giving the impression that the entire garden is laid out in the lap of a gigantic mountain.

Nishat, though a little smaller than the Shalimar is just as breathtaking as the Shalimar. It is a lot closer to the Dal and has the entire lake spread out in front. The garden has 12 terraces with a stream running through the middle creating small waterfalls on different levels. Nishat was built by Asif Khan, Noor Jehan’s brother more than 400 years ago. The garden with a mountain in the backdrop, the massive expanse of the Dal in the front and huge Chinars presents an awesome sight.

Chashm-e-Shahi is the smallest of the Mughal Gardens and was built by Emperor Shah Jehan. It is set up the hill facing the Dal and has a natural aqua duct (chashma) flowing through the garden. Many people believe in the medicinal powers of the spring, though I must admit we refrained from having a sip.

Pari Mahal

As we drove up from the Chashm-e-Shahi the road became narrower and we went past hair-pin bends with dense foliage on either side. We pulled up at the door of the Pari Mahal late on a fine evening. Pari Mahal is a terraced arched garden built by Emperor Shah Jahan’s eldest son Dara Shikoh. The Pari Mahal overlooks the Dal and offers a monumental view of the city of Srinagar. The facade of the retaining wall of the Pari Mahal has 21 arches, in the descending order and on the sides are specious rooms. Sitting on the thick walls of the Pari Mahal, we watched the sun gradually slip behind the iconic Hari Parbat across the city and we witnessed the Dal change colours from blue to ochre, to golden and finally to inky black.

All Pics by the author

 

CT scan at Rs. 1500!!!

On May 31st, which happened to be the World No Tobacco Day, I was holidaying in Kashmir, when I received a strange sms. Since I had decided not to carry my mobile phone on my vacation, I saw it only once I returned to Delhi.

The message, which I reproduce verbatim said ‘On the occasion of the World No Tobacco Day Artemis offers Lung CT at Rs. 1500 only. Offer valid only for My 31 2009 only. For registrations, please call’.

Needless to say that I was quite shocked. This is exactly the kind of lazy and insensitive marketing communication that puts off consumers from hospitals and makes them extremely suspicious of hospital communications.

I am 37 years old, have never smoked in my life, enjoy good health, underwent a health check 9 months ago and  no one in my family had suffered from cancer, which I assume the Lung CT is meant to screen me for. Moreover the hospital is aware of most of this as they were my employers till less thyan a year ago! The message that I really get is that this hospital is so desperate for lung cancer patients that it is sending out these messages to everyone in its database and is hoping that some will bite the offer. This is crass commercialism of the worst kind- a hospital sending out offers for an expensive test, trying to persuade gullible lay individuals to undergo a test they do not need. Can we really blame customers, when they say that they do not trust private hospitals in India?

Let us now assume that I am vulnerable to lung cancer, I smoke like a chimney, have  a family history of the disease and am in the age group, where these cancers are commonly detected. Is this communication inviting me to register for a CT, now justified? I am afraid not. CT scan is an advanced test. It involves a very high dose of radiation and is not a screening modality to be offered to patients so casually. I would even go further and state that it is completely unethical for hospitals to ask individuals to register for these kind of tests, without any clear symptom or indication that this test is required.

Now, if I was keen to communicate the hospital’s desire to screen people for lung cancer I would have devised a promotion, which offered a basic consult with a chest physician and a screening X-Ray free. I would have also added that if the physician felt the need for a CT, the same could be had for Rs. 1500. I would have also indicated that this offer is for people who are let us say 40 years and above,smoke and who have had cancer in their family.

While, this may seem acceptable from a patient’s perspective, Artemis Health Institute, would have had a hard time executing this simply because the chest physician would have baulked at the idea of working on a Sunday and seeing people without a fee. Moreover the free X-Ray would have been a drain as X-Ray machine is well utilised and needs no promotion. Thus the greedy shortcut of asking individuals to register for a CT scan even though it clearly is neither in the interest of the patient nor is it medically justified.

Now the real big question- will you trust this hospital ?

Pic courtesy www.flickr.com

I have taken inputs from some senior physicians, while writing this post.

 

 

Back to Kashmir

Almost 20 years to the day we were in Kashmir once again.

Kashmir has been our family’s favourite holiday destination by a long shot. The last time I was there with my family comprising of my parents and sister was in June 1989. I had just graduated from high school and was awaiting the results of my Engineering entrance examinations. 

I did not know it then, it was a sort of coming of age trip for me. Soon I would head away from home to join the engineering college, the valley will burst into flames and my uncle who lived in the valley (he was a Professor at the Kashmir University), would pack his bags and leave to settle down in Delhi.  My sister would start at the medical school in Aligarh, my father would retire from work and eventually move from Indore to settle down in Lucknow. Life would change forever.

However, we knew nothing of this then.

I remember the train journey from Indore to Jammu and than onwards to Srinagar by  road. I remember walking up to the Shankaracharya temple and the view of the Srinagar city. I remember our visit to the Mughal gardens, Shalimar, Nishat and Chashm-e-Shahi in full bloom and in magnificent splendour and the massive chinars. I remember us gorging on the walnut pastries, buying dry fruits by the sackful and my mother and aunt shopping in the Lal Chowk. I remember the Shikara rides on the Dal from Hazrat Bal to Nishat right across the lake and to Char Chinar and the Nehru Park, islands in the lake.

I also remember our trips to Gulmarg, marred by a sudden downpour chilling us to the bone,  and to Sonamarg, the ‘meadows of Gold’ and our trek to the Thajwas glacier. And their was the botanical garden in Kokarnag, with roses so magnificent and huge and in so many bewildering colours that they took ones breath away, the calm waters of the lake Manasbal and the meadows in Yousmarg, where we were caught unawares by a sudden hailstorm.

The day we were to head back home, I stood at the railings in Nehru Park on the Dal and promised myself that one day sometime soon I shall return to this valley again. I had no idea of the things to come and how this eternal paradise will soon be engulfed in flames. 

Years went by, but the desire and the allure of the valley never dimmed. Last year I had the occasion to travel to Srinagar on work and many of these cherished memories came flooding back. The tug of the valley was now so strong that I knew the day was not far, when I will be back with my family.

I planned a trip in August last year, which we had to cancel because of the sudden flaring of tensions in the valley following the Amarnath yatra. My wife and I went to Laddakh instead.

This summer, finally I took my parents and family back to Kashmir. A promise I had made to myself as a gawky teenager 20 years ago was finally fulfilled. We spent some wonderful days together.

More of that and my views on Kashmir in the next few posts.

Pic courtesy the author

 

 

 

Should Healthcare be free in India?

Yesterday morning I was billeted in a training session on Edward de Bono’s Six Thinking Hats and the power of parallel thinking. Out of the blue the trainer  asked the group to discuss the topic ‘Should Healthcare be free in India? The group that discussed this had well educated professional managers and senior executives. However none of them had a background in healthcare services per se.

Many people in this group felt that healthcare services should indeed be free in the country, pretty much like roads. Those with a a legal view supported this argument by pointing out that our constitution guarantees the right to life as a fundamental right and healthcare services can not be divorced from the right to life. A gentleman in the group gave the example of NHS in the UK and said that inspite of problems, it works. Many felt that in the face abject poverty in many parts of the country, it is only right that people have access to good quality healthcare at the expense of the government. 

Those who opposed the ‘free healthcare for all’ proposition believed that while the concept sounds good, it is Utopian and impossible to implement. They pointed out that since many in India do not still have access to clean drinking water, two square meals a day and a roof over their head, should the government also ensure these being available to millions for free? Where will the government find the resources for something like this? And with the monumental inefficiency and corruption, which is endemic to our government, how will these schemes be implemented. Where will we find honest politicians and upright bureaucrats, who will ensure that the government resources are channelised properly. Moreover, India being a vast under developed country how will we find enough doctors and other medical professionals, who will be willing to work in rural India. After all, India is a free country and no one can be forced to work against his wishes. Another argument put forth was that if the government pays for everyone’s healthcare, we will have a situation, where 30% tax paying population will end up paying for the healthcare for the 70%, who are presently out of the tax ambit, which would be inherently unfair.

Some in the group had other solutions and felt that the answer probably lay somewhere in between. A Private-Public Partnership (PPP) was suggested as a possible alternative, where in the governnment can invite private players to partner in healthcare ventures jointly owned by the government and the private player. These hospitals can then offer healthcare services to the poor at low costs, while the rich will be charged on a full service basis. Most people felt that the involvement of private equity will ensure greater efficiency and better utilisation of the public funds. This arrangement it was felt can work well if it is properly regulated by an independent regulator.  

Health insurance was also suggested as a possible solution. The government can subsidise the insurance premium and get publicly owned health insurance companies to sell health insurance policies to the poor. The insurance companies will remain viable as they will have a large customer base, the government will pay let us say 50% of the premium and the balance will be paid by the end user. Those above a ceratain economic criteria will have to compulsarily buy medical insurance at full market determined rates of premium, pretty much like motor insurance. (Isn’t it strange that it is mandatory for car buyers to have motor insurance and not health insurance). Micro insurance schemes like the ‘Yashaswini’ being championed by Dr. Devi Shetty of Narayana Hridayalaya in Bangalore were also discussed as possible solutions.

Frankly, I was quite surprised that a group with no expertise in healthcare could debate and come up with some of these ideas. Wouldn’t it be wonderful if we can have a government and a health minister who can look at some of these suggestions seriously and work towards facilitating a universal healthcare system that is efficient, takes care of the most vulnerable sections of our society and ensures good quality healthcare for all.

Pic courtesy www.flickr.com

 

 

The Healthcare Opportunity in India

Everybody acknowledges that the healthcare industry in India has a lot going for it. Patients from across the world are looking at state of the art Indian hospitals for cheap and quality care. The doctors and the nurses are considered to be one of the best in the world, their is abundant supply of good quality medical talent, health insurance is penetrating deeper and the market is predicted to grow substantially.

A quick look at the numbers tell the story. Healthcare is presently a USD 35 bn industry and is expected to grow to USD 75 bn by 2012. A Confederation of Indian Industry report says that investments worth USD 50bn are required annually for the next 20 years to meet the growing demand. India will need 3.1 mn additional beds (presently 1.1 mn) by 2018 

While the sector has seen substantial investments in the last year, they are but a drop in the ocean. The healthcare sector has not really seen the kind of action that one would expect considering the opportunities.

The country has just a handful of players who have any significant presence in the market. These include the Apollo Hospitals Group, Fortis Healthcare, Max Healthcare, Wockhardt Hospitals, Manipal Hospitals and Columbia Asia.  Out of these only Apollo and Fortis has a significant pan India presence. Wockhardt is largely present in the west and south India, Max is located only in Delhi and the National Capital region and Manipal Hiospitals has presence only in South India.The expansion plans of some of these are in the ‘go slow’ mode. Manipal’s hospital in Delhi, which was earlier slated to commence operations is no where near completion, Max’ hospitals expansion in East and South Delhi are yet to commence operations. New entrants including Reliance are still testing the waters. Sahara group has recently commenced operations at their first hospital in Lucknow, while the plans for many more are still pretty much on paper. Artemis Health Sciences, which had announced ambitious plans for 10 hospitals by 2015 is still struggling with its first venture in Gurgaon and plans for the other hospitals are on hold. Wockhardt is in the doldrums as its parent, the eponymous pharma company is in a financial mess and has reportedly put its hospitals business up for sale.

Strangely, not many foreign hospital chains has as yet finalised their plans to enter the country. Healthcare consulting firms have done studies for some likely entrants but nothing concrete has come of it as yet. Columbia Asia is the onlyforeign  hospital chain, which is making steady investments and following a well thought through strategy of establishing its presence in tier 2 towns in India.

It appears that amongst the foreign players the reluctance to invest in India largely stems form the fear of the unknown. Everyone is waiting and watching for an opportune moment. The lack of a proper regulatory environment and an uncertain health insurance play is also acting as dampners. 

However, I also believe that for wanna be investors, whether Indian Corporates or foreign players, the time is just about right to make that foray. It is being widely acknowledged that the worst of the economic downturn in India is behind us, a new government is set to take charge in less than 15 days from now and healthcare is bound to be on its priority agenda.

Pretty much like the telecom sector, I believe that the time has come for the healthcare sector to break the shackles and herald the next wave of transformation, which will fundamentally change the way most Indians access healthcare today.

 

Managing Swine Flu in India.

The world is all agog with the global spread of the swine flu. The outbreak first reported from Mexico has rapidly spread to the United States and Europe. Countries the world over are rushing to identify people with flu like symptoms and those who have a history of having been in Mexico or in certain parts of the United States in the recent past are being carefully screened. The airport officials have been alerted to be on the lookout for people with these symptoms and medical personnel have been stationed at the airports to screen travellers arriving from these parts of the world. 

In India a person arriving from the US with flu like symptoms has been  detained and admitted in an isolation ward in a local hospital in Hyderabad. The government is busy procuring millions of Tamiflu pills and the drug manufacturers are rushing to cater to this unexpected demand. The newspapers, TV and the digital media is busy putting out stories on swine flu, highlighting the emergency measures being taken the world over to combat the resurgent rogue virus. Theories are being propounded on the impact the virus is likely to have on the economies across the world. The general refrain seems to be as if the recession was not enough, we now have to deal with a real virus running amok.

If the issues at hand were not so real, one would have been forgiven to think that this was an extract from the latest Robin Cook thriller.

This afternoon as I was stepping out of The Lalit (formerly, the Intercontinental) in New Delhi I saw folks wearing masks in the lobby. Suddenly the threat seemed a lot closer and a lot more menacing. As I hurried out of the hotel I could not help wonder how susceptible we all are to a global scourge like this.

I do not know how well prepared we in India are in handling a marauding virus like this. The Hindustan Times has been reporting that our government as always is fast asleep and that we are in the midst of a general election isn’t helping things. Calls made by intrepid newspaper journalists to the ‘helpline’ set up by the government yielded ignorant and angry responses and even a fax tone!

The government hospitals too appear to be in a disarray. Surprisingly most healthcare professionals including junior doctors are not fully aware about the disease, its diagnosis, treatment and transmission. While the media appears to be going berserk, there is no advertising or proper and organised  dissemination of information about the disease. If things were to continue like this and God forbid cases of the dreaded flu show up I suspect, we will have widespread panic.

I would reckon that the need of the hour is for everyone to remain calm. It would be best to try and get authentic information about the disease, its symptoms, its course and the available treatments. The medical fraternity has a huge responsibility on its shoulders in ensuring that it follows correct protocol in managing the disease, handles patients with symptoms and suspect travel history in a professional manner.

And, while we all take reasonable precautions, let us hope that like SARS a few years before, this threat too will abate soon.

Pic courtesy www.flickr.com/nikboyce

 

Akkriti Bhatia and healthcare services in our Schools

Here is the tragic case of Akkriti Bhatia, a 17 year old  school girl, who died yesterday after collapsing in her school. The Hindustan Times reports that Akkriti complained of breathlessness to her classmates, who then called her mother to send a car to fetch her. Apparently when the car arrived, Akkriti requested her teacher’s permission to go home. The teacher realising that she was seriously ill sent her off to the nearby Holy Angels Hospital, where she was declared ‘brought dead’. Akkriti, it seems died on her way to the hospital.

This is a tragedy that could have been easily averted. Akkriti was an asthamatic child. This was known to the school authorities. Yet it seems there was no one in the school, who had the sense to realise that the girl was in acute respiratory distress and someone needed to call an ambulance. Apparently the school by way of medical support had a medical room and a nurse, and the young girl was administered oxygen in the medical room. Curiously enough when her mother’s car came to pick her up, she was taken off the oxygen cylinder and was sent to the hospital gasping for breath accompanied by the school nurse and another student!

How is it that no one realised how ill Akkriti really was? Why did no one summon an ambulance and trained paramedics? Why was she sent in a car, without oxygen to the hospital? Who should be held accountable for these lapses? Are our children safe in schools? 

I believe that the school was just not equipped to take care of an emergency. There was no one including the nurse, who understood the gravity of the problem. I also suspect seeing the child’s condition deteriorating, the school authorities panicked and failed to act rationally. There was neither a person nor any system to deal with a situation like this and in the ensuing confusion, a patently wrong decision of not calling an ambulance and attempting to transfer Akkriti in her mother’s car without oxygen was taken, pretty much sealing her fate.

This is scary.

Particularly, when I know hospitals routinely approach schools requesting them to manage their medical rooms professionally with well trained staff  (doctors and nurses), equipment and supplies and emergency hotlines being available all the time. While working for both Max Healthcare as well as Artemis Health Institute in Gurgaon I have myself in the past proposed such arrangements to various schools. I am afraid not a single school responded favourably. The school authorities usually fobbed us off by saying that they had a nurse and at times a doctor, who visited the school two hours a day and they believed that this was more than adequate for their needs. The hospital was always looked upon with suspicion of making money off the school. Many a times, I would request our paediatricians to accompany me to help convince the school head mistresses but all to no avail. They just could not look beyond their noses and my old fear of school authorities would make me beat a hasty retreat.

The blame for this tragedy must lie squarely with the school authorities. A child, while in school is their responsibility. In an emergency they must have set protocols and trained personnel to handle the situation in an orderly and efficient manner. That a well known school like the Modern School, reacted in a manner that cost one of their student’s her life is not only tragic but downright shameful.

Pic courtesy www.modernschoolvv.com

 

 

 

Hospitals are all about People’s Skills

I have rarely come across an industry, which requires a range of skills, which are wider than what one sees in the people, who work in hospitals. A hospital actually is an amazing aggregation of skills and talent, which one would hardly see in any other human enterprise.

Among the medical folks, there are doctors who are hugely knowledgeable, highly educated and supremely skilled in the art and science of medicine, there are nurses and paramedics, who symbolise compassion and care and there are support folks who provide critical support for running the medical function in the hospital.

Amongst the managerial teams, there are managers who handle the front office and interact with patients and their attendants. They are the face of the hospital, well trained, well groomed very presentable folks, who help put patients at their attendants at ease. They usually have very good communication skills, are people with immense patience and a sunny optimistic disposition.

A hospital also needs a lot of technical support and thus you find high tech bio medical engineers, who ensure that all the equipment in the hospital works flawlessly. Imagine what can happen if an equipment in the OR or in the ICU malfunctions at a critical moment. Much like doctors, their role requires quick thinking, complete mastery of  technical matters and planning for any eventuality.  Most bio medical engineers are rarely seen and heard in the hospital but behind the scenes they control the levers of the hospital.

These days a modern hospital runs on state of the art software, which connects every hospital function. A doctor can not write his notes or ask for medicines till the orders have been punched in the Hospital Information System (HIS). The nurses can not dispense medicines unless requisitioned through the HIS. A patient can not be admitted or treated unless the relevant files and records have been created in the HIS. While most hospitals do have a back-up manual system, it is rarely used largely because an IT team employed by the hospital ensures that the HIS is rarely down. These people are often quintessential techies, with very sound knowledge of hospital systems and processes.

At a 180 degrees of separation from these folks are people who look after functions such as Food & Beverages, Housekeeping and Security. They are all trained individuals as much an expert in their areas as any techie. They interact with patients and their attendants and hence also have superb skills in handling patient grievances. 

While all of those mentioned above contribute towards keeping the hospital humming, another set of people are those who manage the business side of things and have a completely different set of skills. These include the sales and marketing folks, who represent the hospital to an external environment, purchase managers and store keepers, who ensure that the hospital is well stocked with all the essential supplies and the finance guys, who keep an eye on how the money is being spent. People in all these functions have unique strengths. The finance guys are very good with numbers, the sales people drive innovation and have good communication skills and the purchase folks have tremendous negotiation skills and an uncanny smell for a deal.

A good hospital will always have good Human Resources and training personnel. They are the ones who ensure harmonious working relationships amongst a very varied and highly skilled workforce. They make the rules, which govern the conduct of individuals in the hospital, play a critial role in rewards and recognition systems, act as agony aunts and handle conflicts. To my mind the most important skill they bring to the table is an ability to get on with people, understand differing point of views and manage aspirations of a very diverse bunch of people. 

If I was to select two critical skills, which an individual who aspires to work in a hospital must possess it has to be compassion and communication skills. Anyone, who works in a hospital must have loads of compassion towards fellow human beings, an innate ability to see things from the patients perspective and take decisions with empathy and  with an utmost regard for the plight of the patients. The ability to communicate well with language or through a meaningful silence or by just a touch, would be a close second. Be it a doctor, a front office manager or a sales person the ability to communicate the right thing at the right time to the right person is an immensely valuable gift.

Pic courtesy www.flickr.com

 

The Power of a Compelling Story in the Marketing of a Hospital

Many years ago, when I worked at Max Healthcare, I met an elderly man whose grand daughter had had a major cardiac surgery and was admitted in the hospital. The child was on her way to recovery and the old man was profoundly grateful to Dr. Anil Bhan, who had operated on the child. The old man narrated a very interesting tale.

The old man and his wife lived in Roorkee, a University town about 150 miles from Delhi. His son worked in a nationalised bank in Delhi and he had two grand children, twins as a matter of fact, a grand daughter and a grand son. The children now aged 11 years lived apart, the son in Delhi with his parents and the daughter with them in Roorkee.  The daughter from the time of her birth had been a sickly child and had required heart surgery, when she was 9 months old. Being a girl child and that too a sick one, her parents had entrusted her care to the old couple and they had brought her up. Clearly, the old man and his wife were extremely attached with this child and she was the apple of their eyes.

The child too enjoyed living with her grand parents and they clearly doted on her. They ensured that she received the best medical care and would regularly bring her over to AIIMS, the premier medical institute in Delhi for regular monitoring and check ups. About two years ago, when the child was 9, they had noticed that she would become breathless after a little exertion. Initially they did not worry too much, however things grew steadily worse and they became quite alarmed and brought her to Delhi.

The paediatric cardiologist at AIIMS, who has been taking care of the child in all these years told them that the child needed another surgery, an extremely rare and very risky procedure and she needed it fast. They were also told that without the surgery the prognosis was very poor. Dr. Anil Bhan, who was the paediatric surgeon who had operated on her as a eight month old infant had now moved to Max as their chief of cardiac surgery.

The old couple brought the child to Dr. Bhan, who examined her carefully and pronounced that while the surgery was extremely rare and very risky he was willing to do his best. The old couple let things in the hands of Dr. Bhan and prayed to the almighty to save their grand daughter. Dr. Bhan operated on the child and she was wheeled into the Paediatric ICU after the surgery. Soon post surgical complications set in and hopes of her survival dimmed. Dr. Bhan, however approached the old couple again and requested permission to try surgery once again. The old couple with nothing to lose, told him to go ahead.

The child was again wheeled into the OR and Dr. Bhan and his team once again made a heroic attempt to save her life. She survived the surgery and spent the next 9 days in the ICU under the watch of some very dedicated doctors. The child was than shifted to a ward and when I met the old man, he was preparing for her discharge from the hospital.

The gratitude this man had for Dr. Bhan and his team, the ICU staff and for the hospital was immense. He showed me a poem he had composed in Dr. Bhan’s honour. He could not help narrate the wonderful things that happened to him in the hospital, about the extraordinary skills of the doctors, their commitment and their indomitable spirit in not giving up on them even in the face of unbelievably daunting odds.

There can be no greater hospital marketing tool than a powerful and a compelling story narrated by the patient or a patient attendant about his experiences in the hospital.

 

PS: Dr. Bhan and his team has since moved to Batra Hospital in New Delhi

 

Pic courtesy www.flickr.com