Marketing a Breast Cancer Screening Program

Breast Cancer is one of the most common cancers in India. Latest data indicates that the incidence of Breast Cancer in India is on the rise and is currently pegged at 30 per 100000 women. While this is much lower than what the US reports (100 per 100000 women), one suspects that considering India’s abysmal rural healthcare infrastructure, the actual incidence of Breast Cancer would be much higher.

Experts agree that the best way to treat breast cancer is to detect it early. Technology now allows for detection of very small tumours. Mammography, which essentially is an X-Ray of the breast allows for early detection of the tumour. It is recommended that women in India must undergo a breast cancer screening every year after 40 years of age. There has been some debate on whether the right age for screening should be 40 years or 50, most experts agree that in India, 40 years is the right age for breast cancer screening.

A Breast Cancer program must revolve around breast cancer screenings. The biggest barrier to a screening program is the fear of the disease itself. This may sound ironical and completely irrational but most women do not undergo a breast cancer screening because they fear the outcome of the tests. Not knowing about the disease seems to be a lot better than confronting the reality. Unfortunately, this ostrich like attitude leads to late detection of the disease – many a times it is just too late.

Breast Cancer related communication should be handled with empathy and care. One of the key tasks of the communication should be to educate women to come in for regular annual mammograms. The communication should sensitively address the fear of the disease and highlight early detection as the biggest weapon against it. It should be subtle yet powerful enough to get women to come in for regular screenings. Many hospitals make the mistake of trying the ‘fear’ route by highlighting the horrific aspects of the disease in their communication. This I believe is futile and may end up scaring women further. I have also come across Breast Cancer related communication, which is frivolous and in bad taste. Needless to say it serves no purpose.

Involving Breast cancer survivors in helping spread the message is a great way of attracting women for screenings. At Artemis Health Institute in Gurgaon we worked with organisations like ‘Can Support’ on Breast Cancer awareness programs. Many of these organisations are run by cancer survivors and they bring an uncommon zeal (borne perhaps by their personal experiences in dealing with cancer) to the task of creating awareness and fighting the battle against cancer.

It would also help if the hospitals can organise frequent breast cancer awareness programs and invite women to come in for screenings. The hospitals should also organise sessions for women, where in trained experts can demonstrate and impart  ’Self Breast Examination’ techniques. Hospitals should also publish literature offering information about the disease, common symptoms, benefits of early screening and also the treatment of the disease.

In order to attract more and more women to breast cancer screenings hospitals should bring down the cost of a mammogram. The cost per scan of the machine is negligible and hospitals should try to amortize the capital cost over a larger number of screenings. Hospitals today charge Rs. 1500-Rs. 2000 for a scan. This can be easily halved if the patient volumes go up.

Breast Cancer is a dreadful disease.  No one knows what exactly triggers it. There is no scientifically proven method of avoiding it. The only way to fight the disease is by detecting it early. Technology today allows early detection and a complete cure.

This is the simple message, which a good Breast Cancer Communication program must deliver over and over, again and again, ad- nauseum.

So much for my ‘Indian Hospital Experience’

While trawling the net I came across a blog (http://www.travelblog.org/Asia/India/National-Capital-Territory/Delhi/blog-440604.html) about the travails of an American, getting treated for a mole/wart/skin cancer in New Delhi. The experience narrated in this post is exactly the kind of stuff we do not want. I am amazed at some of the narration and the stereotyping this does of the Indian doctors and medical system.

The blog has a semi mad sardarji (sikh) as a doctor who speaks and understands no English, laughs at his own jokes in Hindi and does not understand the difference between a mole and a pimple. The doctor has never heard of the United States and knows America, a country whose citizens are rich and ripe for fleecing. The doctor prescribes lotions and creams for treating the mole, which are not available at his own pharmacy and the patient (the author) walks out, having parted with Rs. 500 and nothing to show for it. Astoundingly, this gentleman returns to the clinic of the mad sardarji, encounters a ‘wildeyed’ patient on a wheelchair, and asks the doctor to burn off the offending mole in the emergency room next door.  

Coping with Swine Flu in India

Swine flu has finally arrived in India.

So far 4 people have died and 782 people are confirmed to be infected with the virus and are undergoing treatment in designated government hospitals. The deaths have been in Pune, Mumbai and Ahmedabad, while Pune seems to be the worst hit. Strangely, school children appear to be seriously affected and many schools have shut down for a week or more.

Last week when I was in Mumbai a colleague called up in the evening. His 8 years old daughter was having a high fever and flu like symptoms. He had taken her to Max Hospital in Saket in New Delhi and he had been referred by the paediatrician to a government owned facility in Malviya Nagar for suspected swine flu. ‘The doctor did not even touch her, heard us while we explained the symptoms and promptly referred us to the government hospitals for tests. The government hospital admitted her for observation and now we do not know what to do. I fear even if my kid does not have swine flu, she is likely to catch it in the hospital’  explained my colleague Vijay Jain.

Another colleague in Mumbai, who was coughing and sneezing, had a bad throat and a fever decided not to come to work for a few days.  He felt that it wasn’t right for him to put others in office at risk.

These are tough calls. It is difficult for doctors to diagnose Swine Flu from the symptoms a patient presents. If the flu like symptoms are a little severe thay have no choice but to refer patients to the designated hospitals for tests, which means a patient has to visit a hospital, which has confirmed cases of Swine Flu and is therefore exposed to the disease. It is really a catch 22 situation.

In this situation the best thing to do would be to avoid going to busy public places, which are closed, particularly malls, airports, cinema theatres and yes offices and schools.

It would also help not to panic if one develops flu like symptoms. Afterall flu, that is the normal flu is a lot more prevalent than the swine flu and kills many more people every year. Mortality rate due to swine flu is still quite low, less than 7 per thousand. Statistically this is not a big cause of concern.

The government on its part must involve some private hospitals in combating the epidemic. It would help if a few private hospitals were allowed to test blood samples for the disease and admit patients in secluded wards. Large private hospitals are certainly more than capable of maintaining the records, treating the patients and ensuring that the disease remains in check. Additional testing and treatment centres will also help in instilling greater confidence in the public.

The government must also embark on a public awareness campaign. It must use mass media to educate the public about the disease, its symptoms, diagnostic procedure, treatment and prognosis. While I have noticed some advertising, it is hardly adequate.

Finally, the media must behave responsibly. In a situation like this it is indeed easy to create panic and cause mayhem by irresponsible journalism. It is the duty of all journalists to report objectively without resorting to unnecessary sensationalism and devoting too much media space to stories related to the spread of the disease.

Last but not the least, let us spare a thought for folks in the medical profession. They are at great personal risk in handling infectious patients. However, this is part and parcel of their calling. They must take all possible precautions, while providing succor and care to all those who seek their helHospital,p.

At the end of the day all of us are at risk. It is really up to us to exercise caution and help in whatever small way we can to fight the disease.

Pic courtesy www.flickr.com

Some names have been changed to protect privacy

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.    

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    

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.  

Doctor Doctor!

Sushil Jain and I grew up together in Indore, a provincial city in Central India. We were classmates for about a decade and I have known him from the time when both of us were about 8 years old. Sushil is now a cardiothoracic surgeon. I remember him today because unlike anybody else in our school class, he was from very early on sure about the career that he wanted to pursue. From as long as I can remember he wanted to be a doctor, just like his father. 

Sushil chased his dream with a single minded focus, prepared hard, appeared for the Pre Medical Tests, failed once, tried again and eventually succeeded in joining the medical college in Indore. He worked hard and graduated, tried a couple of times for admission in a post graduate course, failed and tried again. Finally, he trained to become a surgeon and is now well into surgical practice in a hospital in Indore.  

The Patient Prime Minister

The Prime Minister of India, Dr. Manmohan Singh underwent a multiple bypass surgery at the All India Institute of Medical Sciences (AIIMS) a few days ago. Dr. Singh is a diabetic and has a history of heart ailments. He has had a bypass surgery almost 20 years ago and also had to undergo an angioplasty subsequently. Dr. Singh is 76. The surgery was performed by the eminent cardiac surgeon Dr. Ramakant Panda, who is considered to be the foremost expert in ‘redo’ bypass surgeries. Dr. Panda, who is presently the CEO of the Asian Heart Institute, Mumbai is also an alumni of the prestigious AIIMS.

While the extremely challenging surgery went of well and the Prime Minister is recovering, I could not help but wonder at the Marketing opportunity celebrity patients present for the hospital and the doctors.

Dr. Ramakant Panda is a very well known surgeon but the kind of fame that operating on the Prime Minister will bring to him would do his already busy practice a world of good. It would also rub off on the Asian Heart Institute, which he heads. AIIMS of course is the premium medical institute in the country. That the Prime Minister chose it over any other hospital in the country is a great vote of confidence in the medical capabilities of the doctors and medical team at AIIMS.

Many years ago Atal Behari Vajpaye, the than Prime Minister of India had had a knee replacement surgery at the Breach Candy Hospital in Mumbai. Dr. Chitranjan Ranawat, a surgeon of Indian origin based in New York had operated on the Prime Minister. The hospital had remained in the limelight for many weeks, with the tremendous media coverage around the event. Though the Prime Minister recovered, his unseemly tottering  gait remained a poor advertisement for the surgery.    

Why Hospitals are not Transparent?

As a consumer of healthcare services and also as a keen observer of the drama that unfolds in a hospital everyday, I have often wondered at the extent of opacity that I see around me. A hospital is usually as transparent as a black hole. Ironically most hospital swear by the maxim of ‘complete transparency’. This is rarely true.

Try getting a straight answer from a hospital executive or a doctor and you will straightaway run into a wall.  They are just not programmed to answer straight. Many a times, I would accept that it may not be feasible or advisable for a doctor to be completely transparent. However, there are times when a doctor must look the patient in the eye and say as it is.

Delivering bad news is never easy. It takes a lot of character and compassion to tell another individual that he is terminally sick. However, not telling or beating around the bush, while doing so is far worse. Than there is the matter of giving hope to those diagnosed with a rare condition, telling them that, while they are gravely ill, they need to put up a fight and the doctors, the hospital and everybody else responsible for their care will walk with them every step of the way.  I would like to believe that the ability to communicate and connect with the patients is a wonderful gift to have and it makes for some very happy patients.  

‘Insurer Offers Option for Surgery in India’

 It has finally begun.

 A story in the New York Times last week, captioned ‘Insurer  Offers Option for Surgery in India’ caught my eye. Rewind to the summer of 2006, when I was in New  York trying to convince some of the leading health insurers to consider developing a  new low premium health insurance product for the huge numbers of uninsured in the US. Everybody I met heard me out patiently but was not willing to take the plunge. I tried hard but success eluded me. Some of my colleagues consoled me by saying that maybe I am ahead of the times.

Now it seems they were right. The New York Times report says that ‘the health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out of pocket medical costs and free travel for both the patient and a companion’.