Surgeries in Covid Times

With India recording over 14000 fresh cases of Covid 19 yesterday, it is little wonder that we are completely immersed in Covid 19. The social media is agog with covid figures, positivity rates, fatality rates, the increased risks to people with co-morbid conditions and the elderly. The government policy making on Covid can best be described as bizarre, with new and often contradictory guidelines emanating from different mandarins. Essentially, we are drowning in Covid.

Yet, it is important we shift our attention to more mundane but equally pressing matters such as the care we need to provide to other patients who have serious medical conditions and cannot wait for Covid 19 to go away. These patients have been postponing their surgeries and treatment in the hope of going to a hospital, which is Corona free. Unfortunately, with the pandemic still running its course, hospitals are seeing only more and more covid patients. No one knows, when the situation will return to normal. Thus, waiting for covid 19 to subside does not seem to be a good idea anymore.

Patients requiring heart interventions, cancer treatments, tumour surgeries and even transplants should plan their surgeries because for them getting timely medical attention may be far more important than waiting for corona virus to go away. While, the fears of these patients are understandable, they must realize that a far greater danger lies in not seeking appropriate medical care when needed.

With the battle with Corona virus now over three months old, many hospitals have learnt their lessons and have built expertise in tackling Covid 19. They have created stand-alone facilities, developed isolation areas completely segregated from the covid areas and put in place stringent infection control measures to ensure not only the safety of the patients but also of their clinical and other staff. In the initial days of Covid 19, the hospitals were still figuring out ways of managing Covid patients, while ensuring safety of everyone else. Many healthcare workers (HCWs) caught the disease, were quarantined and even hospitalized and the media went to town highlighting such cases and painting hospitals as truly dangerous places. A lot of that was the usual media exaggeration and hype. Now, three months in the covid battle, the HCW infections have significantly come down, patient infections are almost nil and the media has gone quiet.

While, it cannot be disputed that patients in times of a pandemic will always face higher chances of infection, they must evaluate this risk against the risk of postponing a treatment, which can potentially be more harmful. This is clearly not an easy decision, as patients will hardly have sufficient knowledge to evaluate their options and make the right choice. Even if they had, the ability to grasp the nuances of the risk involved, many a times their doctors and the hospitals do not share the full details.

This should not be the case.

It is the responsibility of the clinicians to advise their patients about the urgency of a procedure required and the risks associated with a covid infection or the chances of an adverse outcome in the covid times. This is most crucial as the patient and her caregivers must have a clear understanding of the pros and cons of what they might be getting into. The clinicians must explain in sufficient details all the aspects of either catching a Corona infection or (as the case may be) of a greater probability of an unexpected outcome. They must share data supporting their views and enable the patients and their caregivers to make an informed and intelligent choice. Pushing the patient into a hurried surgery or delaying an urgent medical procedure are both equally dangerous. The patient deserves an honest opinion more than anything else.

The hospitals on their part must ensure that they help the doctors walk the talk. The clinicians can advise a patient only if they themselves are confident that the hospitals will be able to support them. The hospitals must demonstrate to their surgical teams that they are really equipped to handle these procedures with minimal risk to either the patient or the hospital teams including the surgeons. Their is no room for any slippages here and empty talk can prove hugely detrimental to the patients as well as the surgical team. They must realize that a surgeon operating a patient in covid times is doing so only because his patient needs the surgery and does not have the choice to wait out the pandemic. Unlike, other times, the medical team too is risking a potentially serious infection while operating the case. They know they have to be doubly careful for the patient’s sake as well as their own.

These decisions are not easy, either for the patients or for their doctors. They must be taken with great care after evaluating various options and understanding the risks to everyone. The medical teams and the patients are in this together, far more than in normal times.

The views expressed are personal

The Story of John and Omar – How Customer Advocacy Builds Brands

200308966-001I was in Nairobi earlier this month. The occasion was to inaugurate Max Healthcare’s information Center in the city. I was accompanied by our partner based in Dubai and the program consisted of the usual run of the mill stuff. We had a couple of doctors accompanying us for the almost obligatory OPD’s, which were being hosted by a local medical center in the Upper Hill area of Nairobi. In the evening was a small press interaction, where all of us were to make some noises about how we expected to partner with the local medical fraternity in improving healthcare services in Nairobi and other parts of Kenya.

I was quite apprehensive about this. It is a known fact that the local medical community does not much appreciate foreign doctors landing up on their shores under the guise of OPD’s and taking away ‘their’ patients to sundry hospitals abroad. Though, I have never really understood the cause of this antipathy, (after-all only those patients will choose to travel abroad whose medical condition is such that can not be treated locally) I have been told by our Kenyan hosts that this is for real. Thus, I was a little concerned about a media interaction, where I may have to respond to some sensitive questions.

Also, I was worried that we really didn’t have much to share. After all an information centre of an Indian hospital chain is not really the most interesting piece of news even from the point of view of the news starved media of the city. When we reached the venue in the late afternoon, I was relieved to see our guests trickling in, the PR guys were busy settling the media folks down, the atmosphere was convivial and relaxed.

We had lined up the doctors to talk about their specialities (cancer and neuro-surgery), I was to speak briefly about Max Healthcare and our reasons for landing in Nairobi and our partner from Dubai was to talk about their reasons for joining hands with Max in this venture. We also had two patients, who had been treated at our hospitals and had returned home safely with wonderful experiences in Delhi.

We were soon done with our respective spiels and I could feel a sense of disappointment in the room. The journalists had come with hopes of an interesting evening and our stories had hardly set the room on fire. The presentations from the doctors were also a little technical, which too added to the gloom. They had tried hard, however for doctors to speak in front of an audience and not to lapse into medical jargon is an herculean task. The only saving grace seemed to be the booze and the plentiful food.

As the evening wore on, we had John come up to address the media. John is a cancer survivor, full of life and vitality. Earlier in the day, when I had met him he had told me about his struggle with the big C and how he had fought desperately to beat it. He had been treated by Dr. Rudra Acharya, the cancer surgeon who had spoken a while earlier. “I am here to tell you all, that cancer can be beaten, I am a living proof of this” began John. He narrated his ordeal with a great deal of emotions, the hopelessness of a patient diagnosed with cancer, how it hits you and what extra-ordinary courage it takes to fight this uphill battle. John appeared to be a man with a great deal of conviction and perhaps driven by a mission to share his story widely. He spoke eloquently about how he was taken care of by a team of doctors drawn from various cancer sub-specialities, how did they collaborate to ensure he received the most effective treatment and how everything came together in the end to pull him out from a very difficult situation. He was effusive in thanking Dr. Acharya and the team of doctors, who saw him through this very difficult phase of his life and spoke very highly of his experiences in an Indian hospital so far away from Nairobi. Soon he had his wife join him on the podium, and the two held the audience completely enthralled while sharing even small incidents that touched their hearts. ” I am planning to be in Delhi once again in February for my check-ups and this time round my doctors have invited me to stay at their homes. We missed the Taj Mahal the last time round, I sure hope to see it now” said John. He than invited Dr. Acharya to join him and his wife and both of them warmly hugged Dr. Acharya, who seemed a little overwhelmed with all the attention.

The media loved John. They were now firing questions at him and were literally eating out of his hands.

Soon we had our other guest, Omar, on the podium. He wanted to talk about the treatment of his son at Max Hospital in Saket, New Delhi. His 12 year old son had met with a freak accident in school. The child had tried jumping across a barrier, had landed on the edge and ruptured his urinary pipe. Omar had taken his son to at-least half a dozen centres in various parts of Eastern Africa. Nothing had worked till he landed with Prof. Anant Kumar  in Delhi. Dr. Kumar took up the challenge and re-constructed the ruptured pipe. Omar had been delighted to see his son recover and for him his Indian sojourn had truly been one of the most rewarding experiences ever. I had met Omar for the first time in the office of Dr. Anant Kumar in Delhi, about two weeks before this press interaction.I had told him of my plans to travel to Kenya and he had volunteered to come and speak about his experiences with the local media. Omar is of Somali descent, not only did he come over to see us and share his story, he helped arrange many Somali TV stations based in Kenya to come for the press conference. He first narrated his story in English for the benefit of the Kenyan media and than for good measure he repeated everything in the local Somali dialect for the Somali audience both in Kenya and back home in Somalia.

John and Omar both did us a great turn, though all they wanted was to help others overcome similar obstacles in their lives. They volunteered to share their stories of difficult times and their struggles and how they found comfort and happiness with a couple of highly skilled doctors and their dedicated teams in a faraway, strange land.

Thank you John and Omar.

Marketing a Cancer Service

cancerCan a cancer service be effectively marketed?

Well, to someone who has dealt with cancer either as a patient or a caregiver, the very idea of marketing a cancer service is appalling, even grotesque. Cancer is often looked upon as the ultimate misfortune, a death sentence if ever there was one and juxtaposing a ‘commercial’ term like marketing with it sounds revolting. Yet, we know that in India there are cancer hospitals aplenty, many of them with great expertise and technology at their disposal, but sadly not many effectively engage with their patients beyond the mandatory sessions of chemo or radiation therapy.

Yet, I believe good cancer centres, need to have an effective engagement program with cancer patients and the care-givers. More than anything else, they need to connect with patients and help them understand their disease better, engage with them as partners in the fight that lies ahead and inspire them to beat the great odds  stacked against them. They also need to connect with the care-givers, help lighten their burden of fear and doom at the likely loss of a near and a dear one. Most of all, cancer centres need to give hope and courage to both the patients and care-givers in a world suddenly drained of light and good health.

A good cancer service should aim to constantly engage with its local community. It should help educate about the preventive aspects of the disease. Many oral cancers are completely preventable. Shunning tobacco, eliminates cancer – a simple message if communicated effectively can prevent almost all oral cancers. Extended exposure to known carcinogens such as pesticides, heavy metals or radiation also causes cancers. Avoiding these by taking sensible precautions can help reduce the incidence of cancer.Similarly, the chances of having cervical cancer can be significantly reduced by early vaccination against the disease.

Yet, I have not come across many hospitals running effective mass campaigns against tobacco use or creating awareness about cervical cancer vaccinations. I believe, in the fight against cancer, that is an opportunity wasted.

There are of course, cancers, which have nothing to do with lifestyle factors. They can hit unexpectedly (like the Germ Cell Carcinoma, that ravaged Yuvraj Singh) and there is little one can do to prevent them. However, in our arsenal are now medicines that can effectively combat these deadly cancers, if only we could diagnose and treat them early. Fortunately, we now also have advanced scanners that can detect tumours the size of a few cells, and raise a red flag. Yet, not many cancer services talk about early detection and encourage people to go for regular testing. A good cancer service must connect with the local community and relentlessly drive home the point that a cancer can be beaten by detecting it early.

The cancer service must also understand the fear that the word cancer causes in a person. Many people have an irrational fear of getting themselves screened for cancers. Good cancer services should develop engagement programs, which gently nudge people to shed their fear of the unknown and go for these screenings.

Fighting cancer requires true courage, uncommon grit and determination. The treatment regimen is often debilitating and painful. More than the physical pain, the sheer magnitude of the struggle against a deadly foe, with unknown odds is often difficult to bear. Cancer patients undergoing therapy, need hope and courage to overcome the disease. A good cancer service must realize that even if the disease succeeds in breaking a man, it must not be allowed to break his spirits. A cancer service, which offers hope and a steady hand is the one, which will connect with cancer patients the best.

Cancer Hospitals owe it to themselves as well as their local communities to constantly engage with each other and fight cancer. At Fortis Hospitals in Mumbai, we have for the last couple of months been doing exactly that. The hospitals recently completely a very successful campaign on cervical cancer screenings called ”Teal to Heal” (http://www.fortishealthcare.com/india/Teal_to_Heal.php), are presently running a cancer campaign, which features cancer survivors, sharing their inspiring stories of early struggle and success in beating back cancer. The stories are true and full of hope. The next phase of the campaign, will take up the fight against tobacco.

I do wish, there were more hospitals joining the fight against cancer by engaging their local communities. We can only win, if we fight together.

The Goody Thing

jade-goodySo Jade Goody wants to go out with a big bang, right on television watched by millions, one last hurrah in front of the ever familiar Television audience. 

To most people this would appear macabre, quite insane. Death, like life must be respected and to make a spectacle of it is wrong. Cancer is a terrible illness. It is relentless, painful and debilitating. It must be fought with courage and dignity and most importantly in private. Losing the battle on television with millions watching is akin to gaining some really cheap publicity and sympathy.

Hospitals where Jade is undergoing treatment must stay away from all this. To allow cameras and lights while Ms. Goody receives her chemotherapy, in the ICU, where she lies emaciated and spent with a feeding tube and where she breathes her last, would be a great injustice to the noble science of medicine. It would be like the hospital colluding in this great farce. 

Hospitals must never move away their solemn duty of caring and nursing sick patients to health, providing succor to those afflicted by terrible diseases, giving hope and courage to those terminally sick so that they face death with courage and equanimity. For a hospital to veer away from this and participate in a circus on national television, just because a patient desires so, would be very wrong.

I wish Ms. Goody would get some sane advise from her friends and care providers so that she spends her last few months in the privacy of her hospital room and home  surrounded by people who love and care for her.

Mocking and demeaning death by making it a sordid ‘tamasha’, a reality show with an inevitable tragic outcome is a bad idea.