Lessons from the Covid Tsunami

March 2021 marked a full year of our battle with Covid 19 in India. At Max Healthcare, this was a time for us to look back and more importantly to look ahead with confidence. Clearly, the worst of Covid appeared to be behind us. We had already fought off two successive waves of Covid 19 in the summer and in the late autumn last year, the Covid numbers were declining fast, the vaccination drives were underway and the spring was awash with hope. We believed that, while Covid will continue to bother us for a while, the chances of Covid 19 taking over our lives once more were remote.

The next 15 days turned everything on its head. We were hit by a massive Covid tsunami which inundated everything in sight. The disease was fueled by a capricious mutant virus now dubbed as the Delta virus, about which we knew very little. The hospitals suddenly had no beds, no oxygen, no medicines and no ventilators to support the relentless march of patients. They were overwhelmed, yet most of them, continued to provide great patient care and support. Their staff turned up for work, put in incredibly long hours, they added beds and managed to find supplies of oxygen and Remdesivir and ventilators. While the politicians fought amongst themselves, the leadership teams of the hospitals put their heads together and focused on the task at hand – saving as many lives as possible.

So what made this possible? Here are some thoughts and learnings.

It isn’t the beds that are important but the person besides the bed who matters – The politicians never shy of telling us how well prepared the city is against Covid 19 by citing the number of beds available for patients in city hospitals. They hardly ever bother to share how many trained and willing people are available to take care of patients on those beds. The real lesson, while handling the Covid crisis has been that the most important resource in the battle against Covid 19 are trained and resolute professionals willing to do their duty even in the face of insurmountable odds. They are the ones, who keep the flame alive. Hospitals, aspiring to fight and win against a deadly foe like Covid must have a way to keep the frontline healthcare workers and their immediate supervisors motivated and well looked after. They need to know that they are indeed the most valuable resource that the organization has and that their own needs will be taken care of and that they will be recognized and rewarded.

Those who move fast, succeed – In a crisis, agility is critical. The speed of execution is everything. Thus, the operational teams need to be suitably empowered to act fast and take decisions rather than wait for someone higher up to ‘approve’. If more beds need to be converted to Covid 19 beds, if more people need to be deployed in Covid wards, if more staff needs to be hired and put to work in the Covid areas and if they need to be paid more or supported better , the hospital operations team should have the authority to take these and more such decisions without hesitation. They should know that they have the full support of the leadership team in moving ahead fast.

Resourcefulness and Flexibility are Critical Attributes – In a crisis of this scale, we have seen the governments muddle through their policy agenda. The hospitals are often confronted with conflicting policy directives from various government bodies and they struggle to wade through the quagmire of daily changing regulations. It is thus important to build flexibility in the system and be prepared (as best as one can) for the changing government policies. One day, the hospital might be told to increase bed capacity overnight, the other day their might be an order to source medicines from a ‘nodal’ agency and another day their might be another impossible order to reserve ‘80% of ICU beds’ for Covid 19 (without giving a thought to what the hospital does with non-covid patients in the ICU). These should be assumed to be par for course and the best is to be prepared to execute as best as possible.

A Focused and Committed Leadership – The role of leadership in healthcare companies during the crisis will be evaluated by experts in the months ahead. In my experience, the leadership team contributes the best by aligning itself to the greater cause and issuing unambiguous directions for the teams to follow. It is essential that the leadership team takes and supports bold initiatives and focuses on the most critical aspects of the crisis. In the middle of April, Delhi had a major shortage of liquid medical Oxygen. The demand had sky-rocketed and it was impossible for the oxygen suppliers to produce enough medical oxygen to meet the demand. The politicians were busy squabbling amongst themselves and the courts too had jumped in the fray, with orders that were well-nigh impossible to execute. The Max Healthcare leadership team resolved that they will not allow a single oxygen related death in their hospitals. The leadership team formed a whatsapp group and relentlessly pursued their oxygen supplies. They pleaded, they yelled, they had people escorting their oxygen supplies from the manufacturer’s plants, they moved courts and pleaded with the government mandarins and they stayed awake late every night to ensure that their hospitals did not out run out of oxygen. They did not even once fail their operational and frontline teams. They remained focused and committed to managing the most intractable problem during the crisis. They led from the front.

Communication ties it all together – We often communicate what needs to be done in clear unambiguous terms. However, while this is necessary, I believe what truly motivates the teams is an explanation of why a task needs to be done. This is something that usually gets left out. In difficult times this is of far more importance because we are asking our teams to get many things done and mostly in impossible timelines. During a crisis, the hospital communication channels need to be always open and buzzing. The directions and the reasoning behind those directions should be clear and couched in a language that is easily understood. In these times, it is also important that we appreciate and communicate the good and selfless work that is happening everywhere around us. That, adds to the magic immeasurably and motivates the hospital teams to do better.

Medical Travel Must Come of Age

Medical Travel to India has now reached a certain level of maturity and business size and it has started getting serious attention from all manner of people. Back of the envelope calculations indicate that the opportunity today is approx. USD 500 mn and growing at least 30% or more pa. And these numbers are only the revenue that Indian Hospitals generate from patients traveling to India for medical treatment. Add to this the possible revenue from their stay in hotels in India and the airfare, we are perhaps staring at a business opportunity worth close to USD 1 bn today.

Strangely, for a business opportunity of this size, we still do not have organised players in the market. Almost all the patients traveling to India are being facilitated by small time medical travel operators, who make a commission in the process. Sadly most of these facilitators are completely unorganized, bring in patients through their personal contacts in places like Iraq and Nigeria and have very little resources to support or provide a vow experience to the patients. Many of them started as translators, who were hired by the hospitals as they received the first wave of foreign patients. They interacted with these hapless patients and earned their trust, branched off on their own and started getting patients referred by those who had come earlier.

While, these folks have so far done a reasonable job of patient facilitation, the time is ripe for the advent of the new generation of medical travel operators. These would in all likelihood be young entrepreneurs, tech-savvy and more in tune with the needs of our ”experiences” driven service economy. They would probably be initially supported by some of the larger Indian Hospitals, who would of course benefit immensely from foreign patients reaching their doors much better looked after. They would also hope to benefit from more patients coming through.

At Fortis Healthcare, which is India’s largest healthcare company and where I work, we are encouraging this trend. We would like to work with and support medical travel operators, who are professionally driven and are much better organised in joining us in sourcing international patients. We are identifying potential partners in various parts of the world and beginning to work with them in an effort to create a new and a different kind of eco-system. Hopefully, this would allow for a far better and a completely seamless experience to the patients who are traveling to us from all parts of the world.

I also believe that very soon we will have large travel operators also entering the business. The business case is so compelling that they can not really afford to stay out. Recent reports have indicated that Thomas Cook has decided to enter the market and I have had several discussions with Abercrombie and Kent, who are already setting up the medical travel infrastructure that they need, to roll out the business across multiple continents. They are exploring markets as far as Eastern Africa and Middle East where they are setting up information and patient facilitation centres to help connect patients to hospitals.

At the global level with medical travel destinations like Jordan and Turkey in Asia, Costa Rica and Panama in Central and Latin America, China and South Korea in the far East emerging as the new medical travel destinations (Thailand and India being there for several years now) the sky is really the limit. A global operator can easily facilitate patients into hospitals in any of these countries. Moreover, this would also provide their existing travel businesses a significant bump up as patients traveling to hospitals are usually accompanied by family and friends. Thus more air tickets and more hotel nights will directly contribute to their existing travel businesses.

Honestly, I have been quite baffled that large travel companies have so far not stepped in. My best guess is that they haven’t really looked upon medical travel as a large enough a business for them to get into. Medical travel in India has grown quietly. Not many people outside the healthcare industry, fully know about the extent of the business today even less about its potential. Also, they are is still a serious lack of awareness about the profile of medical travelers. Today we have patients in our hospitals at Fortis who have traveled thousands of miles and have come for extremely high-end medical procedures such as transplants and challenging paediatric cardiac surgeries.

Something in my bones tells me all this is about to end. Patients, should now be able to choose their hospitals and doctors anywhere in the world a lot more transparently, have their travel arrangements done professionally and receive the world’s finest medical care without the worries of a rickety and unreliable system which exists today.

Patients should be able to travel to their doctors and their hospitals a lot more sure about what they truly are getting into free of worries from everything except their medical condition.

Health Insurers Vs. Hospitals-Patients Pay

So the health insurance companies have started tightening the screws on private hospitals in India.  The tussle between health care services providers and the health insurance companies have been on the cards for a while now. The sordid affair burst into the limelight last week, when India’s 4 largest general insurance companies, all owned by the government of India, refused cashless services to patients in these hospitals. The insurance companies can easily do this, by throwing out these hospitals from the network of hospitals, whose patients are entitled to this benefit. The fine print that you and I sign, while buying an insurance policy says that we are entitled to cashless services in select hospitals only and the insurance companies can change this network at their sweet will.

Well, for the uninitiated here is what the problem is. Health Insurance companies believe that hospitals overcharge patients who have an insurance cover simply because the money is to come from the insurance companies. Insurance companies for long have been asking hospitals to agree to fixed rates for some common procedures and surgeries. The hospitals have been resisting this as they believe that these rates are too low and in medicine, it is quite impossible to have fixed packages for surgical procedures etc. Large private sector hospitals, who offer high standards of medical care and pride themselves on their state of the art equipment, doctors, nurses etc. believe that at the rates offered by these PSU insurers, they will not be able to maintain their standards and lose money. Thus the impasse.

Now, here is the truth. The insurance companies by and large are right in accusing the private hospitals of overcharging patients who have an insurance cover. However, in many hospitals this is not deliberate. It is just that if a doctor is in doubt about ordering a test, he invariably would ask for the test, if the payor is not the patient but is an insurance company. This is largely because he wants to be sure of his diagnosis and reduce the risk of his clinical judgement being wrong. Now one may argue that the additional test, constitutes better healthcare and the doctor is well with in his right to ask for it and viewed from this perspective, this would hardly qualify as ‘overcharging’.

The other reason for inflated bills is that we as consumers do not feel the pinch even if the hospital bill is more than what we had thought it might be at the beginning of the hospitalisation. Since the insurance company is paying we would insist on top of the line stuff for ourselves. It hardly matters, whether we really need it or a cheaper option might have been just as effective, things that we would surely consider if we were paying out of our own pocket.  I recall when my father underwent a prostate surgery last year, we ran up a bill of close to Rs. 200000, which I thought was on the higher side. However, since we had insurance, I hardly felt the need to either question the doctor or the hospital. I believe, mostly this apathy of the hospital as well as the consumers towards insurance payouts inflates the bills.

Apart from inflated bills the insurance companies also believe that hospitals defraud them by manipulating patient histories and making claims on behalf of the patients, who would otherwise be ineligible for the claim. This mostly happens if a patient has a pre-existing condition (ordinarily not covered), which the hospital’s doctors would try to hide from the insurance companies. Well, there is a grain of truth in this as doctors occasionally do try to ‘help’ their patients. This is mostly on the request of patients, who desperately want to make a claim even when they know that they are not eligible. The doctors try to oblige their patients either because they have an existing relationship with the patient or when they fear that if they do not ‘help’ the patient he will go to another doctor, who will do the needful. Thus losing a patient for something like this makes little sense to them.

The insurance companies on the other hand are always looking at ways and means of denying hospitals claims, which are perfectly payable. They arbitrarily make deductions citing obscure and often questionable reasons. Many a times they release the hospital’s payments without even informing them that they have deducted part of the money. The payments are rarely made on time, the third-party administers (TPA’s) working for the insurance companies are given targets to reduce payouts to hospitals and the system is  hugely inefficient. Hospitals have to incur costs by hiring people, whose only job is to follow-up with the insurance companies and TPA’s about the money owed to them.

A summary cessation of cashless facilities in private sector hospitals is hardly the solution that works. The insurance companies need to work together with the hospitals to sort out their differences on a case to case basis. The hospital as well as the insurance companies must appoint reasonably experienced and mature people to manage these relationships, who should regularly meet and discuss all cases, where the insurance company feels that the hospital has overcharged. These cases should be thoroughly investigated and if a doctor is found complicit, he should be asked to explain. The insurance companies and the hospitals should organise training programs for the doctors, making them aware of how ‘helping’ patients helps no one. If the insurance company finds a hospital’s administration itself involved in shady practices than of course they must throw the hospital out of their network. On pricing, the insurance companies must accept that hospitals have a right to price their services as they deem fit. Most hospitals will price themselves according to the quality of their services, the pull of their brand and the existing market realities. The insurance companies must accept these prices and maybe they can ask for some discounts based on the volume of business they conduct with a particular hospital. Dictating prices to a hospital is bad policy as the hospital when squeezed hard will cut corners thus compromising on patient care.

Finally as consumers, it  also devolves on us to be more prudent about our healthcare spends in a hospital. We should be as careful with the insurance money as we would be with our own. If we don’t and the insurance companies keep bleeding we will either end up paying higher premiums or worse, will have no cashless services in spite of having an insurance cover.   

 

 

Why do Hospitals need to invest more in Advertising?

Hospitals in India hardly advertise. Most of them look at advertising as an unnecessary expense and keep it minimal. This really need not be so. Looked from another angle, advertising for a hospital can be a critical investment, which allows it to differentiate its services, educate customers about its core beliefs, introduce new products and services and help gain new customers. Unfortunately, in India hospitals believe that customers do not appreciate hospital advertising and may even be put off by it. Many hospitals, who are doing well do not see the need for advertising. With occupancy rates high, the hospitals feel they are wasting money by advertising. Little do they realise that advertising quite often is not only about getting more patients.

To make matters worse, whatever little advertising one sees is mostly inane and dull. The communication usually bears the imprint of too many cooks adding different flavours to the advertising, making it a weird medley of pictures, long copy and a strange layouts. The marketing teams in the hospital are forced to accommodate various view opinions (that of the hospital COO/CEO, the heads of medical departments, other leading physicians, the sales head,  and sometimes the owner of the hospital ) to arrive at a piece of communication, which is usually a disaster from a marketing communications point of view. While, this piece assuaged inflated egos, ensures gory pictures (usually reflecting some landmark surgery) in the ads, highlights achievements of some or the other doctors, it fails in its primary purpose of connecting with the end-user.

Here are a few reasons, why hospitals should look at their advertising a lot more seriously and spend money wisely in connecting with their customers.

Core Beliefs and Positioning

A hospital must advertise its core beliefs through a well thought of brand campaign. It is imperative for customers to know what their hospital stands for, what its core values are and how does it strive to stay true to those beliefs. Thus, if a hospital professes to provide ‘Total Patient Care’as a consumer I would love to know, what it means and what all can I expect from the hospital. Similarly if a hospital is positioned as a ”cutting edge technology” centre I would like to know what that means to me as a customer. A hospital must stand for something in the consumer’s mind. I am not sure, our big hospital brands Apollo, Fortis, Max and Wockhardt (now part of Fortis) have been able to establish any kind of distinct identity in the consumer’s mind.

Products and Services

A hospital offers a multitude of services. Customers need to know about them and hence advertising is a good way of keeping customers informed. New services keep getting added from time to time and the hospitals need to keep their customers updated. Recently Max Healthcare started its cancer services. All that they did was release a solitary advertisement, welcoming the new Chairman of Cancer services!!! The ad was also supposed to serve the purpose of informing the customers about the commencement of cancer care services at the hospital. Wouldn’t it make greater sense to announce the commencement of a service with a nice campaign and if needed also feature the medical leader/team in the ads?

Hospital Launch

A new hospital commencing operations needs high decibel advertising. Artemis did this well, when we launched the hospital. We had large bill boards in Gurgaon, a fairly heavy presence in the local print media and local community engagement through ‘fam visits’ to the hospital. I recall Max Healthcare during their launch also did a fairly well orchestrated multi-media campaign. However, many hospitals too try to save money by launching quietly and hoping the customers will come through the word of mouth or through doctors pulling in their existing customers. I believe, these are sub-optimal ways of launching the hospital’s services and an old-fashioned media blitzkrieg works the best.

Renewing Existing Services

Sometimes it is necessary that a hospital ‘renew’ its existing services. These days, I am seeing some bill boards near my residence advertising Apollo’s new Knee Clinic. The communication is targeted at the elderly, informs about the new Knee Clinic, which offers Knee Replacement services at the hospital. Now, Apollo hospital has been doing knees for a long time, however the communication is trying to repackage the service and relaunch it. Unfortunately, There are just two bill boards and, while the intent is laudable, the hospital is being very stingy. Similarly, while in Bangalore recently I came across a ‘Short Stay Surgery’ campaign by Wockhardt Hospitals. Again the effort seems to be to reposition their Laparoscopic Surgery services in a customer friendly matrix, but the money behind the campaign appeared too little to make any significant impact. Other hospitals too need to often ‘renew’ and repackage their services smartly.

Driving Traffic

Hospitals can drive traffic to their OPD’s through innovative offers. In fact the bulk of hospital advertising today focuses here. A free Cardiac Camp around the World Heart Day is routine. Similar camps and offers in other specialities help drive traffic to the hospital OPD’s. The problem here is that hospitals do these sporadically, without adequate planning and often as band-aid solutions to transient OPD traffic related issues. Tactical campaigns need to be more consistent and better planned to yield optimal results.

Educating Customers

Wouldn’t it be wonderful if a hospital did an educational campaign about let us say heart disease or diabetes or any other lifestyle diseases. The campaign should aim to educate customers about the disease, its symptoms, treatment options, success rates, technology available and the medical expertise available to treat the disease. The objective should be to inform the customers, help them ask the right questions and thus make the right choices. Unfortunately, none of our hospitals including the big chains are willing to invest in patient education simply because the returns are relatively long-term.

Pic is indicative.

The Rural Doctors

In a bid to provide primary healthcare services in rural India,the Ministry of Health of the Government of India has proposed a 3.5 years abridged medical course. The idea is to churn out doctors  willing to work in rural communities faster. The proposal mooted by the health minister Ghulam Nabi Azad has drawn mixed reactions from various quarters. Many have argued that by introducing an abridged diploma course the government will be playing with the lives of the rural folks. The essential argument is that even the basics of medicine can not be taught in such a short period of time. Others have taken a contrary view, pointing out that replacing today’s rural quacks with doctors having a basic formal medical education will be a huge plus.

In rural India, where more than 60% of India lives access to good quality healthcare is minimal. The government has spent millions of rupees in trying to provide primary healthcare in these areas and has met with little success. The twin problems of medical infrastructure and trained people has stymied government effort for long. Of these, it can be argued that the infrastructure problem is rather easily taken care of, the government just has to find the will power and the money to build primary health centres. The bigger problem is of finding qualified and trained doctors to work in rural areas.

Forcing newly minted doctors from government-run medical colleges, which offer subsidised education is a sub-optimal solution. These doctors hailing from large urban centres have no desire to work in rural, underdeveloped areas, where they can not possibly have the lifestyle that they are used to. The divide between Bharat and India has ensured that the chasm is too big to bridge and these doctors and their patients have almost nothing in common.

In rural India today, primary healthcare services are largely provided by a class of quacks, masquerading as doctors. Illiterate rural folks have no idea of the knowledge or formal qualifications of these ‘doctors’. They do not have the courage or the wherewithal to find out the antecedents or the past experience of these physicians and the entire system works on blind faith. Usually, these quacks have some knowledge of medicine largely acquired by having worked as assistants to doctors in big cities. Thus, they are able to continue the charade by prescribing commonly used OTC medicines and some wide spectrum antibiotics, for almost all ailments. Many people recover from common ailments, those who do not or grow steadily worse are referred to real doctors in nearby towns and cities.In remote and far-flung areas, things are even worse. Faith healers and babas of various hues treat people using ‘jhaad-phoonk’, which are nothing but ancient pagan rituals.  This is the terrifying reality of the 21st century rural India.

In this context, it makes eminent sense to have a cadre of rural doctors with some formal medical education. They would be able to provide far superior care than what is presently available in rural India. That the government proposes to hire rural youths in this program will ensure that these doctors continue to live and serve in their own communities. Unlike, their urban counterparts, these doctors do not run the risk of being fish out of water in this environment.

The government should now swiftly move forward towards evolving a mechanism for setting up rural medical colleges and lay down guidelines for enrolling rural youths in these courses. It should set up a few rural medical institutes and a regulatory body to regulate the proposed system. The government must also apprentice these rural doctors in government hospitals for at least 6 months so that they learn the practice of medicine from senior and more qualified doctors.

This solution I know is far from ideal. It also smacks of a certain class bias (more qualified doctors for slick city dwellers, under-qualified and not as well-trained doctors for poor rural folks), but such is the reality of the urban and rural life in India that even an idea like this has its distinct merits.  

 

 

The Government’s Apathy to Healthcare in India

The Union budegt presented last month by the finance minister, Pranab Mukherjee, is hugely disappointing for the healthcare sector in the country. For many years now people associated with healthcare in the country have been waiting for big-ticket reforms in the sector, but the government has been turning a deaf ear. This year too, the story is no different.

The healthcare services in the country are not only woefully inadequate but also unevenly distributed. The healthcare industry, which is hugely dependent on private enterprise is just not attracting enough investments. Setting up and managing a hospital till it breaks even and makes money requires huge upfront investments. Presently, India has 860 beds for a million people, way below the WHO’s norm of  3960 beds for a million people. Studies by E&Y and KPMG have indicated that India needs to add 100000 beds per year for the next 20 years to reach close to this figure. This alone entails a spend of Rs. 50000 Cr. per annum. Compare this with what the government proposes to spend on healthcare in the next financial year, Rs. 22300 Cr. While this is 14% more than what the government spent last year, this amount is clearly insufficient.

The National Rural Health Mission, the flagship government programme for providing healthcare services in rural areas is riddled with inefficiencies. The government-run Primary Healthcare Centres are usually understaffed, ill-equipped and provide the most basic level of healthcare. Rural and semi urban India also needs good professionally managed secondary and tertiary care hospitals, which provide reasonably good quality healthcare at affordable rates. It seems that the government does not have the will power or the resources to usher in healthcare reforms.

Amazingly, the private sector entrepreneurs are willing to step in and bridge the gap.  All they need is a little help from the government in the form of tax holidays, duty reduction or abolition of duties on medical devices, easy availability of funding from government institutions at soft rates, longer payback periods and land at concessional rates. The government should also set up a regulatory body, a watchdog, which will keep an eye on hospitals being set up through this mechanism. The watchdog is critical as it will establish guidelines for setting up the hospitals, monitor progress, ensure quality through regular audits, lay down a fair pricing mechanism and in general ensure that the private sector, while availing of government policy benefits delivers on the promise of efficient, good quality and easily accessible care.

This is really not too difficult to achieve. Look at how private participation has revolutionized telecommunications in our country. Today India has more than half a billion mobile phone connections, the tariffs are the lowest in the world and even remote, far-flung and fairly inaccessible areas are connected (I had my phone working in the Nubra valley in Laddakh). The phones generally work, the services are efficient and the private sector companies, who had the foresight to start early are making profits. Some are even planning to go global and compete with the best in the world. The TRAI, which is the government watchdog is seen as an impartial and fairly efficient body, doing its job of advising the government on policy matters and ensuring compliance and a level playing field amongst all the operators.

No country can progress and aspire to be an economic superpower unless its citizens have access to good quality healthcare services. Considering India’s size and a population of over a billion people, (the majority living in rural areas), it is imperative that the government kick-start  reforms in this critical area sooner than later. If no significant policy initiatives have been announced this year, can the healthcare industry bodies (like those associated with CII and FICCI) lobby with the government, initiate debate and fuel informed discussion amongst all stake holders so that public opinion can be rallied in favour of these reforms.

Healthcare services impact the health of the nation. It is time all the healthcare stakeholders including the government sat together to prepare the blueprint for the next generation healthcare services for the country. This is very important because, unless we have robust, universally accessible, reasonably priced healthcare services for our citizens, all our claims about being an economic superpower will remain hollow and truly meaningless.

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.  

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 http://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.