Friday, October 15, 2010

Address at the Annual Convocation of the Government Medical College


Role of healthcare professionals in societal transformation
Let my brain remove the pain
I am indeed delighted to participate in the Annual Convocation of Trivandrum Govt Medical College. My congratulations to the graduating students who will be taking up the responsibility of delivering quality healthcare to the society. My greetings to all the graduating students.

Dear friends, when you are offering integrated medicine as a curriculum and practice, I have a suggestion for the Trivandrum Govt Medical College that you can formulate a panel of doctors from all these disciplines and decide which form of medicine is best for the patient at a particular point of time so that the patient will get an integrated medical care from the hospital, instead of having a belief that only one form of medicine is the cure for all type of diseases and end up in switching from one form of medicine to another form of medicine finally incurring huge some of expenditure. You may try to implement this as a pilot by forming the panel of doctors to examine the patients and advice the right type of medicine and if it is successful you may like to roll it out to Kerala and Other states.

When I am here with healthcare experts and students, I would like to share my views on the topic “Role of healthcare professionals in societal transformation”.

Dear friends when I see you all, first of all I would like to share one experience with you. When I was teaching in Gatton college of Business and economics of Lexington in USA, one of my students asked me, Kalam, you have done many tasks? Tell us what one task that gave you the bliss? How to answer? It is important for me to answer. Let me share with all of you. When we launched first indigenous satellite launch vehicle SLV3, it gave me lot of happiness! When we launched AGNI, it gave me different kind of happiness! When I and my team had successfully tested the nuclear weapon at the 52 degree centigrade in Pokhran desert, it gave me great joy! When our team prepared the Vision 2020 document for transforming the nation into a developed nation, it gave me a greatest happiness. But what gave me a bliss!? That is the memorable event which I would like to share with you now.
During my visit to one of the hospitals in Hyderabad, I found many children were struggling to walk with an artificial limb weighing over 4 kgs. At the request of Prof. Prasad of NIMS, Head of orthopedic department at that time, I asked my AGNI missile friends why we cannot use the composite material used for AGNI heat shield for fabricating FROs for polio affected patients. They immediately said it is possible. We worked on this project for some time and came up with a FRO for the child weighing around 400 gms in place of 4 kg, exactly 1/10th of the weight which the children were carrying. The doctors helped us to fit the new light weight FRO on the children and the children started walking and running around. Their parents were also present. Tears rolled down on all of their faces through the joy of seeing their children running with the light calipers. With the light weight device provided by the hospital they could run, ride a bicycle and do all sorts of things which they had been denied for a long time. The removal of the pain and the freedom attained by the children gave me a state of bliss which I never experienced during any other achievement in my life.

Dear friends, what will inspire you, since you are all the graduating students, particularly when you are entering into your career, you will like to hear certain inspiring lives in your healthcare domain. Let me first discuss about three individual healthcare professionals known to me, who through their light of knowledge have been engaged in transformational societal missions to remove the pain and sufferings of humanity. I am sure that the unique life and work of three healthcare givers will be a beacon of inspiration for the young graduates.

The first example of a noble healthcare professional is healthcare giver who left his foreign job and using the strength of cooperative movement that led to the birth of a low cost high quality rural hospital.

Healthcare as a social entrepreneurial mission
Friends, in February 2010, I visited the Warana valley of Kolhapur Maharashtra. There I witnessed, how cooperative movement by the local farmers and villagers is bringing out a socio-economic transformation of the people and the region. The Warana PURA complex has many initiatives for the income generation and amenities for about 60,000 families in the Warana area. One of the initiatives which I visited was the Mahatma Gandhi Hospital at New Pargaon at Warana.
The Mahatma Gandhi Hospital was established by late Shri Tatyasaheb Kore and his son Dr. Sudhakar Kore, who manages the hospital now. Dr Sudhakar Kore is an MBBS and MS in General Surgery. After his education in 1970, Dr Sudhakar Kore worked in many famous hospitals of Scotland, UK for seven years. All this time, the healthcare in his native village of Warana were lacking and the local had to go to distant cities of Pune and Mumbai for even small treatments, Dr. Kore wanted to do service for his nation and the people of Warana. Thus, in 1979, he chose to return to Warana Valley, leaving his foreign job, to serve local needy. He started his own hospital in Sangli district along with his family. With the help of the cooperative movement, Mahatma Gandhi Charitable Trust was established in Warana which led to the birth of Mahatma Gandhi Hospital. This not-for-profit hospital was established on 2nd October 1992. The Mahatma Gandhi hospital is a 225 bedded hospital with 2 medical sub-centres of 25 beds each located about 10 kilometers from the base hospital.

Today, this hospital has an area of 110,000 square feet and built over an area of 27 acres. It has four operations theatres for providing modern surgery facility to the population within Warana. The Mahatma Gandhi Hospital and its extension healthcare centre are offering various healthcare facilities like medicine, surgeries, orthopedics, obstetrics, pediatrics, ophthalmology, ENT, pathology and radiology at affordable cost and even free to the needy. Dr Sudhakar Kore is an example of how educated and talented doctors with spirit of social entrepreneurship and with the help of a cooperative movement can bring about a transformation in the healthcare for people living in an area of poor accessibility. The doctors and healthcare professionals graduating today may like to think on how they can apply their knowledge in an entrepreneurial way for achieve a great societal mission.

Inner Voice Calling
Dr Soma Raju was born on 25th September 1946 in Bhimavaram; West Godavari District of Andhra Pradesh in an agriculturist family of small land holding, Soma Raju walked 8 k.m. to his school and could buy his first shoes when he was 12 years old. Realizing education as his ticket to the better world, Soma Raju educated himself with zeal. He took his MBBS and MD (Internal Medicine) from Guntur Medical College and moved to Post Graduate Institute (PGI), Chandigarh from where he obtained his DM in Cardiology in 1977. At Chandigarh he would pay 20 rupees to a patient to allow him to listen to the patient’s heart beats for an hour so that he can appreciate the nature and rhythm of heart beats.

Dr. Soma Raju played a key role in setting up the Cardiac Facility in Nizam Institute of Medical Sciences and had the historical distinction of performing the first balloon angioplasty procedure in India in 1985. His work with Wayne State University, USA on repairing heart valves with balloon (Percutaneous Balloon Mitral Valvuloplasty; PBMV) not only benefited hundreds of poor children suffering from rheumatic heart disease but also got him an International acclaim (New England Journal of Medicine 1994; 331:961).

Dr. Soma Raju is one of the founding members of society for biomedical technology (SBMT), an inter-ministerial initiative of the Government of India to develop affordable medical devices and technology. Since then he has been instrumental in shaping the development of cardiology and cardiac surgery in Andhra Pradesh in the private sector. Dr. Soma Raju founded Care Hospital and setup a bench mark in providing affordable cardiac interventions and cardiac surgery. We made a coronary stent together. The KR stent, as it was called, resulted in the availability of all international brands of coronary stents in India at the most nominal prices. Now I would like to talk about the work culture of Dr. Soma Raju.

Dr. Soma Raju reports to the intensive cardiac care unit every morning at 6 o’clock after his morning chores. He is on the job from then. At 7 o’clock, he takes a class which is free in the hospital where medical students from any college can attend. Normally, 50 to 100 students attend his class everyday. From 8 o’clock to 9 o’clock, he is in a network with 12 CARE Hospitals (Hyderabad, Visakhapatnam, Vijayawada, Nagpur, Pune, Bhuvaneswar, Raipur and Surat) located in different parts of the country. There he discusses all the critical patients on a conference mode and provides line of treatment based on expert advice. From 9 to 11 o’clock, he goes round the wards and examines each patient who is under his care. From 11 o’clock onwards, Dr. Soma Raju attends to his out patients. Simultaneously, he performs procedures in the Cath Lab. This goes on till 6 p.m. everyday. After finishing the out patients, he meets the administrators after 6 o’clock. If there are waiting patients even after 6, he completes all of them and the administrators have to wait. In between patients, if he gets time, he goes to the tread mill for exercising. While exercising, he listens to the lectures on cardiology delivered by the experts of American College of Cardiology stored in an i-pod. This is a beautiful method of exercising while work and learning while exercising leading to double derivative of time. Another unique feature of Dr. Soma Raju is, he reads at least for one hour before going to bed at 10 o’clock in the night. He says, practicing modern medicine without reading, is like walking blind folded on the street. Unlike other senior doctors, the mobile of Dr. Soma Raju is on 24x7 and any patient can reach him at any part of the day or night.

Dr. Soma Raju has initiated innovative schemes to channelise the good-will of people to help poor patients getting expensive medical treatment. In one such scheme namely Little Heart Project, free corrective surgery were performed on 1080 children born with congenital heart defects. The unrelenting work of Dr. Soma Raju has won him many accolades and awards. He is currently Chairman and Managing Director, CARE Group of Hospitals, Hyderabad having 2000 beds at 12 centres. As per Dr. Soma Raju, the driving force behind his continuous contribution to treatment of patients, medical education and institution building is the inner voice which keeps on calling him to remove the disease and the pain of the people.

Let me give some of the innovation in healthcare research leading to solutions for the diseases which were almost incurable so far.

Innovative Cancer Vaccine Development
In April 2010, while in Louisville in USA, I met researchers from Brown Cancer Research Center who are developing a vaccine for cervical cancer which affects many women in the nation. A World Health Organisation study reveals that every year 132,000 women are diagnosed with this particular kind of cancer and nearly 75,000 die from the disease. The proposed vaccine would be developed on protein drawn out of tobacco leaves and would cost nearly $2 for every individual. I am sure, the healthcare community assembled here would like to take up development in such areas of societal importance.
Since all of you are now going to engage in your mission to be the future leaders of healthcare, let me now discuss with you a unique hospital which I saw in Lexington USA.

University of Kentucky Healthcare Centre
Friends, in the last month, I was in USA for some teaching assignments at various universities and other programmes. On 15 of April 2010, I visited the University of Kentucky Healthcare centre which is a one billion dollar hospital with the best of healthcare of all kinds for the people of the state of Kentucky.
Dr. Michael Karf, the chief designer of the whole hospital, showed me around the under construction building. Dr. Karf introduced the hospital to me as “a visionary healthcare center of the 21st century”. I observed, how the grand hospital was more than a symbol of the best medicare technology, it carried a message of compassion for the patients of all ages and conveyed hope to the ailing heart and brought smile to the sad faces. The hospital, of course had the best medical equipments, but it was also aesthetically designed with large windows, beautiful atrium decorated with beautiful paintings and games for children. The patient when he or she enters the hospital, gets a message of confidence “I will be healed”. At the same time, while the hospital was state of art, it still provided for further space for later technological advancement by having high ceilings and wide doors. Why I am saying this, is because some innovative doctors will come out of this gathering and will be pioneering unique healthcare centers which bring together medicine and compassion.

My visualization of great Healthcare centers
Dear friends, I visualize a great healthcare center with the following characteristics:
1. Patient is the most important person in the hospital. When the patient enters, the hospital presents an angelic look and all the team members of the hospital always wear smiles. The patient feels that “I am going to get cured”.
2. The hospital consumes less electricity and less water by adopting green building for all modernization tasks. The choice of the power source is solar and wind.
3. The hospital premises are totally noise free.
4. All the test reports and treatment schedule get attached to the data base of the patient through Electronic Medical Record without the need of the patient or the relatives to search for the reports. The data-base is updated and authenticated every hour.
5. Maintains the database of all the cases treated by the hospital in the past which are easily retrievable.
6. Patient is not subjected to diagnostic pain.
7. The surroundings of the hospital is green with full of trees with seasonal flowers.
8. Further expansion of the hospital is in vertical mode leading to fast movement of the patient and doctors for medical treatment.
9. There is no case of hospital induced infection to the patients due to bio-contamination.
10. The patients feel that this is the best place to get treated.
11. The hospital is fully IT enabled leading to virtual connectivity of the patient to the doctor, nurse and the chief of the hospital 24x7. Hospital is also networked with other hospitals nationally and internationally for seeking expert medical advice on unique cases.
12. The daily medical conference, attended by the Chief of the hospital, doctors, nurses, paramedics, and relatives of patients of unique cases, reviews problems of the patient and find integrated solutions.

I am sure the Government Medical College, Trivandrum possess all these characteristics.

Conclusion: Six virtues of a healthcare giver
When I am with the healthcare community, I would like to share an experience with Choakyi Nyima Rinpoche, the Chief Monk in Kathmandu and a medical researcher. After nearly a kilometer of walk, I reached the white Kumbha where the chief Monk and his disciples were waiting to receive me. After reception the Chief Monk said, let us go to our study room and I followed him. He climbed the first floor, the second floor, the third floor, the four floor and the fifth floor, just like a young boy. Probably the life style has a positive impact on the mind and body. All along I was following and following. When I reached his chamber, I saw a laboratory and a spiritual environment over looking the Himalayas. What surprised me was, his research students come from different part of the country. Particularly he introduced me to his co-author David R Shlim, MD who is working on a research area, Medicine and Compassion. The Chief Monk Choakyi Nyima Rinpoche and myself exchanged few books. The Monk has written with Dr. David R. Shlim a book titled “Medicine and Compassion”. I liked this book and read it during my journey from Kathmandu to Delhi. This book gives six important virtues which a medical practitioner has to possess towards their patients.

First virtue is generosity; the second virtue is pure ethics; third is tolerance, fourth is perseverance, fifth is cultivating pure concentration and the sixth virtue is to be intelligent. These virtues will empower the care givers with a humane heart. I am sure; all the young students graduating today from Trivandrum Govt. Medical College will inculcate these values.
Dear friends, Today before you go to bed, take a paper and write this question, “What I will be remembered for?”. Will I be remembered as one of the great doctors of the nation in a particular field, or will I remembered as a pioneer in creating unique healthcare center bring brings a confluence of compassion and medicine, or will I be remembered as a pioneering life scientist for discovering vaccines against HIV, malaria or cancer, or will I be remembered as a great doctor who went to the villages and changed the healthcare system for a million people. If you are able to write an answer for this question in a page, who knows that page may be one of the pages the posterity will ever keep referring in the years to come.
Dear young doctor friends, graduating today is a beautiful event of the journey of your life. The real destination of you life, will transpire, when you ask a question what I will be remembered for?

Once again congratulate the Graduating Students. My best wishes to all of you for delivering the best of healthcare to everyone through knowledge, hard work and integrity.

May God Bless you.

Oath for medical professionals
1. I love my medical profession a noble mission.
2. I will follow the motto “Let my care, remove the pain and bring smiles”.
3. I will always radiate cheer to give confidence to patients and their families.
4. I will be a life long learner, I will practice what I learn and I will train my team to be competent.
5. I will deliver quality care with high standards irrespective of whom I am treating.
6. I will not introduce any diagnostic pain.
7. I will work with integrity and succeed with integrity.


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