Convocation Address of National Board of Examinations

MEDICARE WITH COMPASSION AND NOBILITY

I am delighted to participate in the Convocation of the National Board of Examinations. I congratulate all the doctors for their performance in various specializations. Medicine is among the most noble and challenging professions where human intelligence, skills and patience are required to combat human suffering and pain with love and compassion. Today I would like to share with you my experiences with some healthcare institutions who are engaged in providing humane treatment to the needy.

Medical profession and the Mission

During my visit to Sri Sathya Sai Institute of Medical Sciences & Super speciality hospitals last year, I noticed a different model of providing healthcare to the patients. The unique feature of that institution is that some of the specialist doctors are not on the permanent roll of that hospital. They come to this hospital by taking leave for one or two weeks from their parent organisation and extend their services for diagnosis, treatment and surgery. The doctors provide their services whole-heartedly with devotion and dedication and seek in return, only the happiness of the treated patients. The advantage of this kind of treatment is that such benevolent acts of the doctors inspire the recovered patients to further propagate the mission of caring and sharing by voluntarily offering their services to the incoming patients in their best possible capacity.

Speciality Services to Rural Areas

Last year I visited Tripura in the North-East. At the G.B. Pant Hospital in Agartala, a tele-medicine facility has been established by the doctors and engineers working at the CARE Foundation in Hyderabad. There I interacted with a 13 year old boy living in Kalashar, 300 kms away in the hill tracts of Tripura. Dr. B. Soma Raju, an eminent Cardiologist, was with me. He diagnosed the boy who was suffering from narrowing of one heart valve, using tele-medicine technology. The boy was not able to breathe and move around properly. The boy was later shifted to Hyderabad, more than 2000 kms away and a team of doctors performed PBMV (Percutenous Balloon Miteral Vulvoplasty) to correct his heart valve. The boy recovered completely and joined school on his return. He recently wrote me a letter informing about the good marks he secured in his class. This example drives home the point that experts from different fields through tele-medicine can perform together in an integrated way to extend their expertise and services to the rural masses and remove the pain irrespective of the locations.

In October 2002, in Almora, Uttaranchal, a mobile clinic, a joint project of TIFAC and the Government of Uttaranchal , was deployed that carries healthcare to the people at their doorstep. It has visited 50 villages and already treated more than one thousand patients who could not have afforded treatment otherwise. The normal healthcare is provided in the well known hospital in real time almost at no cost. This was possible by integrating technology, good hearted doctors, supporting staff and above all a new style of management. It is essential for every established hospital to provide mobile clinics within 50 to 100 km, as part of the hospital situated in towns, which will benefit the rural population at minimum cost.

Affordable and Effective Healthcare

The Vision of providing affordable and effective healthcare to our entire population goes much beyond the capability of any individual, institution or organisation. Large amount of resources, both financial and in terms of skills, are required. This vision needs to be developed into multi-organisational missions leading to the generation of hundreds of goal oriented projects. These projects will have to be supported and nurtured not only by the Government, but also by our industry and philanthropic organisations. The most important ingredient of such a multi-organisational mission will be the leadership, decentralised, yet linked together. I have seen this happen successfully through tele-medicine system, providing expert medical diagnostics and prescriptions of treatment to the district hospitals. I have just seen an indigenously developed digital cath lab at a Hyderabad hospital. It demonstrates the success of multi disciplinary partnership and technology integration. The doctors who graduate themselves have to have a partnership continuously with technological advancements.

For the development of indigenous medical products, institutions, which do research on various technological systems that are the tools for medical-care, have to be provided with the clinical knowledge. The medico-technical knowledge must then go to the industries which not only productionise cost effective medical system and products but also adopt nearby villages for medical care coupled with education. The hospitals with medical research centres can have themselves umbilically connected with other R&D organisations for developing indigenous medi-care equipments, devices and consumables. I recall this happening when we established the Society of Biomedical Technology common to Hospitals and R&D Labs at the Nizam Institute of Medical Sciences. In the years that followed there was a great wave of development of medical devices - FRO, catheters, stent, cyto-scan system tele-medicine system and digital cath lab.

Challenge of Medical Science

The interfacing between medical science, electronics, material science, bio-science, bio-technology and engineering has given rise to techniques both investigative and curative and has provided the research worker with numerous tools to apply into the working of various physiological functions right up to molecular levels. Developments in bio-technology and molecular biology have now made it possible not only to design drugs for specific properties but also to deliver them to the specific sites where they are most required. Newer imaging techniques have now made it possible to obtain real time images of the various organs at a physiological and biological level and hence right treatment is possible.

With the present trend of progress in research and development endeavours in the field of bio-medical technology and pharmaceutical sciences, healthcare will assume a new dimension in the 21st century. Certain newer concepts that have emerged will find application. Some of these are:

• Availability of quality healthcare at affordable cost
• Use of teleconferencing and tele-sensing to interact with the patients.
• Surgical procedures and demonstration using Net-based video.
• Knowledge systems to provide expert advice.
• Electronic patient records to provide bio-medical information leading to empowering the Doctors.
• Embedded software for telemedicine and tele-surgery including intelligent data-mining for patient treatment and visualization tools.
• Health and nutrition broadcast in electronic media including internet.

Networking the Institutions

Our country is rich in human resources, particularly of scientists, doctors, technologists and engineers. The basic infrastructure is available for advanced research. The need of the hour is to network the existing facilities and expertise with commitment and conviction to augment and facilitate higher rate of research and development. There are tremendous opportunities for technologists to work for an 'Integrated Health for All' in a mission mode which can be suitably evolved for implementation. The mission may include:

• Networking of medical universities, institutions, R&D Labs, industries and social organisations in key areas of assistance to the handicapped and disabled.
• Networked insurance scheme for healthcare coverage
• Launching of awareness-cum-prevention programmes to check the growing incidence of TB, Cancer and HIV.
• Creating a nationwide cold storage chain for polio and other temperature sensitive vaccines.
• Conducting hospital linked diploma level courses on medical technology maintenance at the state technical education institutions.
• Establishing an industry-supported system for maintenance and upgradation of medical equipment.
• Productionising selective assistive devices like hearing aids and medical consumables like electrodes, catheters and leads etc.

Redesigning and Transforming Health Care

There is a need to redesign and transform our healthcare system. An action plan can be drawn that may include prime focus areas like prevention, diagnostics and treatment. Prevention will include sanitation, availability of safe drinking water, basic education and nutritional awareness. Diagnostics will include availability of X-ray, Ultrasound and ECG at every PHC and a CT scan and Colour Doppler at every district hospital. Both would be linked to Tertiary care hospital by telemedicine. Tertiary care hospitals will focus on interventional technologies such as angioplasty, brachytherapy, prosthetics, and molecular level management of immune, endocrine and other systems.

Current Medical profession is where the past meets the present and creates a future. While the ancient values of a healing physician remain fundamental to the medicine, emerging knowledge empowers a physician in his skills to remove pain. That means the syllabi for MBBS and PG courses have to continuously enrich themselves with the emerging knowledge in the field of molecular, biological sciences and technologies and also integrate themselves with psychological and emotional aspects central to the process of healing.

Concluding remarks

Friends, a nation is great, not because a few people are great, but because every one in the nation is great by his/her performance. The challenge in the mission for the Developed India calls for important cohesive and focused efforts of the young. To a very large extent the major problem of health-care is the genesis of disability. Any rehabilitation effort can be made successful only by integrating healthcare with economic activity at the community level. Multiple agencies in our social system - local government, education, business, healthcare - must be brought together. I visualise the clinical connectivity planned to link PHCs which will provide medicare with nobility to the grass-root of our Society with nutrients of technological strength and industrial prosperity. This is possible only in the environment of development of village complexes through providing urban facilities. It means the village complex has to have a connectivity - physical, electronic, knowledge and thereby economic connectivity.

You all have the special privilege of getting recognised by this prestigious Board, which was established with a mission of creating a Body of excellence for maintaining standard and uniformity in conducting postgraduate and postdoctoral examination in the field of medical sciences. Today, when you stand on the threshold of your challenging careers which offer new tasks and responsibilities, I extend my best wishes to you all to excel yourself in your lives as specialist doctors, to grow from strength to strength in order to serve the society at large, particularly the weaker sections and above all to emerge as good human beings with faith and conviction for eternal values and a heart for societal care.

Best wishes to all of you.