Address at the 90th Anniversary of BEL-AIR Sanatorium and Hospital

MULTI DIMENSIONS OF VISION : HEALTHCARE

I am indeed delighted to be here in BEL-AIR Sanatorium and Hospital on its 90th Anniversary Celebrations. My greetings to the staff and management of this hospital and the Maharashtra State Branch of the Indian Red Cross Society. On this important occasion, I would like to recall the visionary behind this noble health care centre Late Dr. Rustomji B. Billimoria who started the sanatorium with his unflinching commitment to this hospital. I understand that visionary was traveling from Mumbai by train and road and then walking some of the distance to remove the pain of this people at this place. Over a period of nearly hundred years, I am glad to see this hospital grow with facilities for admission in general medicines, orthopaedics, paediatrics, gynaecology, and chest diseases. It is also running the a Community Care Centre for HIV/AIDS supported by National Aids Control Organisation and Avert Society.

When I visited the hospital just now, I saw HIV/AIDS patients getting an environment, which gives them emotional support. The environment aims to prevent further infection and give the patients their dignity back. Patients have turned into volunteers who not only care for the sick but also spread the message in the villages of Satara district. I am happy to note that Bel - Air has started a basic training programme for doctors in HIV management, the first of such programmes was started in 2002 - 03.

When I went to Tuensang a remote village in Nagaland, I could see several young with HIV/AIDS infection. I had an interaction with the relief workers and understood that re-use of syringes to inject drugs cause this increased number of HIV/AIDS. I have narrated this incidence to the project co-coordinators of NACO for suitable action. Awareness among the youth is very vital in India to have and ensure healthy living styles. Later when I met members from National Aids Control Organisation I was told that NACO has taken-up the mission of delivery of community based low cost care for people living with HIV/AIDS by

a. providing drugs for treatment of opportunistic infections including tuberculosis

b. anti retroviral post exposure prophylaxis to medical and para-medical workers in the event of an accidental exposure of HIV/AIDS while treating HIV/AIDS patients.

c. Providing single dose nevirapine to HIV positive mothers and her baby attending anti natal clinics in certain states.

d. Encouraging people living with HIV/AIDS to form their network/self help group in order to facilitate care and support to people living with HIV/AIDS.

In addition there is need for a very comprehensive social policy to handle the HIV/AIDS patients particularly for children.

i) Right from the primary school stage at various levels, the syllabus should include, in simple language, the correct appreciation of diseases like the AIDS, Tuberculosis, Malaria, Leprosy, etc. HIV should not be singled out because if that is done, that itself will make it prominent in an adverse sense.

ii) The media should continuously mount an educative campaign on the same.

iii) Like Mohalla Committees to deal with law & order, every district, if not every sub-division, should have a Committee of parents, teachers, medical personnel, social representatives, religious representatives and other NGOs to deal with sociological problems such as these. They should meet periodically and generally review the state of affairs in their jurisdiction. The same Committee should organise seminars and discussions on such issues.

iv) Fine Art organisations could produce programmes which through the medium of fine arts will spread the right message among the people including children.

All these campaigns have to be so intelligently managed so that instead of educating the people, they should not create a scare by overdoing it.

Integrated Healthcare Treatment

The suffering of certain diseases like HIV/TB and cancer does not remain confined to the patient alone. It often engulfs the entire family and the social surroundings. The emotional trauma is just intense. The Bangalore Cancer research Foundation conducted a unique multi-institutional study with DRDO with the participation of Defence Institute of Psychology (DIPR), Defence Institute of Physiology (DIPAS) and Centre for Cellular and Microbiology (CCMB). The study was aimed at establishing the relationship of the stress of breast cancer patients with the neuro endocrine response leading to immune modulation, which will determine the prognosis to treatment or progression of the disease. The perceived stress of the patients will be influenced by the social support being provided by the spouses and caregivers and hence in the study a system approach was made to evaluate the stress of the patients in the social ambience. Patients of breast cancer, their spouses and equal number of the care givers served as volunteers for the study.

Standard psychological methods were used to quantify the stress of the patients, their coping strategies, blood cortisol, cell mediated immunity and humoral immunity were measured in all the three groups. The study revealed specific correlation of the stress of the patients with the immune responses. Patients who received adequate social support had lower level of perceived stress and their prognosis to surgical, radiation and chemotherapy were better than those who had higher level of perceived stress due to inadequate emotional support from the spouses and care givers. The primary message, which emanated from the study, indicates that for successful prognosis, it will be essential to combine psychotherapy along with the conventional medical management of cancer. It also emphasises the necessity to address the problem at the mind-body complex where the etiological factor may have the root. The sample size is small. Elaborate further research in this area is very vital. This effort of typical cancer treatment can be extended to other serious diseases.

Vision for Healthcare

A report on "Health Care in India" was prepared in consultation with leading doctors, medical technologists and healthcare providers in the country. The report brought out typical problems facing us for two decades in the health care and suggested possible solutions. The expert team has identified eradication of three major diseases namely, Tuberculosis, HIV and water-borne diseases by next decade; followed by cardiovascular diseases, neuro-psychiatric disorders, renal diseases and hypertension, gastrointestinal disorders, eye disorders, genetic diseases, accidents and trauma, which need our attention.

There are two major issues involved. First, we have to augment our primary healthcare system in a big way, empower our secondary healthcare system and integrate both with the tertiary care centres. Second, we should see how the advancement in technology could be put to use to improve the health care system of the country. These two efforts will make modern medicine available and accessible to all the citizens of our country. This will contribute for nation's progress as a strong body and sound minds of the citizens are essential to accomplish development.

Stem Cell Research

The recent identification and characterization of progenitors with stem cell properties has opened new avenues that may be useful for treating functional impairments caused by the death of specific cell population. The stem cells may help restore functioning of certain defective organs, by repopulating or rescuing the damaged cells from further degeneration. There will be a revolution in the medical treatment for heart care, cancer, blindness and mentally challenged. It is essential to launch an integrated national stem cell research program with focus on TB and HIV / AIDS.

Doctors as a Guru

Since every one of you are involved in removal of the pain of the patient, you can also play a vital role in preventing diseases through proper health education to the patient as well as to his or her relatives and friends through the life style intervention. This can consist of a proper diet with low fat and high fibre, regular aerobic exercise like walking and stress management through Yoga, meditation and other methods. This can help in preventing the recurrence of the disease as well as promote immunity at the national level. When you treat the patient, they become part and parcel of you the surgeons and considers you almost as God. Hence, the patient will definitely accept your health education considering you as the most respected guru. Every patient receives his family members, relatives and friends when he is receiving healthcare in the hospital. That is the occasion when the doctors can give this message of a healthy life style to all of them. If you do this I can foresee that the incidence of HIV/TB will come down and also the quality of life of life will improve.

Conclusion

Whether India has to eradicate leprosy or TB, to prevent spread of HIV by developing anti HIV vaccine, or to control cardio vascular diseases by multiple technologies and practices, we in India need something important apart from resources. That is creative leadership in all fields, particularly in medical field. Who are the creative leaders? What are the qualities of a creative leader? The creative leadership is exercising the task to change the traditional role from commander to coach, from manager to mentor, from director to delegator and from one who demands respect to one who facilitate self respect. The higher the proportion of creative leaders in the medical field, the higher the potential for successes in medical field in diagnosis, treatment and research for discovering new avenues in healthcare.

May God bless you.