Convocation Address at Nizam's Institute of Medical Sciences

Web of Life **

I am indeed delighted to participate in the third Convocation of Nizam's Institute of Medical Sciences, Hyderabad. I take this opportunity to congratulate the young doctors for their achievement. I greet the Chancellor, Vice Chancellor, Professors, teachers and staff for the excellent contribution in the process of imparting medical education to these young minds as specialist doctors to carry out the noble cause of removing the pain of the people. Medicine is the most challenging profession where human miseries and pain combat with the best out of human intelligence, skills and patience.

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.

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 the skills are required. This vision need to be developed into multi-organisational missions leading to the generation of thousands 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 and yet linked together. I have seen this happening successfully. Telemedicine system providing to the district hospitals expert medical diagnostics and treatment advises.

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 fed with the clinical knowledge. The medico-technical knowledge must then go to the industries which not only productionise cost effective medical products but also adopt nearby villages for medical care coupled with education. The hospitals of medical research centres can have umbilical with other R&D organisations for developing indigenous medi-care equipments, devices and consumables. I can recall in 1993, we established the Society for Biomedical Technology here at NIMS. In the years that followed there was a great wave of development of medical devices - FRO, catheters, stent, cyto scan system and telemedicine system. In October 2002, in Almora, Uttaranchal a mobile clinic has been deployed that carry healthcare to the doorstep of the people. It has visited 50 villages and already treated more than one thousand patients who wouldn't have afforded treatment otherwise. I have just seen indigenously developed digital cath lab at the CARE hospital. It demonstrates the success of multi disciplinary partnership and technology integration.

The interfacing between medical science, electronics, material science 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 the 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 the 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:

Electronic Citizen Card with basic health data.

Availability of quality healthcare at affordable cost

Use of teleconferencing and tele-sensing to interact with the patients.

Surgical procedures demonstration using Net-based video.

Knowledge systems to provide expert advice.

Electronic patient records to provide bio-medical information leading to empowerment to make decisions.

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 the advanced research. The need of the hour is to network the existing facilities and expertise with commitment and conviction to augment and facilitate the pace 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. The prevention will include sanitation, availability of safe drinking water, basic education and nutritional awareness. The 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.

Hospitals as Healthcare Service Providers

Rapid developments are daily events in healthcare delivery worldwide. The combined impacts of new, some even revolutionary technologies, advanced management practices, have created transformations of the mode and means of healthcare delivery. The redesign of healthcare institutions is leading to reshaping the hospital as the main form of healthcare delivery. Other institutions in the healthcare environment are also undergoing radical modifications. All of this is creating challenges and opportunities for researchers and practitioners in "bringing together technology, health care, and management." We will have to gather researchers who are exploring the bridging of these three components of healthcare delivery-with an eye toward the future-and practitioners who are interested in these topics. How will healthcare delivery institutions be shaped in the future? What are the trends and transformations that await us in the coming years? How are we going to merge technology, management, and medicine into a workable and economically feasible combination? What are the barriers that we shall certainly encounter, and how can we overcome them? And, what are the research questions that we should be addressing in this regard?

The following areas will gain highest significance in the future of Healthcare Sector:

a. Management of technology in healthcare organizations: nature of work and skills in healthcare delivery; processes and performance; knowledge management in health care; strategies for technological positioning in hospitals; managed care and cost controls; uses of technology in primary care; logistics, infrastructure, and architecture of the hospital of the future.

b. Management and organization of information technology (IT) in healthcare organizations: applications and processes in the implementation and diffusion of IT in health care; role of standards in communication and organization, networking by using IT; computerized medical records.

c.Organization, management, and applications of emerging medical technologies, e-health, tele-health, and telemedicine: role of these emerging technologies; processes, barriers, and organizational issues in the implementation and adoption of these technologies.

d. Medical technologies and patient value: how medical technologies contribute value to the patients; the role of patient confidentiality in view of technological developments; ethical issues; healthcare technologies and medical outcomes; the role of standards, regulations, government, and their impacts on medical technologies and the value to patients.

e. Medical technologies and emergency medicine: how health care and medical technologies contribute and will continue to contribute to emergency medicine, crisis healthcare delivery, and health care in catastrophic situations.

Conclusion

Friends, a nation is great, not because a few people are great, but because every one in the nation is great. I wish you all to excel in your life as specialist doctors and above all the best human beings with traditional value system and societal care. The challenge in the mission of the developed India calls for an 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 will eventually blossom into 'Web of Life' holding together and feeding the grass-root of our Society with nutrients of our technological strength and industrial prosperity.

I would like to once again congratulate the young specialist doctors and greet the faculty, doctors and staff of this Nizam's Institute of Medical Sciences. I wish these specialists will grow from strength to strength in order to serve the society at large, particularly the weaker sections. Best wishes to you all. May God bless you!