Interviews

Innovating Technologies for Low-cost Healthcare : Dr K Mohandas, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram

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Known for its indigenous development of heart valve, blood bag, dental implants and many consumables needed for medi-care, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, signifies the convergence of medical sciences and technology. It has a 239-bed hospital for tertiary care of cardiovascular and neurological diseases, a biomedical technology wing for developing medical devices from the conceptual stage to commercialisation, and a center of excellence for training and research in public health.

In an interview with eHealth, Dr K Mohandas, Director, SCTIMST, who has been nurturing the institute for the past 15 years, tells us about the institute’s strengths and the current scenario of research in medical informatics in India. Excerpts:


 

What are the new initiatives taken by Sree Chitra in the areas of patient care, academics and adoption of new technologies?

In 1998 , the hospital started a Center for Comprehensive Epilepsy Care for the first time in India which has become a pioneering centre today. It’s a unique centre as it provides the whole spectrum of treatment modalities for epilepsy. The centre has so far performed more than 1000 surgeries successfully. And, in 2000 Sree Chitra opened a Center for Comprehensive Care for movement disorders, again for the first time in this country . These two centres have been some of the most important achievements of Sree Chitra in the one past decade.

We have introduced neuroendoscopic procedures and interventional radiology procedures in the hospital. We also have a new cath lab for interventional radiology. On the technology front, we have installed PACS in the hospital.

The institute offers DM and MCh in Cardiology, Cardiovascular Thoracic Surgery, Neurology and Neurosurgery . Recently, we introduced DM in Neuro and Interventional Radiology and in Cardiovascular Thoracic Anaesthesia. And, we were the first to start a master’s program in Public Health (MPH). Also, we were the first to introduce M. Tech. in Clinical Engineering and Ph.D. in Biomedical Devices and Technology. It’s a joint degree programme with the Indian Institute of Technology Madras (IITM), Chennai and Christian Medical College (CMC), Vellore, is a partner institution in this venture.

The course  was started looking at the changing needs of Indian healthcare industry. With the increased use of high-tech equipments in Indian hospitals there is an urgent need of clinical engineers. Like in the West, where a registered clinical engineer is allowed to operate medical equipments, we need a cadre of clinical engineers who can look after equipment management, safety evaluation and preventive maintenance. Currently, we are at the mercy of manufacturers as once the warranty period expires we have to shell out huge sums of money on maintenance.

What, according to you, are the urgently required changes in the Indian medical device industry?

In the late 70s, healthcare was becoming increasingly dependent on technology with most medical equipments being imported. And, no initiatives were being taken to promote indigenous development of technology and the industry was either unwilling or incapable of investing in research. So, it was decided that the government should take the initiative. By then, Sree Chitra had established its credibility as a tertiary care center for cardiology and neurology. So, we were given the task of establishing a medical device industry base in India by developing technologies for a number of devices and implants. Our primary concern is that our technologies should reach the patients and for this we require the industry to manufacture and market our technologies. Today, Sree Chitra has more than a dozen tie-ups with industries who have licensed our technologies. The industries who had taken up our technologies in the past are now investing in research, because they know that our technologies are commercially viable. For instance, the latest model of Sree Chitra heart valve is fully sponsored by TTK healthcare.

However, to promote indigenous manufacturing of medical devices we need to have more and more industry collaborations. Today, majority of the research work in India is funded by the Ministry of Science and Technology and other government funding agencies, but I hope very soon most of the research will be sponsored by the industry.

Also, we need an independent medical device regulatory authority which is not under the control of the Drug Controller of India (DCA). A good regulatory mechanism in place will assess the quality of medical devices manufactured in India as well as of imported devices. Also, it will help the industry in gaining credibility in the international market.

Can you share with us the new innovations and product developments in the pipeline?

Sree Chitra nearly has 130 patents out of which more than 40 per cent have been converted to technology. And, it is supposed to be a good record. The latest product in the line is oral insulin. The technology has already been transferred to a Mumbai-based company, USV Ltd, for further development. They will start conducting the clinical trials very soon. And, I do hope that they will be able to complete all formalities and market the product, beating several other groups all over the world.}

The industries who had taken up our technologies in the past are now investing in research, because they know that our technologies are commercially viable.

Technology plays an important role in the fields of cardiology and neurology which makes medical treatment very expensive. Are there any ways to provide subsidised medical treatment in cardiology and neurology?

Firstly, I think we need to put more emphasis on health education. We need to re-focus on every aspect of prevention. Preventive medicine should be part of every discipline of medicine, be it cardiology, neurology or oncology. And, I think we should do away with the department of community medicine and make it part of the academic curriculum of every specialty of medicine at the MBBS level and beyond .

Secondly, Indian doctors are extremely good at adopting new technologies, but tend to ignore the cost at which they are  acquired. Consequently, patients bear the brunt when a new technology is acquired by the hospital. It’s important to look into the health economics to control the ever increasing cost of healthcare.

Could you tell us about the steps being taken to improve the quality of R&D in the institute?

We follow a very strict process of selecting scientists and engineers which is purely merit based. We have various committees such as the technology development committee which oversees R&D efforts. The biomedical technology wing has implemented a quality system to meet the requirements of international standard ISO/IEC 17025. The evaluation and testing of devices and implants are in strict accordance with ISO standards by tests accredited by Le Comite Francais d’Accreditation (COFRAC) of France. It ensures that not just the product, but the process also follows ISO standards. Even the canteen follows the set standards. And, any activity that goes in the laboratory goes through the quality check.

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