‘ A world class healthcare facility at an affordable rate continues to be my mission,’ says Dr NareshTrehan, Chairman and Managing Director, Medanta – The Medicity. He discusses with Shahid Akhter, ENN, the gamut of technology and excellence in healthcare that makes Medanta a medical marvel and yet accessible to all
You forayed into healthcare as a distinguished cardiothoracic surgeon and have carved a niche as a successful entrepreneur as well. Please tell us about your journey in these directions so far.
After almost a decade of practice in the US, precisely, New York University Medical Centre, I returned to India in 1988 and helped in the establishment of Escorts Heart Institute and Research Centre (EHIRC) where I served as the executive director and chief cardiothoracic and vascular surgeon for two decades. For the next two years I served the cardio unit at Apollo Hospital and then I set out to realize my long cherished dream, Medanta – The Medicity.
My forte is medicine and I am steadfast in my commitment as a doctor to deliver the best in healthcare. To wheel this idea, I hired the best of health professionals and opted for the latest in technology. It was and continues to be an expensive deal but I never compromised on quality. Have a look at the doctors that we have at Medanta and also the technology or the scientific advances that have been incorporated here. The equipments reflect my vision and the team of doctors have merged as an identity.
Our priority is to deliver the best possible healthcare by serving the patients as best as we can and this is regardless of economic status or social class. People come to Medanta from all walks of life. Today, healthcare has emerged as mega business and corporate hospitals are emerging at an alarming pace. I don’t subscribe to this genre of business where the only consideration is supply and demand. Corporate hospitals have mushroomed and they work on a different parameter. To run our institution, we need revenue and this comes from the patients who are neither exploited nor fleeced. Money is an afterthought and it will come on its own.
For me it was a dream, rather a daunting compulsion to create a facility that could claim to be among the finest in the world. There are just a handful of institutions in the world that can claim to be like Medanta. Our next step would be to create a whole new standard of medicine for India.
How do you evaluate the progress at Medanta since its inception in 2009 ?
Our growth has been phenomenal. Number of beds have increased from 400 to 2000. The array of equipments by way of volume and innovation has witnessed a sea of change. By way of technology, we stand at the highest level and this is an ongoing process.
“ In India, we perform more cardiac surgery than anywhere else in the world and we have better results than anyone else!”
What is the concept underlying Medanta ? Any model that you emulate ?
Besides the best of healthcare professionals, services and the maze of latest technology in medicine, Medanta also offers clinical research, education, development and training. There is a lot to be gained from traditional Indian herbal remedies and we continue to develop and explore newer therapies in medicine. We are keen to integrate modern and traditional forms of medicine.
At Medanta you will find a lot in common with Mayo, Cleveland or Harvard and I aspire to go beyond. It will be a matter of pride to see India setting better benchmarks and offering the highest quality of healthcare by way of research, and teaching as well. We ensure that a patient is examined by all division heads, (depending on the complexity of the case). Any issue in any specialty is addressed by all chairmen to ensure that the best care plan is delivered to the patient.
>> Current projections suggest that India will have the largest cardiovascular disease burden in the world. Coronary heart disease is the most prevalent heart disease in India, contributing more than 95 percent of the total CVD prevalence.
>> One fifth of the deaths in India are from coronary heart disease. By the year 2020, it will account for one third of all deaths. Sadly, many of these Indians will be dying young.
>> Heart disease in India occurs 10 to 15 years earlier than in the west.
>> There are an estimated 45 million patients of coronary artery disease in India. An increasing number of young Indians are falling prey to coronary artery disease. With millions hooked to a roller-coaster lifestyle, the future looks even more grim.
>> Four people die of heart attack every minute in India and the age group is mainly between 30 and 50.
>> Twenty-five per cent of heart attack deaths occur in people less than 40.
>> Nine hunderd people under 30 die due to heart disease in India every day.
>> Indian women account for 15 per cent of the global burden of heart disease which kills about 15 million people every year.
>> One in every 1,000 children suffers from congenital heart disease.
>> There appears to be a steady increase in hypertension prevalence over the last 50 years, more in urban than in rural areas. Hypertension is 25-30% in urban and 10-15% in rural subjects.
Medanta – The Medicity
>> A multispecialty medical complex, spread across 43 acres has 2000 beds, 50 operating theatres and over 350 critical care beds.
>> Medanta offers the widest spectrum of clinical care, education and research.
>> Technology includes Cyberknife VSI, 256 Slice CT, Brain Suite, Hybrid Operating Suit, Da Vinci Robot, Artis-Zeego Endovascular Surgical Cath Lab, Linear Accelerators, Integrated Brachytherapy Unit, Alpha Operation Theatre, etc.
>> Fluoroscopic guided liver biopsies.
>> Video consultations from home.
>> Remote diagnostics at telemedicine centers.
>> Real time health monitoring through telemetry.
“There is tremendous potential for telemedicine in a country like India where there are fewer doctors in rural and remote areas.’’
What’s your vision for Medanta and how affordable it is for Indians ?
The need of the hour is new and cost effective medicine that will impact the life of Indians at large. India is capable of delivering lower price due to abundance of cheap labour. Less than 10 percent Indians are able to afford the kind of medicine that we practice. When you compare costs between Medanta and US hospitals, we are charging just a small fraction. A great chunk of people in Asia and Africa can’t afford American medicine.
How do you see the development of cardiology in India and what to expect at Medanta ?
Once upon a time, we used to prescribe medicines for valve and cornea heart disease. Those were the days when we used to be helpless and a good many patients died. We knew about the availability of treatment but it was not available in India. A sense of frustration prevailed and this prompted me to train myself in the US as a heart surgeon. My mentor was Dr Frank Spencer who taught me at the NY University Medical Centre.
In the recent past cardiac scenario has changed a lot and it is evident even beyond the metros and capitals. Heart attack is common and the treatment is simple but the problem begins when greed sets in and unnecessary tests or procedures are done. At times angioplasty may be necessary and at times not. Same with medicine – good and bad. The real problem in cardiology surfaces in cases that are complicated.
At Medanta, the Heart Institute is a technological maze. The Heart Failure clinic is the first of its kind in this part of the world. The three dimensional cardiac mapping using Carto technique and myocardial scar identification by NOGA enable our electrophysiologists to perform the most complicated RF ablations with ease. Besides, we have early heart disease detection program and community outreach programmes.
How telemedicine can improve healthcare ? What initiatives Medanta has taken in this regard?
Telemedicine has very huge potential but as of now it seems to be in a nascent stage. No less than 90 per cent of the diseases can actually be treated or diagnosed with the help of telemedicine or video conferencing. Now things are taking shape. With ever evolving technology, it would be easy now to connect and incorporate telemedicine over Skype or with advanced webcams. This will immensely help in connecting with the rural areas.
Medanta is known for its medical research. Please tell us about progress in this direction ?
We have created the infrastructure for research but a good deal of it is dependent on government’s rules, guidelines and regulations. These protocols are not just time consuming and at times there is a shift in the authority that approves it. For this reason, many drug development or procedure development are not happening in India. We need a regulatory body in place. India has huge potentials but as of today we are doing as little as 2 percent of research in the world. We have the resources, we have the patients and therefore the need too is here. We are keen to bring a change by initiating institutions which will be licensed to carry on research. My particular interest is in Ayurveda and modern medicine – something new, innovative and has potentials.
Dr Naresh Trehan is the most prominent heart surgeon in the country. His cache of awards, accolades and recognition is simply unending and includes the highest honours including the Padma Shri and the Padma Bhushan . More than 35,000 successful heart surgeries is just statistics to a person who is still passionate, dedicated and keen to see India at the helm of global healthcare. His vision finds space in Medanta – The Medicity, a world class health hub with spokes that are simply milestones.
What are the roadblocks and challenges in Indian healthcare ?
Where do I begin! Primary health care facilities, government hospitals, medical education, health insurance, preventive care, escalating disease burden, the issues are simply endless.
As of today, healthcare is more of disease management. We need to build our system from ground up to create a new blue-print of India’s healthcare. We have over 800,000 ASHAs (Accredited Social Healthcare Activists) in India, but they are ill trained and don’t have any medical expertise. Their costs are a huge burden on the exchequer and nothing gets accomplished in return. All we need to do is to upscale their skills so that they can be the eyes and ears of the healthcare system on the ground. They need to monitor hygiene and find out who in the community needs medical help. This will be a big help. Indian healthcare is akin to a puzzle, rather a paradox, be it medical education or hospitals or any vertical of healthcare. On one hand we boast of the best of hospitals, medical tourism and so on but is it available and affordable to Indians at large ? The answer is no, despite our medical costs being around one tenth of what is charged in the West.
“We need to decrease the disease burden. If we cannot even provide sanitation, clean drinking water and mosquito control to our people, the disease burden gets doubled.”
How good is Medical Tourism ? Your suggestion to make India a healhcare destination.
Call it medical value based travel rather than normal tourism. We have all the ingredients – well trained and talented doctors in almost all verticals. Some of the most acclaimed doctors in the US are from India ! What we charge in India is just a fraction of what one is expected to shell out in the US or West. A coronary artery bypass operation would cost around USD 40,000 in America, in Europe it may scale down to USD 25,000 and at Medanta, it would close down to less than USD 4000. Next we have the technology – some of the best that you can see anywhere in the world. Add to this, the potential of tourism in India People have already started pouring in and in big numbers The government simply needs to create and maintain the upright image that often takes a beating on this or that reason.