Magazine 566

NICU Offers Quality Healthcare

Dr Rajeev Boudhankar

Dr Rajeev Boudhankar
Vice President,
Kohinoor Hospital, Mumbai

Preterm births are the underlying cause for the fetal and neonatal care products and services market across the globe.

Please comment on neonatal infant care unit market in India vis-a-vis the global market.
Preterm birth poses a grave challenge to perinatal and maternal care, and is the major reason for neonatal mortality. Around 28 percent of the four million annual neonatal deaths that occur worldwide are directly attributed to preterm birth. This percentage of neonatal deaths is different for various countries, depending on their respective degree of neonatal mortality. The primary reason for such pronounced differences is the cause of neonatal death and the stark measure of healthcare inequities between low and high resource settings. According to the National Institute of Health (USA), the increased adoption of preterm equipment has enhanced the survival rate of premature babies.

Tell us about your current operations in India and further expansion plans.
Kohinoor Hospitals is planning to have 500 self-sustained beds by 2020. At present, our hospital project has envisaged having 210 beds by the end of this year.

What are your views on the price sensitivity of the Indian market, and how does your hospital counter this problem?
Indian market is very price sensitive; however with increasing awareness, education and disposable incomes, the Indian consumer is asking for quality care for which he is ready to pay a reasonable price.

At our hospital we have, right from the project stage, gone in for a Green Hospital, which cuts our operational costs in terms of savings costs for electricity, water, etc. These savings are passed on to the patients. Additionally, we have different classes of admissions so that we can take care of all sections of society. For the poor, we have tied up with some NGOs who sponsor certain operations at very low costs- paediatric cardiac interventions. Our experience is that patients are ready to pay reasonable tariff if you provide them with quality services and counsel them about the costs rationally.

What are your views on government regulation or any other challenges faced while operating the Indian market?
The problems with regulation are illustrated by India’s medical tourism industry, which according to government sources will be worth Rs 9,500 crore in 2015, and as much as `54,000 crore in 2020. Almost 75 percent of the medical imaging equipment (worth Rs 18,000 crore in 2011) that serves this industry is imported, and the value of imports themselves grew at a compounded rate of 16 percent in 2010-2014.

A part of the problem is corruption and inefficiency. There is no national body to oversee the procurement and provision of generic medicine, which currently originates from local manufacturers known to operate their plants in unsanitary conditions.

What are the various upcoming trends and new technologies?
Time has come when challenging conventional constraints in healthcare can change the scenario in India. I agree with the Mckinsey report, which says that disruptive technologies deployed together have the potential to bring affordable healthcare to millions in the coming decade. The healthcare sector needs to be liberated from the institutional and human shackles that inhibit the transformative power of technology. Despite facing severe challenges, the Indian healthcare sector could become one of the most fertile test beds for technology innovation around the world. India’s myriad healthcare shortfalls are well known, and facts are the most troubling.

Furthermore, poor access to clean water and sanitation compounds are other problems, as does a lack of awareness of preventive measures, which traps many in a cycle of debilitating malnutrition and disease. Finally, affordability alone will not solve the problem. Healthcare operates through a funnel of awareness and promotion, prevention, diagnosis, treatment and compliance. Trained and appropriately incentivised human resources are required across the entire funnel, but India doesn’t have enough of them. The ratio of practising doctors and nurses to the population has fallen to 1.4 per 1,000 in India, far below the World Health Organisation (WHO) norm of 2.5. This means conventional solutions will not make a dent. Those who are trained and want to work are not willing to practise in poor, rural communities. And those who are willing, they are either not trained or not certified, or both. Would you like to suggest any other thing? Some of the new technologies are helping smallest infants progress faster in the Neonatal Intensive Care Unit using new devices to personalise the nutritional needs of premature babies, and help smallest infants with head shape and sleep cycles. Several new technologies being used in the USA are also making it easy for the smallest babies to gain more weight and being healthy. Doctors have begun routinely using a device known as the Pea Pod to measure the body composition of the infants. It looks like a mini Magnetic Resonance Imaging (MRI) machine. It is heated, and the baby is placed inside for approximately three minutes. Using an air displacement method, the machine senses change in pressure and can determine the percentage of body weight that is fat and the percentage that is lean body mass. With this information, health care workers can then personalise the baby’s nutritional supplements to help with appropriate weight gain. The Pea Pod is important in helping the NICU team facilitate a healthy weight gain in the smallest infants by calculating the amount of lean mass and body fat in the infant on a daily or weekly basis. At the same time, some hospitals in the USA conduct ongoing studies of breast milk composition, using a device that analyses the percentages of fat, protein and carbohydrates in breast milk. To date, health care workers have performed hundreds of analyses of breast milk. The information from both analyses, ultimately leads to weight gain, better neurological outcomes and shorter hospital stays for babies in the Neonatal Intensive Care Unit (NICU). Cedars-Sinai is currently the only hospital in the United States with the new technologically advanced mattresses. Together, these new technologies are helping reduce the babies’ stay in the NICU and sending them home to their families, where they belong.

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