To make healthcare accessible and affordable every hospital needs to move into the smaller towns. We have zero subsidiaries on latest equipment. Our aim should be to give world class outcome in cheapest possible way, says Dr Ashok Seth, Chairman, Fortis Escorts Hospital, in an interview with Mukul Mishra of Elets News Network (ENN).
Q Having pioneered many innovations in healthcare sector, you are today looked upon as an institution in yourself. Tell us how has been this journey so far?
My journey has been most exhilarating, encouraging and satisfying. When I returned from England after 10 years, I had no intention to come back to India. At that time, India was far behind the rest of the world in many ways. Facilities which one needs to practice highest level of medicine and highest level of technologies were nonexistent.
I returned for my parents and I was just fortunate that Escort Heart Institute was getting started at that same time. Therefore my first stop of coming was actually the creation of that heart institute. The satisfaction was three-fold for me. Satisfaction was the belief of serving my parents and returning to the country because they were maintaining ill-health. It led me to create highest level of delivery of advanced interventional cardiology facilities in not just for the country but for the region.
I was able to create new grounds for India, did many firsts for Asia Pacific region, brought the highest level of technological care, and higher standard of interventional cardiac care and treatment facilities to India and Asia Pacific region. Living in India and making India proud on world map was my second satisfaction. And third satisfaction of everything was when the Government of India recognised all these services and awarded me the Padma Shri and then Padma Bhushan.
Q You have an expertise in Interventional Cardiology. Is it advanced version of the angioplasty? Tell us something about it.
Interventional cardiology is a whole arena which includes opening of blocked arteries of heart nonoperatively by ballooning and putting the spring like device called stents and treating heart blockages. Interventional cardiology now expands into treating valves also with non-surgical methodologies in cath labs, totally non-operatively. It also comes into play in treating, replacing valves, holes in the heart. Interventional cardiology expands practically a whole array of procedures all of which are non-operative.
All of which can be done through a small hole in groin in conscious patients. Best part is it involves lot lesser risk than a conventional surgery. The field of Interventional cardiology started around 1977. Practically everything which is done surgically has been transferred to minimal invasive non-surgical catcher based techniques. My privilege has been to start off very early in this arena. I have been a part of creation, growth and development of this science not just in India but around world, which is a privilege.
Q Nowadays people irrespective of age keep suffering heart attacks despite being careful about a good diet in some cases. Then what causes heart attack despite all that even among youngsters?
The 50 per cent of death across the world from heart disease are from India. Indians are prone, genetically predisposed to have heart diseases. While in the rest of the world, especially in Europe, the deaths from heart diseases have decreased in last 30 years, in India it has gone up. But among people aged under 45, the disease has grown to twice in last 15 years.
People are addicted to other things than exercise now and exercise is also done to build muscle than having a good health. In addition, fast and packaged food has taken over the diet immensely. And that is how trans-fats seep into the body.
More food joints and luxurious items have taken over life in cities. The space of playing has gone down. All of these factors are responsible for an increase in heart cases in India.
Even women are falling victim of heart diseases nowadays because of the change in lifestyle. Death from heart disease is six times more common than the death from cancers among women. They have to be more cautious to get protected from the heart disease.
Heart disease can attack anyone anytime. We are prone to it. Healthy living should be a standard of healthcare.
Q What kind of initiatives are your hospitals taking to make healthcare affordable and easily accessible?
To make healthcare accessible and affordable every hospitals need to move into the smaller towns. We have zero subsidiaries on latest equipment. Our aim should be to give world class outcome in cheapest possible way.
If we can manage to provide these world class treatment facilities to patients’ doorsteps, they don’t need to travel to tertiary level city for hernia, angioplasty and hydrocele.
We are setting up modular centres along with Philips healthcare in small cities. In hospitals which are already functional we just set up the cardiac facilities and link it with Fortis Escort heart institute through IT technology and online.
Our trained cardiologists will be placed in these centres and will provide same level of expertise what we provide here. Every angiogram would be viewed by expert doctor like me. We have set protocol on how we manage the post operative procedure. These modular would be low cost centers i.e low infrastructure cost and low equipment cost yet will provide highest level of efficiency and best level of expertise.
We have tied up it with outcome measures. On our website one can see plotted results of outcome measures of angioplasty and heart surgery of last six months.
Cost versus quality is a big equation. One should provide cheapest and best services.
We have linked 500 beds with eICU technology. It has been started in small towns like Raipur, Dehradun and even in Khulna in Bangladesh. We do real time monitoring of critical patients from here only. ECG, blood pressure and other clinical details are monitored.
Patients get high standard of medical facilities in Rs 350. We have saved life of many patients of septicemia and other life threatening diseases through eICU technology.
Q How do you view the challenges of Indian healthcare sector in terms of failing drastically to improve the doctor-patient ratio?
This is huge challenge and India is doing too little and too late to improve the ratio. This reflects some of the apathy around healthcare development for years not in present scenario.
We knew that one of the biggest challenges in coming days will be the healthcare because of the rising population. At that time all healthcare measures were abysmal. One would have worked hard to improve these measures. But it is only much later things started to improve. This is the reason why private healthcare grew. It grew because there was nothing else. We actually lagged behind quite a lot in delivering care to our public.
Healthcare is huge priority. It figured very low on priority list. And therefore every ratio not only doctor patient, but nursing, district general hospitals, private hospitals everything is lagging far behind. And we never catch up with it.
I believe more hospitals need to be opened, more medical colleges have to be created. Why we are pushing private medical colleges which charge huge money from students. Medical education shouldn’t be so expensive. We are actually fuelling private care by starting private medical colleges. Today we have more private colleges than government colleges. Why money shouldn’t be pumped into public medical colleges. Students should get admission according to their merit in these public medical colleges.
There can’t be two parallel verticals which compete with each other. We should unite both private and public healthcare to deliver unified healthcare.
Public sector has great intellect and reach but doesn’t have infrastructure and technology. The Government should realise that free treatment will never come but highly subsidized treatment of quality care can come. And that is what we should aim for. Both public and private healthcare should respect each other’s qualities.
If we will concentrate each other’s pluses or qualities then we will be able to create greatest healthcare system.
Q Do you think using Artificial Intelligence like methodologies at large scale can be useful in taking ‘doctor’ to every village and small town?
IT will develop into artificial intelligence. Smart phones have revolutised every form of delivery of any kind, what we need in small town. Nobody needs bypass surgery, nobody expects robotic surgery or heart transplant in villages. They need sanitation, hygine, clean drinking water nutrition, control of infection, hypertension and diabetes. These things must be controlled at basic level. If one can control these eight things, 90 per cent healthcare delivery is done. And moreover out of these eight, five are the basic right of public.
Funds need to be utilised properly to keep a check on these determinants. Executions of funds are as important as an outlay. Triage system should be applied. Only complicated cases should be referred to AIIMS and Fortis like big hospitals.
Q What is your vision on the importance of technological innovation to address the challenges of India’s healthcare sector?
My technological innovations revolve around some of these I have said and second aspect is low cost development products. Let encourage our own industry, our own manufacturing industry indigenous products. At the time 80 per cent products are imported. We should encourage indigenous manufacturer. We should create tax free zones. We should bring in robust quality parameters which actually makes sure the public of India gets best at low cost. Low cost should not be sacrificing. So ‘Make in India’ but also ‘Make best of India’. Make in India should be ‘Make best in India’.
They should be able to match to the best quality standard of the world. The problem of low cost even in stents is even concerns that any research, any developmental process, any trials which have to be done to make them safe in humans or in animals and thereafter come at a cost. It doesn’t come at no cost. Any new technology comes with a price. We should have inbuilt mechanism for actually rewarding science and research. Thirdly, we have to have very robust quality measures which we haven’t actually done at the policy level at the moment.
‘Make in India’ is the future of this country and we should augment that future by saying that ‘Make best of India’ so that the patients get the best. Low cost should not be equated to poor quality. And we have not built in those security systems to support that.
Even Companies from outside are coming in India. GE has done great in development centres in India. Low cost models for ECG machines have been created. Similarly, low cost baby warmers have been created.
We have to create value for actually encouraging them. IT is also playing a pivotal role in education teaching treatment through skype OPDs through skype, communication and awareness. Low cost models of creation and delivery. We can get into Robotics and it will be able to do perhaps procedure at another site with same accuracy. Government should make it mandatory for doctors to serve at least one year or two in rural areas. And I believe why they can’t do that as government provided them subsidised medical education in public hospitals. That is why I believe the government should open more public hospitals. Next 10 years will show actually where we are progressing towards our vision of better healthcare which has to be subsidized to make it cost efficient.