Dr. Dipak Limbachiya, one of the foremost laparoscopic surgeons in the country, is advancing the field of laparoscopy through comprehensive training programmes for doctors across the country.

Since 2012, Dr. Limbachiya, advanced gynaec laparoscopy and onco surgeon and Founder of Eva Women’s Hospital, Ahmedabad, has trained more than 1,200 doctors, showcasing his commitment to mentorship and continuous professional development of fellow medical practitioners. He conducts multiple training sessions, each hosting 12-15 doctors from across the country, training over 100 doctors annually.

The initiative has significantly impacted laparoscopy, ensuring that the latest advancements in the field are disseminated nationally and internationally. The most recent group of doctors, hailing from prestigious hospitals in cities such as Pune, Surat, Chennai, Kolkata, Indore, Rajkot, Bhopal, and Noida, participated in an intensive two-day training session on June 5 and 6 in Ahmedabad.

The participating doctors learned cutting-edge techniques, including the use of the harmonic scalpel and other high-tech equipment, and performed a variety of complex procedures such as surgeries for endometriosis, endometriosis with bowel suture, ovarian cysts, endometriosis with resection and anastomosis, and other complications, all under the expert supervision of Dr. Limbachiya.

“Training the next generation of laparoscopic surgeons is a commitment and responsibility I hold close to my heart. It is immensely rewarding to watch these young doctors learn about the newest advances in laparoscopy and improve their surgical skills, enabling them to provide enhanced care to their patients. I am committed to sharing the knowledge and expertise I have gained over the years with fellow medical practitioners,” says Dr. Limbachiya.

The charitable initiative has not only enhanced the skills of hundreds of doctors but also benefited patients directly, who received essential medical care. The programme has also created a ripple effect, as trained doctors return to their practices equipped with new skills, ultimately improving patient care across the country.

The post Dr. Dipak Limbachiya – Enhancing Patient Care Globally appeared first on Health Vision.

Headquartered in Hyderabad, Thalassemia and Sickle Cell Society (TSCS) is a registered non-profit, non-governmental organization founded in 1998 representing mainly by a small group of patient’s parents, doctors, well-wishers, philanthropists, to provide the best treatment and management to patients suffering from Thalassemia and Sickle Cell Anemia. With the objective of helping all Thalassemia and Sickle Cell Anemia affected children, TSCS has established, well-maintained transfusion centre, high-quality blood centre, modern diagnostic laboratory, and advanced research centre under one roof to support more than 3500+ registered patients for the past 25 years.

1. Can you provide a brief overview of the Thalassemia Sickle Cell Society and its mission?
The Thalassemia Sickle Cell Society (TSCS) is dedicated to supporting children afflicted with thalassemia and sickle cell disease. They provide essential services such as blood transfusions, operate a blood bank and diagnostic center, and have collaborated with medical institutions like Bhagwan Mahaveer Jain hospital, Narayan Hurdayalaya, Sankalp Foundation Bengaluru, Electronic Mart India Ltd and other philanthropists, corporate bodies under their CSR initiative for bone marrow transplants. TSCS aims to eliminate these genetic blood disorders by promoting awareness and offering comprehensive medical care. It is a massive initiative serving the most neglected, almost unknown genetic blood disorder. It has taken more than two decades of selfless work by dedicated doctors, parents, and donors to reach this stage.

2. What are the key objectives and goals of the society in supporting individuals and families affected by thalassemia and sickle cell disease?
The society’s key objectives and goals revolve around assisting individuals and families affected by thalassemia and sickle cell disease. Our primary mission is to make the nation and Telangana thalassemia-free through mandatory HbA2 testing for pregnant women. TSCS strives to provide the best possible medical services to ensure the survival of affected children and create a supportive environment for their well-being.

3. How does the society raise awareness about thalassemia and sickle cell disease within the community and among healthcare professionals?
TSCS raises awareness about thalassemia and sickle cell disease through various channels. When a child is born with these disorders, medical professionals refer them to the society for specialized care. TSCS has been conducting free testing services in major government maternity hospitals and organizes blood donation camps in schools, colleges, and during festive occasions. We have been effectively optimising social and print media to collaborate with other agencies and spread awareness.

4. In what ways the board members or the senior management providing services to the TSCS?
The key board members of TSCS are Dr. Chandrakant Agarwal, President, Ms Ratnavali Kottapalli, Vice-President, Dr Suman Jain, Secretary & CEO – TSCS & Mr. Aleem Baig, Joint Secretary. The society’s board members and senior management play a vital role in overseeing the operations, make strategic decisions, and ensuring effective implementation of programs and initiatives, responsible for collecting of blood through donation camps to support individuals affected by thalassemia and sickle cell disease.

5. What initiatives does the society undertake to advocate for improved healthcare access and quality for thalassemia and sickle cell patients?
The list is endless, over the last 25 years, we have not left any stone unturned in spreading awareness. Recently on a single day in Hyderabad, we have been able to collect more than 1500 blood units that were donated by generous donors. TSCS has received many accolades and awards for its selfless services. In All India Industrial Exhibition in Hyderabad a unique campaign was launched for more than 40 days continuously spreading awareness to eradicate Thalassemia. “Red the City” a marathon was launched at necklace road in Hyderabad long back and people still have those red T-Shirts spreading the message for blood donation and prevention of thalassemia.

6. In what ways does the society collaborates with other organizations, healthcare providers, and researchers to advance knowledge and treatment options for thalassemia and sickle cell disease?
TSCS collaborates extensively with other organizations, healthcare providers, and researchers to advance knowledge and treatment options for thalassemia and sickle cell disease. We have partnered with institutions like NGO’s, maternity hospitals, healthcare professionals, local bodies, and primary health centers to ensure comprehensive care and treatment for affected individuals.
A thalassemia patient survives purely on blood donated by a donor and the collaboration starts right from there till it continues to flow in our blood. We are proud to say that we get help from unexpected quarters and challenges spur us to perform even better. Our partners in blood donation facilitate blood donation, donors help in whichever way they can and we are grateful to them. Every thalassemic child is grateful to them.

7. How does the society engage with the affected community and encourage participation in its activities and programs?
TSCS engages with the affected community by actively involving patient groups and volunteers in their activities and programs. They encourage participation from families, friends, and associates of affected individuals, as they possess first-hand experience and understanding of the challenges faced. This community engagement ensures a collective effort in fighting against thalassemia and sickle cell disease.

8. Can you share any success stories or notable achievements of the society in improving the lives of individuals with thalassemia and sickle cell disease?
The society has achieved notable success in improving the lives of individuals with thalassemia and sickle cell disease. They are the largest NGO in India serving 3500+ thalassemia patients daily and have successfully completed 70 bone marrow transplantations. TSCS has received numerous awards from the Government of Telangana, acknowledging their selfless service and significant contributions.

9. What are the major challenges or obstacles the society faces in achieving its objectives, and how does it address them?

TSCS did face several challenges in achieving its objectives, primarily due to the lack of awareness and knowledge about thalassemia and sickle cell disease. The late identification of these disorders in children adds to the difficulties. However, TSCS addresses these challenges by providing free medical services, spreading awareness through various campaigns, and leveraging the support of government schemes, generous donors, and corporate entities.

10. What kind of support does TSCS get from government (Govt of Telangana & Govt of India) for Thalassemia patient’s treatment? If yes, in what ways?
TSCS receives support from the Government of Telangana and the Government of India for the treatment of thalassemia patients. The government’s “Aarogyashree” scheme funds the treatment of eligible children, and voluntary donations from philanthropists, as well as support from pharmaceutical companies and corporate entities through their CSR initiatives, further contribute to the cause.

11. In your opinion, what are the most important steps that should be taken to raise awareness and improve support for individuals with thalassemia and sickle cell disease?
Thalassemia is a genetic related disease, which can be identified and prevented at the pre-birth stage only. The only thing everyone should do is to go for an HbA2 test in their first trimester of pregnancy. With that, we can reduce the cases of Thalassemia very easily in the upcoming days.

12. Is there anything else you would like to share about Thalassemia Sickle Cell Society or any future plans or goals?
Our only aim or goal is to request the Government of Telangana to pass a G.O making HbA2 test mandatory in all the hospitals, which can totally eradicate the Thalassemia disease in the state. Also, after that we will request the Government of India, to pass a bill on making HbA2 test mandatory in the whole country as well. In the days to come we believe TSCS will play an instrumental role in making India – Thalassemia Free Nation.

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Maharashtra’s capital, Mumbai, on Tuesday, overtook China in the number of corona virus positive cases and deaths. Notably, COVID-19 was first reported in China in late 2019. According to the Brihanmumbai Municipal Corporation (BMC), Mumbai’s recovery rate is 67%. The overall growth rate of cases in Maharashtra’s capital is 1.60%. In an exclusive interview  BMC Commissioner, Iqbal Singh Chahal speaks on how COVID cases are plateauing in Mumbai.

Excerpts from the interview:

Q – Since you are leading the situation of Covid-19 in the city, can we say with the degree of certainty that Mumbai has managed to flatten the curve and how have you managed to do that? 

A-In Mumbai, we may have 85,000 positive cases but if you see the statistics of the last one month that’s exactly on the 7th of June, we had 47,000 cases and 30,000 active cases. Today, we have 85,000 cases and only 23,000 active cases. Total cases have gone to 47,000 to 85,000 but active cases fell down from 30,000 to 23,000 only. The doubling rate is highest in the country. We have now 67% discharge against national average of 61. Two months back, our rate of infection was 8.6 %, it is almost 1.4% now. This is very reassuring. In the last two months, our beds went from 3,000 to 15,000 fully staffed in the DCHC and DCH hospitals only. 8,000 beds are already also ready to take us to 20,000 beds in hospitals. If you add quarantine beds and triple C beds, then we are at 95,000 beds now from 24000 beds.

Q – How would you respond to the folks who say that one of the reasons perhaps that we have seen a declining trend in Mumbai is because of the lower amount of testing compared to a city like Delhi. If you were to take a daily test, I believe it’s been kept under 5,000; Delhi is testing about 15,000 per day. If you were to take it as a per million population, Mumbai is roughly around 30,000 per million. Delhi is about 40,000 per million. How would you respond to that?

A- As far as testing is concerned, Delhi is 33,868 per million and Mumbai is 27,916 per million. In Delhi, they have added RT-PCR figures and antigen figures also. We are not merging these figures. If you take RT-PCR figures only, then we are still number one in the country.Today, we took a bold decision and that is to totally scrap prescription. Anybody, whether he is symptomatic or asymptomatic, can call up a lab. We have allowed 100% lab testing without prescription.

Q – Isn’t there a fear now that the outskirts, satellite cities and the satellite towns surrounding Mumbai, Navi Mumbai, Thane etc, which are all in lockdown now are seeing a spike of cases? Many people in Mumbai live in these outskirts and work in the city. As and when these cities open up and people start coming back to work again isn’t there a fear that the caseload in Mumbai will also increase?

A – We are fully prepared for that right now. Right now, we are in a very commanding and controlling situation as we have a very strong grip on this virus now. Right now, only 8500 beds in hospitals are occupied by our 23,000 active cases because most of the 14,000 cases are asymptomatic or home quarantined. So, the actual number of occupancy in the hospitals is only 8,500 and we have 15,000 beds fully staffed and we have 23,000 beds now and other 8,000 which we can add. We are fully prepared for that. Even if this spike is there, still we will be able to manage these patients and that is our strength today.

Question – Isn’t there a risk of this infection now possibly spreading further because of the opening up of hotels? How have you got to this point that you are confident that hotels can be opened?

A –On 3^rdJune, we decided that 50% of the shop in Mumbai will open on one day and 50% the next day. So, in 48 hours cycle, cent percent shops in Mumbai are opening for the last one month. Our cases have come down from an average of 1700 to 1200-1100 now. Today, I got the lowest figure of 785 cases since 8^th May, despite 10 million people on the road. That is why, that made us confident that now we can open the hotels and next week we are planning to open the restaurant also.

Courtesy to CNN-News18

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Excerpts from the interview:

Q: How would you rate India’s fight against COVID so far? Has India surprised you on the upside with its ability to keep the number of deaths quite low especially compared to countries like the US and the UK where we’ve had massive number of cases and deaths?

A: I’ve been looking day by day at reports coming from India and I’d like to say that the efforts people, local authorities and governments are making are quite extraordinary. We know that this virus is capable of spreading incredibly quickly and if you don’t take action, you can get double the number of cases every three days. In India, you’ve been able to reduce the rate at which the number of cases doubles and depending on which part of the curve you look but your current doubling time is at least 11 days. That means that there is a great reduction in the rate at which the virus is able to prove from person to person.

Secondly, I’m very pleased to see that you’ve managed to get improve your contact tracing so that when you found a person with the disease, you’re also able to locate the people with whom they’ve been in contact and that greatly reduces the rate of spread.

Thirdly, you’ve actually got quite a good management of your cases because the mortality rates, at least, in the studies I’ve seen are quite low.

It’s going to be really important that the economy restarts fully quite soon. The big challenge for everybody, not just in India, but in the whole world, is how to go about normal life, economic life and getting employment back whilst at the same time pushing back the threat from this virus. I’d just like to stress that we’re going to have to keep up with this vigilance, response and the capacity to ask people with the disease to isolate from other people for the foreseeable future.

Q: The rise in the number of cases we’re seeing is in big cities like Mumbai, Delhi, and Chennai etc. How do we contain in these places?

A: As movements are increasing it’s pretty well inevitable that you are going to see an increase in number of cases. This has being seen in many other countries as well. The reason for that is quite simple – the virus actually likes it when there are more contacts between people and it means it can spread more widely. Countries all over the world are now getting used to this. When they see a slight increase in cases, they intensify the containment efforts in the areas so that you get restricted areas where movement is being slowed down or stopped.

In India, as I understand it, your main challenge is in densely populated urban areas of Mumbai, Ahmedabad, Delhi, and Chennai as it’s hard to isolate people there because people are living very close together. That means, you end up having to try to isolate sections of a city which is really difficult to do. In other countries what’s been done is that people are being taken out from the areas where they are living and are being asked to stay in hotels or makeshift accommodation.

I know that in some cities in India you’ve done that which probably does slow transmission more but it’s a very difficult thing to do because you’re taking people away from their families and they feel it’s quite an imposition on their lives. I think, there will continue to be some increase in cases until ways can be found to really interrupt transmission so that the outbreaks that are going on in India do subside. We should try to heat the virus as far as possible out of the areas where it’s not present at the moment. If it arrives in the green districts, make certain that it can be quickly contained and transmission can be stopped because if you’ve got vast parts of the country that don’t have corona virus, try to keep it that way as it helps push the virus back.

Q: The larger question is what you can do to better manage the situation. Like you said, the bulk of the cases seem to be concentrated in the big cities and yet you need to be able to open up these big cities. As we approach the next phase of lockdown in this country, we’re looking at a new set a concept, not just red, green and orange zones but also containment zones and buffer zones. Is it possible to have enhanced testing and enhanced surveillance within those containment zones? Is it possible that in one city, you can have multiple containment zones but outside of those containment zones, life is as good as normal is?

A: I think this is the ultimate challenge actually for most countries right now. They’re finding that the virus is often concentrated in areas of maximum economic activity, whether we’re talking about Europe, North America or East Asia. I don’t have a simple solution but I think what I’m going to say I think is the best that we’re finding as we look around the world – you just have to be absolutely vigilant to try to find cases and ask people to isolate and then if you’ve got a really heavy amount of transmission in a particular area you’ve got to try to restrict movement out of that area. At the same time, enable economic activity to continue as much as possible around a place where you’ve got full transmission. This is the challenge.

I believe, India has got such an enormous capacity right across health systems. If India can actually show a best way of doing this then that’s really going to be a lesson for the world. The other point I want to stress to everybody is that of course you find the virus when you look for it and you’ve really wrapped up your corona virus testing but this is also slightly working against you. The more testing you do, sometimes the more cases you find. So, part of what we’re doing at the moment in every country, is trying to work out if the increased number of cases is because the testing availability is improved or is the increased number of cases actually because the virus is just spreading more. I’ve talked to colleagues in India and they do feel they are finding more cases because of more testing but, at the same time, this virus is still moving stealthily.

Q: There are now reports of a possible second wave in countries like China. We’re hearing those reports from Wuhan and from South Korea. There are also some WHO reports which seem to suggest that COVID could be coming in waves and could rise up again in August till September. Do you foresee something like that? If that were to happen, how do we learn to live with this virus?

A: I tend not to talk about corona virus coming in waves because this virus is still very much there. A new outbreak can start simply if somebody’s got the disease and is in contact with other people. Constant spikes of disease are going to crop up until we’ve actually got rid of the virus completely. To be on the alert and be able to respond to new spikes is going to be a characteristic of our new lives living with this disease. The challenge will be to make certain that when a new spike or a new outbreak starts up, it’s possible to contain it very fast by going to places where the virus transmission is occurring, restrict movement out of them and then in a painstaking way, find people with the disease and ask them to isolate. This way you contain and suppress the outbreak. That’s going to be the new norm and that is what we’re going to actually be doing for the foreseeable future until this virus is no longer a threat. This is going to be a real hallmark of our new society. So, we’ve just got to do what you’ve done in India – to protect the people whose livelihoods are affected by it. That’s going to be the new norm or what I call COVID ready, being able to identify outbreaks quickly and suppress them.

Q: How soon can we expect a drug to be able to solve COVID-19 or as a treatment for it? According to Dr Fauci, by January we could expect a vaccine in the market. Would your timelines be also similar?

A: I really hope that all this happens fast because to be living with the threat of COVID all the time right across the world is going to create a lot of difficulties, particularly, for poorer people who tend to suffer the most when these kinds of problems happen. Like everybody else, I’m overjoyed with the level of scientific cooperation right now and the engagement between different business groups to try to develop an effective treatment that will cure everybody at low cost and also a vaccine that’s safe and effective and could be administered to every single person in the world.

It does take time to move from having a candidate vaccine to proving that it is fully safe and at the same time works well in every single population in the world. Usually, we say that the time from having a candidate vaccine to having one that’s been proven to work well is certainly more than 12 to 18 months. I know that there’s a lot of optimism in several countries, now that we’re going to be able to accelerate that process. The only concern that I have as any other public health person has, is wanting to be sure that whenever we offer people a vaccine, we can put hand on heart and say this is safe and this works. That’s why, I’m being a little cautious on the timing and saying about 18 months probably because of the need to make absolutely certain that whatever we offer people does fulfill both those tests. I also want to make sure that it’s available in large quantities and that those who most need it, can receive it first.

When it comes to treatment, I really am delighted to see some of the progress with this new candidate – Remdesivir. My third area that I really want science to be giving us a solution is on testing. I would like there to be a very straightforward and simple virus test that can be done on saliva or on a nasal swab that doesn’t need to be taken to a laboratory and should be done on the spot. That would make the task of all of the people who are trying to work to contain outbreaks and stop them from spreading. I’m so confident that with this cooperation will see rapid movement.

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New Delhi: While India is slowly easing its lockdown restrictions, the number of Covid-19 cases remains on the rise. Receiving adequate and on-time treatment, apart from monetary and other associated concerns have gripped large sections of the populace, particularly the migrants and the poor. Dr Indu Bhushan, chief executive officer (CEO) of Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB–PMJAY) and the National Health Authority (NHA), underscores the benefits passed on by the scheme so far to those hit by the pandemic, key features of the programme such as portability, and the challenges that remain.

Q: 1 crore beneficiaries of PMJAY, and counting, for you to be associated with this programme for close to 2 years now, how did you achieve this?

A: This shows there was a lot of pent up demand. A lot of people needed the support. We are glad we could deliver. Linking 50 crore beneficiaries with more than 21,000 hospitals in 32 states and union territories was never easy. But with the strong IT framework, we could achieve it. This is the beginning.

Q: Portability is a big advantage of Ayushman Bharat. How are you going to help migrants, who are moving back to their villages, get the benefits of the programme?

A: You are right. We are proud of the portability. Many schemes in different parts of the world didn’t have this portability advantage. This process is complex. And we could achieve this because of the background. It is a big service for those who are moving to their villages. We will be counselling migrants, making them aware of their rights and benefits. They will still have the cover when they move around. More than 1 lakh portability cases have been provided.

Q: Tell us how Ayushman Bharat is serving the people to get access to Covid-19 care?

A: Any beneficiary won’t have to pay in any empaneled hospital. More than 2,000 Ayushman beneficiaries have received free treatment under the scheme for Covid-19. And testing free for more than 3,000 beneficiaries. Right now the system is able to take care of patients, but when there is a surge the public system may not be able to help. That’s when Ayushman Bharat will be important.

Q: Hospitals say you don’t provide reimbursements on time. Is that the biggest hiccup?

A: No I don’t think so. Private hospitals have not told us about this. The payment is timely. More than 85 per cent of payment is done within 15 days. We have heard that our rates are not viable. The rates are actually based on a regression analysis.

Q: Are you expanding the coverage of the scheme, because the pandemic shows more and more people need not just affordable but free healthcare?

A: The aim is to consolidate right now. If we can provide quality services to those 50 crore people, then we will be moving to other groups.

Q: Will you be looking at giving benefits to healthcare workers under the scheme since the government has given them insurance now?

A: We are for including many groups, like ASHA workers and Anganwadi workers. Any group the government decides to include we will be happy to cover.

Q: With the current pandemic exposing many poor and vulnerable groups needing financial protection against ill health, are there any plans to expand population coverage?

A: This is a pertinent point. Because of Covid-19, our footfall in hospitals has gone down. We were doing 25 to 30 thousand treatments before the lockdown. This has gone down to 12 to 15 thousand. The drop for critical care has been about 15 to 20 per cent. People are scared to come to hospitals. Many hospitals have converted to Covid-19 hospitals. Some hospitals have closed down because they feel it is not viable to run them now. We have to look into this. There is contraction in services and demand.

Q: While PMJAY is entitlement based with no formal enrolment process, yet only 25% have been registered for availing benefits from the programme over the past 1.5 years. Are there plans to accelerate registering the target coverage?

A: People can come even without cards. Giving them a card gives them surety. We will be expanding this process of giving cards and improve enrolment when the lockdown is over.

Q: What is the biggest hiccup that’s preventing you from expanding the scope of the scheme?

A: The government is committed to providing universal health coverage. It is a question of stages. You can look at expanding a scheme without looking at lessons learnt. We provided cards to over 12 crore beneficiaries. 75 per cent of the beneficiaries don’t have cards. Small steps are better than leaps.

Q: Which states are doing very well under the scheme?

A: I don’t want to single out states. I am saying sincerely most states have done well. Some states like UP and Bihar didn’t have any scheme and have done remarkably well. Some states converged their scheme with ours. We had RSBY going and they had experience and they have done well. Gujarat and Chhattisgarh have done well. Even Rajasthan. Punjab has done well. They have recently joined. Jammu and Kashmir, in spite of the tough times it has gone through, has done very well.

Q: Your personal interventions with Delhi, Telangana, Odisha and West Bengal have been ongoing. They are still not on board.

A: Delhi is coming on board. Within a week. Odisha, we are trying. It will benefit people from the states. Even if they have a scheme they can merge it with Ayushman Bharat and improve their existing ones. You can take the benefits by joining Ayushman Bharat like national portability. West Bengal was on board. They were a part of the scheme and for some reason opted out. We hope they will join back.

In Association with CNN-News18

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The coronavirus outbreak is undoubtedly the biggest challenge faced by Health Minister Dr Harsh Vardhan. At the forefront of India’s battle against the deadly COVID-19, he faces an arduous task of ensuring that India’s health infrastructure holds up against the pandemic. In an interview with  CNN-News18, Dr Harsh Vardhan outlines the steps taken by the government to combat the spread of the virus and the impact of lockdown.

New Delhi: Blaming people in metros like Delhi and Mumbai for not following the lockdown guidelines properly, union health minister Dr Harsh Vardhan said that’s one of the main reasons these cities are not performing well in controlling the spread of corona virus as compared to other cities in the country. “I have a feeling that people in these cities have not followed lockdown principles quite adequately,” he told after being asked about why major urban centres account for a lion’s share of India’s cases. “Rural (India) has behaved much more responsibly than urban India,” he added.

Mumbai, alone has reported more than 20 per cent of India’s overall cases. The overall case count in the financial capital stands at 8,613, while the death toll is 343. Delhi has so far reported 4,549 confirmed cases, after a record single-day hike of 427 cases on Sunday. The minister, however, admitted that some of these big cities had also borne the maximum brunt of international travellers and that could have contributed to more cases there.

“They also have huge slums where it’s not practically possible to implement the guidelines of social distancing and lockdown principles in a perfect manner,” he said. He praised the response to the crisis in rural areas, and said he has a “feeling that these migrant labourers are not so much a cause of concern for Covid-19 because they probably never got in contact with those who got the disease from foreign lands because of the socio-economic status.”The explanation for less cases in villages or migrant workers not being carriers of the virus does not take into account the variance in testing rates in urban centres and rural areas.

India’s overall testing rate, at around 694 per million, too, is one of the lowest in the world and the testing figures vary by state. Dr Harsh Vardhan pointed out that India has tested over a million people now and the number of positive cases is far lower than other coronavirus-hit countries at the same stage.The government had said on Sunday that India reported roughly 40,000 confirmed cases after a million tests, as compared to 73,000 in Germany, 1.6 lakh in USA and 2 lakh in Spain.

“We have plans to test 1 lakh people per day. Anybody with symptoms must be tested. We are testing in a judicious manner and the results speak for themselves. This is a well-crafted strategy,” he said.The minister further said that government data shows that over 11,000 patients have recovered, and “a majority are recovering well. Less than 1 per cent of the patients are on ventilator, 2 per cent need oxygen supply and 2-3 per cent are in ICUs.

India is not in stage-3 of transmission of the virus:

The main goal of his ministry, he said, is to control unwanted mortalities. “Covid-19 is infectious and spreads fast. My concern is to catch everyone with infection early and make sure they are tested. If positive, they should be shifted to a hospital,” he said. He also insisted that India is not in stage-3 of transmission of the virus, or no community transmission has taken place so far. Going by the definition of the World Health Organisation, he said the government has saved the country from going into community transmission. “In India we have checked at number of places at number of occasions, random samplings have also been done and we couldn’t find significant number of people who got the disease whose contact tracing we couldn’t do successfully. Again reiterating, we have saved country from going into stage 3 of transmission.

The minister also weighed in on the issue of treatment options, and said the use of experimental anti-viral drug Remdesivir, which has been called the biggest hope against Covid-19, is being discussed at highest levels of the government. “Scientists at ICMR and CSIR are also deliberating upon this issue. Right now we are in the position to participate in the WHO solidarity trial. We have been given some 1,000 odd doses by the WHO. We’ll be able to use them in clinical trials on some patients in some states in India,” he said.

1. As lockdown 3.0 begins, how would you describe India’s fight against COVID-19?

India’s fight against COVID-19 has been exemplary and it has been acknowledged across the globe. Indians have shown determination and discipline.

2. How are you planning to bring down the rate of daily infection?

COVID-19 spreads fast but we should not have unwanted mortalities. Our data shows that 10,000 patients have recovered and majority are recovering as well.

3. On March 20, India tested close to 14,514 citizens…percentage positive was 0.43 percent…After testing nearly 10 lakh citizens, the percentage of people testing positive has gone up to over 3 percent. How do you read this graph?

Our graph has been steady. We have tested over million people and only 3 percent have tested positive. Our guidelines say that we have to test all symptomatic patients. I am content with the data.

4. Why has the number of deaths in the past one week gone up? Is it because of the stigma that is associated with the disease?

It has nothing to do with stigma. Anybody who falls sick because of the disease is reporting to the health system with symptoms because of mass awareness. As far as deaths are concerned, most deaths are among’st co-morbid condition patients. Our endevaour has been early diagnosis and early transfer to hospitals. I want to ensure that no one dies because they couldn’t avail facilities.

5. Though we are ramping up our testing capacity, many argue that it is much less compared to other countries. What is your view on this?

Our testing strategy is devised by ICMR. We have kept on revising and modifying strategy as per the need of the hour. From one lab in the country, we now have 420 labs. We are testing 75,000 people and we have done a million tests till now. We are testing in a judicious manner. Results speak for themselves and this is a well- crafted strategy.

6. Given the size of our country, is the government looking at community-based random testing?

We are doing it regularly across districts. Some states like Karnataka and Odisha are doing it more aggressively. The National Centre for Disease Control is monitoring these tests.

7. What is the thinking behind classifications into various zones? 

To fight a disease, you need to have a well-defined strategy. With two stages of lockdown gone, people have made huge sacrifices. In India, 319 districts are unaffected while 130 are hotspots. Well-defined containment strategies must be there for areas with high infected numbers. We need to have house-to-house survey. Affected houses must be sealed with relaxations. We must take care of the disease in a scientific manner and open economy is a graded manner.

8.The Health Ministry has said that that case doubling rate for many states like Karnataka, Assam, Telangana, Haryana and UP are much higher than the national average of 12 days doubling rate. But the fact is that we have states like Maharashtra, Gujarat, Madhya Pradesh where it is below the national average. Is it a cause of concern and what is your ministry doing at this front? Also, are some states under reporting?

The situation is a cause of concern for us and we are monitoring them at all levels. I have been personally talking to their health ministers. We had central teams for all these states. We feel they also have to start performing well.. We expect that everyone will report every case or mortality in their state.

9. Which stage of the infection India is currently passing through? How confident are you of India avoiding Stage-3 infection?

I have said this repeatedly and WHO has also endorsed what I have said.  In India, we have checked at number of places at number of occasions, done random samplings and we did not find significant number of people who got the disease whose contact tracing we couldn’t do successfully. I am again reiterating, we have saved the country from going into stage 3 of transmission.

10. Another area of concern is our urban centres like Mumbai, Delhi and Indore. These places have dense population and are centres of country’s economic activities. What according to you went wrong in these cities? Also, what’s the assessment of rural India now that migrants are returning home too?

It is very difficult to pin-pointedly establish the cause of these cities not performing well even at this stage. But some of these bore the maximum brunt of the international travellers. They have huge slums where it is not practically possible to implement the guidelines of social distancing and lockdown principles in a perfect manner. I also have feeling that people in these cities have not followed lockdown principles quite adequately and that is the reason that these cities are not performing well compared to the rest of the cities in the country. The good thing for India is that rural India behaved much more responsibly that urban India. We saw some of the best examples from panchayats and village heads training and motivating people. I have a feeling these migrant labourers are not so much as a cause of concern because they probably never got in contact with those who got the disease from foreign countries.

11. There has been a lot of misinformation and confusion around rapid testing kits. What exactly is the government planning to do? And, do you have the sufficient quantity of these kits?

RTPCR test is confirmation for the diagnosis of COVID-19. These tests are used for surveillance purposes, epidemiological studies and research purposes. To assess the extent of infection in the community, we had plans to use them in our hotspot areas. We procured kits for the whole country and distributed to the states. But when we got reports from the states that their efficacy was under doubt, we withdrew them after testing them in our own labs. As soon as we get good quality kits, we can think about restarting these antibody tests.

12. Who is responsible for this entire fiasco around testing kits? 

I think ICMR or the empowered committee have adopted the exact procedure for procurement of the kits and they had given the contract to the lowest bidder. Unfortunately, kits by china were ineffective and as soon as we came to know about it, we ensured that we are no longer using them. Also, we have not paid anything to china for these kits.

13. In US, FDA has allowed use of Gilead’s Remdesivir for emergency cases. Many are calling it biggest hope for treatment. Now, the debate is how to bring it to India. Gilead has today said that it is open to partnering with an Indian company. How soon can we expect that to happen and is your ministry involved in the process?

It is being discussed at highest level at government also. Scientists at ICMR and CSIR are also deliberating upon this issue. Right now, we are in the position to participate in the WHO solidarity trial also. We have got some 1,000-odd doses given by WHO. We will be able to use them in clinical trials in some patients in some states in India.

14. India’s supply of HCQs to the world when it needed them the most stood out. Some foreign policy observers called it ‘HCQ diplomacy’. What are we doing to ensure mass manufacturing?

We have always been very large-hearted. There is strong push from the government to support the industry. We have been supplying HCQ to 97 countries of the world and now saving some for us. We are also supplying paracetamol to 103 countries. The government in its exit plan for the lockdown is supporting the industry to improve its production of various drugs because large number of drugs are exported to some of the less developed countries by India.

15. Even though India is among the leaders in manufacturing of generic drugs, we are heavily dependent on China for import of APIs. What can be done to become self-reliant vis-a-vis APIs and how are we planning to do that?

India has done well in the pharma sector. We have been exporting drugs to some developed countries also. Are only drawback had been that we have been importing these APIs from countries like China. But now endeavor is to attain self-sufficiency in APIs also and is a significant reform that is taking place in this industry at this moment.

16. Many economists are making the argument that since our mortality rate is so low, probably we should open up the economy in one go and treat people as much as cases come. The view is quite contrary to most of public health experts’ advice to flatten the curve like South Korea, etc. What is the way forward for India?

Our government’s thinking is very clear and has been elaborated by PM himself when he said that ‘jaan’ is also important and ‘jaahan’ is also important. For me as Health Minister, my foremost duty is to save every life from succumbing to COVID-19. We are into a dynamic strategy to mitigate covid but you have seen yourself we are now opening up lockdown also and that’s been done by the Home ministry is to make sure that we are able to take care of the economy also and we are able to help people who have suffered because of the economic slowdown post-lockdown.

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The global healthcare industry is going through a major transformation. There is a growing emphasis on improving the quality of care being delivered and artificial intelligence has already started making inroads into the healthcare industry. A discussion paper floated by Indian government’s Niti Aayog places healthcare among one of the focus areas for AI intervention.

 AI & ML is becoming increasingly sophisticated at doing what humans do, but more efficiently, quickly and at a lower cost. India produces only about 50,000 doctors every year – not nearly enough to get to minimum standards. To get to the WHO recommended minimum of a doctor patient ratio of 1:1000, India will need 2.3 million doctors by 2030 and the nurse: patient ratio is 1:483, implying a shortage of around two million nurses. Intervention of AI is not only a novelty but also prove to be a vital part for the sector.

Intuitive brings more than two decades of leadership in robotic-assisted surgical technology and solutions to its offerings, and develops, manufactures and markets the da Vinci® surgical system. The da Vinci system, which was the first FDA approved system to conduct robotic assisted surgery, has improved the lives of millions worldwide, with outcomes ranging from reduced bleeding, trauma and hospital stays.

In 2018, Intuitive established a direct presence in India. Intuitive’s ‘commitment to India’ has been  built on a foundation of success and innovation in India. The DaVinci was used for India’s first robotic assisted surgery, which took place in Delhi in 2002 and prior to 2018 Intuitive has spent several years giving Indian hospitals, surgeons and patients access to robotic assisted surgery through the Vattikuti Foundation.

In this context, HEALTH VISION had an interaction with Mandeep Singh Kumar- Vice President and GM, Intuitive Surgical India.

1.Tell us about the background of Intuitive and its operations in India.

Intuitiveis a global technology leader in minimally invasive care and the pioneer of robotic-assisted surgery.Intuitive brings 25 years of leadership in robotic-assisted surgical technology and solutions to its offerings. We develop, manufacture and market the da Vinci® surgical system and the Ion™ endoluminal system.

Our origins date back to the late 1980s, when robotic-assisted surgery was emerging in Silicon Valley at the former Stanford Research Institute (SRI).The National Institutes of Health supported surgical applications, and by the early 1990s the U.S. Defense Advanced Research Projects Agency had added funds in search of systems that could perform battlefield surgery. One of the founders of Intuitive acquired the initial technology from these projects, leading to the further refinement and development of surgical system technology.

In 1995, Intuitive Surgical Devices was founded, commercializing what was known as the time as the SRI system. In 1997, we began testing the first da Vinci surgical system. Intuitive received U.S. FDA clearance for the first da Vinci surgical system in 2000. Since then, more than 7.2 million da Vinci procedures have been performed globally.

In mid-2018, we moved to a direct business structure in India to expand access to the benefits of robotic assisted surgery to patients, surgeons, hospitals and healthcare system. We are headquartered in Bengaluru, which is Intuitive’s sixth international office.While our decision to go direct was recent, it was built on a foundation of many years of success and innovation in India. The first robotic assisted surgery procedure in India took place at a hospital in Delhi in 2002 – since then, the technology has been adopted by surgeons and hospitals throughout the country. 

2.Could you briefly explain about RAS?

Robotic-assisted surgery allows surgeons to perform many types of complex procedures with more precision, flexibility and control than is possible with more traditional techniques. The da Vinci system isdesigned for complex surgery using a minimally invasive approach – in other words, procedures performed through very small incisions.

The da Vinci surgical system includes an ergonomic surgeon console or consoles, a patient side cart with three or four interactive arms with a high-performance vision system and wristed instrumentation.   The surgeon controls the arms while seated at the computer console near the operating table. The console gives the surgeon and OR staff a high-definition, magnified, 3D view of the surgical site, which allows everyone in the OR a clear and unobstructed view of the patient anatomy.

3. Please provide a background on da Vinci System

da Vinci surgical systems are advanced robotic-assisted surgical platforms designed to expand a surgeon’s operating capabilities and offer a state-of-the-art minimally invasive option for patients.Our systems have pioneered new capabilities in the OR, transforming the field of minimally invasive surgery.In 2000, the da Vinci became the first robotic-assisted surgical system cleared by the FDA for general laparoscopic surgery.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the technology makes it possible for skilled surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. The system also scales, filters, and translates the surgeon’s hand motions into more precise movements, and its instruments bend and rotate with greater dexterity than the human hand, and can offer enhanced access to the surgical site.

Globally, more than 7.2 million robotic-assisted surgical procedures have been performed using da Vinci systems. In 2019, 1.2 million procedures were performed, and every 26 seconds, somewhere in the world, a surgeon starts a da Vinci procedure. As of today, more than 5,500 da Vinci robotic-assisted systems have been placed in 67 countries and more than 52,000 surgeons have been trained on da Vinci worldwide. 

4. What do you think has led to the rise of robotic assisted surgeries in India?

 Two key factors have helped to drive the rise of robotic-assisted surgery in India – the skill and pioneering spirit of Indian surgeons, and the impact that robotic-assisted surgery has on their patients. Indian surgeons have made important contributions to the evolution and development of robotic assisted surgery over the past two decades. Since the first robotic-assisted surgical procedure in India was performed in 2002, we have been training and collaborating with pioneering Indian surgeons throughout the company’s history. As a result, India now has a pool of committed, skilled and highly passionate RAS surgeons, who have a robust patient flow, manage complex cases and collaborate with their peers around the globe.

It is clear that Indian surgeons are adopting the technology and adapting quickly to it,seeing it as a tool that can give them additional capabilities and deliver clinical benefits for their patients. The recent 2019 launch of the Indian Chapter of the Clinical Robotics Society Association (CRSA), a global association dedicated to surgeon training, and now the first Indian robotic surgical society, demonstrates the growing enthusiasm and maturity of the surgeon community.

5. What are  the advantages/benefits of RAS?

 The benefits of robotic-assisted minimally invasive surgery have been explored in more than 21,000 peer-reviewed, published studies and reports. For patients, da Vinci surgery can offer many potential benefits compared to open surgery, including less blood loss, less pain, fewer complications, shorter hospital stays, fewer re admissions, faster recovery and smaller incisions. 

Surgeons who use the robotic-assisted systems find that it can enhance their precision, flexibility and control during the operation and provide superior visualization compared to traditional techniques such as open and laparoscopic surgery. With robotic assisted surgery, surgeons can perform complex procedures that can be difficult with other methods. 

6. How many systems have you brought in so far to India?

We have more than 70 da Vinci systems installed in India, to date, which includes a number of government institutions.However, it is important to emphasize that installing a system is part of a longer relationship.  Of particular importance to us here in India (and globally) is not merely introducing a da Vinci system, but also supporting our customers in establishing strong robotics programs through everything that supports the technology: training, customer service and support. We call this our “ecosystem” and it helps us help our customers by ensuring the long term success of each robotics program.

This process starts well before installation of a system at a hospital or institution. We assess key factors related to starting and maintaining a successful robotics program – such as if a program will have the right patient flow, a pool of passionate surgeons who have the right skill sets, and the potential to achieve the right clinical outcomes.

7. Is the adoption for RAS higher in urban metro city hospitals only or is there a distinct trend towards spreading to the hinterland and smaller private hospitals?

 Surgeons across India are adopting the technology, adapting to it quickly and looking at it as a tool that provides them with additional capabilities and that can help them deliver clinical benefits and economic value.Linked to the availability of tertiary care facilities and patient flow, the deepest penetration has been in teaching and referral hospitals as well as private multi-specialty chain networks. We continue to work with surgeons and hospitals across India to expand access to robotic-assisted surgery.

8. Could you please shed some light on the cost factor?

 Intuitive offers a range of systems at different price points and flexible purchasing terms, which we use to help individual customers develop robotic-assisted surgical programs that meet both their clinical and economic goals. We do not comment on profit margins or individual transactions with customers, as they are confidential. As a ballpark number, the da Vinci is between a 1 and 2 million dollar investment.

9. What are your plans for India and how do you see this segment contributing to your overall growth?

 We see an exciting opportunity for surgeons in India to use our robotic-assisted surgical systems to make a difference for their patients. Intuitive is building a robust presence in India to meet and support this growing interest and demand. To strengthen our presence, we have invested in training centres, hiring employees, including teams that works closely with surgeons, to support hospitals for the long run.

One of our key focus areas is on hiring employees in sales, support, clinical affairs, marketing, training, regulatory and other areas in order to best support our customers and facilitate access to, and expansion of, robotic-assisted surgery to more patients and institutions throughout the country. Intuitive has a very strong, mission-driven global corporate culture, and we are excited to bring that to life here in India, working to build our team in order to develop and deliver the tools, technologies and solutions to help improve the lives of patients.

10. What is Intuitive’s vision for India?

 Robotic-assisted surgery has made a meaningful impact in India, but is in a relatively early phase and has enormous potential. India is a long-term, important market for Intuitive, and we are investing in India for the future. Demand for robotic assisted surgery in India is high, and we believe we have an important opportunity to help surgeons to positively impact patients throughout the country by enabling access to the benefits that robotic-assisted surgery can provide.

11. What are the areas of therapies you focus on?

 Since 2002, da Vincisurgical systems have been used in more than 7.2million minimally invasive procedures across a number of surgical specialties. Some of our key focus areas include gynecology, surgical oncology and urology.

12. Please mention about the new products that you are considering to bring in?

 Recently we expanded from RAS to lung cancer biopsy by launching Ion. It is an FDA approved system that features an ultra-thin, ultra-maneuverable catheter that allows navigation far into the peripheral lung, and unprecedented stability enables the precision needed for biopsy. It enables the physician to extract a sample to detect the disease without the need for invasive surgery. Currently Ion is in use in the US, and initial results are promising – over time we will evaluate opportunities to bring Ion markets where it can make an impact.

13. Could you please name some of the hospitals that are using your technology?

So far, we have installed more than 70 da Vinci surgical systems in major hospitals throughout India. Some of the key hospitals where da Vinci is installed include:

Manipal Hospital, Bangalore, HCG Hospitals, Bangalore, HCG Hospital Ahmedabad, Max Hospital, Delhi, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, All India Institute of Medical Sciences, Delhi, Postgraduate Institute of Medical Education and Research, Chandigarh. 

14.Are you providing any training for doctors/surgeons?

 Yes, we have two training centres in India: Amrita Institute of Medical Sciences and Research Centre, Kochi and M.S. Ramaiah Medical College, Bangalore. We aim to provide the best-in-class training and support to surgeons in India throughout their careers – from initial exposure to the technology, to progressing from basic training through to more advanced training.In India, over 500 surgeons have been trained on the da Vinci system.

The post Demand for robotic assisted surgery in India is high: Mandeep Singh Kumar appeared first on Health Vision.