Healing touch

Femto Laser surgery in progress at Sankara Nethralaya in Chennai. A file photograph. - R. RAVINDRAN

Chennai has put India on the global health care map.

IF there are two fields in which Chennai has emerged as the leader, they are health care and the automobile sector. Be it in neurosurgery, telemedicine, ophthalmology, liver transplantation, orthopaedics, cardiac surgery, keyhole surgeries in shoulder, elbow and wrist, cranio-facial surgery and diabetes treatment, private and government hospitals provide quality care. Sankara Nethralaya, Apollo Hospitals, MIOT Hospitals, Sri Ramachandra Medical Centre and Global Hospitals and Health City draw patients from Orissa, West Bengal and the north-eastern States.

Dr K. Ganapathy, neurosurgeon and president, Apollo Telemedicine Network Foundation (ATNF), is certain that Chennai is the medical capital of India. Definitely yes, he said. We are also the telemedicine capital of India. Apollo Hospitals, Sankara Nethralaya, Aravind Eye Hospitals and other private hospitals in Tamil Nadu account for more than 75 per cent of the telemedicine consultations in India. Apollo Hospitals has the largest and the oldest multi-speciality network in South Asia. With more than 9,000 beds across 54 hospitals in India and abroad and about 4,000 consultants, the Apollo Hospitals group, which had its genesis in Chennai, is one of the world's largest hospital groups.

We were the first in the world to start VSAT-enabled telemedicine services to villages, Dr Ganapathy said. The world's first VSAT-enabled secondary care hospital was commissioned on March 24, 2000, at Aragonda village in Chittoor district of Andhra Pradesh by the then President of the United States, Bill Clinton. Dr Prathap C. Reddy, founder of Apollo Hospitals, is from Aragonda. The ATNF has done 70,000 telemedicine consultations in the past 11 years in 25 different disciplines to patients who were 200 km to 7,500 km away. The ATNF has 125 peripheral centres, including 115 in India and 10 overseas, including in Afghanistan, Bangladesh, Maldives, Mauritius, Muscat and Nigeria.

On August 9, as Dr Nithya Narayanan, an ENT surgeon, sat in the telemedicine room of the ATNF in Chennai, a patient from the peripheral centre in Port Blair appeared on the monitor before her. Dr Nithya had already received the details of his problem through a faxed message. He was suffering from hearing loss and had been told to undergo a surgery. Now, he wanted to know how much the surgery would cost and how long he would have to stay in Chennai.

We are convinced now that we can transform health care by using technology, said Dr Ganapathy. The ATNF has initiated a new concept in telemedince by facilitating telemedicine consultations wherever the consultant is present. The patient can contact him through the Internet, from any personal computer where a dedicated software is available. According to Dr Ganapathy, Chennai has 200 per cent tele-density with 10 million mobile phones in use while its population is about five million. Eighty-six per cent of the people living in rural Tamil Nadu have mobile telephones. We can use technology, including mobile phones, to provide health care. We can do tele-camps, tele-screening, and so on, he said.

In appreciation of the good work done by the ATNF, the Government of India selected it to provide tele-consultation and tele-education to several African countries under the Pan African e-Network Project.

Dr Anand K. Khakhar said, We are the fastest growing centre in terms of number and the entire range of services provided. These include living donor and cadaveric liver transplantation, split liver transplantation, the domino transplant, and paediatric liver transplant. Dr Khakhar is the Senior Consultant Transplant and Hepatobiliary-Pancreatic Surgeon, Centre for Liver Disease and Transplantation, Apollo Hospitals, Chennai. In the three years since its founding in 2008, it has done 115 liver transplants, including live and cadaver categories while centres in Delhi took eight years to complete 100 liver transplants. We have done liver transplants for a five-month-old baby and a 70-year-old man, Dr. Khakhar said. In India, liver transplants are heavily dependent on live donors. To convince the family of a brain-dead person to donate the liver, you have to share the family's grief, he said. About 40 per cent of such families agree to the donation. Indeed, his centre accounted for 50 per cent of the various organs donated in the past three years for transplant in Tamil Nadu. Liver transplants involve replacement of the diseased liver with a healthy whole liver or part of the whole liver. The liver can come from a brain-dead donor or from a living, related donor. In emergency situations, a living donor or a brain-dead donor should be identified fast. His centre, he said, has proposed that institutions which have the licence to do the transplant should be allowed to examine the case legally, and implement the process within the constraints of the law. Such cases could be reviewed later.

Apollo Hospitals has set up a stand-alone Apollo Children's Hospital on Shafi Mohammed Road, Thousand Lights, Chennai, with 80 beds, said N. Sathybhama, its Director of Medical Services.

Discipline is the watchword at Sankara Nethralaya and it is obvious that the writ of Dr S.S. Badrinath, its founder, runs here. Through the Medical and Vision Research Foundation, it not only uses cutting-edge technology in patient care but pays equal attention to education and research in ophthalmology. It is an academic institution that conducts graduate, postgraduate and continuing education programmes in ophthalmology. The hospital says that it has one of the lowest post-operative infection rates in the world 0.01 per cent against the world average of 0.04 per cent. It attracts hundreds of patients every day from West Bengal and the north-eastern States.

Sankara Nethralaya's Lasik cell at the Refractory Surgery Centre (RSC) is increasingly sought after by people in the age group of 20 to 40, keen to get rid of their glasses. At the heart of the RSC is the Wavelight Allegretto Excimer Machine for treatment of myopia (near-sightedness), hyperopia (long-sightedness) and astigmatism (distorted vision).

The latest tool in the armamentarium of the refractive surgeon is the Femto-second laser vision correction (Femto-LASIK), said Dr N. Radhika, Senior Cornea Consultant, Sankara Nethralaya. (LASIK is short for Laser Assisted In Situ Keratomileusis). Until now, in the Laser-LASIK procedure, a flap in the cornea was created by using a motorised blade and the Excimer laser was delivered to the bed of the cornea to reshape it permanently to neutralise the glass power. After the laser delivery is completed, the corneal flap is restored to its original position. In the Femto-LASIK procedure, the surgeon uses the Femto-laser to create the corneal flap.

The predominant advantage of the Femto-LASIK procedure, said Dr Radhika, was the precision obtained in creating the corneal flap. This ensured that there were no under-sized or over-sized flaps and that the risk of infection was minimal. Another advantage was that certain corneas were more amenable to the Femto-LASIK procedure. In a short span of time, Madras Institute of Orthopaedics and Traumatology (MIOT Hospitals), on 14 acres at Manapakkam, Chennai, has metamorphosed from a centre for orthopaedics into a multi-speciality hospital that deals with thoracic and cardiovascular care, cardiology, nephrology, neurosurgery, craniofacial and cosmetic surgery, keyhole surgeries in shoulder, elbow and wrist, paediatric cardiology, obstetrics and gynaecology, oncology and haematology. Dr P.V.A. Mohandas, managing director and chief surgeon, Department of Orthopaedic Surgery, is its founder. It was started as an independent entity at Vijaya Hospital in 1988. In 1999, MIOT moved to Manapakkam.

Although MIOT was originally started as a centre for orthopaedics, we realised that we need to be a multi-speciality hospital to provide complete and holistic care, said Mallika Mohandas, its chairperson. In a matter of months, she said, MIOT would have a radiation oncology department. The building is getting ready, equipment has been ordered and radiation oncologists have been appointed. For cancer treatment, we do surgery and chemotherapy. We send out the patients for radiation. They are not happy about it, she explained. Plans are under way to set up a liver transplantation centre. Our strength is spinal surgery. We are strong in joint replacement surgery, knee replacement and revision surgery, hip replacement, spinal surgery and trauma care, she said. MIOT pioneered total knee replacement surgery in India.

On the staff of MIOT is Dr Ram Chidambaram, a young specialist in shoulder and upper limb trauma, with 12 years of practice and training in the United Kingdom. People in India sustain shoulder dislocation mostly from accidents. Impingement, rotator cuff tear, acromio-clavicular joint arthritis, and calcific tendonitis in the shoulder cause acute pain. Earlier, we used to address these problems by performing open surgery. But now, keyhole surgery can address all these problems, he said. While open surgery led to pain, muscle damage, cuts and slow recovery, the advantages in keyhole shoulder surgery were less or no pain, no big cuts, reduced chances of infection and quick rehabilitation.

Dr Eapen Koshy heads the Craniofacial and Cosmetic Surgery Department at MIOT. He trained in England for nine years in craniofacial surgery. There are very few departments in India that do facial surgery as a full-time speciality [as we do here at MIOT], he said. In MIOT, he met difficult craniofacial deformities in persons from different parts of India and from Nigeria, Rwanda, Ethiopia, Zimbabwe and Sudan. We see cases which have been turned down by surgeons in their own countries because they are too complicated, said Dr Koshy. They come to Chennai because they cannot afford treatment in the West. And we give them affordable treatment here, which is as good as anywhere in the world. On his monitor are pictures of people with facial deformities before and after surgery.

Professor Vijay Viswanathan, managing director, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, has a mission to prevent foot amputation in diabetic patients. My mission is to prevent amputation. For the past 20 years, I have been working on it. So the M.V. Hospital for Diabetes has launched a community programme to educate the people on the diabetic foot, which Dr Vijay Viswanathan called the costliest complication. Diabetic neuropathy might lead to foot ulcers and amputation.

We concentrate on primary and secondary prevention, he said. His father, the late Dr M. Viswanathan, worked for 50 years on diabetes and its prevention. The disease may lead to ulcers in the foot. The muscles become weak and the foot loses grip. M.V. Hospital for Diabetes and the Central Leather Research Institute, Chennai, worked for 15 years to develop light-weight footwear for diabetic patients. It has a sole made of ethyl vinyl acetate, an insole made of polyurethane foam and a counter at the back so that the footwear does not slip out. Another footwear, named Diastep, is available off-the-shelf.