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Sri Sathya Sai Institute of
Higher Medical Sciences, Bangalore
First anniversary celebrations on January 19, 2002
The first
anniversary celebrations on January 19, 2002 saw an exchange of
information and ideas to make healthcare accessible to all
A panel of eminent
personalities shared their thoughts and ideas in the afternoon. Dr
A S Hegde, Chief of Neuro Sciences, Sri Sathya Sai Institute of
Higher Medical Sciences, Bangalore and Dr Shekar Rao, Head, CTVS,
Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore
were the moderators.
Dr A S Hegde, in his
opening remarks said that while life expectancy was going up, a
large section of the population are not touched by this. This
large section is most likely to be passed by as nations develop
and move with these times of globalisation. The burden of
inequality, poverty and ill health is heavy on this section. The
WHO has envisioned two concepts -health development (including
water & sanitation) and preventive medicine. Baba's institutions
have worked on these very fundamentals.
Dr Shekhar Rao said
primary, secondary and tertiary care are equally important and are
simultaneously needed. The fact that over 68,000 patients have
sought treatment here for neuro and cardiac illnesses illustrates
this point. For many in the country there is no hope. This is very
demoralising for them. Therefore it is important for the morale of
the nation that they feel assured that every sort of hi-tech care
is available to them. Tertiary care upgrades a medical structure.
Here are the
highlights of the presentations made by the panelists:
PROF APJ ABDUL KALAM
Honourable President Of INDIA
EXPERIENCES IN
HEALTHCARE TECHNOLOGIES AND FUTURE CHALLENGES
I have been thinking of what to share
with you for the next ten minutes. This morning, for first time, I
happened to hear a Divine Discourse by Baba. I had prepared a talk
but after hearing the discourse, I discarded it. I am not going to
speak to you about any ideologies, but of an experience.
A cardiac surgeon and I work together. Between us, we have
extended the preventive area I thought of sharing with you. I was
traveling to Bhopal and on the way somebody told me, "I have two
cardiac stents in my body". Out of three arteries, he had stents
in two. The man was just an upper division clerk in Aligarh. He
used to feel a pain quite often and went to one of the famous
medical institutions in Delhi. They told him he needed to get an
Angioplasty done that costs Rs 1.5 lakh. The cardiac stents cost
another Rs 75,000. The total medical bill amounted to Rs 3 lakh.
He could not afford it. He has two children and he just put up
with the pain quietly for some time.
Now there was our fast forward program. We have a stent that we
developed out of a ferrite free bio-compatible material. A team of
Prof. Somaraju, his doctors and my colleagues reprocessed a
material -ferrite free and bio compatible, and made a stent out of
it. After a series of tests it went into production.
Now that is our
cardiac stent. We are very happy there is a patient who is
carrying a cardiac stent like this. At a conference attended by
many medical professionals, physiologists and cardiac patients, it
was said that even after an Angioplasty or bypass surgery,
reoccurrence of the problem still takes place. Around 15 patients
reported that reoccurrences took place 5 to 7 years later.
I had a good friend
called Dr Selva Murthy. He runs two institutions. The Institute of
Physiology and the Institute of Psychology. This morning we heard
that the treatment given here was not just for the body, but for
the mind. Can we treat the mind? I read a famous book 'Man the
Unknown'. The author is a noble laureate. The point he makes is
that the doctors treat patients like they are machines. How do you
treat the pain created by the mind? That is a key issue.
Dr Selva Murthy and
I went to Mount Abu. At that time I was not aware of the great
work that you are doing here. In Mount Abu, there is the Brahma
Kumari Academy. There is an allopathic doctor there who believes
that you have to treat both mind and body. It is very rare for an
allopathic doctor to believe in this fact.
There, in the Academy, we enlisted 80 patients who had instances
of reoccurrence. The treatment started. We call it a
three-dimensional treatment. This three-dimensional treatment
involves a vegetarian nutrition, meditation and aerobics -
specific aerobics. In the course of this treatment on the 80
patients, we found the blockages of the arteries started
dissolving. Still there were some who did not believe this
phenomenon. So we decided to expand the base to 400 patients. In
the last one year 400 patients have been treated. The records of
350 patients show that either the blockages have dissolved or are
dissolving.
I am telling you of this today to covey
a message we get out of this experiment. It is possible to design
and develop indigenous technology in this country. To give you an
example, how did I develop the stent? Prof Somaraju wanted me to
develop a stent. He came to my laboratory one day and said,
"Kalam, what are you doing? You are creating pain". With missiles,
according to him I create pain! "You remove the pain", he said. He
took me to his place and showed a stent costing Rs 1.5 lakh and
said as soon as we put our stent in the market the cost would come
down. That is another phenomenon which has taken place.
In any super speciality hospital, 90 per cent of the equipment is
imported. I believe that a movement to develop indigenous
technology by doctors should start here. In this campus any
movement you start will work. We must use our own technology. If
you start a movement towards that, it will be great.
We prepared a 20-volume document two
years ago. 'How to transform India into a developed machine?' One
of the documents, the Health document dealt, with how to provide
healthcare. What is healthcare? Healthcare is not medical care.
Medical care is one of the components of what you are all doing.
Actually, healthcare is medical care, education and nutrition.
Healthcare happens only when all these three are combined. You are
doing that in both Puttaparthi and here. You are treating the
mind. You are providing good water. You are doing all the three.
I was telling some friends of mine today that an antiballistic
missile has been launched by Bhagawan Baba against poverty. How
does this missile work against poverty? Through water, education,
and healthcare.
DR MICHAEL NOBEL
Chairman, Nobel Family Society
USE OF MEDICAL TECHNOLOGY TO ENHANCE MEDICARE
I have been asked to
speak about medical technology and its impact on healthcare, and I
think it is safe to say that medical technology has seen more
progress over the last 30 years than in all history. This is
mainly due to the arrival of digitisation and the advancement of
computing power. The wealth of information available today to the
referring physician is simply overwhelming. In diagnostics the
physician can choose from a plethora of procedures unknown to him
a few decades ago.
As you know Magnetic Resonance Imaging, Ultrasound, Positron
Emission Tomography, Digital Subtraction Angiography, Electron
Beam Tomography, all provide new and additional insights into the
human body. The doctor can also order sophisticated laboratory
procedures including exhaustive chemical analysis of the patients'
body fluids. There are new chemical markers for tumour and mental
illnesses. There are protein and enzyme identifying agents that
help him diagnose hereditary diseases and so forth. The progress
in medical technology offers doctors an added insight. We have
also seen the replacement of often painful and potentially harmful
examinations. You might remember at one time, coloured liquid or
air would be injected into a patient's brain. With non-invasive
and non-harmful procedures such as the MRI and Ultrasound,
Arthroscopy and Myealography have practically disappeared in the
Western countries.
In treatment, research and technological developments have been
equally impressive. In the case of cancer, for example, because
it's a huge field, the traditional three methods of radio beam
therapy, chemotherapy and surgery have been complemented by
superior treatments. In treatments such as Brachiotherapy,
radioactive micropellets are inserted, some times coated by
liposomes, into the tumour and are subsequently released by
external heating. We have the hormone therapy, the gene therapy,
and the focused ultrasound where the tumour is burnt. We have the
cryotherapy where it is frozen. We are starting to see the arrival
of cancer vaccines and the enhancement of the body's outer immune
system by the release of heat shot proteins through hyperthermia.
All of these offer exciting avenues of medical technology
development. In cardiac treatment, for example, Jarvic artificial
heart implant with immuno suppressive drugs have shown increasing
promise together with more advanced research projects such as gene
altered cloned pigs, growing body parts including hearts which can
be transplanted into humans without fear of rejection. Stem cell
technology is another area of increasing interest as we have seen
in the mass media. Particularly, in the area of treatment for
mental diseases. Permanently clogged up areas of the brain,
diseases such as the Parkinson, Alzheimers / CP, and multiple
sclerosis can now be potentially restored by the use of these
cells.
Diagnosis through tele-medicine and
distance learning of medical technology is growing through the use
of the Internet and satellite communication channels such as those
provided by our company Worldspace. One thing is for sure. All
these technological advances that I have mentioned in medicine
will certainly not make healthcare less costly for the State or
the individual. Presumably, quite the contrary. Tremendous
increase in healthcare budgets makes it less available to the
under-privileged sections of society. We heard this morning, for
example, a MRI examination costs between Rs 30,000 and Rs 45,000
in the USA [625 and 830 USD]. A light ion accelerator for cancer
treatment [less harmful to the patient as compared to the
traditional linear accelerator], is now being installed at the
Karolinska Hospital in Stockholm. Do you know how much it costs?
It costs an unbelievable Rs 1 billion [21 million USD
approximately]. A simple fluid electrolyte replacement I had to
undergo in Chicago cost me Rs 90,000 [1,875 USD] and surely, I
will get more bills. This is beyond what many people can afford in
India as elsewhere and always in the end, it's the man on the
street, taxpayers, and the patients who have to foot the bill. It
is therefore so rewarding to encounter a true phenomenon here in
Whitefield. As hospital that offers the latest state-of-the-art
medical technology without charging anything for it. I think we
need hundreds more hospitals like this in the world to offer the
poor the same facilities as the wealthy. But again the very
relevant question, where do we find a hundred Sai Babas.
To accomplish even a fraction of this the world needs an increased
sense of compassion among those who have the resources towards
those who do not. To do that we need the teachings of Bhagawan Sai
Baba distributed worldwide. Our company offers its world
communication channels to do that.
A disadvantage of the modem healthcare system is the risk that
patients tend to become numbers in a computer file rather than
individuals. This has happened in the West and I hear from a local
doctor that this seems to be a trend in India also. Computerised
archiving communication systems allow the doctor to access the
complete past history of the patient who is identified by his code
or personal identification number. Today, the overburdened
healthcare systems only allow most doctors a few minutes with each
patient, enough to make a prescription or to refer him to a
diagnostic procedure. So the patient becomes a biological specimen
or even a pathological state. The doctor thinks, 'now here comes
the diseased kidney', or, 'here comes the torn ligament', rather
than Mr. Smith or Mrs. Jones.
What is lacking in the hi-tech electronically oriented
Western society is the aspect of spirituality i.e. the synergistic
effect - mind together with the physical health. The positive mind
on the patient's health. The patient's belief system does not
enter into the healthcare consideration in Western Europe except
of course when it comes to psychiatric illnesses. So I was very
surprised, being a Westerner, the first time I visited the
hospital here, to see the large number of photos of Bhagawan Sai
Baba displayed. Most hospitals abroad might have one picture,
perhaps of the Head of State in the reception room. I was informed
that it was the patients who needed them for spiritual support and
the assurance that Baba was present to lend his support to the
healing process. The psychological belief of the patient that a
higher being will get him well is largely ignored in the West. But
history abounds with examples. In the two world wars, for example,
soldiers after being cured in hospitals and told that they would
have to return to the inferno at the front simply turned their
faces to the wall and died without any physical cause or reason
for their death.
The impressive hospital created by Bhagawan Sai Baba is thus the
combination of the state-of-the-art technology, healing powers of
His presence installing in the patient the firm belief that he
will get well, and all this offered for free. This is something I
believe the Western healthcare would do very well to consider
also. I would like to call for a serious study comparing identical
treatment procedures to identical patient groups with or without
spiritual guidance and reinforcement and subsequent belief
enhancements. A significant difference shown in such a study could
well change the way we look at cure and healing, away from a
purely empirical and rational view.
DR NOAH SAMARA
Chairman and CEO, Worldspace
SOCIAL RESPONSIBILITY OF CORPORATES IN HEALTHCARE
This is not simply an anniversary. It is a celebration because we
rejoice today at the first year of the Sri Sathya Sai Institute of
Higher Medical Sciences. A year of service and a year of loving
kindness. Over the past one year, we have heard that thousands of
men, women and children, without money and often without hope,
have come to this remarkable Institute, and left with their health
and spirits restored. As we celebrate today let us praise the
medical professionals of the Sri Sathya Sai Institute of Higher
Medical Sciences who have demonstrated skill, caring and devotion
in the practice of their healing arts. We should also praise
volunteers in India and the world over who serve here with
dedication, devotion and humility. And most of all, we praise
Bhagawan Sri Sathya Sai Baba himself. The magnificent, world-class
medical facility we see before us is an embodiment of Baba's great
vision. The outpouring of the kindness and the healing energy so
evident here today is a gift Bhagawan Baba in his boundless love
shares with all of us.
I want to address the subject of corporate responsibility in the
delivery of healthcare services. Today, when someone says
'corporate', we often think of large office buildings. We think of
financial statements, and of men in expensive blue suits. But the
superficial trappings of these corporations distract us from the
deeper meaning. Actually the word 'corporate' in Latin, which
comes from 'corpore', means to make into a body. Every corporation
is nothing other than a group of people formed together in a body
to get something done. By their nature, corporations focus on
themselves. But in truth, all corporations are really a part of
the larger body. Nearly 400 years ago the English poet John Donne
wrote, "No man is an island entire unto him himself. Every man is
a piece of the continent. Every man is a piece of the mainland".
His words are ever truer for the corporations than it is for
individuals. Today's dominant corporations such as Microsoft have
thrived by creating a web of interdependencies and business
connections that have supported the world. As Microsoft has
proven, the more the corporate is involved with others the more
likely it is to succeed. Conversely, the surest path to the death
of a corporation is isolation. Yet the illusion of separateness
persists. Corporates use the law to limit their liability.
Liability is a very narrow legal concept whereas responsibility is
the universal requirement for a principled human life. The author
Alien Massey put it beautifully, "we are responsible for actions
we perform in response to things we are not responsible for". For
example, corporations do not cause disease, but surely, as they
are connected to society they are responsible for contributing to
public healthcare.
Many corporations support the health of their employees and their
families. But that is just an appropriate first step. It is not as
much as what is needed. Western corporations would do well to
follow some of the examples here in India. My colleagues from
Worldspace, Bangalore tell me it is an emerging trend for
corporations in India to sponsor healthcare for a whole village or
locality. There is so much that corporations can contribute to
treatment, research, and education. Whether large or small there
is an important role for every corporation. Healthcare needs are
so great that a corporation does not need to look far to get
involved. Worldspace actually came into being in response to a
public health crises. In the mid 1980s I had read about the spread
of the AIDS virus and how it was affecting Africa because there
was no infrastructure available there to inform people about the
epidemic. I realised that people were dying due to ignorance. This
realisation changed my life and I quit my profession to found
Worldspace Corporation to pursue, what at that time seemed an
unattainable goal, which was to put up a big satellite in the sky
over Africa that would deliver information to the entire
continent. That vision then, as now, was to create information
wealth by directly broadcasting to small receivers that would be
inexpensive, from satellites that are in a geo-stationary orbit.
We were guided by this vision and now operate two satellites to
serve all of Africa and Asia with information that is being
delivered in the form of entertainment and education. Our end
obviously is to deliver information because at the core of our
vision we believe that everything is reducible to information. If
you look at the human being, he is reducible to a DNA information
package. The chair we sit on, this dais we are on, the wealth that
we have at the end of the day, is reduced basically to bits and
bytes or to information. If you look behind the wealth of a nation
you find a wealth of information and when you look at the poverty
behind a nation you find a lack of information. Malaria, for
example, may not kill me because I have a doctor who knows how to
deal with it. But it may kill some one in a village simply because
that person does not have a doctor who knows how to deal with it.
What makes a doctor capable is not the individual but simply the
information that is in that individual. In a very real way,
information equals health. Our system to provide information to
maintain health and well being for vast populations has been used
over the last few years and it is beginning to show some results.
While it is not possible for every locality in India to have a
facility as splendid as the Sri Sathya Sai Institute of Higher
Medical Sciences, with systems that can deliver information remote
villages can get the information that empower them with values,
spirit, and health. We can deliver the information substances
behind such institutes, but even more importantly we can deliver
the spirit of love and generosity that animates this wonderful
Institute. I am actually very proud to tell you that Worldspace is
doing just that. On the occasion of Baba's birthday last November,
the Sai Global Harmony Channel began broadcasting on Worldspace to
all of Asia. We now expect to take it all over South Africa and
Europe in probably the next two or three months. It's wonderful
for us to broadcast the Sai Global Harmony Channel because all
great things originate with beauty of spirit.
Undeniably, corporates have a responsibility in healthcare. The
question is, with what spirit will they face that responsibility.
Is it going to be a grudging sense of obligation or is it going to
be a loving awareness of being able to serve one and all? Spirit
ultimately shapes reality. As our beloved Bhagawan Baba has taught
us, if there is righteousness in the heart there will be beauty in
character. If there is beauty in the character there will be
harmony in the home. If there is harmony in the home there will be
order in the nation. If there is order in the nation there will be
peace in the world. Corporations that nurture a sense of
righteousness and enjoy service will help in peace and health in
our planet.
Dr H SUDARSHAN
Head, State Task Force (Health and Family Welfare), Government of
Karnataka
CHALLENGES OF RURAL HEALTHCARE -BALANCE IN HEALTHCARE IN RURAL
AND URBAN ENVIRONMENT
I started my work 21 years ago, inspired by Swami Vivekananda. I
have been involved in integrated tribal and rural development in
Alandur and T Narasipur Taluks, where we are trying to show an
alternate low-cost technology in primary healthcare. In the last
one and half years, the Chief Minister has given me an opportunity
to serve the 52 million people of Karnataka. I look into the
entire health sector and make recommendations. I also had the
opportunity of working at the national and international levels. I
am not an expert in healthcare. I am not an academician, but I
have some experience and based on this experience, I want to share
some of my thoughts with you on rural healthcare. There is a rural
and urban divide. I am referring to three issues - equity, quality
and integrity. In India we have 72 per cent living in the rural
areas and 28 per cent in the urban areas. In Karnataka we have 66
per cent living in the rural areas and 34 per cent in the urban
areas. While the rural areas are considered very important and
needing attention, the urban areas cannot be neglected. The urban
poor are more neglected than the rural poor. We need to understand
this. The slum dwellers in the urban areas have no primary
healthcare. So we need to look at the problems of urban poor also.
In terms of primary healthcare in the rural areas versus the
tertiary care available in the urban areas we have a divide. There
has been an inequity in terms of resources being pushed to
tertiary care. By and large, the public sector is spending mostly
on primary health in Karnataka and India. What pains me is that
even after 54 years of independence, while we have people doing
heart transplants, people here die of simple hook worm anemia. No
facilities are available in primary healthcare and people are
dying. We don't have a simple diagnostic laboratory in the primary
health centres. If you have a good microscope, a technician and a
few rupees worth of chemicals, you can diagnose leprosy,
tuberculosis and malaria. Even that facility is not available in
50 per cent of our primary health centres in India. This is a
national shame. We have MRIs, CT scans and all the latest
technologies and this inequity cannot be tolerated any more. We
must provide basic primary healthcare to the people of India.
We also have the problem of caste inequity. How it is related to
health? The gender inequity is a major area. In the population of
zero to six, the population of the girl child has drastically come
down all over India. In Karnataka, sex determination and
terminating the female foetuses, a heinous crime is happening. We
also have the problem of quality. I just attended a laparoscopic
camp. A simple instrument is poked into the abdomen and it will do
tubal ligation. It is very simple. It takes 3 to 4 minutes. I have
seen them being sterilised with a spirit swab. They just wipe it
with a spirit swab and poke it into the next abdomen. This is an
example of the quality of standards in the public sector,
sometimes in the private sector also. It is also an example of the
quality of care, not only in terms of physical cleanliness, in the
surgical standards and the humanness in the treatment.
We have given a report to the task force concerning integrity. In
the report to the Chief Minister, we have identified 12 major
issues. One of the major issues that we have mentioned is
corruption. Many of the people advised us not to put it at the
top. People said that corruption as a major issue cannot be
presented to a Government, especially when you are presenting it
to the Chief Minister. But I thought, if we cannot tell the truth
to the Government, who else can? If we, and those in the voluntary
sector do not have the courage, who else will tell the truth to
the Government? So we didn't compromise and put it at the top. We
have to learn in the presence of Baba, the value system that He
spoke about so lucidly this morning. There is no value in the
system. Bringing back values is a challenge.
We have to take low-cost technology to the rural poor. The neglect
of public health is a major problem. There are implementation
gaps. Another problem is the 'ownership' factor. No one 'owns'
hospitals in the Government sector. There are beautiful buildings
and equipment, but no one 'owns' it. Here, every devotee and
volunteer 'owns' the hospital. The Government needs to get into
partnerships with the private sector and voluntary organisations
such as this. Better healthcare leads to a better economy.
PROF M S
VALIATHAN
Homi Babha Senior Fellow
TERTIARY CARE - THE NEED AND RESPONSE
Tertiary healthcare depends on two things for excellence. One is
efficiency. Efficiency includes knowledge, skills, and attitudes.
The second is compassion. Efficiency and compassion are the two
components for success or excellence in tertiary healthcare. In
India, in the last 25-30 years, tertiary healthcare has expanded
dramatically. A large number of institutions have come up in the
private and public sectors. Here, you get two types of
institutions. In one, you find a great deal of efficiency, run
extremely well but there is no place for compassion there. You see
them in urban centres. Then there is the public sector where there
is neither efficiency nor compassion. There is one solitary
example in the whole country where compassion and efficiency can
be seen in equal measure and that is in this institution [Sri
Sathya Sai Institute of Higher Medical Sciences]. That is why,
speaker after speaker was overwhelmed by what they are seeing
here. This is something we do not see elsewhere. In India Divine
people come. They show us a model and we expect them to do
everything for us. We do not do everything ourselves. This is a
mistake because the Gita says, 'you remember me, but you work'.
In India, tertiary healthcare
particularly, in cardiac surgery about which I am more familiar,
is available to not more than 60 million people, which may be an
exaggeration. The other 940 billion people have no access to
cardiac care. The US Department of Commerce published some figures
in 1998. In exports of medical equipment to India, they have shown
the Indian market as worth 80 million people. The rest of the
population of 900 million people simply doesn't exist.
These people are going to be ignored. In the Health Ministry's
projections, there is an increased allocation for health and all
of it goes, and rightly so, for primary healthcare. The emphasis
is different and there is nothing being said about these people
even with all the prevention that we can do. In spite of basic
measures such as not smoking, better nutrition, physical activity,
you are still going to have heart disease. Children will continue
to be born. We do not know how to prevent congenital heart
disease. A large a number of children are born with crippling
congenital heart diseases. These diseases can be corrected. Dr
Shekhar is doing this remarkably well here and they have a healthy
normal life later. So you need facilities for cardiac care. How
are we going to make this available 900 million people? We may not
succeed in replicating this model because we are nowhere near the
Person who inspired this. But we can go halfway, we can go a
quarter of the way. That is the kind of effort which we should
make after listening to Him this morning and I feel some new
thinking is required. I am reminded of a mundane example. In the
US, if you want to travel from one place to another, say from
Detroit to New York you can take a regular airline and pay 250
dollars. But there is something known as a 'no frills airline'.
That is the South West Airline. Here you can cover the same
distance paying only 80 dollars. They do not compromise on safety,
they do not compromise on punctuality but on everything else. No
food is given, and no fruits are offered, it's a 'no frills
airline'.
We can have a 'no frills cardiac hospital'. It means
you need to have new kinds of institutions based at district
levels. You have to standardise the kind of procedure they will
do. 70 per cent of the cardiac procedures are straightforward
whether it is a septal defect in the child or a value replacement.
The risk is very low. Only such procedures should be tackled at
that level and the capital investment for a centre like that may
not be more than Rs 10 crore.
If we have one such centre for every 10 million people in India,
we are talking about 100 centres over a period of 10 years. This
kind of money is very little for the Government. The Government of
India today spends only 0.9 per cent of the GDP on health which is
less than what many African countries are spending. If the
Government can spend 2 per cent over the next 2 years [and this 2
per cent of the GDP, you will be surprised to hear, is Rs 38,000
crore], we are talking about Rs 100 crore per year. Over 10 years,
these centres can be set up with different functional targets.
Then we need an insurance system. For those below the poverty
line, the Government should buy the insurance. It is not
expensive, far less expensive than running the health services
today. So based on an insurance system, while for those below the
poverty line the Government buys the insurance, others can buy it
for themselves. Then, nobody will go without cardiac care.
This is one of the things we must do and the insurance must be
tied to quality. There must be an accreditation system. We are
capable of setting up an independent accreditation system. Such a
system should accredit their district-based centres. I know the
reaction immediately would be, "how can we do it?" This is a
general kind of reaction. A bit of cynicism has crept into our
blood and I am reminded of a story that I must relate to you. We
marvel at Japan's progress. Japan had shut the doors to their
country for two centuries. They never allowed anybody to go out
and come in for two centuries. In the 19th century they slowly
started opening their doors and allowed a few Japanese - very
intelligent people - to go to Europe to find out what were the
changes taking place there. One of the men sent was Masang. He
went to Paris which was the centre of Europe then. When he reached
Paris, he wrote letters to his friends in Japan. He was
overwhelmed by the splendour of Paris. He wrote to his friends
saying, "there is no way we can ever catch up with these people.
They are way ahead of us. What can we do?" He wrote despairing
letters to his friends. While he was in Paris, there was a war and
right before his eyes the whole of Paris was ransacked by the
Germans. The tragedy boosted Masang's morale. After all, what he
had marvelled at disappeared overnight. Maybe it is not all that
great. His tone had changed when he came back to Japan. He was one
of the authors of the famous ten-volume 'Japanese Plan for
Development'. In that he wrote in the introduction, "for the
industrial development of the nation three things are required
-capital, a road map, and the will". Then he went on to say, "if I
have to award scores for these, I would give one mark for capital
four marks for the road map and five marks for will. Because
capital and road maps are immobile and they will move only with
human will". Where does human will come from? It comes from faith.
And faith is the evidence of the unseen. It is the substance of
things hoped for. It is that which moves mountains, which Baba
here radiates for all of us. I hope this kind of faith will
animate in us, in what we hope to do in the next ten years.
Dr. GOWRIDEVI
Director, National Institute of Mental Health and Neuro Sciences
(NIMHANS)
ACCOUNTABILITY - KEY TO QUALITY TERTIARY CARE
I just saw the hospital [Sri Sathya Sai
Institute of Higher Medical Sciences] and asked the person who was
taking me around, "is it a hospital or a temple?" The impressions
I get is, yes it is a hospital. There are patients, though the
structure is like a temple. Everywhere we see Baba's photographs.
Can every hospital, every institution in this country be a
cohesive model of both a hospital and a temple? That should be our
goal.
We heard many views on primary and tertiary healthcare. I want
to talk about accountability. I would like to look at health as a
spectrum rather than as primary, secondary and tertiary entities.
Because tertiary healthcare evolves out of a system of good
primary and secondary healthcare.
When we mean tertiary, we are talking about medical
colleges. We are talking of apex institutions. The role of the
tertiary care is to deal with complex and complicated problems.
When I sit in the out-patient department, do I function like a
tertiary neurologist, or am I a primary health doctor? I wonder
because NIMHANS receives 3 lakh patient in a year. A person with a
mild headache has to ravel 500 kms to see the doctor for 2 minutes
in a busy OPD, and get a prescription. The cost of the drug may be
just about Rs 5/-. Why did the person have to travel all that way
for just this? It is a tragedy. Can we decentralise most of the
primary care to the district level and the tertiary hospitals can
take care of the bigger problems, conduct research, develop new
methods and new strategies of diagnosis and treatment. This is
what the tertiary centres should be doing.
The private sector should be linked to the Government sector.
Prevention should be an inherent component of tertiary care
hospitals. Can we do something that many institutions like NIMAHNS
is doing? We train up the doctors at the periphery. In neuro
surgery, psychiatry or neurology, and there is a continuous
feedback and feedforward of information. Feedforward i.e. from the
periphery to the centre and feedback i.e. from the central
tertiary hospitals back. So it is not a one-time contact.
We heard about the communication systems and the corporates'
responsibilities. If these communication systems improve, the
neuro surgeon or cardiac surgeon sitting in Bangalore can direct
how the peripheral surgeons situated at the periphery should
tackle a problem. Could be by distance education or distance
management. Small experiments have started in the country and it
should become a massive movement. Then the tertiary care system
can work.
When the number of patients are
restricted, many of us will be very efficient under any system.
But, if the system is bogged down by huge numbers, the quality
will suffer. The doctor-patient time interaction will be less
inspite of the best efforts and dedication of the doctors. We
should have more institutions of tertiary care with modem
technology and equipment.
Now is it out of context? Yes people die of malaria and
diarrhoea. But I remember when we were undergraduate students,
brain tumour surgery was a big. People had to go abroad for
cardiac problems. Today, all types of postgraduate courses and
services are available in the country. How many people access them
is the question. There are the marginalised people and the poor. I
would classify women in a marginalzed group in a way. We have seen
statistics of out-patients and inpatients, and conducted community
based studies. How many women access healthcare? You will be
shocked. Foe every 2-3 men, only one woman accesses healthcare.
Then there it the question of time. Doctors say that
patients come late to tertiary hospitals because of a lack of
awareness. They cannot come early because they don't have the
information of the referral system. So, the tertiary care centres,
apart from offering healthcare, have to do a lot about awareness
and education too.
Dr CHANDRASHEKHAR
SHETTY
Vice Chancellor, Rajiv Gandhi University of Health Sciences
ACCESS TO TERTIARY CARE - MEANS AND METHODS OF IMPROVEMENT
After 54 years of independence, lets look at the overall
development in this country. In the 11th report of the Human
Development Index, our country has been bracketed somewhere
between 110 and 120. It improved over the 10th report for India as
a result of the contributions many by the information technology
industry. Thanks to Bangalore and the contribution of Karnataka.
Its praise worthy that in the WHO report on health responsiveness
for the year 2000, India is again recorded as 120. In the case of
the Human Development Index, the parameters of life expectancy at
birth, literacy parameters, the buying capacity of the common man
of his daily requirements, and the general development index are
not good enough. However, the most important aspect of human
development is the human governance index. That is, the
contribution and accountability of the political leadership,
accountability of the bureaucracy, accountability of the
professional and ultimately the accountability of the community
itself. All of us have an equal role to play. To say that human
development has taken place only in urban areas and neglecting
rural areas is not answering all the questions. We have to find
out what the rural development index is. What are the developments
in the areas of the vulnerable sections of society, women,
children and the elderly? By the time we reach 2016 we are going
to have more than 100 million people who are above the age of 60
years because longevity of life has increased.
We say primary education and primary health are the fundamental
rights of every human being. Just 6 per cent of the people have
access to higher education in this country. We talk about
universal higher education. When we say universal higher education
or universal health what kind of quality of health are we going to
get? This has to be kept in mind. Higher education is always for
self and self-reliance. Higher education is always an investment
for self-development or the future development of himself, his
family or the country, and let's not forget that higher education
is a catalyst for social and economic changes in society. For a
developing country, higher education, including professional
education should be a catalyst for socio-economic change. This we
have to bear in mind.
Now, when it comes to healthcare we are talking about tertiary
healthcare. Tertiary care and prevention is a continuation of
primary care in the natural history of the disease. The natural
history of disease signifies the way in which the disease evolves
in the absence of intervention. What is usually seen in a hospital
is just one episode in the natural history of a disease. One has
to go beyond the walls of the hospital and into the community to
understand this concept. Healthcare should not be professional or
doctor-oriented. It should be patient-oriented. And as you proceed
further, in any healthcare at any level, there are certain things
we have to remember. The first one is to make it available. The
second important point is the accessibility of healthcare. We also
need to go into the reasons why people are not accessing
healthcare. Is it the distance? Is it the fear? Or affordability?
Unless people can afford to pay for the services, whatever the
hi-tech facilities you are going to offer will reach only a
microscopic minority of the people.
People these days talk about the high technology. We are talking
in terms of nuclear medicine, virtual reality and we have to
understand that what is important especially for a developing
country is the appropriate technology and not just high
technology. What is appropriate for Bangalore need not be
appropriate for Shillong or Manipur. What is appropriate for New
York need not be appropriate for Bangalore. This has to be kept in
mind always. Professionals say they can't perform well because of
lack of machines. They need to be adaptable. We have to adapt to
the situation. Whether you are working in a primary health centre,
secondary care centre, tertiary care centre or in an institution
where you have access to higher technologies, you should be able
to adapt to the conditions.
Ultimately the important point is the accountability. He may have
the equipment, buildings, and people, but something is missing.
That is the attitude and compassion. Baba has preached in the
morning that it is not enough to say that I have the highest
knowledge available in the world and I have acquired the highest
skills. To practice this knowledge and skills in an appropriate
manner, and in a very compassionate manner, your attitude has to
change. That is all about medical ethics. In every area from
education to practice, attitude and compassion are vital. Apart
from accountability, medical ethics is the most important thing,
especially in tertiary care. In terms of accountability first of
all you are accountable to yourself. Then you are accountable to
your conscience, to your chief executive and to God. But first,
try to be accountable to yourself.
As far as tertiary care is concerned, it is not that the country
has no ideas about these things. We have the Srivatsava Committee
report and we are supposed to have in a district of 3 million,
2500 beds. It's called the '3 millions plan'. It does not mean
that tertiary care should be made available only in apex centres.
What is required is that every area with a 3 million population
should have access to tertiary care. The problem arises when we
ask who has to do it. Only 0.9 per cent of GDP is available for
healthcare in this country. Only 3.5 per cent is available for
higher education and naturally we always fall upon what is called
private initiative. In medical education and healthcare, 80 per
cent is always private initiative. Private initiative need not be
commercial initiative. Social marketing is different from
commercial marketing. It's a very thin line sometimes. We always
try to cross that line and say all private initiative is
commercial. What are required are partnerships. The partnership is
the most important one of the linkages we have to develop. If the
Government is not in a position to pay, somebody else has to pay
for tertiary care. You have to find out who that somebody is. You
should have system where Medicare to nearly 50 - 60 per cent would
be available almost free. Maybe to 20 to 30 per cent it could be
on a social marketing or social rate - what normally the middle
class would be pay. The 20 per cent in the high income bracket
should pay the most. At the end of the day the paying patients
will be able to take care of the non-paying patients.
I would like to emphasize here the
Government alone cannot do this job. There should be a joining of
hands. That's what is called unity for health. A developing
country has to move towards unity for health with social
accountability. That kind of accountability is not personal
accountability; it's called a social accountability. Social
accountability of relevance. The social accountability of quality
of care. The quality of care has to be actually identified. Any
healthcare should have total quality management. It is not enough
to look into just the equity because you have to give a large
section of society, quality care. It is not good enough to say
only a small segment has the best treatment in the country.
Lastly, the cost effectiveness. To give the highest quality of
service to every individual in the world is not possible. We need
to have a kind of a balance. The most important parts of
healthcare are the coverage of the care and its quality. Unless we
cover a large populace, whatever we do will only be for a small
percentage of people. In this I really appreciate the contribution
of the Sri Sathya Sai Institute of Higher Medical Sciences. This
institution has been offering free service. While people are not
expected to pay, I hope they will be very generous to come back
and say let me contribute to this hospital so that it will be able
to serve many more poor patients. Let's not use this hospital just
because Baba is offering free service. Nobody should exploit this
Institute. Those who can afford to pay should pay so that this
hospital can serve the neediest and grow.
PROF B M HEGDE
Vice Chancellor, Manipal Academy of Higher Education
COMPLETE HEALTHCARE - THE PHYSICAL, MENTAL AND SPIRITUAL
DIMENSIONS
Let me tell you of the effect of Bhagawan Sri Sathya Sai Baba on
all of us. I call it the 'Bhagawan effect'. Has any one of you
seen the Bhagawan effect? There is an American poet called
Christina who wrote these two beautiful lines: 'Who has seen the
wind? Neither you nor I. When the trees dance and bend, the wind
is passing by'.
Who has seen the Bhagawan effect? Neither you nor I. The multitude
of people who come here like a stream and go back contented tells
us what the Bhagawan effect is.
The most important difference between the hi-tech West and the
poor East is the epidemics of diseases. Diseases in the West are
totally different from those in the East. The major epidemic
diseases in the West are suicide and divorce. Not cancer, not
heart attack. We do not have these two diseases here because we
have a lot of the 'Bhagawan effect' on all of us. When people tell
me under the guise of being scientists that God does not exist, I
always tell them that God cannot be seen. God cannot be measured
but God can be felt. Materialism took the West to an end where
materialism has no end at all. You can buy the costliest bed
available but can you buy sleep with it? To sleep, you need peace
of mind. How do you get that? When you get frustrated with
materialism, if you surrender yourself to a higher power like
Bhagawan Sri Sathya Sai Baba, your difficulties melt away. Your
frustrations disappear. Your depression lifts and that is what is
keeping most of us going.
Depression is the cause of heart attacks, cancer, and every known
major killer disease in the world. Ayurveda, the ancient Indian
wisdom that goes 1,000 years back has this stanza that says, 'if
you have a pleasant mind, if you have a soul which is absolutely
pure, you will never ever suffer from any illness. Health will be
yours for the asking'. The West has realised this now. A recent
study of people working in the White House and in Scandinavia
showed very clearly and unequivocally, that the most important
risk factor of heart attack is frustration and hostility. When you
hate somebody, that is the time blood clots inside your blood
vessels blocking it and giving you a heart attack. It is not the
block in the vessels that the doctors show you in the angiogram,
for cosmetic reasons that kill you. What kills you is not what you
eat. It is not the cholesterol. What kills you is what eats you -
the negative thoughts in your mind. Studies have shown that greed
and hatred have an effect on the heart. Frustration and depression
can lead to cancerous growth and anger can cause a stroke. This
brings us back to Ayurveda that has talked about spirituality.
'Eat in moderation. Work very hard. Never tell a lie, backbite,
cheat, and hate'. You may say, I don't hate anybody but somebody
hates me. Forgive him for he doesn't know what he is doing.
Ayurveda prescribes what Bhagawan has been saying all through,
'treat everyone in the universe as your near and dear ones,
diseases will never come anywhere near you. Ayurveda also explains
why we get diseases. 'Every single disease comes from the mind'.
The latest in quantum physics tells us if you split every human
being, we all become small, little, jumping leptoquarks. A
leptoquark is small particle. A human being is just a bundle of
jumping leptoquarks that never stop. Though you look solid, there
is nothing solid about you because every leptoquark is bombarding
around its nucleus. Now that is what Shankara said -you and your
neighbour are not two people. It's an illusion. You are the same.
Jesus said Love thy neighbour because you and your neighbour are
the same.
No doctor can actually heal a disease. A doctor can probably give
you a medicine, but the healing has to be done by your immune
system. The immune system gets provoked by compassion. What kind
of compassion? Universal compassion. When you love someone and
want to do something for someone, if you check your CD4 T cells -
an index of your immune system - the CD4 T cells would have gone
up. The minute you think of helping anyone sincerely, your CD4 T
cells go up. When you want to destroy somebody your CD4 T cells go
down. So, health is in your hands. What does health require? A
mind that is evolved, clean drinking water, and good food three
times a day. You must go to the villages and see. They drink the
water from a pond in which children ablute and women wash clothes.
How can you have good health there? 80 per cent of the
gastro-intestinal diseases come from polluted water. Have you
heard of hospitalism? Before 1854, a large number of people who
went into a hospital in the West, never came back alive. Going to
a hospital was like performing your last rites! This was called
hospitalism. Florence Nightingale asked the British Government to
build the St. Thomas hospital in London across the Thames. She
said, "I want a pavilion court and a high ward where there is
cross ventilation". She just gave the patients clean air and good
food. Before she introduced the cleanliness, wounds often turned
into sores and many of them led to gangrene and caused the death
of the patients. She changed that and brought the high hospital
mortality rate down.
Healthcare should not depend on doctors and hospitals. Healthcare
should depend on the simple needs of healthcare. It has nothing to
do with medical care at all. When healthcare fails, we require
medical care. Medical care is the quickfix that you make to mend a
broken glass. It does not make the glass normal again. Healthcare
is something that preserves health. There is a difference between
the two. What we need is more than all the infrastructure is a
change in the mind. This change in the mind can be brought about
through the education system.
Our education system sows the seeds of anger, frustration and
pride in children. We need to change it and make it very simple.
It should be subsidised with internal intuition based subjective
education, which is simply, who am I? Why am I here? Whither I am
going?
One definition of spirituality is sharing and caring which is
identical in every religion. Religion is not what we need. We need
spirituality. And spirituality is alive every one in this world.
Now most of us meditate in the morning and then in the rest of the
23 hours in the day, we only think whom to cheat. All the good
that you get after meditating for half an hour is undone. You can
meditate all the time if you follow the path of universal
compassion Baba has been selling to the world. If you think of
compassion as your being, your breathing changes. When you are
angry, you breathe fast. When you are filled with love you breathe
slow. Just bringing down your breathing rate has shown to improve
the condition of advanced heart patients.
We need to give our children, the future generation, a good,
compassionate education, and provide the society with water, food,
smokeless houses and create economic empowerment among the masses.
Source:
http://www.srisathyasai.org.in/sssihms/Pages/Events/speech.htm
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