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Continuing Innovation

To meet the patients' needs is the key to search of new innovation reveals Dr PVA Mohandas, Managing Director, MIOT Hospital, Chennai. K Deepalakshmi finds out more about this septuagenarian

Search is the quest of life,' goes a saying. This statement holds good for Dr PVA Mohandas, Managing Director, MIOT Hospital, Chennai. "My search to deliver what a patient needs keeps me going," says this 77 year old orthopaedic surgeon, who has earned acclaim not just for his innovations in his field but also as a teacher for more than 40 years. In his career life spanning more than four decades, he is one of the most sought after surgeons in the country for orthopaedics. "I put my patients first," says he. In fact, 'putting patients first' is the tagline of MIOT, the Hospital envisioned by him in early nineties. Dr Mohandas is a member of numerable professional bodies. He was the President of the Trauma Section of Association of Surgeons of India. He is also the Member of Association of Surgeons of India and Indian Orthopaedic Association. He is also the Vice President of Arthroplasty Society of India. Dr Mohandas is the Author, Founder and Secretary of Indo German Orthopaedic Foundation Trust.

'Joint' Efforts

Dr Mohandas began his career as a tutor of anatomy in Madras Medical College, Chennai. His first job made him well versed about bones and joints. This triggered him to specialise in orthopaedics. "The field of orthopaedics has come a long way," he says. He remembers using 'plaster of paris' to dress a fracture and the number of days needed for recovery. "Today, most of the surgeries are bloodless, minimal invasive and day care," he claims. This was the change, Dr Mohandas dreamt years ago. "Surgery puts a patient off. There is a sense of fear that grips the patients if they have to undergo a surgery. The complexity of the procedure and long recovery time are the reason for this," he says. He sincerely feels that it is the duty of the doctor to comfort the patient and remove his fear. Dr Mohandas wanted to erase the fear of complexity of surgery and thus introduced several simplified surgical procedure. He specialised in orthopaedics in University of Liverpool, England. He was trained by ace orthopaedic surgeons like Dr Morris Muller, Sir John Charnley and Dr MAR Freeman in England. He also took training in countries like Germany, France and Switzerland. "The next big thing in orthopaedics will come from stem cells," says Dr Mohandas. Stem cells can be used to create joints and bones. These autologous (from the same individual) bones and joints will be a permanent solution. He has encouraged research in these areas. MIOT Institute of Research (MIR), the research body of MIOT has started exploring in the areas of culturing osteoplasic and extensive loss of bone.

Simplicity Rules

Dr Mohandas is credited with the first joint replacement in India in 1975. "Joint replacement procedures were common in European countries," he recalls. Dr Mohandas learnt the procedure while pursuing his higher education in England. He also introduced rigid internal fixation for musculoskeletal injuries in India. As a member of AO International (Association for the Study of Internal Fixation), he still conducts various lectures on hip and joint replacements. Dr Mohandas is also credited with the coining of the word, 'keyhole surgery.' The minimal invasive surgery conducted laparoscopically by a small incision is referred as keyhole surgery. "The terms minimal invasive and laparoscopy are too complicated terms for a patient," says he and adds, "The simplest way of explaining is to say the surgery will be performed by making a opening as small as a keyhole and thus the term was born." Sometimes, patients would complain the 'hole' is much bigger than a keyhole. He would immediately reply, "It's for a bigger lock!" Keyhole surgery is the most sought after one in MIOT Hospital. The term is registered as a trademark by the Hospital. "Now, its pinhole surgery," claims Dr Mohandas. With the development of catheter, reaching the most difficult areas is no longer difficult. The catheter is inserted through the blood vessels. The navigation is controlled by the computer. "New things always attract me," he says. He pioneered computer navigated surgery in orthopaedics. These kind of surgeries are beneficial for both patients and surgeons. "There is better magnification and hence the surgeon enjoys a better view. For the patient, he can walk off immediately after the surgery," he says.

Dr Mohandas introduced the concept of the 'ideal joint.' "Each one is different, so are the bones," he says. Each emphasised that each patient requires a customised joint. This was taken to people by an awareness campaign, where MIOT Hospital taught the need for a customised joint to orthopaedic surgeons. Another major awareness campaign rolled out by him was 'Joint for life’. Anything artificial has a life span. A combined effort by surgeon, patient and manufacturer can enhance the life span of an artificial joint. This was the theme behind 'Joint for life' campaign. "Any innovation will gain prominence only when it is taken to public in simple words, which is easy to understand," he says.

On the Personal Front

Dr Mohandas' day begins from 5 am in his Hospital. He works till 6 in the evening. "I would really love to stay here for some more time. But my family wants me to wind up by six," he says. His favourite pass times are walking, jogging and mountain climbing. Last month, he along with his friends climbed the Central Alps, Switzerland. He was part of hockey team during his college days. He was also an athlete champion in MMC. Though both his parents were members of Congress party, Dr Mohandas is not inclined to politics. He says he prefers serving the public as a doctor. Dr Mohandas' wife is Mallika Mohandas. She is presently the Chairman of MIOT Hospital. The couple has three daughters and a son, out of which one daughter is an artist and other three children are doctors.

Global Inspirations

Dr Mohandas returned to India after completing his education and training in UK and Germany. His stay in these countries gave him exposure to various aspects of hospitals. He liked discipline, efficiency, hygiene and cleanliness practiced in those hospitals. "The government hospitals here lacked in these areas and I always wanted to bring a hospital here similar to what I saw in abroad," he says. He served for 15 years as a Professor of Orthopaedics in Madras Medical College and Kilpauk Medical College, Chennai after returning from abroad. "I felt I lacked opportunities to grow in Government sector and shifted to private sector to turn my dreams to reality. I dreamt of having a hospital that I saw in European countries in India. That is how MIOT Hospital was started in Chennai," he says. Thus MIOT came into existence in 1988 and a doctor became an entrepreneur. Initially, it functioned in the premises of Vijaya Hospital, Chennai. With the aid of friends and acquaintance, MIOT shifted to its current location as a super-specialty Hospital for orthopaedics.

India Calling

Despite doing extremely well in UK, one of the reasons why Dr Mohandas wanted to return to India, was for the love and respect a doctor earns here. "It is an honour to be a doctor in India," he says. "An emotional bonding builds up between the doctor and patient. This can be seen only here," says Dr Mohandas. "Doctors are seen as god sent persons here," he adds. He happily recalls memories of his patients who offer him gifts, invite him for family functions, and discuss their personal matters and so on. "Patients from Salem (a place in Tamil Nadu famous for mangoes) offer me mangoes grown in their farm. They feel offended if I refuse," he smiles. "Some even ask me to recommend an eligible match for their children," he exclaims. However, he feels even the educated Indian patients lack basic awareness in medicine and treatment. "Even, the educated people believe in astrology, black magic for curing their illness, then imagine the case of rural people," he says. He says getting cheated by alternative medicine to medical treatment is universal. "The lack of scientific approach is the reason for this," he says. He also feels the patients are not focused. Some patients want tasty food, just like they give in restaurants. "We then have to explain to them the need for a regulated diet prescribed for their condition," he says. He feels a general awareness on medicine should be imparted to Indians.

The Journey

"Initially, I faced a financial crisis while running this Hospital," Dr Mohandas confides. His friends and well-wishers lent him a helping hand to overcome his financial hurdles. Being located in the suburban Chennai, it took some years for the Hospital to get its current popularity. But, Dr Mohandas was a renowned person and the quality of treatment provided attracted more patients here. Today, the Hospital has a turnover of Rs 120 crore. As the name suggests, the Hospital was initially concentrating only on orthopaedics and trauma care. "In orthopaedics, we provided treatment for fractures, dislocation, joint replacement and spinal surgery," he recalls. Trauma care demanded more specialties. The increasing patient flow, expanded the Hospital by adding more specialties like neurology, neurosurgery, maxillofacial surgery, head and neck surgery, thoracic, plastic surgery, cardiac, pelvic, urology and the latest addition - nephrology. "From one hero, we created many heroes," he says. Thus, MIOT Hospital became a multi-specialty Hospital. Apart from treatment, he emphasised on key areas like cleanliness and hygiene. His reputation, brought in many patients from abroad, especially Gulf and African countries. Again, taking a cue from European countries, he concentrated on the 'hospitality' part in the Hospital. A retreat centre was started in the Hospital premises called MIOT retreat. The patients along with an attendant stayed in this centre. The centre has state-of-art facilities like restaurant, deluxe rooms, gym. The Hospital assists the patients in case they wish to go sight seeing. He makes it a point to visit every patient and understand his or her needs. But having said that, he strictly preaches and practices discipline in the Hospital. "There is an unnecessary crowding of friends and relatives in the hospitals here," he says. He discourages crowding of visitors, patients having outside food and littering the surrounding in his hospitals. These practices are slowly gaining acceptance among the patients too. "The work of the doctor does not end with just treatment. He should educate the patient too," he says. He repeatedly stresses the need for satisfying the patients' wants. "We should first listen to the patient. Patiently hear the problems, explain and make him aware of the treatment," he says.

It's all in the Genes!

The medical profession runs in his blood literally. In fact not only his grandfather but even his great grandfather was a country doctor! He drew his inspiration from his grandfather, who was a Licensed Medical Practitioner (LMP) and today even his son is a doctor. "In those days, it was not MBBS but LMP. My grandfather graduated from Madras Medical College (MMC)," he recalls. After successfully completing his school education, he decided to become a doctor just like his grandfather. "Goodness is important in this profession," says he. He feels that understanding the patients' need is an art every doctor should possess. "This enthusiasm to innovate and deliver better and better each time keeps me going," says Dr Mohandas. He is a firm believer that practice makes a man perfect. "Performing a surgical procedure several times gives hands on experience and proficiency in that field," he says. Doctors are also human beings and are prone to errors. "There can be an unpredicted complication during a surgery. Proficiency lies in solving it without panicking," he believes. A successful doctor is one who has mastered these skills. Four decades of service and still continuing, the sheer passion for his profession is evident in him. "I don't know if there is a rebirth but if there is one for me, I would like to become a doctor in the next one too," his eyes light up as he sums up.

k.deepalakshmi@expressindia.com