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'In vascular surgery, the use of endo vascular techniques with balloons, stents and covered stents has been the latest trend'

Angioplasty and device closure of congenital defects of the heart are becoming more and more common in India scenario. Dr Anand Somaya, Consultant - Vascular Surgeon, Hinduja Hospital, talks to Express Healthcare about the newer trends and developments in the cardio vascular segment, his experience in a army hospital set up and the future of healthcare sector. Excerpts:

Dr Anand Somaya Consultant - Vascular Surgeon Hinduja Hospital

Since you have been largely associated with the cardio vascular segment, what have been the trends and developments in the segment with regards to issues, growth drivers, opportunities and challenges faced?

The cardio vascular segment in India is dynamic and well abreast about the latest techniques available around the world. All kinds of surgeries today are moving towards minimally invasive methods. In this specialty too, especially in vascular surgery, the use of endo vascular techniques with balloons, stents and covered stents has been the modern trend. However, in India the huge cost involved in these new techniques prove an insurmountable barrier to the majority of our population. The lack of health insurance cover to the majority of the Indians is a major stumbling block in this area. The other major problem is that even those poor middle class Indians who have health insurance find it difficult to recover their bills from the TPAs due to objections from the poorly qualified doctors who work in these organisations who have the temerity to challenge treatment given by senior specialists in their subjects. I have found that my rich patients have absolutely no problem in recovering their money from these insurance companies. However, at least 60 to 70 per cent of the poor segment have their money held up for years together due to silly technical objections which keep being raised until the poor patient gets fed up and stops asking for the money.

Private hospitals in India have the means and equipment to offer the most modern treatment in the cardiac, thoracic and vascular surgery. Angioplasty and device closure of congenital defects of the heart are becoming more and more common with excellent results and short hospital stay. However, as I mentioned above, the cost involved in these procedures and the intransigent attitude of the insurance companies is a major stumbling block preventing the more widespread use of these methods. Due to our huge population the numbers of cases of rheumatic heart disease, coronary artery disease and vascular disease is probably the highest in this part of the world. Unfortunately, a large percentage of this population does not have access to centers of excellence where such problems can be treated at subsidised rates.

Fortunately, beside the excellent set ups in the various Governmental and municipal hospitals, private hospitals also receive huge Government tax benefits to treat patients free. Therefore, all private hospitals in Mumbai and other major cities of India do have a certain number of free or highly subsidised beds. All types of surgeries done for poor patients are on par with the ones done for the higher class patients. They are done by the same surgical team and kept in the same post operative intensive care with excellent results. Also in Mumbai as well as in other metros there are a large number of charitable trusts who are willing to help poor patients who require expensive medical treatment.

You have also served a few army hospitals in your career? How is it different working for the army hospitals and the general public? What inspiration did you elicit from the same while your stint in these hospitals?

Yes it is true that I have served in both small and large army hospitals during my nine year service in the army. The discipline and cleanliness of these hospitals is excellent and because of the increase in the defense budget, the equipment available in these hospitals is absolutely state-of-the-art. The doctors are extremely well trained and all the senior specialists are sent at the Government's cost to train abroad for two or three year periods. However, parents and families of serving soldiers are also entitled to free treatment in these hospitals and, therefore, add to the clinical material available to the doctors. Unfortunately, anything given free is not always appreciated and I still see serving soldiers of all ranks preferring to go to civilian hospitals for treatment thinking that they are getting better treatment. This is simply not true and I try and sent them back to their hospitals instead of wasting their money.

What are the pain points of army hospitals? Which areas do you think need improvement?

The problem in army hospital is that the staff keeps changing because they have to move from place to place. Also when super specialists reach their peak in the profession they have to move to administrative jobs as there are very few clinical jobs in the higher ranks of the military. Thus, I feel that they are losing their best and most experienced doctors to administration which seems a total waste of their vast clinical experience and expertise. The Government is happy to spend on capital expense to buy state-of-the-art equipment but running costs and replenishment of disposables for these equipments is sometimes a problem. However, as I have mentioned earlier these problems have reduced greatly due to the large budgets allotted to the health segment of the military services.

What have been your areas of interest and why?

I am from the old school of doctors who likes to do different types of surgeries and my operation list cover all types of cardiac, thoracic and vascular cases. In cardiac surgery, my unit does all types of coronary, valves and congenital heart disease surgeries. However, today the name of the game is to super specialise in a specific segment. I, therefore think that my junior colleagues after being trained in the basics will have to find a niche segment to produce better results with more modern and less invasive methods of tackling the problems.

Vascular surgery had not been given due importance in our country till eight to ten years ago. Because of this multiple limbs were lost due to ignorance of vascular reconstructive methods. To change this scenario I was one of the founder members of the Vascular Society of India and later the President of the Organisation whose goal was to improve awareness of vascular disease in India, to hold national and international conferences, to discuss problems in vascular surgery, and to train young vascular surgeons to excel in this specialty. The society has grown by leaps and bounds and is now authorised to conduct the Diploma of the National Board (DNB) in vascular surgery as well as conduct certain large centers are conducting an M Ch in vascular surgery. The society is also able to send young vascular surgeons abroad to be trained in specialised fields.

Where do you see the healthcare sector in the next 10 years? What will drive the growth of this segment?

There is a huge surge in the healthcare system in India and private hospitals with state-of-the-art facilities are sprouting in all the major and minor cities. The industry has finally realised that private healthcare can be a profitable business and are expecting a huge boom in the medical tourism business due to the comparative low cost of treatment and the excellence of doctors in our country. The young doctors in our country can look forward to working in these state-of-the-art facilities and the huge brain drain of the seventies and eighties will come down to a trickle as our best and brightest will have both the clinical and financial incentive to stay in the country and work for the betterment of its people.

anand.somaya@vsnl.net