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Kolkata: Nucleus of the East

Once a mecca for medical care, Kolkata's reputation as a medical hub took a dive in the '70s. It's retrieving its lost glory with existing hospitals augmenting their facilities and a slew of new projects dotting the landscape, says Rita Dutta

It's a city that had nurtured legendary doctors. Like Bharat Ratna Dr Bidhan Chandra Roy, an accomplished physician and academician, who established the Indian Institute of Mental Health and Infectious Diseases Hospital. Like Dr AK Basu, who successfully performed the first cardiac surgery in this country at Nil Ratan Sarkar Medical College and Hospital. Like Prof AK Saha who performed his leading experiment on 'dislocation of shoulder joint' at a city hospital. Like Sir UN Brahmachari who synthesised Urea Stibamine, the cure for kala azar. Like Sir Ronald Ross who did invaluable research for the cause of malaria, for which he received the Nobel prize, at SSKM Hospital. The city gave the country its first medical college - Medical College and Hospital, Kolkata.

The public hospitals in Kolkata, be it SSKM, Kolkata Medical College or Nil Ratan Sarkar Medical College, were a melting pot for the best clinical acumen and a crucible for medical treatment and research, in the heydays of 1960s, which set new benchmarks for other institutes. Not just West Bengal, but patients from Bihar, Orissa, and the seven North Eastern states flocked to Kolkata for treatment.

Days of Decadence

However, in the period from '70s to the '80s, healthcare services in Kolkata began a downward spiral from their position of strength. As political turmoil and union uprisings derailed development and complacency set in, the overloaded public healthcare system failed to cope with the enormous inflow of patients. While the South emerged as a hub for medical care, public hospitals in Kolkata started lagging behind in technology and clinical acumen. The best clinical brains in the public sector either migrated overseas or joined the fast mushrooming private setups (which were mere nursing homes then). The days of glory were finally over.

The immediate effect was that patients from Bengal and Eastern India lost faith in Kolkata's healthcare facilities and started surging down South or to Mumbai for specialised medical care. If it was ophthalmology, people opted for Sankara Nethralaya or Aravind Eye Hospital, for neuro-surgery people went to CMC, Vellore and for oncology, people sought care from Apollo, Chennai or TMH, Mumbai. Most people preferred the South as the treatment was much cheaper there.

BM Birla Heart Institute prides in being the first hospital in India to bag NABH	Woodlands was set up about 60 years ago as East India Clinic
Bell Vue Clinic was started in 1967 as a nursing home	CMRI, established in 1969, was the first corporate hospital of Eastern India

Winds of Change

"What is attracting corporates is the fact that land and manpow are comparably cost effective in Kolkata" - Suyash Borar COO BM Birla Heart Research Centre

"Kolkata is projected to face a massive shortage of 13,735 beds in 2011" - Sandip Chaudhuri Assistant Manager Business Development HOSMAC Consultancy

"Several highly qualified doctors who had moved overseas from Kolkata have started returning"   - PL Mehta Director Neotia Healthcare Initiative

The darkness that engulfed the healthcare vista of the city for two decades started clearing only by the mid-'90s with the advent of hospitals like Peerless Hospital, Ruby Hospital, AMRI and BM Birla (the cardiac wing of GP Birla group that was already running CMRI). The city's healthcare landscape got a further boost in the decade beginning 2000 with the establishment of hospitals like Apollo Gleneagles, Wockhardt (now Fortis), RTIICS, Bhagirathi Neotia Woman and Child Care Centre, Desun, Sankara Nethralaya and Columbia Asia.

And today, the momentum has picked up further. The existing hospitals are scaling up their bed strength, setting up multiple units in the city and exploring other business models. New entrants like Global Hospitals, Ohio Cardiology, Tata Medical Centre, Hinduja Healthcare and Israeli Group Elbit, have either planned a project in the city or are exploring opportunities. Major south-based groups like Narayana Hrudayalaya, Apollo Hospitals, Sankara Nethralaya, and Aravind Eye have set up units in the city either as standalone projects or JVs. Hyderabad-based LVPEI helped CMRI set up its ophthalmology centre. This year, while Medica Super Specialty Hospital and Institute of Neuro Sciences were inaugurated, Fortis Hospital in EM Bypass, Tata Medical Centre and Ohio Cardiology in Rajarhat and AMRI in Salt Lake are scheduled for commissioning.

Besides corporate governance and the customer friendly approach of hospitals, technology has been a hallmark for development. Whether linear accelerator with IGRT and IMRT or radio surgery for cancer, beating heart surgery in cardiac sciences, deep brain stimulation in neuro-surgery, ocular oncology in ophthalmology, steel OT with laminar airflow, 64 slice CT, 3 Telsa MRI, JCI and NABH accreditations for hospitals or NABL and CAP for laboratories, Kolkata has it all.

Contributing Factors

So, what turned the tide of bad times and spurred such an unprecedented growth? Here are some factors:

Untapped market: There was and continues to be a glaring gap between demand and supply in this region. As per data available for 2008, the total number of sanctioned beds in Kolkata stood at 26,739 for an estimated population of 51 lakh. With population served per bed ratio being at 188 as against three to four beds per 1,000 population in developed countries, does the city need more beds? Of course, says Sandip Chaudhuri, Assistant Manager, Business Development, HOSMAC Consultancy, Kolkata: "The city just does not cater to the city's population alone. The catchment area is the entire state, neighbouring states and neighbouring countries like Bangladesh, Nepal, and Bhutan as well. According to a study which took stock of the demand supply situation (considering local demand, demand from neighbouring districts and countries), Kolkata is projected to face a massive shortage of 13,735 beds in 2011."

Dr Suresh K, Assistant Manager, Business Development, Elbit India Healthcare, explains why his group is scouting for land for a tertiary care hospital in the city, "Though the hospital industry in Kolkata is growing at a fast pace, there exist some lacunae which we aim to plug and offer the citizens of Kolkata truly world class medical services."

According to Dr RM Mukherjee, Medical Director, Woodlands Nursing Home, the oldest private healthcare institute in the city, the realisation that something needed to be done urgently to stem the tide gained momentum. "With the success of the Apollo group, people became aware that healthcare could be a profitable business proposition, not merely an outlet for charitable work for individuals or business houses," he avers.

RTIICS became a super specialty hospital in 2004	Ruby General Hospital is adding radiation therapy with linear accelerator and IGRT
Apollo Gleneagles is the he only JCI-accredited hospital in Eastern India	Bhagirathi Neotia Woman and Child Care Centre is coming up with a chain of community clinics

Strategic Location: Kolkata is strategically located and is considered the gateway to the East. It is also gradually becoming the hub for medical tourism, especially from the countries located near the Eastern border.

Says Anurag Dubey, Industry Manager, Health IT and Healthcare Delivery Practice, South Asia, Middle East and North Africa, Frost and Sullivan, "As Kolkata became the only growing city in the Eastern region, it became the hub for the entire region for medical treatments and services, thus the potential for healthcare facilities and services increased." The poor state of Government's healthcare infrastructure also fuelled the growth of private facilities.

Change of Perspective: The reforms had much to do with the change in perception of hospital management. According to Dr Rupali Basu, CEO, Apollo Gleneagles Hospital, "It's only in the '90s that the thinking that hospitals should be managed by professional managers and not doctors gained ground. As professionally qualified hospital managers held the reins, hospitals became quality conscious, competitive and become far more professional and patient-friendly in their approach."

People's Demand: Demand from patients for better service could no longer be ignored. "The paying customer in the wired world is increasingly aware of the trends, facilities, and rights enjoyed by customers in other parts. In such a competitive scenario, the healthcare facilities in Kolkata cannot afford to remain isolated and immune to the changes taking place. They have read the message on the wall - 'shape up or ship out'," says Chaudhuri.

A wave of quality consciousness swept some leading institutes. Thus, BM Birla became the first hospital in India to get NABH, while Apollo Gleneagles Hospitals became the only hospital in Eastern India to have JCI.

AHEI's Role: Experts also acknowledge the proactive role played by the Association of Hospitals of Eastern India (AHEI), a consortium of 15 private hospitals, to streamline the healthcare system in Kolkata. "Right from the beginning, the association has been working with the Government to help identify gaps and modify the Clinical Establishment Act and other such regulations that thwarted growth. It also laid down dos and don'ts for various hospitals, underscoring the importance of corporate governance, patient friendliness and transparency," says Dr Basu. In the wake of the recent ransacking of Peerless Hospital by angry mob for allegedly not admitting an accident victim, AHEI played an active role in mediating with all possible fora, the media, industry and the Government to prevent such incidents in the future.

Reverse Brain Drain: Says PL Mehta, Director, Neotia Healthcare Initiative, "What had given the movement an added fillip was that several highly qualified doctors who had moved overseas from Kolkata and Bengal started returning." s

Cost: Says Dr Vishal Beri, COO, Hinduja Healthcare, which is exploring an opportunity to set up a hospital in Kolkata, "As medical treatment is becoming prohibitively expensive, especially in cities like Mumbai, the focus now needs to shift to other metros, and Kolkata is most certainly one of the preferred choices."

Adds Suyash Borar, COO, BM Birla Heart Research Centre, "What is attracting corporates is the fact that land and manpower, the most essential factors for the growth of this sector, are comparably cost effective in Kolkata."

The Early Movers

"We were the first hospital to provide standardised packages for cardiac surgeries" - Dr Ashutosh Raghuvanshi Vice Chairman Narayana Hrudayalaya

"AMRI is are the first hospital in Eastern India to start IMRT in cancer" - DN Agarwal Executive Director AMRI

"We are the first tertiary care hospital in this region to have 24x7 emergency facility" - Rupak Barua COO CMRI

It's interesting to note that most of the first movers in private sectors, except for CMRI, were all in the form of nursing homes.

Woodlands Nursing Home: Woodlands was set up about 60 years ago as East India Clinic, running two nursing homes. In 1959, it moved to the current site at Alipore Road with 75 beds. Subsequently, the name has changed a number of times, as has the nature of the institution. Says Dr Mukherjee, "It was set up by around 600 'member companies' to provide good healthcare for their executives and family members." At the time, it was set up as a premier institution with state-of-the-art facilities and cost around Rs 35 lakh. Today, it has grown, in various phases, to a total of 230 beds.

"Woodlands was the first private hospital in the city to start cardiac surgery as well as kidney transplantation, to use lasers in urology, to have harmonic scalpels for surgeons, to give a few examples. The trend continues with installation of the first 3 Tesla MRI and Dual-Source CT Scanner in the last few months," says Dr Mukherjee. Woodlands is currently being overhauled, be it medical equipment, infrastructure or processes. Simultaneously, some new programmes like heart failure clinic, neurospine services etc., are being introduced.

Belle Vue Clinic: This multi-speciality hospital from the MP Birla Group was established in 1967 as a nursing home. Thereafter, it was managed by late Priyamvada Birla, followed by late Rajendra Singh Lodha and now is being looked after by Harsh Vardhan Lodha, trustee and member of the Managing Committee.

Over the years, the clinic introduced the first ICCU/CCU ICCU in the private sector in 1971 and thereafter, a dedicated dialysis unit, followed by a kidney transplantation unit and to support this, the first tissue typing department in Eastern India. Under one roof, the hospital provides all diagnostics, including 64 Slice CT Scan, 1.5 Tesla MRI, Digital X-Ray etc. Says P Tandon, CEO, Belle Vue Clinic, "Gradually, the clinic started diversifying from one discipline to another, as a result of which it is today a full-fledged hospital having 168 beds for all disciplines of medicine." Another 46 beds exclusively for eye care under the name of Priyamvada Birla Aravind Eye Hospital was started in its annexe building. Shortly, the hospital will be expanding to become 304 beds. It is also opening three state-of-the-art departments, namely invasive cardiology, mother and child, and blood bank, for which a 17,000 square feet area is nearing completion. "Thus, the only discipline of invasive cardiology, which was absent in our hospital, will also be made available," says Tandon.

The Calcutta Medical Research Institute (CMRI): Founded in 1969 by late BM Birla, CMRI is a part of the Rs 5,000-crore CK Birla Group. This was the first corporate hospital of Eastern India. Says Rupak Barua, COO, CMRI, "There were a few nursing homes before us, but they had no OPD or emergency department. We are the first tertiary care hospital in this region to have 24x7 emergency facility."

This 400-bed multi specialty hospital pioneered the city's first stroke clinic with a view to provide comprehensive stroke care with latest clot buster treatment or thrombolysis. It has introduced Eastern India's first sleep laboratory for conducting sleep studies. The hospital installed the first MRI with Ambience in a hospital setting in Eastern India in 1993. "Our radiology department is fully digitalised running on PACS," says Barua.

It has a geriatric clinic and a lifestyle management clinic and has centres of excellence in neuro-sciences, urology, GI, critical care, cosmetic and mother and child. It started Survodaya Eyecare with technical support from LV Prasad Eye Institute to develop a tertiary eye care centre with focus on research and training. Recently, it has introduced an eye bank.

CMRI runs DNB courses in six disciplines. It is the only institute in Eastern India that offers DNB in Gastroenterology. CMRI is also one of the very few centres selected for the MRCS examination conducted by the Royal College of Surgeons, UK. It also has a nursing college. "In the pipeline is an IVF centre. We will soon introduce a SAP-based ERP solution to ensure quality and bring about complete transparency in billing and other operating procedures," says Barua.

Kothari Medical Centre: The hospital, located in Alipore Road, was founded in 1971 by philanthropist GD Kothari. It is a 340-bed super specialty hospital.

In the '90s

BM Birla Heart Research Centre: Hailing from the same GP Birla/CK Birla Group that runs CMRI, BM Birla Heart Research Centre is the cardiac hospital of the group. The hospital, founded in 1989, is the first super specialty hospital in India to receive the National Accreditation Board for Hospital and Healthcare (NABH) and also NABH re-accreditation. Besides, it is the first hospital in India to be awarded ISO 9001, ISO 14001, has the first hospital laboratory in India to be accredited by National Accreditation Board for Testing and Calibration Laboratories (NABL) and College of American Pathologists (CAP), the first private nursing college in Eastern India with BSc, MSc and CVT nursing courses and the first hospital in Eastern India to initiate air-ambulance service.

Says Borar, "Some of our clinical achievements include being the first in India to conduct keyhole surgery to close a hole in the heart, to do Video Assisted Thoracic Surgery (VAT) to close PDA, perform Extra Corporeal Membrane Oxygenation on a neonate for respiratory distress, the first in Eastern India to perform angioplasty from the wrist in interventional cardiology, and cardiac resynchronisation therapy by biventricular pacing, and the first in Asia to perform 'Dynamic Cardiomyoplasty'."

The centre has incorporated the latest generation of cardiac equipment like Philips Allura F D 10 which is the latest cardiac care system having special features such as stent boost, and has a 3D reconstruction and rotational angiography facility, the first in the eastern region comparable to international standards. The hospital also has a Rotablator System for CTO calcified lesion, a 3-dimensional echocardiography which can be done on adults, paediatric patients as well as on a foetus. "Our centre also has a department of Nuclear Medicine which has a unique Dual Head Infina Gamma Camera which would provide economic and accurate non-invasive diagnosis of artery disease," says Borar.

Peerless Hospital and BK Roy Research Centre: This is a 300-bed multi specialty hospital at Panchasayar from the Peerless Group that runs business in real estate, finance, travel and security. Commissioned across nine acres, the hospital was started in 1994 with 75 beds. Says Dr PK Nayak, Medical Superintendent, "Peerless Hospital since its inception has been responsible for changing the orthopaedics scenario of West Bengal. This was possible due to influx of latest technological advancements and cutting edge instruments by us." Total joint replacement was started in Peerless Hospital from April 1994. "By adopting Computer Assisted Orthopaedic Surgical System, total knee replacement procedure can be executed more accurately," says Dr Nayak. In the pipeline are plans for upgrading the department of gastro-enterology and also urology at a later date.

Ruby General Hospital: The hospital was founded by US-based NRI gynaecologist Dr Kamal K Dutta with his entrepreneur brother Sajal Dutta and Dr Binod Prasad Sinha. The hospital was started as a 130-bed unit in 1995. Most of the instruments and technology was imported from US. It was Eastern India's first ISO 9001:2000 hospital. Today, this is a 170-bed unit, offering cardiology and cardiac surgery, surgical and medical oncology, ophthalmology, ENT, nephrology, urology, gastroenterology and orthopaedics.

Says Brig (Dr) SB Purkayastha, CEO, Ruby General Hospital, "We have a record of 100 per cent success rate in more than 400 consecutive heart bypass surgeries using beating heart. In the present hospital, we will add radiation therapy with linear accelerator and IGRT. Also on the agenda is adding a 1.5 Telsa MRI. Among private hospitals in the Eastern region, the highest number of cancer surgeries is being carried out in Ruby." After starting a nursing school last year, the hospital has planned to start postgraduate courses (DNB) in a few subjects.

The management is coming up with 250 more beds in a separate building in an adjacent land measuring 2.3 acres. The new building would house super-specialised care in neuro and cancer. "The hospital building will have seven floors of 140,000 square feet. "The plan for building this Rs-55-crore project has been submitted to the sanctioning authority. As soon as the plan is approved, the construction will start. Fund to finance the project is ready," says Dr Purkayastha.

Jubilant Kalpataru Hospital is soon going to launch an infertility clinic and a spine surgery centre	Artistic impression of the upcoming 300-bed Tata Medical Centre in Rajarhat
Fortis is starting tertiary care hospital in EM Bypass	AMRI is starting another hospital in EM Bypass
Columbia Asia offers flat and uniform pricing, irrespective of the room	Desun Hospital offers CABG at an amazingly low price of Rs 70,000

The Big Thrust

An array of biggies who entered in 2000 include:

Apollo Gleneagles Hospital: The 425-bed Apollo Gleneagles Hospitals, a joint venture of Apollo Group of Hospitals, India with Parkway Health of Singapore, is spread over 8.5 acres campus in EM Bypass. The six-storied main hospital building, spread over an area of 3 lakh square feet, houses the inpatient and most diagnostic facilities. Opposite the inpatient building is the five-storied daycare centre spread over 90,000 square feet, which is meant for outpatient consultations, daycare services and nursing college.

It's the only JCI-accredited hospital in Eastern India and also the only hospital in Eastern India to receive NABL certification in six separate categories: clinical biochemistry, clinical pathology, haematology and immunohaematology, microbiology and serology, histopathology and cytopathology. Some of the achievements of the hospital include performing the first (in Eastern India) minimally invasive hip replacement surgery, the first cadaver transplant and intravenous thrombolysis, and renal transplant on the youngest recipient (a seven-year-old child).

Says Dr Rupali Basu, CEO, Apollo Gleneagles Hospitals, "We are planning to go for liver transplant soon. This would be the second hospital in this region after PG Hospital to conduct liver transplant." The hospital is soon going to start a dedicated centre for cosmetic surgery and functional neuro-surgery.

The newly-launched five-storied Apollo Gleneagles Cancer Hospital, spread over an area of 50,000 square feet, is located in the same campus. The radiation therapy department offers IMRT, 3D-CRT, stereotactic radio-surgery, stereotactic radiotherapy, 3D-CRT with IGRT, 4D-CRT with IMRT, IGRT, Rapid Arc, Gating, radical brachytherapy, convention radiotherapy and palliative radiotherapy. "In radio surgery, we have adopted Novalis Tx which provides a non-invasive treatment option by offering flexibility in treatment protocols and providing faster planning, setup and treatment," says Dr Basu.

Fortis Hospitals: Established in 1988, the 67-bed Fortis Hospital and Kidney Institute (formerly Wockhardt Hospital and Kidney Institute) at Rash Behari Avenue was the first hospital in Eastern India dedicated to urology surgery and kidney care. Over the years, it has become the pioneering destination for patients suffering from all kinds of urology and nephrology disorders from Eastern/North Eastern India and Bangladesh. It is recognised across India as a centre of excellence in urology/nephrology.

The hospital has pioneered lithotripsy in Eastern India, besides performing the maximum number of PCNLs (stones extracted through a small hole at the back). It performs the maximum number of kidney stone and kidney surgeries per month with high success rate in Eastern India catering to over 50 million people. It performed the first successful laparoscopic donor nephrectomy in kidney transplant surgery and introduced penile implant surgery in Eastern India.

The Kolkata Medical Centre at Sarat Bose Road is a multi specialty outpatient clinic which has a specialised eye clinic that provides clinical expertise of international repute, and sophistication of diagnostic and treatment procedures, serving the needs of patients across a spectrum of eye disorders, specifically for cataract and anterior eye surgeries. The centre also provides corporate health checks and a complete dental unit.

AMRI: The group, a JV between Emami and Shrachi and the Government of West Bengal, started its first hospital in 1996 in Dhakuria with 160 beds. Today, the Dhakuria unit has expanded to 360 beds and is adding 40 more beds soon. Says DN Agarwal, Executive Director, AMRI, "It is the first hospital in Eastern India to start IMRT in cancer and also the first multi specialty hospital in Eastern India to get NABH accreditation."

The hospital, which already has two linear accelerators with IMRT, is going for IGRT, PET Scan and SPECT CT at a cost of Rs 22 crore. This would be the first PET Scan in a hospital setup in Eastern India. In 2005, the group acquired Suraksha Hospital in Salt Lake. This hospital, which started with 160 beds, now has 180 beds. Another 60 beds are being added in a nearby building. The total capacity of the hospital will become 240 beds. The new building will house an ultra-modern gastroenterology and nephrology department.

The group also has a medical centre on Southern Avenue in south Kolkata. This centre provides diagnostic facilities, comprehensive outpatient treatment, preventive healthcare checkups, ophthalmology, dentistry and ENT.

RTIICS: Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), a unit of Narayana Hrudayalaya, has built a health city comprising a cardiac centre, a trauma centre, a kidney hospital and an ophthalmology hospital.

RTIICS was started in April 2000 as a cardiac hospital at Mukundapur in Jadavpur. The 120-bed cardiac centre started the first EP study in Eastern India in 2000. It was the first hospital to have a separate section for paediatric cardiology and intra vascular ultrasound for angioplasty. Says Dr Ashutosh Raghuvanshi, Vice Chairman, Narayana Hrudayalaya Group, "We were the first hospital to provide standardised packages for cardiac surgeries in these parts." In 2004, the hospital became a multi specialty hospital and today, it has expanded to a 445-bed unit. Built on approximately four acres of land, the hospital has state-of-the-art equipment like IVUS (first in Eastern India) to image coronary artery disease.

The group also runs the Armenian Church Trauma Centre (ACTC) in the same premises. This wing has a full-fledged trauma centre with some associated specialties along with a department of laboratory diagnostic services, nuclear medicine and radio diagnosis, and a blood bank.

The group also runs Manjulaben Mehta Kidney Hospital in the same premises. This unit with 45 dialysis machines is the largest in Eastern India. "This centre, started in 2005, has performed more than 350 renal transplant cases so far," says Dr Raghuvanshi. The group also built Rotary Narayana Nethralaya Hospital in Salt Lake. The hospital provides treatment for cataract, glaucoma, occuloplasty, paediatric ophthalmology and retinal surgeries.

"Over the last 10 years, we have emerged as the largest healthcare provider in Eastern India and have performed more than 15,000 cardiac surgeries, 50,000 cath lab procedures, 1,20,000 dialysis procedures, 350 renal transplants and provided subsidised treatment worth Rs 70 crore to poor and needy patients," says Dr Raghuvanshi.

The group is in the process of establishing a nursing college and paramedical training centre at Sonarpur, eight kilometres from the main hospital. The college will offer BSc and MSc in nursing. The nursing school will have provision for GNM nursing and the paramedical training centre will have 40 disciplines of vocational training.

BP Poddar Hospital: This 220-bed multi-specialty hospital, located at New Alipore, is from the Poddar Group that runs business in healthcare, entertainment, education, housing and the service sector. Spread over 1,40,000 square feet, the hospital was started in 2005. It offers advanced healthcare services with emphasis on oncology, traumatology and advanced medical research. It is the first hospital in India to run its ventilators on Medical Air (FDA Approved).

Bhagirathi Neotia Woman and Child Care Centre: Bhagirathi Neotia Woman and Child Care Centre of Ambuja Realty was set up in the year 2002 at an approximate cost of Rs 20 crore. This NABH-accredited hospital, started with 63 beds, now has 83 beds. Says PL Mehta, CEO, Bhagirathi Neotia Woman and Child Care Centre, "Over time, we have started our own diagnostic centre, named Neotia Mediplus, which is offering advanced diagnostic services with full time experts." It soon started an infertility clinic nicknamed Genomee in collaboration with an Israeli hospital. "Today, Genomee has turned into one of the most noted infertility centres in Eastern India. We are able to save babies even at low birth weight of about 800 grams. In infertility, Genomee has achieved a success rate of 35 per cent which is substantially higher than the industry prevalent rate," says he. The group is putting up a chain of community clinics in the name of Neotia Mediplus.

Columbia Asia: In 2007, a brown-field hospital project in EM Bypass was acquired by the Malaysia-based Columbia Asia Group to establish its footprint in the city. The hospital, with 100 beds, was started in June 2008. According to Arindam Banerjee, General Manager, Columbia Asia, Kolkata, "This hospital is the only private hospital in the Eastern region to have a Labour Delivery Recovery Suite and offer flat and uniform pricing, irrespective of the room that the patient chooses. We follow internationally benchmarked standard protocols for infection control and hygiene, and our OTs conform to ASHRAE standards. We don't unnecessarily invest in technology; we believe in ethical practice and don't exert pressure on doctors to earn revenue for us." In the pipeline are a cardiac cath lab and renal transplantation.

Desun Hospital and Heart Institute: The 303-bed Desun Hospital and Heart Institute at EM Bypass was started in November 2008. This super specialty cardiac hospital was founded after Sajal Dutta, one of the founder promoters of Ruby General Hospital, moved out of the management of Ruby General Hospital in 2006. Desun's 10-storied hospital, spread over 2,50,000 square feet, also offers treatment in ENT, gastro, dentistry, cosmetology, critical care, dermatology, endocrinology, general medicine, general surgery, nephrology and haematology.

The USP of the hospital has always been its low-cost model. It offers CABG at an amazingly low price of Rs 70,000 and is known for catering to lower socioeconomic strata of the society. Says Sajal Dutta, Chairman & Managing Director, Desun Hospital, "We are the only hospital in Eastern India to have steel OT and 1:1 ratio for bed to ventilator for each ICU / ITU bed to reduce infection rate."

Now, the hospital is planning the second phase to add 450 more beds in adjacent land to add more specialties like ortho and neuro. However, the upcoming hospital would focus on mother and child care, "We will be adding 2,45,000 more square feet. The cost of the project will be Rs 140 crore." The second phase is to be started by 2012.

Sankara Nethralaya: The huge rush of patients from the Eastern region to Chennai's Sankara Nethralaya inspired the management to plan a hospital in Kolkata. Sankara Nethralaya signed a tri-partite agreement with Dr Devi Shetty's Asia Heart Foundation (AHF) and Rotary to start the Rotary Narayan Sankara Nethralaya. Sankara Nethralaya exited the agreement in July 2007 and planned a new hospital at Mukundapur in Jadavpur area. The initial hospital in Salt Lake was thus renamed as Rotary Narayan Nethralaya.

Sankara Nethralaya made arrangements for a makeshift hospital while the new hospital was coming up in Mukundapur. It thus started a unit at Raja Subodh Mallik Square in July 2007. The new hospital, built at a cost of Rs 34 crore, was commissioned in January 2009. The hospital has six OTs, four of which are for paying patients and two for indigent patients. The hospital has a tele-ophthalmology and Mobile Refraction Van that takes quality eye care to the doorsteps of people living in rural and semi-urban West Bengal. It holds regular eye camps in neighbouring district to identify patients with complex eye problems.

According to Komal Dashora, Administrator, Sankara Nethralaya, Kolkata, "The USP of the hospital is that it provides comprehensive eye care under one roof, with all full-time consultants from Chennai. The hospital caters to complex ophthalmology problems of the population of the whole of the Eastern region." With over 500 OPD consultations per day and with a waiting time of one month, the management is contemplating setting up more OPD clinics in future in Kolkata. "We have immediate plans of starting a full-fledged corneal transplant programme and Lasik surgery department. Later, we plan to have ocular oncology department," Dashora reveals.

Jubilant Kalpataru Hospital: This is a 120-bed super specialty hospital in Barasat, which comes under the North 24 Parganas district, but falls under the purview of the Kolkata Metropolitan Development Authority. The hospital started functioning in its current location at Barasat in December 2009. However, a 50-bed hospital under the same name was functioning for the last two years, about three kilometres away. The hospital is owned by Jubilant First Trust Healthcare (JFTHT), a subsidiary of Jubilant Organosys. The subsidiary was created in association with a group of doctors with entrepreneurship experience in West Bengal. Recently, the hospital conducted the first workshop for total ceramic-on-ceramic implant for hip in the country led by Padmashree Prof KH Sancheti. According to Satadal Saha, Director and CEO, JFTHT, "We are soon going to launch an infertility clinic and a spine surgery centre."

In This Decade

Institute of Neuro Sciences: Situated on AJC Bose Road, the 150-bed Institute of Neuro Sciences (INS) was commissioned in March this year, with 50 beds. The not-for-profit hospital, built at a cost of Rs 100 crore, is a PPP between the Kolkata Municipal Corporation, the Government of West Bengal and Neurosciences Foundation (founded by London-based neuro surgeon Dr RP Sengupta).

The hospital was planned to cater to a population of 55 crore in the Eastern and North Eastern part of India as well as the neighbouring countries of Bangladesh, Bhutan and Nepal. Says Dr RP Sengupta, Chairman of INS and the brain behind this project, "It will offer facilities of international standard, like that of Mayo Clinic. It will offer dignified treatment to the poor and would be a centre of excellence in South East Asia."

The hospital is offering services in neurology, neuro surgery, neuro radiology, neuro psychiatry and rehabilitation and has a stroke centre, trauma centre, endovascular centre and diagnostic centre. The hospital also provides specialised medical care for the following: cure of stroke by thrombolysis, DBS for PD patients, cure for intractable epilepsy, cure of dependency with brain stimulation, sleep lab, localisation of tumour with neuro navigation, precision brain surgery guided by intra-operative MRI and robotic surgery.

Medica Superspecialty Hospital: This 206-bed hospital (expandable to 500 beds), located at EM Bypass was inaugurated in April this year.

Says Dr Alexander Kuruvilla, CEO, Medica Superspecialty Hospital, "The department of neurosurgery is providing stereotactic surgery with the unique facility of functional neurosurgery (deep brain stimulation and lesion making)-a first in Eastern India with help from Oxford (UK)." This Rs100-crore project has installed pneumatic chute system, which is the first in Kolkata. The hospital has taken multiple initiatives to be a green hospital and has applied for LEED accreditation, which is also the first in this region.

On the Anvil

Tata Medical Centre, Rajarhat: With 80,000 new cancer cases detected in West Bengal every year, Tata Medical Centre (TMC) is the most awaited project in the city. This 300-bed cancer hospital from the house of Tata is coming up at New Town, Rajarhat. The foundation stone was laid on 21st February, 2006 by Chief Minister Buddhadeb Bhattacharya and construction of the project began on 16th February, 2007. Spread over 13.36 acres, the FSI of the hospital is 3,26,000 square feet.

Ohio Cardiology Associates (India), Rajarhat: Promoted by US-based cardiologist Dr Ashish Rakhit, this super specialty cardiology hospital is coming up in New Town, Rajarhat. Says Rajiv Shil, Manager, Ohio Cardiology Associates, "The project, spread on a two-acre land, is built at a cost of Rs 200 crore. The project is expected to be commissioned by December, this year."

Global, Rajarhat: Coming up on three acres in Rajarhat, Global Hospital Kolkata, a joint venture of Hyderabad's Global Hospital with Sureka group, will be a 450-bed facility. This Rs150-crore project will be a tertiary care and multi-organ transplantation facility. The hospital will be commissioned by the end of 2011 with 300 beds. Says Dr K Ravindranath, Chairman, Global Hospitals, "This will later be scaled up to 450 beds."

Belle Vue, Rajarhat: It has planned a 500-bed tertiary care hospital in Rajarhat. "The cost of the project would be Rs 150 crore with Rs 40 lakh per square foot," informs Tandon.

Fortis Hospital, EM Bypass: Spread over 1.5 acres, with total area of over three lakh square feet, this 400-bed specialty hospital is coming up at Anandapur, near the EM Bypass. Construction for this Rs 175-crore project, stalled for 14 months, resumed in January. And now, the hospital is scheduled for commissioning by July this year. This is a super specialty hospital with core focus on cardiology/cardiac surgery, urology/nephrology, neurosciences, orthopaedics, minimal access surgery and critical care. Says Vishal Bali, CEO, Fortis Hospitals Limited, "The group has developed clinical leadership in providing patient care in these specialties for over a decade and half across India. The demand by patients in Eastern India for high quality super specialty care is growing rapidly and this hospital aims to fulfil this need through a combination of modern infrastructure, outstanding clinical expertise and professional management practices. This facility will be amongst the most advanced hospitals in India."

AMRI, EM Bypass: It is starting a 275-bed hospital at Mukundapur in EM Bypass. The first phase of this Rs 100-crore project with 175 beds is coming up by September 2010. The hospital is dedicated to women and children.

Narayana Hrudayalaya Dental Clinic: Narayana Hrudayalaya Hospitals has started a wholly-owned subsidiary unit, Narayana Hrudayalaya Dental Clinic (NHDC) to foray into dental clinics. NHDC, which already has one clinic at Hiland Park, is now in the process of opening a chain of 50 clinics throughout the city. These dental clinics provide diagnostic, preventive, restorative, oral surgical, orthodontic, rehabilitative, and cosmetic dental care under one roof.

Says Dr Nitish Shetty, Managing Director, NHDC, "This year, we would start 30 clinics in Kolkata and by next year, we will scale it up to 50 clinics. All of these clinics will be standalone, apart from a few which are located in our own hospitals. The average cost of starting each clinic ranges from Rs 20 to Rs 30 lakh."

GP-CK Birla Group: The group has planned a slew of 25 diagnostic clinics in Eastern India, out of which six are coming up in Kolkata. "These clinics will be a mix of owned and franchisees. The cost of setting up a centre without CT and MR would be around Rs 2 crore and would be more than Rs 4 crore with CT and MR," says Borar. The group is also exploring the opportunity of setting up another cardiac hospital in the city. The project is proposed to come up in Rajarhat at an estimated cost of Rs 100 crore. "Talks are on with the Government to identify the land for the project," says Borar.

On the Prowl

Elbit: Elbit India Healthcare (EIH), a subsidiary of the Elbit Imaging of Israel, is planning to establish a multi-specialty tertiary care hospital in Kolkata. Elbit India Healthcare had initially tied up with the Neotia group to form Neotia Elbit Hospitals Venture. The JV started a diabetes specialty centre on Rashbehari Avenue, near Gariahat. However, the JV was called off and Elbit sold the diabetes clinic to BM Birla. Now, Elbit is focusing only on the tertiary care hospital. Dr Suresh avers, "Since we are deliberating on several options in Kolkata, we wouldn't be able to release any other information."

Apollo: It is looking for land in both north and south Kolkata for future hospital projects.

Hinduja Healthcare: Hinduja Healthcare, which runs the trust hospital PD Hinduja Hospital in Mumbai, is interested in setting up a corporate hospital in Kolkata.

Scope for Improvement

"Eastern India being a price sensitive market, hospitals need to work on right price performance equilibrium" - Sajal Dutta Chairman & Managing Director Desun Hospital

"It's only in the 90s the thinking that hospitals should be managed by professional managers and not doctors gained ground" - Dr Rupali Basu, CEO Apollo Gleneagles Hospital

Development of Specialty: There is a need for further development of specialties, specially neuro, trauma and burns. "People are still going down south for neuro surgeries like skull-base brain tumour and complex joint replacements," says Brig Purkayastha. Some experts point out the need for a standalone diabetes institute.

Trained Manpower: For a city bursting with new healthcare projects, dearth of specialists, trained nurses, paramedics and technicians poses hurdle. According to Dr Basu, the city needs more paramedical courses and medical colleges. "The eight medical colleges of the Government and the upcoming KPC Medical College are not sufficient to churn out enough doctors," Basu observes.

Government Support: Burdened with augmenting the infirm public healthcare infrastructure, the state Government has not been proactive in promoting investments in healthcare. But to meet the burgeoning demand for cutting edge technology, the Government needs to encourage private investments and must provide better infrastructure to aid that.

Tackling Union and Mob Violence: Union problems have always besieged hospitals. Mob violence against doctors and nursing homes/hospitals has often hampered the functioning of hospitals. Continuous 'bandhs' and political disturbances in the city also deter investors.

More Insurance Coverage: With only 2.8 per cent coverage of health insurance in Eastern India, there is definitely a need for more coverage to make healthcare more affordable to all.

Improve on Soft Skill: A lot is desired in soft skills of medical and non-medical staff. Insensitivity and rudeness of staff and their lack of commitment to patients have often created unpleasant situations.

Image Overhaul: From doctors to hospitals, everyone needs to work on improving their image vis-a-vis patients. "We need to make an attempt to gain the confidence of patients, many of whom still prefer going down South for treatment of complicated ailments," says Borar.

Future Trends

Here are some trends that would define the city's healthcare landscape:

More Healthcare Units: The future will witness more corporate setting up their units in Kolkata. According to Dubey, for any city to have potential for development there are three key factors - manpower, infrastructure and financial index (for cost of living and real estate prices etc.). Secondary factors include aspects like Government support, stable Government and commercial development. "Kolkata has been scoring on all the above key factors recently and so has seen the recent growth of IT and healthcare sector. This will continue in the coming years, making Kolkata a key healthcare destination of Eastern India," he avers.

Price Performance Equilibrium: Hospitals in the city are getting quality conscious, but quality comes at a price and people in the Eastern part are often not ready to pay for quality. "As quality consciousness rises, it would be a war of quality and not only price. People want value for money," says Banerjee. According to Dutta, Eastern India being a price sensitive market, hospitals need to work on right price performance equilibrium.

PPP: Experts predict more public private partnership ventures in the coming years. After all, there is a need for tertiary care treatment to be more accessible and affordable to the masses. In the past, the Government's effort to outsource some services of public healthcare to private groups did not take materialise. It's time to devise a PPP model that will be viable for the private players.

Consolidation: Whenever some behemoth enters an untapped market, the smaller ones are gobbled up. Consolidation after all brings in economies of scale. "Rather than surviving on one leg, the smaller setups need to bring in the necessary investment to properly serve their client base," says Choudhury.

However, from an era of having monopoly in the Eastern region, soon hospitals in upcoming healthcare hubs of Bhubaneswar and Siliguri (both with air connectivity) would give Kolkata tough competition. It would be interesting to watch the cascading effects of this competition!

rita.dutta@expressindia.com