Apollo Hospital Interview

My name is Raj Kr Raina, General Manager, Marketing and Strategic Business,  Apollo Hospital, New Delhi,  Inida

In the last few years, more than a 100 doctors have had their trainings done in Apollo Hospital. We have been receiving batches of doctors from Nigeria,  especially University of Jos Teaching Hospital, we have an understanding with them.
So we are training them in the field of heart, including, peadiatrics cardiac services, neurosciences, cancer, transplantation; liver, kidney and bone, gastroenterology, orthopaedics. These are the major specialties for which the doctors come for their training programme. They stay up to three or four months during which they are attached to different senior consultants, doctors to see patients and learn new technology. Then they come back home to apply the training programme.
What is the programme you are holding today  all about?
This is a continuous medical education (CME) where our doctors come and exchange their clinical experiences with the local medical doctor. These doctors also could refer patients abroad, they have an open offer from the doctors.

Are the doctors here on their own or it’s a partnership?

No, we usually have local partners that organize these CME programmes. We are partnering with Diamond Clinics, they usually organize this programme. It’s a purely academic programme where the objective is to update the doctors on the latest medical expertise or experience which are happening, or technological breakthrough. It’s a purely technical experience. . Its an ongoing programme. Every time, we come, sit with them and go and do a new programme in a new state or city. We have covered almost 60 or 70% of the states in Nigeria and the programmes are CME for the medical doctors

With the knowledge being imparted, you think our Nigerian doctors are equal to the task?
Training is one part. The other part which the Nigerian health authority has to see to is the infrastructure. The infrastructure has to be in place in Nigeria. You can learn but you need the infrastructure back home to implement those learnings. For example, if you want to open a cancer centre, you need to have bed scan, radiotherapy machines. Only then  you know whatever learning programmes has been done in India can be used with the help of technology, which is available in Nigeria and then, if these two things are available; skilled manpower and infrastructure, probably, the patients who are travelling overseas, not only to India but other countries will stop, especially for cancer. So there’s  need for the authorities to develop  infrastructure in Nigeria so that people don’t have to go out for basic medical treatment.

Nigeria Needs Infrastructure To Curb Medical Tourism- Apollo Hospital

By Winifred Ogbebo, Abuja
A leading specialist and research hospital in India, Apollo Hospital, has said that for Nigeria to curb medical tourism, it needs to put infrastructure in place in the nation’s tertiary hospitals.
Speaking to LEADERSHIP during its continuous medical education programme for doctors last weekend in Abuja, the General Manager, Marketing,  Apollo Hospital, New Delhi,  India, Mr Raj Kr Raina, said many Nigerian doctors have undergone specialized trainings in their India-based hospital but what is needed is adequate infrastructure for them to put the knowledge to use.
“In the last few years, more than a 100 doctors have had their trainings done in Apollo Hospital, India. We have been receiving batches of doctors from Nigeria,  especially University of Jos Teaching Hospital, we have an understanding with them.
“We train them in the field of heart, including, peadiatrics cardiac services, neurosciences, cancer, transplantation; liver, kidney and bone, gastroenterology, orthopaedics. These are the major specialties for which the doctors come for their training programme. They stay up to three or four months during which they are attached to different senior consultants and  doctors to see patients and learn.”
Raina, however,  called on the federal government to put infrastructure in place, to complement manpower for effective patients care so as to curb medical tourism.

 “Training is one part. The other part which the Nigerian health authority has to see to is the infrastructure. The infrastructure has to be in place in Nigeria. You can learn but you need the infrastructure back home to implement those learning.
“For example, if you want to open a cancer centre, you need to have bed scan, radiotherapy machines, etc. Only then will whatever learning programmes have been done in India be used with the help of technology, which should be available in Nigeria.”
According to the General Manager, Marketing and Strategic Business, Apollo Hospital, India,  if these two things are available; skilled manpower and infrastructure, probably, the patients who are travelling overseas, not only to India but other countries will stop, especially for cancer.
“So there’s need for the authorities to develop infrastructure in Nigeria so that people don’t have to go out for basic medical treatment,” he added.
He disclosed that Apollo Hospital has an ongoing continuous medical education programmes for medical doctors in almost 60 -70 per cent of all the states in Nigeria.
“It’s an ongoing CME programme. Every time, we come, sit with medical doctors and in a new state or city. We have covered almost 60 or 70% of the states in Nigeria.”

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Oluyemi Omitola

09090355162,  08024118483

Head, Research & Brand Strategy

Robotic Urology in India

Introduction

The story of the operating surgeon relinquishing his hallowed position
beside an operating table to a chair positioned a few feet away began in
the 1980’s in the USA when NASA, Stanford Research Institute, and the US
Department of Defence developed the SRI Telepresence Surgery System, which
was intended to aid the wounded in a battle by surgeon’s miles away from
the frontline (1). Although it did not accomplish the intended objective,
this surgical system eventually led to the development of the present day
Da Vinci Robotic System.

Robotic surgery is the latest cutting-edge technological advancement in the
surgeon’s armamentarium. Almost like science fiction to the uninitiated,
the surgeon sitting at a console controlling a robotic arms assembly has
revolutionized the surgical approach to many procedures which were hitherto
either very complicated or fraught with prohibitive complications.
Although newer modifications of the Da Vinci robot are on the anvil, the
present configuration is likely to remain the mainstay in the Indian
scenario for the foreseeable future.
The Da Vinci Surgical System was released in April 1997 and received FDA
approval in 2000 for laparoscopic surgeries. (2) Today it is being used in
increasing number of specialities including gynaecology, ENT, Cardiac
Surgery, General Surgery, Orthopaedics and Urology.
In its present configuration Da Vinci Surgical System can be used in most
contemporary operating suites. It has 3 major components
- Robotic Tower: Assembly where instruments are attached and
mechanically manipulated within the patient
- Surgeon’s console: Workstation where the surgeon sits and
manipulates the instruments
- Ancillary Vision Cart: Supports a flat screen monitor

Advantages

Any technical advancement is a tool for execution of the basic technique of
surgery and hence must be examined with the question - Does this further
aid, simplify or facilitate our adherence to our time honoured basic
surgical steps and their outcomes?
The answer for the robot is probably a resounding “Yes”. It unquestionably
offers some distinct advantages. (3)
1. 3D vision and depth perception: One of the biggest hindrances of
Laparoscopic surgery has been a 2 dimensional representation of a 3
dimensional operating field. The incorporation of binocular optics in the
operating console offers the operating surgeon a 3 dimensional simulation
and thereby improves depth perception which is invaluable when operating in
the limited confines of areas like the pelvis.
2. Elimination of hand tremors and field magnification: Robotic arms
eliminate tremors and help in movement scaling. This increases the
precision of the surgical steps and helps define difficult anatomical
landmarks.
3. Ergonomically superior and cause less fatigue to the surgeon:
Better operating posture and surgeon’s comfort translates into better
surgical outcomes.
4. Reduces the learning curve of Laparoscopic surgery: The exposure
to robotic surgery offers a chance for surgeons who are not
laparoscopically trained to offer a minimally invasive surgery option. (4)
The additional advantages of minimally invasive surgery like lesser
post-operative pain, shorter convalescence period, lesser bleeding and more
cosmetic incisions unarguably further the case of robotic assisted surgery.
(5)

Disadvantages

The biggest and possibly the only uncontested disadvantage of the Robotic
Surgery is the incurred cost. The Da Vinci Surgical systems robot costs a
considerable $ 2 million with a further $ 100,000 required for annual
maintenance. (6, 7)
Undoubtedly the higher costs involved translate into higher cost of Surgery
which is principally borne by the patient. In the Indian context this is a
very pertinent consideration where a vast majority of the population cannot
afford such high costs. Another uniquely piquant condition in India is that
even in patients who have medical insurance; the companies refuse to cover
surgeries done using the robotic technology.

The Indian Scenario

Major diseases causing maximum number of deaths in India are still TB and
infectious diseases like malaria. (8) A question that is most frequently
and arguably the most aptly asked in this scenario is – Can we afford it?
At present this question is akin to asking - Can India afford to market a
Mercedes Benz or an Audi car?
The reply to the question, as written in an essay by Vipul et al is, that
the Robot is already there in India and the question is becoming
increasingly redundant.

Role of Urology

In July 2006, India witnessed its first Robotic Assisted Surgery at AIIMS.
Fittingly, it was pioneered by the Department of Urology and a Robotic
radical prostatectomy was completed successfully (5). We have indeed come a
long way since then. As PN Dogra et al have analyzed, the results of a
series of 190 cases performed at their centre compare very favourably with
the western figures. The number of Robots in India has also been steadily
increasing and although the precise number is not available, there are
about 21 centres, across the country, which are regularly performing
Robotic surgeries (10).
In terms of departments, Urology is quite definitely the forerunner in the
use of Robotic technology. The number of radical prostatectomies being
performed has gone up tremendously as compared to the open era. The
improved continence results (some patients at our centre report continence
at day 1 or day 2 post catheter removal) and the lesser erectile
dysfunctions attributable to better nerve sparing achieved due to the
robotic technology, have gone a long way in establishing radical
prostatectomy as the flagship surgery of robotics worldwide and in India.
The advantages have also been extended to procedures requiring precision
and accuracy like partial nephrectomy which has enabled efficient nephron
sparing surgery with resultant renal function preservation. Robotic
assisted adrenalectomy, pyeloplasty, radical nephrectomy and donor
nephrectomy are being performed with increased frequency as the Surgeon is
getting more and more acclimatized to the Robot. A further testament to the
proficiency of the Indian surgeon with the robot is the increasing number
of Robotic Renal Transplant surgeries being performed successfully at some
centres.
Other Surgical departments in India are also joining the Robotic revolution
in increasing numbers. Gynaecology, ENT, Cardiac Surgery and General
Surgery are using the Robot in a wide variety of cases.

The challenges

As Dr Mani Menon, of the Vattikutti Institute said in an interview to
Express Healthcare, - “India is ideally suited for robotic surgery as the
surgeons are skilled, the patient volume is high and a full spectrum of
complex diseases are encountered. In India particularly, multispecialty
robotic surgery has a great future.”
Even with this well recognized potential, Robotic surgery is still in its
infancy in India.

As mentioned earlier the inherent costs associated with it remain the
biggest challenge to be overcome for a more uniform dispersion of this
technology throughout the country. The only way to tackle this and to make
robotic surgery financially feasible is for multidisciplinary utilization
of the robotic system to its fullest potential. The maintenance cost
remains the same whether one case or 6 cases are done in a day. So it is
logical that if more cases were generated out of a robotic system, the cost
per case would automatically decrease. Government support is also of
paramount importance in making this technology available to more people at
a subsidized rate.
With Indians at the forefront of Robotics worldwide, it is not unreasonable
to anticipate the development of an indigenous robotic surgical system in
the future. The department of biomedical engineering at the Indian
Institute of Technology have made some headway in the goal of developing
our very own Indian prototype. (5) Needless to say, such a system will go a
long way in making this technology come within reach of a majority of our
population.

Another major drawback with the current Indian scenario is the lack of
robotic surgery fellowships in India. With increasing number of centres
attaining competence in performing surgeries, it is expected that a number
of them shall make the logical transition of imparting Robotic training
also.

Conclusion

India today, is gaining momentum in the process of becoming a very
competent Robotic Surgery destination. Our costs still remain lower than
most western counterparts while our skills match up to the world’s
standards.

Steve Jobs famously said at the inauguration ceremony of the Macintosh
– “Everyone here has the sense that right now is one of those moments when
we are influencing the future”. Witnessing and actively participating in
the rapid growth and spread of Robotic technology in India, one cannot help
having the same sense of shaping the future of health delivery in India

References

1. Nguyen MM, Das S. The evolution of robotic urological surgery. Urol
Clin North Am. 2004 Nov; 31(4):653–8. vii. Review. [PubMed
< http://www.ncbi.nlm.nih.gov/pubmed/15474592 >]
2. 5. Carpentier A, Loulmet D, Aupecle B, Berrebi A, Relland J. Computer
Assisted cardiac surgery. Lancet.1999; 353:379–80. [PubMed
< http://www.ncbi.nlm.nih.gov/pubmed/9950451 >]
3. Cathelineau X, Rozet F, Vallancien G. Robotic radical prostatectomy:
The European experience. Urol Clin North Am. 2004 Nov;31 (4):693–9.
4. Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO, et
al. Laparoscopic and robot assisted Radical prostatectomy: Establishment of
a structured program and preliminary analysis of outcomes.J Urol.
2002;168:945–9.
5. Dogra PN, Current status of Robotic surgery in India. JIMSA
July-September 2012 Vol. 25 No. 3; 145
6. www.modernhealthcare.com/article/20140419/magazine/304199985
7. Morgan JA, Thornton BA, Peacock JC, Hollingsworth KW, Smith CR, Oz
MC, et al. Does robotic technology make minimally invasive cardiac surgery
too expensive? A hospital cost analysis of robotic and conventional
techniques. J Card Surg. 2005;20:246–51.
8. Girish G. Nelivigi, Robotic surgery: India is not ready yet. Indian J
Urol. 2007 JulSep; 23(3): 240–244. doi:10.4103/09701591.33443

1. Vipul Patel, Robotic surgery: India is not ready yet. J Urol. 2007
JulSep;23(3): 244–245.
2. Jain S, Gautam G. Robotics in urologic oncology. J Minim Access Surg.
2015 JanMar;11(1): 40–44.

What (VSD) Ventricular Septal Defect is in Health

Ventricular septal defect is a hole between the pumping chambers of the heart. Traditionally this has been closed by open heart surgery, which involves opening of the chest, by-pass-machine and closing the hole surgically. The last 10 years there has been a tremendous development in treatment of this condition where we have started closing the hole by pin-hole technique [angiogram] without any scar in the chest. However a particular type of VSD- Subarterial VSD, a hole just below the main valves of the heart has to be closed by surgery only. This article unfolds the story where we have closed such hole without surgery.

A twelve year old girl had a congenital heart problem. She was detected to have sub arterial ventricular septal defect as early as two years of age. The doctors had advised her for surgery as the hole was very close to the valves and can damage the valves.The parents were scared of surgery as it can cause a scar and also the risk of the by-pass procedure. They postponed the surgery till they heard about us when the child was 14 years of age. By this time the hole has damaged the valve mildly.

They came to Apollo Children’s Hospital for opinion in September 2014. After the initial assessment we felt that we can close the hole by pin-hole technique avoiding surgery. After explaining this to the family we took the child for the procedure. The procedure was done under local anaesthesia. It took us half an hour for the procedure. The hole was successfully closed by VSD Device by transcatheter technique and she was discharged from the hospital on the very next day.The family was ecstatic, as their14-year mental burden had come to end. During one year follow up, she was doing fine, there was no residual leak and there was no problem in aortic and pulmonary valve. This single day procedure helped her to avoid a cardio-pulmonary bypass surgery, lifelong scar on the chest and 5-6 days hospital stay following surgery.

This is not only the story. Transcatheter closure of VSD is being successfully done for more than two decades. Long term follow up studies have shown that transcatheter closure of Ventricular Septal Defect (VSD) is a feasible alternative of surgery.Traditionally, surgery is the treatment of choice for VSD. But, it does have some potential risks of complications, including complete heart block, significant residual VSD, the necessity for re-operationand even death. Furthermore, infections, tachyarrhythmias, and neurological complications may occur after surgery. After successful surgical management, surgical scar will persist lifelong. Keeping these in mind, transcatheter closure of VSD is an acceptable alternative and effective mode of treatment.

In Apollo Children’s Hospital transcatheter closure of VSD was successfully done for more than 300 children over last 5 years with very less incidence of complication. More than 50% of the small to moderate sized VSDs can be closed by transcatheter technique. Experience of the operator, proper patient selection and proper planning are the key of success in this technique

Keep Tobechukwu’s Hope Alive

Recently we brought you the story of a
certain Tobechukwu Nkwocha, a little boy with a cancerous left eyeball; after the intervention of Mrs Adaugo’s Hope Alive Child Care Initiatives, the boy seemed to have found life, succor and a last gasp lifeline. Little did we know that further negligence on the part of our Nigerian doctors can ruin the hopes…

Tobechukwu was on drip few days ago and was left unattended to when he exhausted the drip, his ailing blood replaced the drip since there was no nurse to remove the pin from his skin, the little boy’s blood flooded the bed until until his father woke up. How many of this negligence story do we talk about? I met Tobechukwu once and despite the eye challenge, the boy was full of life, he looked healthy and was primed to make it, but the young chap slipped into coma since Sunday and is yet to snap out.

Mrs Adaugo Nwalema, President of HACCI has been torn apart in anguish over the boy’s situation and is no longer willing to take chances, she’s ready to fly the boy for treatment and needs partners all around. We need Oncologists to give us proper diagnosis of why the boy hasn’t snapped out of coma after four days.

Apollo hospital... Keeping hopes alive

Apollo hospital... Keeping hopes alive

The moving train of Apollo Hospital's health support in Nigeria stopped by at the Hope Alive Child Care Initiative center on the 10th of December 2015, HACCI is a child care initiative, founded for the good of children across the land, since Apollo is about restoring hopes and sound health, it was another opportunity for them to continue their good works in partnership with HACCI.
However, it's quite difficult to sustain the achievements of HACCI without a reputable international hospital offering backings; that is where the first hospital with international accreditation in A.P, Apollo Hospitals came in. With Rakesh Jalla, Dy. General Manager, International Marketing (Nigeria) in attendance, HACCI and Apollo Hospitals took on the case of a young boy (pic below) of about three years suffering from cancer of the eyes.
The case started five months ago when the mother (pictured below) noticed a blood stain in the boy's left eyeball, back and forth trips to the hospital only generated referrals and little hopes until HACCI and Apollo Hospitals teamed up to render assistance to the boy. While speaking to newsmen, the confident Rakesh Jalla explained in detail how Apollo Hospitals analyzed the condition and placed him on an effective schedule of MRI scan ahead of surgery which is estimated at about $12,000.
A cheque was presented to the boy's parents for the scan with assurance of smooth medical service for the boy by Apollo Hospitals. Mr Rakesh Jalla stressed that this is not the first time Apollo Hospitals is coming to the aid of Nigerians and he assured it certainly will not be the last.
Cancer, neurological diseases can be treated in Nigeria
Experts from Apollo hospital, India have said that Nigerians no longer have to travel abroad for the diagnosis and management of cancer and neurological disorders as these services are now available in the country.
The Head Manager, Health Care Services International, Apollo Hospitals, India, Abubakkar Siddique, said this at 2-day free medical camp organised by the hospital in collaboration with the Capitol Hill Hospital, Warri, Delta State.
According to Siddique, the Indian hospital would be collaborating with local hospitals to facilitate proper diagnosis of cancer and other neurological disorders.
He noted that the group had 64 hospitals across India and four in other countries and would be bringing its rich expertise and resources to Nigerian hospitals.
Siddique stated,“ Our doctors from Apollo hospitals are poised to take Nigerian hospitals to greater medical heights especially in the area of continuous medical education and the provision of tele- health services, training and development programmes”.
The Chairman, Delta State Chapter of Association of General and Private Medical Practitioners in Nigeria, Dr. LuckysOkparanyote, stated that prompt diagnosis of cancer and access to specialists could reduce the number of Nigerian patients dying of cancer.
Okparanyote identified ignorance and poverty as factors militating against early detection and treatment of cancer and called on government to support affected patients.
Medical experts from Apollo hospitals who offered free medical consultation programme included Prof. Krishna K.N, a Neuroscience Consultant and Dr. Anil Kameth, Senior Consultant/Surgical Oncologist