President’s address at the Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra
ofile of Medicare
"Let my brain
remove your pain"
I am delighted to address and interact with the Members of
Mahatma Gandhi Institute of Medical Sciences (MGIMS) at Sevagram, Wardha. I congratulate
the students of this Institute for their academic performance and the faculty
members for shaping the young minds. My greetings to the DEAN, Faculty Members,
Students and distinguished guests. During the last four decades, the Institute
has generated more than thousands of medical professionals who are playing a key
role in providing quality Medicare to the needy patients in different parts of
Wardha district and other parts of the country and abroad. Of course, Kasturba
Hospital attached to MGIMS using the best of technology available and care removes
the pain of over 4 lakhs outpatients and nearly 35 thousand inpatients. I am happy
that MGIMS is providing a sound community orientation to the students, working
on reducing maternal mortality ratio in the adopted villages and exploring the
traditional Indian system of medicine. Hence, I would like to present the "Profile
of Medicare".
Dear students, when I see you all, a scene of our country appears
in front of me, which links the doctors and their role in the national mission.
What is that scene? In our country, 700 million people live in 600,000 villages
equivalent to 200,000 panchayats. We have Technology Vision 2020 Document prepared
by TIFAC (Technology Information, Forecasting and Assessment Council), which indicates
about the typical disease pattern which will be faced by the country during the
period now to the year 2020. It is expected that HIV/TB combination, water borne
diseases, cardiac diseases will be the predominant diseases and we have to find
solutions for diagnosing and treatment. Simultaneously, there is a need of medical
scientist to specialize in the field of preventing such diseases. Also there are
challenges for researchers for discovering molecule leading to drugs for various
diseases such as diabetics, cancer, allergic diseases, inflammatory diseases,
and certain type of new pattern of diseases in the tribal sector such as sickle
cell disease. Many of you may take up healthcare practice in various fields and
some of you may opt for research and development. The opportunities for you in
the country will be challenging both in the urban and rural areas. With the development
of electronic connectivity and knowledge connectivity, and the spreading of health
care centres and quality education we should be able to provide quality health
care to our rural citizens. I am sure, many of you will find working in rural
areas really challenging.
First and foremost, I would suggest the students and faculty
members of MGIMS in partnership with the other medical college in the district
to activate all the 27 Primary Health Centres including the 180 sub-centres and
link them with a Tele-medicine network with district hospitals, sub-district hospitals
and rural hospitals and also private sector hospitals. This will bring the best
possibilities in diagnostic and treatment from urban to rural areas of Wardha
district. Another area which is knocking at our doors is preventive healthcare.
Some of you may participate in the research, development and use of vaccines against
HIV, malaria and even against the cardiac diseases. There are several other avenues
such as application of stem cell therapy for many ailments like treatment of heart
failure and diabetics. Students should be aware of such developments taking place
in the country and elsewhere.
Tradition of Research and Vision
Recently, I met Dr. Charles Cummings, of the Johns Hopkins
University Board and his team. I asked him, a question which was in my mind, “Dr
Charles, What made Johns Hopkins a world class medical research institution in
addition to its cherishing societal missions?” His answer was, “it is due to a
great tradition, and it started with a number of visionaries simultaneously with
focused missions and the nature of working together. Medical ethics and value
system in life both dominate in providing day to day happiness to many patients.
The most important aspect is the research, research base and the quantity of clinical
data added everyday. Teaching-research-teaching cycle has become an important
component of quality growth of Johns Hopkins. This tradition continues even now”.
Indeed it is a great message from Dr. Charles. I am sure, MGIMS would like to
imbibe this culture which comes out of research tradition, leading to the results
of the research reaching the people in the form of medi-care, medicines or vaccines.
I recall, one of the leading institutions in Hyderabad L.V. Prasad Eye Institute
has set a tradition of providing quality eye care particularly with social commitment
of 1:1. 1:1 implies one free eye care service for every paid eye care service
provided by the Institute. Also, they have a tradition of excellent research in
Ophthalmology and they are spreading the mission to various parts of the country
particularly their research in stem cell which has led to the restoration of eye
sight to over 300 patients with burn affected eyes.
Health status of India
India has made considerable progress in its health status since
its Independence and particularly during the last fifteen years. At the time of
Independence, the life expectancy of our people was less than thirty years. Between
1991-2006, the life expectancy of our people has gone up from 58 to 64 years,
infant mortality has come down from 87 to 60 per 1000 live births and population
growth rate has decreased from 19 to 14 per thousand. Still, IMR is very high.
We have to bring infant mortality to less than 10 per thousand. I would like to
briefly talk to you on some of the diseases and actions proposed and future need.
Drug for faster cure of tuberculosis
The entire country has been brought under the Revised National
Tuberculosis Control Programme (RNTCP). This will ensure that maximum number of
Tuberculosis cases are detected every year and brought under direct surveillance.
The medical community must ensure that at least 80% success in fully curing the
disease is achieved within the year. If this regime is followed continuously for
over ten years tuberculosis load will come down to less than ten per one lakh
of population. It is essential to work faster on the development and clearance
of new drugs which are in the pipeline. Educational and research institutions
should also participate in this mission.
Our country has also made significant contributions in developing
drugs that are critically required for India. CSIR lab has developed a new therapeutic
molecule for Tuberculosis which has demonstrated the potential to cure TB in around
2 months, as against the standard treatment of 6 to 8 months. After completing
the pre-clinical studies, the molecule transformed into a drug called Sudo-terb
is undergoing clinical trials in humans. This development has been done as a public-private
partnership. It is hoped that the drug will be in the market soon after the clinical
trials. In addition to the above, there is also a need to develop a more effective
vaccine against tuberculosis. The combined action of surveillance, detection and
disciplined treatment have to work together to ensure faster cure of existing
cases.
Malaria
Incidence of Malaria has reduced from 22 lakh to 18 lakh in
the period 1998-2006. However, the death cases has increased from 644 to 943.
I understand that the conventional medicine used for treatment of Malaria namely
Chloroquin has become resistant to Falciparum which causes cerebral Malaria. CEMAP
(Centre for Medicinal and Aromatic Plants, Lucknow) in partnership with a Pharma
company has developed and produced a drug named Arteether from Artemisinin which
has been found to be an effective cure for cerebral Malaria. I understand that
this drug is being exported to over forty countries. Also, Ranbaxy has acquired
a malarial drug molecule and they are progressing towards clinical trials. This
will also be available in the market soon. This will be another important milestone
in the treatment of Malaria.
Over the years, I find that in spite of our efforts there is
no rapid reduction in the occurrence of Malaria cases in the country. We have
not succeeded in creating a vaccine so far for Malaria. However, Italian scientists
have recently found a bacteria that lived symbiotically inside the pest. They
claim that such bacteria could potentially be genetically altered later to attack
the Malaria parasite when it reaches the Mosquitoes. The bacteria is called “Asaia”
which is found throughout the mosquito body. It is said that instead of spraying
chemical and biological pesticides, we could use the symbiotic bacteria that is
passed on and you do not have to spray every year. Now, I would like to present
HIV /AIDS control.
HIV/AIDS Control
The genetic study of HIV / AIDS has enable the researchers
to find that retro virus is RNA based and not DNA based. Most retro viruses have
only three genes, whereas the HIV virus had nine genes, with 9200 base pairs.
With this understanding of the genetic nature, a number of drugs have come in
to control HIV in as it is where it is condition. This intervention extends the
life of HIV affected persons. The typical drug which has been developed and produced
abroad is AZT, based on DNA synthesis. It halts the spread of the disease. Another
medicine found is INDINAVIR with equally good results. A foreign University has
tried a combination of AZT-INDINAVIR and 3TC, for some patients, which gave unique
results fully suppressing the HIV/AIDS virus. Of course research is continuing.
I am sharing this with the young students, to convey that there is a possibility
of controlling HIV and extending the life of patients. However, the cost of the
medicine was so far prohibitive. Indian companies have already brought down the
cost of first line treatment to an AIDS patient from nearly Rs 5 lakhs to Rs 12,000,
per year. Similarly, the cost of second line treatment has also been brought down
through the development of medicines such as Viraday a substitute for Atripla
from Rs 5 lakhs to Rs 4,500/-, per month. Even this reduction does not make the
drug affordable to the common man in our country. Medical community assembled
here apart from making use of these medicines for curing their patients should
also work towards discovering much cheaper medicines for poor patients.
Development of Anti HIV Vaccine
Apart from the HIV control protocol, the most important mission
for the country today has to be the prevention of the spread of HIV further. There
is no other way other than developing and leading to production of an effective
anti-HIV vaccine.
Phase one clinical
trials of an imported Adeno-Associated Virus based HIV vaccine and Modified Vaccinia
Ankara (MVA) based vaccine are taking place in Pune and Chennai respectively.
It is also essential to take up a third fully indigenous anti-HIV programme as
a collaborative work between educational institutions like MGIMS research laboratories
and traditional medicine practitioners. Such an approach will enable higher probability
of availability of a vaccine to control HIV among Indian population within a short
time. I am sure some of the students passing out from MGIMS will participate in
this anti HIV programmes and facilitate its launch in a time bound manner. Nationally,
it is important to realize commercially available HIV vaccine before 2010.
Management of Cardiac Diseases
Multi-dimensional solutions are available for management of
the diseases based on my discussion with experts. The solutions include medicinal
treatment using Statins, which lowers the cholesterol in the blood by reducing
the production of cholesterol by the liver. Statins block the enzyme in the liver
responsible for making excess cholesterol. However one has to be careful about
the side effects and take adequate precautions while treating the patients. The
second is through angiography and angioplasty using stents. I understand that
very soon we may have bio-degradable stents. The next generation stents may be
nano-stents. If the heart blockage is severe, valve defect and death of cells
in the heart due to less blood supply etc. surgical intervention will be necessary
or it may lead to treatment using stem cells.
Non-invasive treatment for Coronary Artery
Disease
Today, I find that cardio vascular treatment moving towards
a totally non-invasive treatment using EXTERNAL COUNTER PULSATION (ECP), a truly
non-operative, non-pharmaceutical, safe and effective treatment which is being
used in many countries. In India also a few centres have come up. This is a ripe
area for research of the faculty members and students of MGIMS. Now, I would like
to discuss promotion of three dimensional life style approach for health-care.
Promotion of 3-D Life Style Approach for Healthcare
Experimental evidence has demonstrated the importance of a
favourable lifestyle for realizing long term disease free life. I happened to
visit a number of hospitals to see the healthcare delivery systems. During my
visit to hospitals, I found that doctors tend to focus their attention on treatment
of body ailments to reverse pathology to physiology. It was realized that the
success rate of such treatment is only partial.
A group of Indian scientists had an opportunity to experiment
the concept of mind-body complex approach for therapy on breast cancer patients,
when the psycho-neuro, immunological axis was demonstrated to significantly influence
the prognosis of these patients. Another experimental evidence of this concept
emerged from a study, we had initiated at the Defence Research and Development
Organization (DRDO) in collaboration with Global Hospital Research Centre at Mount
Abu in Rajasthan, on the regression of Coronary Artery Disease (CAD) through a
3 dimensional life style intervention. It included (a) low fat high fiber diet
(b) regular aerobic exercise of walking and (c) meditation. The study clearly
demonstrated that lifestyle intervention resulted in regression of Coronary Artery
Disease (CAD) as evidenced by the disappearance of plaque in angiograms. Every
individual has an inherent ability of spiritual potential which lies dormant.
If we invoke this potential, we can definitely enhance the process of healing
and improve the quality of life of patients.
Such a three dimensional approach to health care will be a
significant evolution of health care philosophy and can be applicable for the
treatment of diseases including HIV/AIDS, cancer, diabetes and many other chronic
diseases. This life style approach is not only less costly but also provides a
sustainable solution for improving the quality of life of individuals.
Conclusion
Recently, there was a meeting of cured heart patients, their
doctors and a few social workers. One important point emerged during the interaction
was that the relationship between the patient and doctor extends to patients’
family. This in turn, transmits effective messages from one family to another
family on advice to prevent diseases, necessity of periodic checks, the dietary
habits and the need for life style changes including exercise for good health.
Actually, I believe this good contact between the doctor and patients is very
valuable. I request every doctor graduating from MGIMS to play the role of a teacher
in advising every family on disease prevention and methods to lead a healthy life
in addition to his or her regular medical responsibilities. When I am with you
I would like to share an important advice given to Mahatma Gandhi by his mother.
She said "Son, in your entire lifetime if you can save or better someone's
life, your birth as a human being and your life is a success. You have the blessing
of the Almighty God". This message is an important message for all doctors.
If you can remove the pain of one human being a day, I am sure, you will have
the blessings of the Almighty God all the time.
My greetings to all
the members of MGIMS and my best wishes to the students and faculty members of
this institute.
May God bless you.
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YSR/JS
(Release ID :28655)