On May 1, 2019, I began a journey that I could not have anticipated would change the way I see myself as a writer. It was not born of ambition or grand design but of inspiration. Gopi Reddy and his wife, Tanya, nudged me toward blogging as a form of expression. Tanya...
Take the Bull by the Horns
Take the Bull by the Horns
I am a mechanical engineer who worked for 15 years at the Defence Research & Development Laboratory (DRDL) in Hyderabad. There, I developed the Trishul and Akash missile airframes and Titanium Airbottles. In 1992, Dr APJ Abdul Kalam, then Chief of the Defence Research & Development Organization (DRDO), decided to develop civilian spinoffs of defence technology. I came out of the mainstream to interact with doctors and learn from them to indigenously develop medical materials and devices as affordable import substitutes.
The success of developing a unique variety of 316L stainless steel led to the development of an indigenous coronary stent that became famous as the Kalam-Raju Stent. Cardiologist Dr B. Soma Raju, who guided this effort, invited me to leave the confines of defence research and development. We created the Cardiac Research and Education (CARE) Foundation, a biomedical research platform recognised by the Department of Scientific and Industrial Research (DSIR), Government of India.
The importance of indigenous development cannot be overstated. Innovation—a new method, idea, or product—is at the root of creation. Innovation involves creative brilliance and a particular type of people who think differently from the typical and conditioned ways of life. Using the vast infrastructure of defence R&D for civilian spinoffs was a historical innovation. We were driven to address the cost prohibitiveness, and our little initiative prepared the ground for many multinationals to open their factories in India.
By the turn of the new millennium, I found myself stranded, working with doctors and with little government support forthcoming. The advent of broadband connectivity saved the day for me, and we remained relevant by developing teleradiology, which became the basis of the Pan-Africa e-Network launched by the Government of India to connect African hospitals and universities with their Indian counterparts. The concept of delivering medical images directly from where they are generated to expert radiologists at their locations addressed the issue of a shortage of radiologists in the country. For a while, radiology became the most sought-after medical speciality, but as imaging machines became intelligent, the role of radiologists was reduced to verification.
Then came the era of generative AI, and machines started learning from radiologists’ work. Major equipment manufacturers integrated machine learning features into their machines, enabling imaging machines like CT and MRI to instantly identify patients’ apparent health issues. Today, machines can deliver highly accurate results, not only in imaging but also in laboratory tests. Blood is still needed, but in minimal quality—a drop rather than a vial—and soon, even that may be replaced by non-invasive methods.
Saying that COVID-19 was a watershed moment in modern times may sound like a cliché, but the fact remains that it has changed the way the world works. The way in which primary healthcare was abandoned during that period and private hospitals made money, is an embarrassing testimony to the fact that healthcare has become a commercial business. The medical profession has almost destroyed itself, being controlled by big money; most hospitals function with profit-making policies and how things will change is unclear.
So, the focus shifts back to innovation; its purpose is now redefined as delivery rather than mere availability. How do we take intelligent machines to needy people? They cannot access expensive hospitals because of a lack of money, nor are they always welcomed, as their presence is often viewed as spoiling these hospitals’ clean, polished ambiences that outshine even five-star hotels. This situation is untenable and, unless corrected, will lead to another healthcare crisis sooner rather than later.
Over a decade ago, I met Dr Bharat Veeramachaneni, an Internal Medicine specialist. The grandson of legendary leader Smt. N.P. Jhanshi Lakshmi (1941–2011), Dr Bharat is conscious of his responsibility towards primary healthcare. We create unsolvable issues for ourselves if we neglect to serve the poor and fail to address their issues. Once a pathogen develops anywhere, it becomes impossible to stop it. Today, the biggest problem is the need for more doctors in primary healthcare settings. Before the NEET system, state governments used to deploy doctors to work in such settings before granting them a PG seat, but now, no one goes there. What is the remedy?
I shared the famous story of Belling the Cat with Dr Bharat. In it, a group of mice agrees to attach a bell to a cat’s neck to warn them of its approach in the future, but they need help finding a volunteer to do the job. Technology, funds, and people are available; political will needs to be improved. I asked Dr Bharat if he would bell the cat. He surprised me by saying, “The time to bell the cat has long since elapsed. Our inability to mount a combined and concentrated effort, which included the screening and triage of patients at the primary healthcare level, adversely impacted and overwhelmed our secondary and tertiary healthcare response to the COVID pandemic, causing morbidity and mortality on an unprecedented scale. It is time to deal decisively with a difficult or dangerous situation or live burdened with chronic diseases.”
The productivity of a nation directly depends on the health of the country. With the existing secondary and tertiary healthcare infrastructure, which has neither the required manpower nor the physical reach, it is impossible to cater to the healthcare needs of 1.42 billion Indians. This challenge is compounded by the financial burden of accessing secondary and tertiary care centres for health issues that can often be managed at the primary healthcare level at a fraction of the cost. The responsibility for healthcare delivery cannot rest solely with corporate hospitals and private health insurers, who would manage it for their profits, which is a no-brainer.
There is an urgent need to develop a robust primary healthcare infrastructure: a formidable force of specialists fully vested with knowledge, power, and authority tasked with protecting our nation’s health. Further strengthening our primary healthcare with government policies and new-age tools such as AI would help improve surveillance, delivery and service efficiency and provide an opportunity to educate people on maintaining good health and preventing diseases. AI can bridge the six cardinal information gaps in receiving treatment in the hospital – first contact, longitudinality, comprehensiveness, coordination, person or family-centeredness, and community orientation.
Yes, the time to bell the cat has long since elapsed. The bull is running amok in the shop of fragile glassware, and the only way to prevent further damage and destruction is to take the bull by the horns, wrest control of our great nation’s health from the clutches of private and for-profit players and place it firmly back in the hands of capable, empowered primary healthcare providers. The question is not who will allow it but who will stop it. Life is all about taking the right actions at the right time.
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