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Dr.APJ. Abdul Kalam's address and interaction with the faculty, doctors, nurses, nursing students, para-medical personnel of Kerala Institute of Medical Sciences
Thu 4th March 2010
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| "Patient, doctor and staff friendly Hospital". |
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Dear friends, my greetings to all of you. When I am with you, I would like to talk on the topic “Patient, doctor and staff friendly Hospital”. I am delighted to know that the mission of Kerala Institute of Medical Sciences is “Care with courtesy, compassion and competence”. With this motto, the institute has been treating over 70,000 patients per year. The work done by the institute in the area of health tourism, centre for drug trials, and pollution control through waste management is noteworthy. I am impressed with the task of travel medicine clinic which has been created for helping travelers to make well informed and cost effective choices for travel. I congratulate the pioneers both present and past who have created a robust medicare system during the last nine years.
Delivery of health care in a large country like ours has unique challenges. Care has to be provided to all in the region, not only those in metropolitan areas, but also to rural people. Getting specialists routinely may not be easy. Primary healthcare, secondary healthcare and tertiary healthcare have to work in unison. Fortunately in this modern electronically connected era, practicing doctors and other health care professionals have access to latest information through literature and consultancy. The development of telehealth systems will be important to support health centres in remote locations and to deliver continuing education programs to them. From your side as an institute, you may consolidate periodically the most prevalent and unique disease patterns in your region, your experience of life style and other characteristics and practical approaches to treatment. This can lead to special treatment schemes appropriate to the region which you can beexecuted through mobile health clinic deploy for the entire Thiruvananthapurm district.
When I see you all here at KIMS, I am visualizing how hospital’s image influences the patients.
“Hospital has to be angelic by look and gives the confidence to the patient that “I will be cured”. Smiling doctors, smiling nurses, smiling paramedics and smiling staff, and the beautiful environment of the building together bring cheerfulness and hope to the patients.” What is the one quality that you need to possess as healers? That is medicine with compassion. |
| Six virtues a care giver must possess |
Friends, I would like to share an experience with Choakyi Nyima Rinpoche, the Chief Monk in Kathmandu and a medical researcher. After nearly a kilometer of walk, I reached the white Kumbha where the chief Monk and his disciples were waiting to receive me. After reception the Chief Monk said, let us go to our study room and I followed him. He climbed the first floor, the second floor, the third floor, the four floor and the fifth floor, just like a young boy. Probably the life style has a positive impact on the mind and body. All along I was following and following. When I reached his chamber, I saw a laboratory and a spiritual environment over looking the Himalayas. What surprised me was, his research students come from different parts of the world. Particularly he introduced me to his co-author David R Shlim, MD who is working on a research area, Medicine and Compassion. The Chief Monk Choakyi Nyima Rinpoche and myself exchanged few books. The Monk has written with Dr. David R. Shlim a book titled “Medicine and Compassion”. I liked this book and read it during my journey from Kathmandu to Delhi. This book gives six important virtues which a medical practitioner has to possess towards their patients.
First virtue is generosity; the second virtue is pure ethics; third is tolerance, fourth is perseverance, fifth is cultivating pure concentration and the sixth virtue is to be intelligent. These virtues will empower the care givers with a humane heart. I am sure, doctors, nurses and para-medical staff will be continue to acquire human virtue that will reinforce confidence on the healthcare system.
Since I am in the environment of multispecialty hospital, I would like to share some thoughts on interventional cardiology. |
| Growth of Interventional Cardiology |
| When I think of interventional cardiology, I am reminded of Werner Forssman, a resident surgeon who catheterized his right atrium, from the antecubital vein, a landmark had been made to unravel the mysteries of heart and circulation in 1929. Since then, the coronary heart diseases had found many solutions through coronary arteriography, coronary artery bypass surgery, robotic surgery and coronary balloon angioplasty. Later, stents (metal scaffoldings) were developed to keep the balloon-opened coronary arteries by providing support to the coronary artery from within. This dramatically improved the safety and efficacy of coronary angioplasty. The drug-eluting stents, the second generation stents, have drug coating embedded on its surface for slow local release, so as to prevent unwanted tissue growth encroaching into the stent lumen thus significantly reducing re-stenosis of these stented coronary arteries. This ensured long-term efficacy of coronary angioplasty. However, as you can see, none of these procedures could recreate the permanently damaged heart muscle or the damaged blood vessels. Attention has now been focused to tissue regeneration, be it cardiac muscle or cardiac blood vessel. Stem cell therapy has come in for this type of problem. |
| Need for basic research and environmental upgradation |
Few points, different from normal thinking, I have come across from my cardiac friends which I would like to share with you.
a. The medical research is undertaken predominantly by medical devices and pharmaceutical companies. There is a need for reporting the results of negative studies in scientific journals. This will make the practitioners of medicine to take a well informed decision.
b. Every industry spends significant amount for preventing accidents and building in reliability. Similarly the medical and health care institutions should also spend significant amount on research for preventing accidents and in building reliability in medical devices and treatment. There is a need for conducting enhanced research to prevent disease and search for curative solutions in addition to allocations for carrying out research on interventions. Medicine today needs a paradigm shift.
c. Twenty years back the inventor of Kidney dialysis called it as the second best option. According to him the best option was prevention of kidney diseases. It is truer in case of cardiovascular disease also.
d. The amount of resources allocated to research for curative medicine and launching of preventive programs at the community level are very much limited. Whereas degradation of environment is taking place very fast because of urbanization, industrialization and fast pacing of life. Infusion of right kind of money and altruistic professionals can only bring the normal health to people.
Now I would like to present the findings of a research study jointly conducted by DRDO (Defence Research and Development Organisation) and Global Hospital, Mount Abu on lifestyle intervention on cardiac patients. I was participating in this programme. We found that Apart from mind-body-social synergy to attain good health, we need to add the fourth dimension, that of spiritual health. |
| DRDO - Global Hospital Initiative |
| Keeping this in mind the DRDO took the initiative of formulating a project in collaboration with the Global Hospital and Research Centre, Mount Abu an institution of the Brahma Kumaris. They added a spiritual environment to take care of total heart health. In addition, this project involved a partnership from many hospitals and research institutions spread in different parts of the country, wherein cardiologists, endocrinologists, physiologists, fitness experts and spiritualists worked hand-in-hand for more than ten years to understand if this integrated mechanism can provide an antidote to the expanding global heart problem. |
| Study Design |
| This hypothesis was tested in more than five hundred and eighteen patients, who had angio-graphically proven coronary artery disease. Two trials were carried out, Mount Abu Open Heart Trial in which patients served as their own controls and Abu Healthy Heart Trial in which hundred and twelve patients received a healthy life style, whereas hundred and five patients served as control and did not receive the healthy life style intervention. In fact, the control group was also prescribed the same diet and exercise but was not given instructions on meditation. Most of these patients had advanced coronary artery disease involving all three heart arteries and had coronary artery intervention. These patients were tracked over a period of ten years by the Global Hospital and DIPAS. I had an opportunity to be with the research group for 5 times during the review process of patients (Dilwallahs). |
| Life Style Intervention |
| The life style given to these patients was very simple and elegant. In fact, they received a traditional Indian diet having lots of fiber, fruits and sprouts which I understand was a staple diet of every Indian family about five decades ago. The exercise given was simple; a brisk walk both in the morning and evening hours (5 km in one hour). The major component of the intervention was stress management through meditation. The three dimensional preventive methods heart is: (1) high fibrous vegetarian diet (2) aerobic exercises – 30 to 60 minutes (3) meditation, apart from meeting the medicinal requirement and progressive reduction based on periodic tests. The main efforts were to empower patients with information and education on heart disease and how they themselves can control or reverse it. |
| Angiographic Evaluation |
Angiographies were coded and analyzed by a panel of independent angiographers. The outcome appears to be quite rewarding. Like any medical treatment, a visibly marked improvement in cardiac health of these patients could be seen within seven days of the commencement of the intervention. Their requirement of drugs prescribed by their cardiologists decreased markedly. The symptoms of chest pain and uneasiness reduced. Their capacity to exercise improved dramatically. After six months of intervention, some of the patients were even able to take to swimming. The so-called bad cholesterol, stress hormones profile reduced. The psychological or mental health showed considerable improvement. The heartbeat became very rhythmic and natural. The brain waves especially the Alpha wave, which I understand is an indicator of mental tranquility increased dramatically. In fact, the increased Alpha waves could be recorded both during eye closed and eye open conditions, suggesting that while they were doing their routine work mental tranquility was well maintained.
When their angiographies were repeated the control group showed an increase in artery blockage whereas the group, which received life style intervention, showed a substantial decrease in artery blockage. Thus, this experiment clearly gives us ample evidence to confirm the hypothesis about the efficacy of lifestyle intervention in promoting sustainable healthy hearts. I am happy to know that over 2500 doctors and over 5000 teachers from different parts of the country and abroad have been trained on three dimensional approach to heart care. Also, the treatment has been accepted by hospitals like CARE Hospital - Hyderabad, Medwin Hospital, and Government Hospital – Raipur for application among their patients. KIMS may like to introduce such three dimensional lifestyle interventional programme as part of the treatment regime for heart patients. Let us now take one example of treatment pattern based on special gene study. |
| Special gene in Indian population |
| I came across a report which has been published in the Nature Genetics Journal about the findings of a typical gene called MYBPC3 or Myosin Binding Protein C which is present in over 50.5 million Indians. This gene is said to be responsible for the occurrence of heart attack among the Indian population when they reached around 45 years of age. This important finding has come from Dr. Kumarasamy Thangaraj of Centre for Cellular and Molecular Biology, Hyderabad. Based on this finding, the heart care experts should discuss the possibility of screening of this gene among members of the families which have heart patients. The family members who have been found to have this gene can be asked to follow a strict vegetarian diet schedule along with aerobic exercises and meditation. A healthy life style change can make a good impact on the heart.
An important challenge for hospitals is to prevent the occurrence of hospital induced infections and diseases.
Bio-decontamination movement
Last year, I participated in the Scientific Symposia on Bio-Decontamination organized by KLENZAIDS at Chennai, where Dr. Mohan Nair has suggested a table of action for preventing healthcare related infections. He also suggested that as the body fluids and perspiration of the patients settle on the fabric used in the hospital, it is necessary to turn the fabric into an active anti-microbial or anti-viral material. This is an important research and development task for the scientific community. Also, it has been reported that the air-conditioning systems in many hospital do not have provision for completely destroying the bacteria and viruses in the circulating air. Since it is a new hospital, I would suggest the hospital authorities to test the air-conditioning system in the entire hospital for this important capability which will reduce the possibility of hospital induced infections. |
| My visualization of Quality Hospital |
Dear friends, I am visualize a quality hospital with the following characteristics:
1. Patient is heard everywhere. All the doctors, nurses and paramedical staff feel that they are contributing in the great mission of removing pain. Whenever required, a group of multi specialists see the patient and arrive at a treatment regime with speed.
2. The hospital consumes less electricity and less water by adopting green building for all modernization tasks.
3. The hospital premises are totally noise free.
4. All the test reports and treatment schedule get attached to the data base of the patient through Electronic Medical Record without the need of the patient or the relatives to search for the reports. The data-base is updated and authenticated every hour.
5. Maintains the data-base of all the cases treated by the hospital in the past and easily retrievable.
6. Patient is not subjected to diagnostic pain.
7. The surroundings of the hospital is green with full of trees with seasonal flowers.
8. Further expansion of the hospital is in vertical mode leading to fast movement of the patient and doctors for medical treatment.
9. There is no case of hospital induced infection to the patients.
10. The patients feel that this is the best place get treated.
11. The hospital is fully IT enabled leading to virtual connectivity of the patient to the doctor, nurse and the chief of the hospital 24x7. Hospital is also networked with other hospitals nationally and internationally for seeking expert medical advice on unique cases.
12. The daily medical conference, attended by the Chief of the hospital, doctors, nurses, paramedics, and relatives of patients of unique cases, reviews problems of the patient and find integrated solutions. |
| What you would like to be remembered for? |
| Each one of you can contribute uniquely to bring quality healthcare to needy people. You may take a note book and write down an answer to the question “what I would like to be remembered for?
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| Conclusion |
There was a meeting of cured patients, their doctors and a few social workers in a hospital. One important point emerged during the interaction was, that the relationship between the patient, doctor, nurses and paramedics 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, nurses, paramedics and patients is very valuable. I request every one of you to become a teacher for the families of patients. For reaching the unreached in distant locations – I would suggest creation of tele-medicine facility through satellite connectivity by KIMS specially since you are located in the midst of space research organization.
My greetings and best wishes to all the members of Kerala Institute of Medical Sciences for success in their mission of providing quality healthcare to every needy person at an affordable cost.
May God bless you.
I would like to administer an oath. |
| Oath for medical professionals |
I love my medical profession a noble mission.
2. I will follow the motto “Let my care, remove the pain and bring smiles”.
3. I will always radiate cheer to give confidence to patients and their families.
4. I will be a life long learner, I will practice what I learn and I will train my team to be competent.
5. I will deliver quality care with high standards irrespective of whom I am treating.
6. I will not introduce any diagnostic pain.
7. If any patient is unhappy with my treatment, I will find out the causes and treat the patient with utmost care, free of cost.
8. I will work with integrity and succeed with integrity. |
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