Saturday June 23, 2018

ICU Care from far: How India is solving its problem of doctors shortage

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Doctors remotely monitor live footages of patients inside an electronic intensive care unit (eICU) at Fortis hospital in New Delhi, India, January 20, 2016. REUTERS/Adnan Abidi
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A doctor remotely monitors live footage of patients inside an electronic intensive care unit (eICU) at Fortis hospital in New Delhi, India, January 20, 2016. Picture taken January 20, 2016. REUTERS/Adnan Abidi
A doctor remotely monitors live footage of patients inside an electronic intensive care unit (eICU) at Fortis hospital in New Delhi, India, January 20, 2016. Picture taken January 20, 2016. REUTERS/Adnan Abidi

By Aditya Kalra

NEW DELHI (Reuters) – A doctor at a hospital in India’s capital, New Delhi, was recently tracking a wall of monitors displaying the vital signs of intensive care patients admitted hundreds of miles away when red-and-yellow alerts rang out.

The oxygen flow to a 67-year-old patient had stopped when no critical care doctors were present in a hospital in the northern city of Amritsar.

But the doctor in the New Delhi centre run by Fortis Healthcare quickly issued a set of instructions and stopped the patient from suffering brain damage or death, the Indian hospital chain said in an account of the episode.

India’s top private hospitals, seizing on a shortage of critical-care doctors, are expanding into the remote management of intensive care units around the country and, starting this month, in neighbouring Bangladesh too.

India has seven doctors for every 10,000 people, half the global average, according to the World Health Organization. Data from the Indian Medical Association shows the country needs more than 50,000 critical care specialists but has just 8,350.

Such a shortage of doctors means small facilities in India’s $55 billion private hospital market are ill equipped to provide critical care even as numbers seeking private healthcare rise because the public health system is in even worse shape.

India’s largest healthcare chain, Apollo Hospitals Enterprise, and Fortis will this year expand their network of electronic intensive care units (eICUs), scaling up operations thanks to advances in communications technology.

“We want to leverage (doctors) using technology,” said K. Hari Prasad, head of hospitals business at Apollo that employs more than 700 critical care doctors.

Apollo, which monitors 200 patients in six states from its only eICU in Hyderabad city, will open three new centres to track 1,000 more patients. Prasad said he is also in talks to extend the service to government hospitals.

Fortis will start remote monitoring of intensive care patients in the Bangladeshi city of Khulna this week, its first such cross-border operation. The hospital chain tracks 350 patients from its New Delhi centre but will start two more eICUs by mid-2017.

Jayant Singh, director of healthcare at Frost & Sullivan India, a consultancy, estimates that eICUs are boosting industry revenues by $220 million a year by giving smaller hospitals the ability to treat critical patients at the hands of top-flight intensive-care specialists, even if they are in another city.

India’s eICU beds will expand by 15-20 percent each year from about 3,000 now, Singh said.

SAVING LIVES

With multiple computer screens inside these high-tech eICUs, doctors suggest treatment procedures after assessing medical history and real-time heart rate charts of patients fighting for their lives in distant facilities.

Doctors recently saved a 30-year-old pregnant woman in a hospital in the southern city of Warangal after her heart stopped beating, assisting a resident doctor not specialised in intensive care to carry out chest compressions through a video link.

“We save about 25 lives a month,” said Shamit Gupta, medical director at Fortis’ eICU unit.

Hospitals charge between $10 and $30 a day to virtually monitor a patient from their eICUs, with revenues shared between hospitals and companies such as General Electric and Philips that have developed the tracking software.

That comes on top of standard critical care costs of about $200 a day in a small city hospital.

At that price, eICUs do little to address concerns of millions of India’s poor patients who often share beds or wait for days to gain admission to a public hospital.

“This technology basically is not bridging the gap between the poor and the rich, but increasing access to specialized healthcare for those who can afford it,” Frost & Sullivan’s Singh said.

(Reporting by Aditya Kalra; Editing by Sanjeev Miglani, Robert Birsel)

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  • Rakesh Manchanda

    Indian doctors in lobby with politicians have insulated themselves with conflict of interest.They need to be courageous to help break this deadlock and seek solutions while inviting health awareness groups to connect to humanity is spite of Rich-Poor patient divide.

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  • Rakesh Manchanda

    Indian doctors in lobby with politicians have insulated themselves with conflict of interest.They need to be courageous to help break this deadlock and seek solutions while inviting health awareness groups to connect to humanity is spite of Rich-Poor patient divide.

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Across Asia’s Borders, Survivors Of Human Trafficking, Dial in for Justice

The trial has been ongoing since 2013

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Tara Khokon Miya is seen in her village home in Shipur, Bangladesh, Feb. 26, 2018. She is helping to prepare her 27-year-old daughter to testify via videoconferencing technology against the men who trafficked her to India.
Tara Khokon Miya is seen in her village home in Shipur, Bangladesh, Feb. 26, 2018. She is helping to prepare her 27-year-old daughter to testify via videoconferencing technology against the men who trafficked her to India. VOA

When Neha Maldar testified against the traffickers who enslaved her as a sex worker in India, she spoke from the safety of her own country, Bangladesh, via videoconferencing, a technology that could revolutionize the pursuit of justice in such cases.

The men in the western city of Mumbai appeared via video link more than 2,000 km (1,243 miles) west of Maldar as she sat in a government office in Jessore, a major regional hub for sex trafficking, 50 km from Bangladesh’s border with India.

“I saw the people who had trafficked me on the screen and I wasn’t scared to identify them,” Maldar, who now runs a beauty parlor from her home near Jessore, told Reuters. “I was determined to see them behind bars.”

“I told them how I was beaten for refusing to work in the brothel in the beginning and how the money I made was taken away,” she said, adding that she had lied to Indian authorities about her situation after being rescued, out of fear.

Thousands of people from Bangladesh and Nepal — mainly poor, rural women

and children — are lured to India each year by traffickers who promise good jobs but sell them into prostitution or domestic servitude, anti-slavery activists say.

Activists hope the safe, convenient technology could boost convictions. A Bangladeshi sex trafficker was jailed for the first time in 2016 on the strength of a victim’s testimony to a court in Mumbai via video link from Dhaka, Bangladesh’s capital.

Convictions for cross-border trafficking in the region are rare as most victims choose not to pursue cases that have traditionally required them to testify in Indian courts, which meant staying in a shelter for the duration of the trial.

“They have always wanted to go back home, to their families,” said Shiny Padiyara, a legal counsel at the Indian charity Rescue Foundation that has facilitated videoconferencing cases and runs shelters for trafficking victims. “And most never return to testify.”

But videoconferencing is making it easier to pursue justice. Survivors have given statements, identified their traffickers, and been cross examined in at least 10 other ongoing international cases in Bangladesh, advocates said.

“Enabling victims to testify via video conference will lead to a possible decrease in acquittal rates for want of prime witnesses,” said Adrian Phillips of Justice and Care, a charity that supports the use of video testimony to help secure justice.

Even then, it is tough. During Maldar’s three-hour deposition, she withstood a tough cross-examination, showed identity documents to prove her age and countered allegations by the defense lawyer that she was lying about her identity.

Students Combat Human Trafficking
Students Combat Human Trafficking, flickr

‘Unpardonable’

Tara Khokon Miya is preparing her 27-year-old daughter to testify against the men who trafficked her to India from Dhaka, where she had been working in a garment factory.

“I almost lost my daughter forever,” she said, sitting in her home in Magura, less than 50 km from Jessore, describing how she disappeared after work and was taken to a brothel in India, and raped and beaten for almost a year before being rescued.

“What the traffickers did to my daughter was unpardonable,” Miya said, wiping her tears. “We seek justice. I nurtured her in my womb and can’t describe what it felt like to not know about her whereabouts.”

The trial has been ongoing since 2013 when the young woman, who declined to be named, was repatriated. The charity Rights Jessore is helping the family through the process, by providing counseling and rehearsing cross-examination.

“The best thing is her father will be by her side when she talks in court,” Miya said, finally breaking into a smile.

India signed a bilateral agreement with Bangladesh in 2015 to ensure faster trafficking investigations and prosecutions, and with Nepal in 2017, and laid down basic procedures to encourage the use of videoconferencing in court proceedings.

“The procedure is very transparent,” said judge K M Mamun Uzzaman at Jessore courthouse, which often converts its conference hall into a courtroom for videoconferencing cases to protect survivors’ privacy.

“I’m usually present and victims are able to testify confidently … it is easy and cost effective for us,” he said. “But the biggest beneficiaries are the survivors.”

Silencing Victims
Silencing Victims, pixabay

The future

Videoconferencing in Bangladesh has been plagued by technical glitches such as power cuts and poor connections.

“Sometimes the internet connection is weak or it gets disconnected during the testimony,” said Binoy Krishna Mallick head of Rights Jessore, a pioneer in using this technology to encourage trafficking survivors to pursue justice. “But these are just teething troubles.”

The bigger challenge, activists say, is to ensure survivors remain committed to the trial despite delays caused by a backlog of cases and witnesses’ failure to appear to testify.

Swati Chauhan, one of the first judges to experiment with video testimony in 2010, is convinced that technology can eliminate many of these hurdles.

Also read: Imagining Panun Kashmir: Dissent And Detente in South Asia

“Victims go through a lot of trauma, so it is natural that they don’t want to confront their trafficker in a court — but that doesn’t mean they don’t want the trafficker to be punished,” she said. “A videoconference requires meticulous planning and it is not easy coordinating between departments and countries. But it is the future for many seeking justice.” (VOA)