Sunday February 18, 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.

  • 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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Study: Partial Dose of Yellow Fever Vaccine Provides Protection

A full dose of yellow fever vaccine provides lifelong immunity. Researchers will continue to study how long people who received partial doses are protected

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Yellow fever is a mosquito-borne viral disease found in tropical Africa and South and Central America. Wikimedia Commons
Yellow fever is a mosquito-borne viral disease found in tropical Africa and South and Central America. Wikimedia Commons
  • Yellow fever is a mosquito-borne viral disease
  • Severe cases can cause jaundice and death, but most cases involve fever, muscle pain and vomiting
  • More than 350 people have become infected with yellow fever in Brazil since late last year

When stockpiles of yellow fever vaccine run low, partial doses are effective, according to a new study.

The report on the vaccine, which currently is in short supply, comes as officials in Brazil attempt to contain an outbreak with what they describe as the largest-ever mass vaccination campaign using partial doses.

Yellow fever is a mosquito-borne viral disease found in tropical Africa and South and Central America. Severe cases can cause jaundice and death, but most cases involve fever, muscle pain and vomiting.

Also Read: Tips That Will Help In Recovery From Surgery

Congo outbreak, experiment

During a major outbreak in the Democratic Republic of the Congo in 2016, the government aimed to prevent the disease from spreading in the capital, Kinshasa. Health officials launched a mass vaccination campaign targeting 7.6 million people.

But the outbreak had depleted vaccine stockpiles. Hoping to stretch the available supply, the World Health Organization reviewed the small number of available studies on using reduced doses and recommended using one-fifth of a dose per person.

It seemed to work.

Health officials have launched a campaign targeting nearly 24 million people with a one-fifth dose of the vaccine. Wikimedia Commons
Health officials have launched a campaign targeting nearly 24 million people with a one-fifth dose of the vaccine. Wikimedia Commons

Researchers took blood samples from more than 700 people before and after they received the partial dose. In the new study, published in the New England Journal of Medicine, nearly all of those vaccinated with the lower dose developed enough antibodies to the virus to prevent infection.

“That was the encouraging thing, that this can be done as a potential way — when there’s supply limitations on the vaccine — to help potentially control an outbreak,” said study co-author Erin Staples at the U.S. Centers for Disease Control and Prevention.

Hundreds infected

More than 350 people have become infected with yellow fever in Brazil since late last year, and health officials have launched a campaign targeting nearly 24 million people with a one-fifth dose of the vaccine.

Also Read: A spurt in Unneeded Medical Interventions for Healthy Pregnant Women: WHO Study

Staples says the new study is good news for controlling outbreaks like Brazil’s in the short term. But, she notes, “We still need some information about how long immunity will last.”

A full dose of yellow fever vaccine provides lifelong immunity. Researchers will continue to study how long people who received partial doses are protected. (VOA)