- 1 year ago
At India Today Conclave South, Dr. Arun N Palaniswami and Ashwani Kumar say that the South Indian region’s strength lies in decades of institution-building, a dense network of medical colleges, and a culture that blends empathy with technology.
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00:00Thank you so much for being here this afternoon as we are slowly coming to the end of the session before lunch.
00:10So I want to start by talking to you about South India's model and how it has been credited with relatively better performance when it comes to education and health.
00:20How do you think this legacy has shaped up in health leadership in the South?
00:25I think there's been a large history of institution building, that you have a large number of institutions which don't just see themselves as transactional, but we're looking at 50, 100 years of leadership.
00:38I, myself, belong to Covey Medical Center and Hospital.
00:42We have now existed over 35 years invested by my investors from the U.S.
00:48We've now grown into a medical college, nursing college, paramedical colleges, and we've gone from 250 bed to 1,000 students.
00:551,600 beds, super speciality, multi-center, quaternary care, what we say.
01:01And we built hub and spoke models to feed this.
01:03So we have a medical college for the poor patients and a well-established center for it.
01:09This multiple institutions have done.
01:11The number one program in Harvard Business School is still Arvindai.
01:16Apollo has, again, followed us.
01:18They were also nationally recognized.
01:20And then you have a large number of institutions, as Savita is here.
01:26They have all been established as almost large, longstanding institutions, and they've been growing and expanding upon that self.
01:33So it is the spirit of competition.
01:35I think that we are building a huge HR capital, which is now translating that into technicologic advancement and the general improvement of care and quality.
01:45I want to come to you, Professor Ashwini, as an educator and vice chancellor.
01:52How do you see medical education in the south, particularly influencing the quality of health care professionals that we are producing?
02:01First of all, I would like to thank for this invitation.
02:05And I bring to all of you and the country the greetings of Dr. N.M. Virayan, the chancellor of CIMATS, who is an institutional builder and an iconic visionary in the field of education and medical care.
02:24So as far as your question is concerned, as has been mentioned by my fellow panelists, the south India, particularly the number of institutions that we see, whether it is in Tamil Nadu or it is in Karnataka or Kerala,
02:45I mean, the saturation of institution, attracting talents from all over the country, I think south India is number one, without any doubt.
02:56Why it is so?
02:57Because of the very quality rooted in the way we conduct education, the way we lay emphasis on innovations, research, and also on clinical care and services that we provide.
03:15And this is a milieu which is very important for sustainability of any educational institution and also giving an affordable and quality care to all the patients across different backgrounds.
03:35We cater to the diversity from the poor to the elite patients with equal care and empathy.
03:42I think that is very important as far as, you know, building these institutions are concerned and attracting the talents from all over the country.
03:53You know, I'm going to talk about that aspect in greater detail.
03:56But before that, I also want to talk about the onset of AI and how technology is really changing the face of health care.
04:04I was talking to Dr. Balal also this morning, asking him the same question that, you know, with the way things are going, how relevant will doctors be in the decades to come?
04:14You know, will robots be performing all the important surgeries?
04:19How do you see that shaping up?
04:21Dr. Arun?
04:22Still, people want personal care.
04:24Right now, what we have is large language models.
04:27They're not able to fully give us, they're as good as the sensor data that's being put in, but they can still only very limited in task.
04:35They may advance, but still you need a human component controlling it, talking to people, convincing them.
04:42See, half the job of the doctor is not just giving patient data, but finding a guide path, what to do with all this information.
04:49Convincing a patient to do surgery when they're very scared of doing surgery.
04:55That the robot still cannot do.
04:58So guiding patients, showing compassion, finding a way for our poor patients, somehow we have to get them therapy.
05:08Finding that clear pathway is still the role of the doctor.
05:11So I may add, we use technology in a big way, use AI as well.
05:21We have robotic surgeries in our hospital.
05:26We, our medical specialists, talk to our engineers in engineering college to write the algorithms.
05:33And for better patient care, we have digital, digitized all our records.
05:40And we can pull out any patient's record any time, whenever the patient visits us again.
05:48And we also have something called three printing of organs.
05:53Actually, this is not about the real organs, but this is for teaching our undergraduates.
05:58By printing very lookalike, mimicking the real organs, rather than depending on cadavours, which is becoming very difficult to obtain now.
06:09So we have state-of-the-art 3D printers, which will print muscles just like looking like actual muscles.
06:19The vessels looking like vessels.
06:21The nerves looking like nerves.
06:22The bones looking like, exactly like bone.
06:26And this is not a single layer.
06:27This is a multi-layered.
06:29So that's the kind of advancement that we are going through to teach our students and, of course, those who come to our institutions to learn as well.
06:40So they get exposed to all these latest technologies.
06:45That's extremely important.
06:47And, you know, again, when you keep talking about how care in the healthcare is so, so important,
06:54and that is something that technology can never take away.
06:56It is about the human touch that is most important.
06:59And like both of you were sharing with me at an earlier point, that as a doctor, as the hospitals and the practices running,
07:08and even in institutions imparting that medical education, this aspect is particularly being entrusted upon.
07:14The NMC is trying to do it, but then it's still the job of institutions.
07:21I run a medical college, and he runs a medical college.
07:24It's still a day in, day out that we must teach our students in multiple ways.
07:29You can't just teach it in a textbook and write an exam.
07:32We have family adoption.
07:33They have to go to villages, see what the real people's problems are.
07:37What is the effect of alcoholism in a family?
07:39You can't really look at that in a textbook, that a student must go see, experience, and develop.
07:47Only then he'll understand how to treat them.
07:51If he doesn't understand human beings, he won't understand how to treat them.
07:55So, we cater to two centers, which are rural centers, with about one lakh population.
08:06And we have mobile hospital clinic, which goes to the population, serves that population right in the villages.
08:15And our public health specialists, our doctors visit there.
08:19And adding to this, how with empathy we take care of our patients, you will be surprised that perhaps CEMETS is the only hospital in the country
08:32which upon admission of a patient credits 5,000 rupees in their account.
08:39Why do we do that?
08:40We do this because if a patient comes in emergency, he's not worried about its diagnostics or money and all that
08:49while the family members are coming to take care of this patient.
08:55So, that's the kind of care.
08:57And we give three meals free as long as the patient is admitted.
09:03Now, how does it serve?
09:05It serves to attract our, you know, it serves to bring in large number of patients every day.
09:14And that helps our students to train better because our young doctors get to see a large number of patients.
09:23They train very well.
09:25And also, at the same time, we help the community.
09:28And many a times, we have waived total expenses of the patients running in LACs.
09:35So, that is the kind of care that we provide perhaps.
09:40This will be a prescription from south to the rest of India.
09:43You know, Dr. Arun, I want to talk about the affordability and accessibility factor in greater detail
09:48because that becomes a huge concern when it comes to quality health care
09:52and reaching out to the common man, the poor people, every small pocket.
09:58And again, to ensure lowering costs through a strong and enduring system of primary, secondary, tertiary health care.
10:06How are you doing your bit on that front?
10:09We're working on two fronts.
10:10One is our large corporate hospital.
10:14That's to develop the latest and the best of care that's no longer available anywhere in the world
10:19and to develop research and giving people the chance that they can survive deadly illnesses,
10:26which they would not have before.
10:27No one should leave, we said it, my father had put it, no one should leave Quimbator for health care.
10:32So, that's the job of our corporate hospital.
10:34The job of our medical college is to make it more affordable.
10:40So, that's our 30-rupee hospital that we have doing a huge number of patients,
10:45huge number of cardiac caths, huge number of operations.
10:49So, those are the jobs to make it more affordable and we cross-subsidize it with student fees.
10:54Now, we use some of the facilities we cannot be duplicated.
10:58For that, we take them to the main center and do it at a subsidized cost.
11:03But we should try not to turn any patient away.
11:06We try to find a patient and we run, right now we're running a new pediatric cardiothoracic program
11:13and we're running a pediatric oncology program.
11:16And we deal with a lot of unaffordable children.
11:19So, we first tell all the patients, please come and then we'll find a way to make it affordable.
11:25See how we can treat you.
11:26And then we can find ways that we can enhance ourselves and give back to the community.
11:34Professor Ashwini, I understand that, you know, Savita has put in these practices like you mentioned
11:40and indeed very thoughtful, indeed something that, you know, is a larger practice in healthcare
11:47would really change the face.
11:48But also to understand the kind of help that you seek from the government, you know,
11:55the inputs that you may have in terms of policy change.
12:00Of course, work is happening on that front.
12:02But how can we fast track to ensure that it is largely reached?
12:08Well, there are already government schemes, central government and states' government schemes,
12:14which are accessible to our patients.
12:18And we do extend those to the patients.
12:22And, for example, insurance and similar schemes of the chief minister scheme, etc., etc.
12:30So, all those facilities are made available to the patients as they come to us.
12:36Besides the investment that we make into making the patient comfortable with full empathy,
12:45and you will be surprised that we make no distinction between rich or poor,
12:54everybody gets the same treatment, same attention.
12:58And interestingly, in our model of Savita, which we would like to share with all of you,
13:04we have integrated clinics, which are patient-centric.
13:10When I say integrated clinic, we have six of them.
13:13The patient comes to the clinic.
13:15He doesn't have to run around, you know, from one department to another.
13:21The doctors move around the patient.
13:23That makes the whole place look much simpler, less chaos, and patient is made very comfortable.
13:37Our BGs, our doctors, specialists, they come to the patient once notified and provide the care.
13:45That's the kind of system we have built in.
13:47I still think the government has a strong role.
13:51We usually, in most countries, I think our chairman put it, the role of education, basic education in health care should be provided by the government.
14:00There are certain things that the hospitals can't do.
14:02At our current earning income, we can't cross-subsidize that much.
14:07So what we really need is a little bit stronger insurance, especially if you were to ask me, especially when it comes to elderly care at an older age.
14:19Buying insurance when you're young from 20 to 60 is fairly easy.
14:22You may or may not need to go to the hospital.
14:25But past 60, you are definitely going to end up in a hospital.
14:29You are going to have a preexisting condition.
14:31So these problems have to be set out at a larger government policy level.
14:35It can't be done by a single hospital or institution.
14:39So there, I think, government has to step in.
14:42Oh, yes, absolutely.
14:43And any specific points that you particularly want to make, being in the system, being in the setup, that you feel that, you know, if health steps in?
14:53Because even when we talk about state-sponsored health cover, and while that access is improved for the poor,
14:59there are still a lot of hospitals who complain of delayed payments, unpaid bills.
15:05And those cases are out there.
15:06So I think that there's going to be a large trial and error.
15:10I think there's multiple systems that work around the world.
15:13U.S. is considered a very expensive, bad model with a lot of people falling through the cracks.
15:18Canada is a little bit better, but they have their own limitation.
15:21One thing is, I find, is the Taiwanese model, which doesn't give you a whole lot of payment,
15:25but almost admin costs are almost 0.1% of the treatment, whereas it focuses more on patient care.
15:33So we are having to go to some sort of cost model.
15:37I think with that, you have to have an efficient payment system, an efficient system for the government to act.
15:45It can't be, okay, I may get 50,000, but I know I'm getting 50,000 rupees on day one.
15:50It can be, I may get one lakh or one crore after one year, two years, question mark.
15:59I don't know when the money is going to come or not come.
16:01So I can't plan my payment system or how do I cross-subsidize.
16:07If it comes in a quick, efficient system, even if the payment is a little bit less,
16:11we can actually predict and know how much we have to spend and how much to cross-subsidize.
16:16But if you put this questioning method, I don't know when the cash flow is going to come in,
16:21for any insurance company, not just government, then that really puts a strain on the hospitals.
16:26You want to add to that?
16:28Well, I completely agree with Dr. Arun.
16:31We don't wait to extend our services just because the government has delayed payments to us.
16:41We never deny, we understand these delays are part and parcel of day-to-day life,
16:47and we go on doing what we think is right.
16:50So eventually the payments would come, and we understand completely.
16:55Also, Professor Ashwini, the other point I want to talk to you about is greater transparency.
17:00While you do make a point to say that digitization has largely helped on that front,
17:06and I also say this from the point of view of running an educational institute that imparts medical education,
17:14in every which way, from how the students are admitted to how the procedures happen in the hospital,
17:23how has that changed over the years?
17:26Well, as you may be knowing, that right now we cannot admit any student who has not come through need in the medical college
17:37and similarly in dental college through national eligibility tests.
17:44And it's a very transparent process.
17:47The merit is very much seen by every candidate,
17:52and we cannot bypass any candidate and admit the one who is not, you know,
18:01who is above this particular candidate.
18:06We cannot bypass any candidate.
18:08So we strictly go by norms, and there is a complete transparency.
18:13And fortunately, in case of our institute,
18:18CEMETS as well as the Savita Dental College,
18:20in the second round itself, most of the admissions take place.
18:25And hardly we go to the third round, and we have a full quota already.
18:29And there has never been a controversy in our admissions so far.
18:34So we maintain that transparency.
18:36Similarly, in digitization also, our records are very much transparent.
18:41It can be seen by anyone.
18:42Absolutely transparent.
18:44And you need only patient ID, and you will get the entire, you know, database related to that patient,
18:53whether these are clinical tests that have been done, or diagnosis that has been done,
19:00the prescription that has been given by the specialist.
19:02Everything is listed.
19:03And it is accessible to anyone.
19:06In fact, our students can also visit to study the cases.
19:11They can actually go back and visit the entire record of our patients to learn.
19:18So that kind, this is the advantage this digitization gives to you.
19:23So all these facilities are very, very transparent.
19:27Absolutely transparent.
19:28So I think so that we're going to a much stronger sense of transparency.
19:35We're going to electronic records, universal health ID.
19:37Government is heading in the right direction.
19:40The one negative which we have seen, I think, hospital season, the postgraduate side,
19:46is that you can no longer choose the people training under you.
19:50So you don't know if they're dedicated and they're going to stay with your organization.
19:53If I were to tell you that you're going to train a young journalist,
19:57it might be very transparent that she's selected through your score,
20:01but then you don't know if they're going to be with you.
20:04They're not going to be with your organization in the long term.
20:07They may just say hi and just disappear.
20:10It helps a little bit in the long term with institution building.
20:13So that's the only downside.
20:16But it does help on the transparency side now.
20:19If anyone asks me any questions, I can be very transparent.
20:22And it's very open that I can't influence, alternately influence it in any other way.
20:30The other point I want to come to, Professor Ashwini, is of retaining talent in India.
20:37You know, while we have incredible talent, but there is also this chat about doctors, researchers,
20:44students seeking education or wanting to work abroad while they're all homegrown.
20:51How is it that we create that environment to ensure that we can keep them to ourselves and help us flourish?
20:57That is a very fantastic question.
21:00I mean, I'm very proud and happy to inform that Savita Dental College, which was country, which is country number one,
21:10top most dental college for last many years, has 650 dental chairs, several clinics,
21:19and a busiest dental college with 3,500 patients every day.
21:26And what we charge is 300 rupees to 1,000 rupees.
21:31It's the cheapest care, but the best state-of-the-art care that we provide.
21:36If you look at our college, dental college from outside, we have made it as a temple of dentistry.
21:42It looks like a temple with Ganesha holding the dental instruments, the instruments that are used.
21:51And nine specialties, Ganesha is shown to or depict to take care of all these specialties.
21:59And inside, you have state-of-the-art facilities.
22:04And that attracts students, researchers, as well as specialists, not only from rest of India.
22:12Savita is a big name as far as dental dentistry is concerned throughout the country.
22:16But also, we are one of the topmost dental colleges in the world.
22:20And therefore, you know, specialists as well as students come from USA, from Australia, from UK, from Southeast Asian countries.
22:30You name it and we get it.
22:32We have over 200 MOUs with different institutions.
22:36And there is a student exchange program.
22:38Our students go abroad.
22:39And last month itself, we had 100 visitors from different countries who took training in our dental college.
22:49So, why students have to go abroad?
22:54Of course, you visit, see how those countries work as well or provide health care to their people.
23:02But believe me, the number of patients and the kind of exposure our students get is not available elsewhere.
23:13That is wonderful and sounds like a very, very ideal model.
23:16You want to make a point?
23:17Yeah.
23:18So, I would say that everyone asks me this question.
23:21And I would say that Canada is aging.
23:23UK is aging.
23:23Europe is aging.
23:25Russia is aging.
23:26Japan is aging.
23:26China is aging.
23:27Philippines is aging.
23:29Even Australia is aging.
23:30And they're all demanding Indian health care workers.
23:35Multiple admissions have come to Qaimbatore and asked for, how do I get health care workers, nurses, doctors to come there?
23:43So, there's a huge demand.
23:44The only way we can keep and retain talent is the ethos of the organization.
23:49You're going to have to take young doctors, train them, build an environment in which they can grow and develop.
23:54You're not necessarily going to find all the people running to join sitting here in Qaimbatore.
24:01But you have to have not a one-year view, but a five, ten-year patient view, a building culture where people want to work for you.
24:09And that you will back them whenever they're in trouble.
24:12And that you will be there for them.
24:14So, that is the most important thing.
24:16I think we need to retain talent.
24:18Otherwise, there's too much competition around the world for their talents.
24:22You know, while it's heartening to know that the change is in the positive direction, we are running out of time.
24:28So, as a closing remark, I want to know from both of you, what makes you optimistic in terms of how the health care industry is shaping up?
24:36And how do you see it in the decades to come?
24:39We are adopting the state-of-the-art facilities, AI, that our heart is the service.
24:50Patient is the nucleus for us.
24:53Everything we do is patient-centric.
24:55However sophisticated our facilities may be, but we will always take care of our patients.
25:04That is the bottom line.
25:06The patients are at the end of the king.
25:07If you don't give good service, they'll just go over to the next hospital and then go get treated.
25:13So, we are at a stage where we can teach people that we can deliver the best, and we're on par with world quality care right here.
25:23And that is our continued mission.
25:25And that we can deliver and save people where other people have not had the chance.
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