On the Road- India

Today I left for India. I am flying Jet Airways. I do have to say that the Business Class accommodations are pretty amazing- at least to me. Separate cubicles of sort for each person. I posted photos. I think I need a manual to figure out how the seat works. There was a lot to prepare for me to go. First I need to get a “visa.” This was a 2 day process but painless in retrospect. There is a company that the India Consulate farms this out to on 53rd and first in Manhattan. The good news is that there is a cigar bar a couple of blocks away allowing a Davidoff Double R and Gloria Cubana Serie R while waiting.

With Visa and Passport in hand I am on my flight. So how did I get this idea to go to India? First of all, as far back as I can remember India seemed a most exotic place to me. Asia, elephants, Gandhi. King Cobras, The Jungle Book (Disney movie), The Jungle Book (Rudyard Kipling). Not exactly why I am going. I am going because I really do believe this is a very small planet and that connecting the healthcare in the United States with the growing medical systems in India is happening now and I have some ideas on how this can happen- especially our of a hospital in the South Bronx that services some of the poorest people at least in the USA. I know there are all kinds of organizations that do this and do that but somehow I believe that individual people meeting individual people and doing things between each other will accomplish something different than corporate health ideas. This is a trip of colleagues meeting colleagues. Giving back and forth. There was an interesting opportunity to connect with some very interesting people and places so here I am. Along the way- we will see what happens.

Last May, I had the honor of being asked to give the keynote lecture to a very interesting and extremely smart group of people- the CIO Executive Summit in New York organized by a company Evanta (www.evanta.com, www.bycios.com). I was invited by the then CIO of Stryker Brian Lurie and met the CIO’s of many outstanding companies including JP Morgan, Avon, UPS, Ace Insurance, and TCS (Tata Consulting Services). As a long-time geek I felt quite at home, my talk- “It’s a Bug’s Life- Healthcare Reform from the Ground Up” was well received (I think) and afterward I was able to speak to many of the participants.

Chandra Sekar, the CIO of Ace Insurance, approached me about possibly meeting his brother-in-law who is a senior Orthopaedic surgeon in Chennai, India. His BIL, Nandkumar Sundaram (Kumar) within a month came and visited me at my hospital and into our operating room and had the chance to observe the information management system we put together in our department. This included a cloud database running over 80 databases analyzing every activity in the hospital and the clinics real time (programmed by the docs), OR video capture and streaming done with all off-the-shelf products, live feed videoconferencing with no more than $100 start-up, and more. After the visit he invited me to Chennai and I accepted.

Since I decided to go the Chairman of Pediatrics at my hospital Ram Kairam, spoke with me about extending my trip slightly north to the city of Visakhapatnam where he and the Chairman of Medicine at our hospital Sridhar Chilimuri went to medical school. With that said and with a lot of help from my colleagues I arranged two days there at Andhra Medical Collage and King George Hospital. Then Vellore Pirithival, MD, a general surgeon and colleague at my hospital invited me to speak at the 4th Indo American Winter CME Conference in Coimbatore, India. WIth all this done and with the extraordinary help of Chrissy Manning the Department Director of the Orthopaedics somehow all this and a tight itinerary was constructed and like a scene in Saving Private Ryan I was extracated from the Bronx, plopped on a Jet Airways flight to thrust to India.

Left at 6:30 PM from Newark on Saturday. Will arrive 12:30 AM on Monday in Chennai. Somehow there is a loss of a day. You need a physics PhD from Cal Poly to figure that one out.


Sign Me Up

After a quick nap and a call home through Skype i was picked up at my hotel and brought to Fortis Malar Hospital to meet Dr. Nandkumar Sundaram, the senior orthopaedic surgeon of the hospital. The professionalism, courteousness, and warmth sent to me by the entire staff was tremendous. The operations I observed were state-of-the-art with the entire orthopaedic team engaged and on point. I say that not because I expected less but in some sense, on the outside the hospital may not appear to an American to be palatial- there was no grand piano in the lobby, no grand marble entrance and other totally useless signs of American waste as there are in many of our Ivory Tower hospitals. Instead there was a complete focus on the medical and surgical care. In the end the patients received the exact same knee replacement (a Smith and Nephew Oxinium Genesis II) that the CEO of Goldman Sachs would receive here. Everything necessary was there, anything superfluous to the care was not.

If my knee was arthritic today I would have jumped on the table to be the third knee of the day. Luckily I was feeling just fine.

What I was most struck by were the many “doctors in training” surrounding Dr. Kumar. The system of training in India is quite different from the US. Younger surgeons after their general training do at least 4 more years in subspecialty training and then essentially apprentice for as many as ten years prior to entering as a fully independent surgeon. As I consider myself a more seasoned surgeon than I once was I actually find this approach one that makes more sense to me than a surgeon being allowed to operate independently after only 4 years of general Orthopaedic training and only one year of subspecialty fellowship. I can assure you that if I was just out of my subspecialty training and not 20 years out as I am now I would argue against this.

Enjoy the pictures and videos I posted.

Helios Hospital

Dr. Nandkumar also operates at another hospital, Helios Hospital. This is a different concept than the Malar Hospital. This is a physician-owned twenty bed hospital concentrating in selective, high-level Orthopaedic care.

I met him and his Orthopaedic Surgeon Team and was presented a series of cases that probably represented the most difficult cases I may have seen in the world. Their expert treatment of these patients was extraordinary. The extreme is treated in a routine manner in his and his team’s hands.

I had the opportunity to also consult on a difficult knee patient and showed the patient and his staff a wide range of patient education and Internet tools we use in the USA.

The volume of Orthopaedic disease in this area of India is remarkable. The talent taking care of it- even more so.

Press Day

Today started late and was, so far event filled. I observed an excellent knee replacement operation again at Fortis Malar Hospital.

Later Dr, Nandkumar Sundaram and I held a press conference with the Fortis Malar Hospital Administration announcing the launch of our joint education and surgical training efforts. We will be sending Orthopaedic Fellows from India to New York City and Fellows from NYC to India on a regular basis to share education and surgical technique education. Additionally we have setup a videoconferencing arrangement to do combined conferences case consultations, and research projects to improve patient care. Thirdly we will be changing medical delivery information on how to make the care of patients better worldwide. This was covered by the regional press and also by Sun Television. It was all in the language Tamil. Needless to say, my fried Kumar did all the talking. My Tamil is a little rusty.

Dr. MGR Medical College

Last night I had the honor of having dinner with a world-renown physician and surgeon Dr. Mayil Vahanan Natarajan who aside from being an authority on orthopaedic oncology is the Vice Chancellor of The Tamil Nadu Dr. MGR Medical University. He is responsible for 17 major medical schools in this region of South India as well as all the allied health professions. We traded many stories- professional and personal over dinner.

The next day I went to his office and we discussed a wide range of medical education and healthcare policy issues. I was humbled by awarding to me the honor of Visiting Professor (International) of the University. Right after that ceremony he conferred upon Dr. Nandkumar the appointment of Adjunct Professor of the University, a great honor in India.

After a brief rest at the hotel, the Orthopaedic Team and I had dinner on the beach in Chennai overlooking the Bay of Bengal.

© 2011 Ira Kirschenbaum Contact Me