‘There will be only one AIIMS— others will be AIIMS-like’
From the first successful heart transplant in India on August 3, 1994 to the current position of the Director of India’s most prestigious hospital, Venugopal’s journey has been marked with many firsts. He introduced, for the first time in Asia, the implantation of left ventricular assist device for more than 90 days. He has also successfully pioneered the use of autologous stem cells implantation for the repair of the myocardium as an alternative to transplantation in 26 patients. Not only this, he has also implanted stem cells into the pancreas for curing type II diabetes. Over the last three decades, he was associated with over 50,000 open-heart surgeries and over 12,000 closed heart surgeries. He has trained more than 100 cardio-thoracic surgeons who are working in various hospitals in India and aboard. Dr Venugopal, who has established a well co-ordinated heart transplant programme at AIIMS and performed 26 successful cardiac transplants, has been conferred with prestigious honours like Padma Bhushan, Dr BC Roy Award, Indira Priyadarshini Award, Vijaya Ratna Award, Ratna Shiromani Award and Rashtra Ratna Award. Excerpts from an interview with Sapna Dogra:
– Dr Panangipalli Venugopal Director,
All India Institute of Medical Science (AIIMS)
What is your opinion on the current healthcare scenario in the country?
Healthcare resources in India though not adequate, are ample. There has been a definite growth in the overall healthcare resources and health-related manpower in the last decade. The number of hospitals is growing, but mostly in the private sector. There are 5,479 hospitals having 3,80,993 beds in the country. At the national level, the number of physicians available is more than the estimated requirements. The current doctor population ratio is 1:1,800 if only the modern system is considered and 1:800 if ISM&H doctors are also taken into account.
To a casual observer this looks like a good proportion, however on further study, unequal distribution of resources becomes apparent. The manning and critical stores at peripheral health outposts are very poor. The ratio of hospital beds to population in rural areas is 15 times lower than that in urban areas.
The ratio of doctors to population in rural areas is almost six times lower than that in the urban population in India. Per capita expenditure on public health is seven times lower in rural areas, compared to Government health spending for urban areas.
There’s a general concern about the diminishing public health fund. Is public-private partnership (PPP) an answer?
There is no comparison between Government and private hospitals. The Government hospitals offer unmatched infrastructure and facilities for research
Though the spending on healthcare is six per cent of gross domestic product (GDP), the state expenditure is only 0.9 per cent of the total spending. Thus, only 17 per cent of all health expenditure in the country is borne by the state, and 82 per cent comes as out-of-pocket payments by the people. This makes the Indian public health system grossly inadequate and under-funded.
As a result of this dismal and unequal spending on public health, the infrastructure of health system itself is becoming ineffective.The private sector has to come forward and accept rural healthcare as a part of its corporate social responsibility and extend the benefits of modern healthcare to the rural areas.
PPP is a good way of involving the private sector in sharing the burden of healthcare of the country. There are many successful models of PPP in operation in different countries of the world, like the UK, Australia and France. Nevertheless, PPP need not be limited only to hospitals. Sectors like education, water and sanitation have a profound and long-term effect on the health of the society.
You have been a pioneer in the heart transplant programme in the country. Why is heart transplant not picking up in India?
After the first heart transplant, I have performed a total of 26 transplants. But heart transplants cannot progress without donor hearts. There is an immense need to create awareness about organ donation, along with addressing various psychological, social, cultural and religious issues of people through various educational programmes. The medical community also needs to be educated about brain death and organ donation.
Is medical tourism the next big thing for India?
India has an immense potential to share its medical expertise–which is not only affordable but also matches the best in quality. This is a good sign, as it depicts the maturing of healthcare sector, as patients from distant countries like USA, Canada and Europe have also made India a health destination.
Government plans six AIIMS-like institutes in the coming years. What are your views regarding the replication of the AIIMS model?
AIIMS was created in 1956 as an autonomous institution, through an Act of Parliament, to serve as a nucleus for nurturing excellence in all aspects of healthcare. The Institute has comprehensive facilities for teaching, research and patient care. As provided in the Act, AIIMS conducts teaching programmes in medical and para-medical courses both at undergraduate and postgraduate levels and awards its own degrees. Teaching and research are conducted in 42 disciplines. In the field of medical research, AIIMS takes the lead, with over 600 research publications by its faculty and researchers annually. We are very happy that the Government plans to create six more AIIMS-like institutions to make available super-speciality treatment facilities for the people. They can certainly try to emulate the examples set by AIIMS. But there will always be only one AIIMS; all others will be AIIMS-like.
There’s a huge disparity in the remuneration of doctors in the Government and private/corporate sectors. How can this gap be bridged?
There is no comparison between Government and private hospitals. The Government hospitals offer unmatched infrastructure and facilities for research. There is immense potential for personal satisfaction. Private/corporate hospitals cannot match these opportunities. The number of brilliant doctors who are working at AIIMS at a fraction of the pay that the corporates offer is itself a testimony to the fact that money is not the only criterion in the profession.
What is the role of stem cell research in various heart disease and other ailments at the Institute?
We have been actively involved in stem cell research in various degenerative disorders. The Stem Cell Facility was established in 2005 to explore the safety, feasibility and the efficacy of autologous hematopoietic and cord blood stem cell transplantation in degenerative diseases. As of now, 360 patients have undergone this therapy. Some of the diseases covered are myocardial infarction, dilated cardiomyopathy, cerebral palsy, motor neuron disease, biliary atrisis, spina bifida, macular degeneration, retinitis pigmentosa, fracture non-union, peripheral vascular disease and acute ischaemic stroke.
A PhD programme has been introduced. We have also imparted short-term training in stem cell techniques to under-graduate and postgraduate students. At the moment, 10 departments are involved in both clinical and basic research in stem cells.