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.
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.
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.
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.
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.
Unfortunately my time, this time, in Chennai is coming to an end. My host, Dr. Nandkumar Sundaram, was, in the English language-- a true gentleman. In Tamil- எ த்ருஎ கேன்ட்லேமன் .
On this last day we solidified our commitment to a Fellowship relationship and continued affiliations between departments. We will begin Video Conference Meetings as soon as I return to the US and start the curriculum and structure of sharing Fellows across the two countries.
I had the pleasure of meeting many wonderful people of the Fortis Hospital System. At the press conference announcing the relationship between the departments I sat next to Dr. Sajan Nair who is the “Medical Superintendant” of the hospital. In the US this would effectively be the Chief Medical Operating Officer. Later at dinner we were further honored by the presence of Krish Ramesh who is the “Zonal Director” of Fortis. In the US this is the equivalent of the Chief Operating Officer of a large region of hospitals. Their depth of knowledge of healthcare reform and medical delivery systems was an education for me and I thank them sincerely for the precious time they were able to spend with me.
Of Dr. Nandkumar Sunsdaram (Kumar) I cannot say enough. A master surgeon, a remarkable and respected teacher, a leader of his departmental group and a visionary on the delivery of Orthopaedic care in his community. More importantly he is great fun to go out and have a beer with. For the record I now only drink Kingfisher beer. If you haven’t tried it- get it. Excellent.
Vizag is the old British name of what is Visakhapatnam. EIther way this is a beautiful and blessed place on this planet filled with wonderful people doing amazing things.
A person cannot help but be changed by India and Vizag is an agent of that change. I visited King George Hospital. A hospital that started as a dispensary in the early 1800’s and then a full hospital in 1923. Attached and integrated to this hospital is the famed Andrha Medical College. I had the honor of meeting the Superintendent of the Hospital Dr. G. Santarao who is also a general surgeon and was a classmate of my friend and colleague at Bronx-Lebanon Dr. Sridhar Chilimuri.
Dr. B. Udaye Kumar, the Head of Department and Chairman of Orthopaedics took care of my entire stay in Vizag and for that I am moved and grateful. My experiences with him, his, staff, his fellows, and his residents were enjoyable and educational.
Vizag is right on the water as is the hospital and medical school. It breathes tradition and dedication to a people whose level of poverty is barely imaginable. What this group of doctors and nurses do every day is breathtaking. While they do this with equipment that can be updated there is no shortage of expert care.
I also had lunch with Dr. Vijaykumar who was a classmate and is a friend of ny friend and colleague Dr. Ram Kairam at Bronx-Lebanon. He just retired back to a home in Vizag after a life as a reconstructive surgeon for leprosy through a mission hospital. You can see photos of him and his wife as well as Dr. Rafi with Princess Di and also with Mother Theresa.
On this last night we went to a restaurant that also had a band. Many of the surgeons got up to sing with the band- sort of like a live karaoke. Great food, scotch, and times.
We agreed to start a sharing relationship with conferences and traveling fellows. The planet just got smaller.
Arrived in Coimbatore late today. I am here to lecture at the 4th Indo-American Winter CME sponsored by a friend and colleague at Bronx-Lebanon Vellore Parthivel. He was original;y from Chennai which is in the state of Tamil Nadu. He runs this course in Coimbatore which is also in Tamil Nadu. It is a bit of a change going from touring hospitals and new friends homes to a CME course. There will be quite a few doctors here and I am looking forward to the exchange of ideas.
I was taken by Dr.Muguganathan to a famous Hindu temple Avanashi. This is a destination for many people. At first I thought that it was very more of a shrine but actually it is the local temple as well. Dr. Munuganathans brother is the lay Chairman of the temple which is very similar to religious institution. The temple was dramatic. A thousand years old with inner courtyards that had inner courtyards. Just before I left for India I read a book about India (as if a singe book can give any real justice to anything- like “I read a book about the US before I went there.” At least the book was heavy on an introduction to Hinduism. Prior to this trip I knew little about Hinduism. I see now there are no excuses for knowing little about something so important and present in the world. Hindusim has been around nearly 4 thousand years. Ira Kirschenbaum, a little over 53. What took me so long to open an eye. That really does happen to us sometimes. We wonder what I life was like before we now know this other thing is there. Before a change. There is no conversion going on here just another piece of knowledge of something else out there that is now part of me.
A Bronx-Lebanon general surgeon, Vellore Parithival (Depupy Chairman of the department) organizes a course for doctors each year with his India course counterpart Dr. Munuganathan. What was very interesting was from diabetes to infectious diseases that the course covered many areas of medicine- not common in the US. Lunch was great. I can’t yet get a handle on the actual item names but like anything else it is beginning to come to me. I should know how to order in an Indian restaurant in the US. BTW in India they are not called Indian restaurants. The are just restaurants.
On the morning of the last day in India I went to a superb and highly efficient and modern Orthopaedic hospital in the world.
Ganga Hospital in Coimbatore started with humble family beginnings in the early 1970’s. The father of the current head of the hospital (Dr. Rajasekaram) started this private hospital that now has over 400 beds dedicated to Orthopaedics and Plastic Surgery. Over 4000 major procedures are done here. India has a massively growing middle class and don’t be fooled by the word private. It is private only in that it is fully owned and run by a large family. It serves a large number of people with remarkable skill and dedication. India has a growing middle class that chooses to go to hospitals like this (the wealthy choose this hospital as well).
There was a 150 seat academic auditorium and dedicated support staff. If I had one regret on this trip to India was not extending the trip 8 more hours to spend time with this remarkable orthopaedic staff and hospital. As it turns out it was only after all my reservations were done that a social connection was made with Dr. Rajasekaram and all I was able to do was attend Grand Rounds in the morning where I had the honor of giving a lecture.
Even in that brief time I was humbled by the remarkable accomplishments of Dr. Rajakumar and his brother growing on the deep foundation started by their father. The entire family is involved n the management and they serve the family of man with distinction and honor.
Having seen three cities in southern India I have come to the following conclusion- no one can come to any conclusions about India. It is so remarkably diverse nearly every corner you turn is a surprise and a different community. In comparison with Chennai (a city on the water) and Visag (a large town on the water) Coimbatore feels more like the India I have seen in movies. Busier streets, rich and poor living near each other, and powerful traditions that rule business and family. All that is India, though. There is constant motion. Everyone moves quickly although no one is rushing.
Blogs really should not have summaries-they are running thoughts in time. Time does not stop and summarizing constant movement is not a summary at all. This is the end of my trip now., though. I am writing this entry on the plane from Mumbai to Brussels (yes I am in those amazing seats). I missed my family tremendously. Emily was great every day talking with her and Jacob couldn’t get enough of the India stories. Josh and I Skyped once in wee hours (more than we get a chance during test week for him) and Laura and I did our quick text thing. My summary, therefore is that I am coming back. Not only to expand on the sister hospital relationships I developed while here but to bring my family and even come here with friends to this remarkable land.