As I write this there are 382,000 cases of coronavirus globally (perhaps will reach 400,000 by the time some of you read this) with 16,558 deaths and over 12,000 patients critically ill. Over 100,000 have recovered, but this should not give us a false sense of security. In India, 511 cases are diagnosed so far, but the rate of daily new cases is now exceeding 100. As our testing rate is very low, it is likely that there are hundreds, if not, thousands of undetected cases. This point is to be taken seriously, since in the coming days, we may be hit with an avalanche or tsunami of patients in various parts of India.

Keeping this in mind, our institute has already started plans for COVID 19 disaster, and in my videoconference call yesterday, I emphasised the need for enhancing our disaster preparedness. Such disaster planning has to get into the “nitty gritty” details than what we have now: command-control structure, communication process (3 levels of redundancy, unity/unified command), activation and drills (3 steps of disaster warning, disaster alert, disaster action), corona virus specific protocols (out patients, quarantine/isolation facilities, inpatients, levels of integration with state system etc).

Each one of us (employees, contractual workers, students) is to be involved and each should know his/her “positional role” (where to serve, what role to play, who to report up/down, and who to work in team laterally). As it is happening in rest of the world, during this pandemic, specialty barriers come down and every physician/nurse will become member of corona virus treatment team. This is now happening in all countries hit with corona virus.

So, work together, empathetic in every encounter, saving as many lives as possible.

At the end of the day, when all said and done, and after we prepare and enact disaster management, what will distinguish the best are: the love and care within us for the fellow human beings, and the commitment & passion we have for the profession we have chosen :)

Opening the prestigious journal The Lancet, I was struck by the editorial “Eliminating cervical cancer”. It’s a cancer that is most preventable and yet is woefully prevalent in India. According to recent statistics (WHO Globocan), among the 5,00,000 patients with cervical cancer diagnosed globally each year, most are in developing nations. India is among the countries with high incidence and prevalence.

Almost 97,000 women are diagnosed with this crippling cancer annually in India (20% of global incidence). More alarming, 88% of deaths from cervical cancer are from Sub-Saharan Africa and South Asia. Among the 97,000 diagnosed, 60,000 die — this is way too high, to have two of three women diagnosed die. The prevalence (those living with cancer) is about 2,25,000 and the quality of life of these women is poor. This is a double burden of death from cervical cancer and significant disability in those living with this disease.

Cervical cancer screening and prevention using PAP smear and HPV vaccination are highly effective. The WHO envisions 70% of women between the ages of 35 and 45 to be screened; 90% of girls fully vaccinated by age 15; and 90% of patients with disease to receive evidence-based care. There shall be no choice for the Indian healthcare system but to take up this cause for eliminating cervical cancer. We should meet and exceed WHO targets.

Zero harm treatment

Now, the next target is zero harm in healthcare delivery. Unsafe care in hospitals is a global concern. Deaths from preventable harm are among the top 10 causes of mortality. In keeping with the adage Primum non nocere (First do no harm), we must make our health systems safer. Are our hospitals safe? Not safe enough! The Union and the State governments and the medical profession should ensure healthcare safety — both for patients and the workforce. Zero harm in healthcare implies achieving absolute patient and workforce safety by eliminating preventable harm… in many dimensions: diagnostic safety, medication safety, surgical safety, healthcare-associated infection mitigation, and safe and effective communication culture, to name a few.

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Prof. T S Ravi Kumar, President, AIIMS Mangalagiri - publication in The Hindu 12th January 2020

Our honorable President, AIIMS Mangalagiri was also the chief guest at SRMIST convocation; He addressed thousands of young minds on importance of "Quality of Health Care and Patient Safety"

It’s a fact that sticks out starkly: 10.6% of the total amount in the Interim Budget is allocated to defence, while only 2.2.% is allocated to healthcare. Funding need not be redirected from current allocations to preventive care, but surely India can make health spending a priority, much like defence? Despite several innovations in the healthcare sector in recent times, in line with India’s relentless pursuit of reforms, the government remains woefully short of its ambition to increase public health spending to 2.5% of GDP. At present, health spending is only 1.15-1.5% of GDP.

Per capita spending on health

While the Interim Budget is responsive to the needs of farmers and the middle class, it does not adequately respond to the needs of the health sector. The total allocation to healthcare is ₹61,398 crore. While this is an increase of ₹7,000 crore from the previous Budget, there is no net increase since the total amount is 2.2% of the Budget, the same as the previous Budget. The increase roughly equates the ₹6,400 crore allocated for implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY).

According to the National Health Profile of 2018, public per capita expenditure on health increased from ₹621 in 2009-10 to ₹1,112 in 2015-16. These are the latest official numbers available, although in 2018 the amount may have risen to about ₹1,500. This amounts to about $20, or about $100 when adjusted for purchasing power parity. Despite the doubling of per capita expenditure on health over six years, the figure is still abysmal.

To understand why, let’s compare this with other countries. The U.S. spends $10,224 per capita on healthcare per year (2017 data). A comparison between two large democracies is telling: the U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.5%. In Budget terms, of the U.S. Federal Budget of $4.4 trillion, spending on Medicare and Medicaid amount to $1.04 trillion, which is 23.5% of the Budget. Federal Budget spending per capita on health in the U.S. is therefore $3,150 ($1.04 trillion/ 330 million, the population).

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Professor (Dr.) T. S. Ravikumar Sir, President AIIMS Mangalagiri introduced the concept of ‘Research’ to the AIIMS first batch of MBBS students on 19th December 2018. The students understood the need for doing research in medical field. Sir taught the concept of Observational and Interventional research, Translational research, public health research, outcomes research. The students learnt that Randomised controlled trial (RCT) are the most rigorous way of testing a new drug or a new interventional procedure. The students learnt the concept of ‘placebo’ and ‘blinding’ in a RCT. Sir has instilled in the young minds the concept of ‘Altruism’ in research. In ‘Altruism’ a human being is voluntarily willing to participate in a clinical trial for the larger benefit of others even though there is no direct benefit to the participant of a clinical trial.

‘T’ shape in research

Sir gave his own example of how he did research and developed novel surgical procedures and therapies to operate on liver metastases cases and thereby prolong life of patients in advanced stages of cancer. The undergraduate students learnt the concept of ‘T’ shape in research wherein the horizontal line represents the expertise and knowledge of the researcher in his or her respective field. The vertical line of letter ‘T’ resembles the depth of research which every student should strive in his or her life and achieve it. Sir encouraged all the students to develop their own research projects right from their undergraduate days.

Our students were really privileged to learn from an exceptional Professor (Dr.) T. S. Ravikumar Sir.

He articulated the concept that , even though every student will not become a researcher, every student must get a thorough grounding in research ,such that he/ she will develop “critical thinking” that will make him/ her a superb clinician. The steps in conducting good research involves developing a hypothesis, catalogue all background information, set up methods to carry out hypothesis testing, analyse the data, and arrive at conclusion , ensuring limitations ( if any)of the research thus conducted. Good clinical practice mirrors these steps: using history / physical examination to develop a preliminary diagnosis, order tests and consultations to support diagnosis / eliminate other possibilities, put together all information to render final diagnosis and treatment plan , and be aware of complications and adverse events in order to avoid/ mitigate. Therefore, a good research training makes the clinician an astute and critical thinker.

• Lecture summarized by: Dr. Dhrubajyoti J Debnath , Associate Professor, CFM Dept., AIIMS ,Mangalagiri
• Approved for website uploading by: Dr. Desai Vidya Sripad, Associate Dean (Academic and Exam), AIIMS ,Mangalagiri.

The newly inducted faculty had a video conference with Dr. Ravikumar on the philosophy of concept of health in general and on the role of AIIMS on the health of the people of Andhra Pradesh in specific.

Emphasis on quality

He underlined the need for initiating the concept of quality of life into the fabric of medical practice right from the beginning of a medical career.

The innovation in curriculum envisaged at AIIMS will help in suitably orienting the students to fill the "know-do" gap existing currently in India.

The students have to be lifelong learners and hence the understanding of health from a world-view as projected by WHO was of greatest importance. The virtual classrooms and modular delivery of curriculum must help achieve that aim.

• The subjects will be taught in an integrated manner with thrust on problem solving exercises of various modes including case-based learning.
• The spiral curriculum will achieve a level of understanding of facts which translates knowledge into skillful practice.
• The students shall keep their portfolios in digital media and this will serve to mentor them in the right career direction in the future.