Visitors at Krishna Institute of Medical Sciences (KIMS)

Yet another time, the jaunty team of SIIP 3 fellows set out on their visit to Krishna Institute of Medical Sciences (KIMS).  At the break of dawn, on the 9th of April 2018, along with their manager, they got onto a 3 and a half-hour-long oscitant bus journey which ended with a view of the striking premises of one of the biggest rural, multi-speciality teaching hospital in the upcoming town of Karad, Satara district. After a wholesome breakfast at the institute’s canteen, they headed straight to meet with the registrar of the institute, Dr M.V. Ghorpade. Dr Ghorpade further introduced them to Ms Archana (Asst. Registrar) and Dr Patil (HOD Academics). 

Together, they discussed the aim of the visit, agenda for the day and the possibility of further collaboration between Venture Center, Pune and KIMS, Karad. Following the introductory meeting, Dr Ghorpade had arranged for a roundtable meeting for the SIIP team with various Head of Departments at KIMS. From their expertise, each of the speciality doctors spoke about the gaps and problems faced by the elderly in their fields. After this insightful session, a guided tour, with Dr Patil and one of the 3rd year residents was arranged, showing them through the IPD, OPD, wards, speciality services, super speciality services and community services. During this tour, the team got to interact with doctors, nursing staff, technical staff and patients and observe all the facilities available.

ABOUT KIMS 

Krishna Hospital is an institute that resonates the coming of age of medical services in India. May it be a day to day regular ailment or a concern that requires speciality services and care it can all be found here. A team of expert doctors with decades of experiences highly trained nursing and ancillary staff, latest equipment and machines handled by skilled technical staff and a strong backbone of support services has helped elevate Krishna Hospital to a premier healthcare institute. The hospital with a capacity of 1125 beds, 31 wards, 8 different ICUs has added a number or various capabilities over the years, however, has always stayed true to its DNA of “affordable, quality medical services for all”.
No. of Beds: 1125  

  • 12 fully equipped major operation theatres 
  • 4 Minor Operation Theatres 
  • 8 ICU’s (88 beds) 
  • Pharmacy 
  • Central hospital Laboratory (Pathology, Biochemistry & Microbiology) 
  • Blood Bank with components 
  • Computerised medical records 
  • Departmental offices & Library 
  • Hospital Kitchen / Canteen. 
  • Counselling (Clinical Psychologist, Child Psychologist, Speech Therapist) 

 

OBSERVATIONS 

The hospital is an extensive, well-equipped, well-staffed facility in a rural set up that provides services at nominal charges for rural population in and around Karad. This in itself is a salvation. The hospital handles cases of the ageing population across all departments.

  • In the General medicine department, cases of chronic ailments and accidents due to negligence are most common. The ICU’s are populated by such cases.
  • The Orthopaedic department majorly gets cases of domestic falls that lead to multiple fractures due to degrading bone density of the elderly and specifical osteoporosis amongst women. They had developed various low-cost limbs, which are affordable as compared to market prices. 
  • The Physiotherapy Department aims to evoke postoperative and physically degenerating patients. They use paraffin wax mostly for  painful hands and feet and is used by our physiotherapists in conjunction with gentle mobilising techniques and a tailored exercise programme.
  • In Ophthalmology old people come in with problems of declining eyesight, cataract, CMV retinitis.
  • In the gynaecology department, prolapse and hormonal imbalance was commonly observed in patients due to lack of regular follow-ups.
  • In the Dental department, doctors expressed the lack of good quality local make equipment,  which in turn would reduce the cost of operation. The materials used for strength of moulds, implants is not of good quality and bio-compatibility is a concern.

 

Legalogy of Marketing & Distribution Arrangements for Tech. Products

Mr. Ashish Porwal is the Founder of HREEM LEGAL, a law firm focused on corporate and transactions practice. He is a practicing Advocate and a non-practicing Certified Investment Banker. Ashish is also a registered Insolvency Professional (registered with the Insolvency and Bankruptcy Board of India) and a member of the Indian Institute of Insolvency Professionals of ICAI.

He was invited to Venture center on the 21st of March 2018 to draw light on critical legal procedures and issues that budding entrepreneurs come across during their company’s formative years.

He started by addressing the basics like

  • Making an agreement to record basic key terms
  • Commercial arrangement and methods to go about it
  • Rights/ Duties/ Obligations of Parties involved
  • Consequences of Breach and Remedies

Then he went on to explaining the various models of marketing and Distribution Arrangement for a product or process as listed below

  • Commercial Trading Model
  • Commission Based Model
  • Royalty Model

After which he spoke about IP Licensing and the key terms to be considered while sharing your IP with other parties

  • Nurturing a relationship
  • Delegation of Authority
  • Territory of Operation and Exclusivity
  • Obligations of parties
  • Confidentiality
  • Non-Compete and Non-Solicit

He also discussed other priorities like

  • Security Deposits
  • Indemnity
  • Limitation of Liabilities
  • Dispute Resolution

It was an interactive session where Mr. Ashish explicitly answered all queries and doubts that attendees had regarding the points he covered and beyond. It was also very insightful for those who are just starting off their journey.

Visit to Athashree Aastha

Persons Interacted with:
Dr. Rhayakar (Aastha)
Mr. Yadav (Athashree)

Date of Visit: 29th Mar, 2018

Description:

A visit was organized to Astha and Athashree at Pashan, Pune on 28th Mar, 2017. Astha is a high end assisted living facility for seniors who are willing to live on their own, with high-end facilities provided to them based on their requirements. This is primarily managed by Dr. Rhayakar, who is the resident doctor managing the facility. Athashree on the other hand, is a residential facility built by Paranjape Builders and Developers primarily catered to the senior citizens, who can buy flats in the society and live with their family members.

Aastha:
Aastha primarily is a 42-bed facility with independent rooms spread across 4 floors at Pashan. This facility has resident nurses in each of the floors who are present to take care of emergency medical needs of the occupants in that particular floor. The facility did not have high-end medical equipment to deal with complicated cases. Most of the residents had limited mobility and were suffering from paralysis, arthritis and similar disorders. They have a clear policy of not taking in residents with higher levels of dementia/ Alzheimers, and a specific laid down criteria of the kind of residents they admit, based on a lot of factors such as medical complications, financial considerations, facilities needed, background of the family and so on. A collaboration has been set-up for referring emergency cases to hospitals such as Jupiter, Poona Hospital and DMH. This is facilitated by an ambulance available round the clock for taking patients to these hospitals. They focus on providing a good quality of life to people post-retirement, who could afford to pay and not stay at homes. One of their main focus areas is to have a lot of activities which ensures social inclusion and participation among the residents. The rooms have all basic furniture, which were customizable based on the needs of the residents in those rooms. The lighting in the rooms is kept adequate to ensure the residents do not face any discomfort. The bathrooms have support structures to prevent falls and also notify the caretakers in case of emergency. A dietician, physiotherapist, gerontologist and specialized doctors have scheduled weekly visits and have access to the medical records of each of the residents. Caretakers and nurses stay in-house, who have been primarily recruited from specialized caregiving courses run by TISS, Mumbai. The monthly cost per room is around 45000 INR per month with a deposit amount. Due diligence is carried out to ensure that the resident staff at Astha and families are in agreement with the process of on-boarding at the facility. Interactions with family members are also facilitated from time to time, to ensure healthy ageing for the residents.

Overall, in brief, this facility is catered to a specific target segment, who has the willingness to pay for good services, highlighted by the fact that more than 50% of the residents have stayed for more than 4 years in the facility. From a need perspective, nothing significant could be found out. However, we hope further interactions with Dr. Rhayakar might provide us with some useful insights.

Athashree:
Athashree is primarily a residential project facility intended for the stay of senior citizens. It has 1 bhk, 2 bhk, 3 bhk options spread across the entire housing society along with all facilities such as gym, swimming pools, guest rooms, common recreational area, parks etc. This society provides the option of staying with their own family members, as long as the flat is booked on the name of a senior citizen in the family. They have rooms with different dimensions and architecture based on the liking of the individuals. The rooms have high enough friction to avoid slips and falls, and there is a chain like a lever in the bathroom for the resident to highlight, in case of any emergency while at the bathroom. The rooms had locks from inside, and could be private properties for individuals. They have a common kitchen facility, where the residents can come and eat together. The kitchen facility has a fixed menu for each time of the day, prepared by a dietician and it is ensured that every 15 days the menu is changed. They have specialized lifts for residents with disabilities and have access to a round the clock ambulance. An electric vehicle plies around the housing society to help residents commute across the society. They also have spaces where they come together and celebrate different festivals together, due to the presence of a diverse crowd. They also have bus facility which takes the residents to various parts of the city once a week. There are caretakers and a resident house manager available round the clock 24 x 7 to ensure all contingencies are taken care of.

Overall, it is a facility where senior citizens can live together in the comfort of homes, but with the company of other senior citizens to ensure social inclusion, which might prevent the onset of various disorders associated with ageing. No significant need as such was observed during the visit and after our discussion with Mr. Yadav (resident manager at Athashree).

Observations:
The presence of facilities such as Astha And Athashree points towards a society where due to the formation of nuclear families and better-paying jobs/ pension post-retirement, senior citizens appreciate the value of a life with a good quality of living. The family members have been mostly found to reside outside and with their busy lives, are not able to give enough time to family members. This leads to social isolation, which degrades the cognitive skills much faster than usual. This establishes the need for a service, where:
a. Basic living requirements are met,
b. Social inclusion is addressed with group activities along with similar age group people,
c. The continued companionship of similar age group with whom they can talk or just share their feelings/ sentiments with,
d. Assisted living facilities, which prevents daily mishaps occurring at old age, using customized design and architecture,
e. Access to round the clock medical emergency services including access to specialists and ambulance services,
f. Weekly consultations with specialists to cater to their healthy living from all aspects.

Don’t do it Akela! – Co-Founders’ Guide by Srikant Sastri.

Srikant Sastri is an alumnus of IIT Kanpur and IIM Calcutta with interests in current affairs, contemporary history, and economic development. He is a seasoned entrepreneur who spearheaded multiple ventures and exited two successful ventures. He provides strategic leadership as the co-founder of Crayon Data, the ambitious Singapore-headquartered start-up, which aims to build a global business around a Big Data platform and products. This is his third start-up. As a successful entrepreneur, Srikant had founded India and Southeast Asia’s largest CRM & Digital agency, Solutions – Digitas, in 1995. Sastri is a known name among Indian technology start-ups and an active angel investor. He created a theme-based web series called ‘Chalo Startup’ which focuses on helping entrepreneurs to unravel the start-up ecosystem through the experiences of early stage entrepreneurs.

Mr. Srikant Sastri visited Venture Center to give a talk about finding co-founders for start-ups on 23rd March 2018. He discussed important aspects of having a cofounder as a part of the startup.

He addressed three important questions through his presentation.

  1.    What you look out for in a co-founder?
  2.    What are the expectations from cofounders?
  3.    Why having co-founders is important?

According to him, it’s difficult to manage a new business as a sole founder and at times it becomes stressful handling everything. The complementary cofounder plays an important role here, helping them to make better decisions. Also, investors are most likely to invest in start-ups with multiple cofounders because multiple brains are better than one and cofounders complement each other’s skillsets. Looking out for a person who has rights skillsets and personality traits who can complement yours helps in growing your company in the right direction. Mr. Sastri quoted,

“Finding right co-founders and a great working relationship is key to a successful start-up.”

He mentioned that relationship with cofounders is similar to the relationship with a spouse. There needs to be mutual respect among co-founders to make it a long-standing relationship. Co-founders should regularly spend time together to maintain that partnership. Seeking out cofounders from ex-colleagues, classmates and juniors is one way of finding the right candidate. Start-up events and Entrepreneurship summits is another way of bringing in like-minded people. Social networking platforms like LinkedIn and Facebook is another place to look out for cofounders. First among equals is a principle which helps in successful business partnerships. Having a clear founders agreement amongst cofounders is critical to safeguarding start-ups future viability. It should cover important areas like equity distribution, ownership, roles and responsibilities etc.

Mr. Srikant Sastri interacted with the present entrepreneurs and answered all their queries.

Visit to Tapas, Elderly Care.

The fellows of SIIP III who are looking to identify problems under the broader theme of geriatric care visited an elder care home in Someshwarwadi, Pashan, on the 26th of March 2018, along with their manager. This facility is run by Ms. Prajakta Wadhavkar who is an activist and has been working for social causes since many years.

The fellows entered the care home during the ‘prayer time’ for the elderly residing in the facility. Most of the elderly recited these mantras along with mobility exercises with movement of hands and legs. Few seniors who weren’t interested in chanting mantras, were listening to the old songs from ‘60s and ‘70s through ‘Saregama Carvaan’ speaker exclusively designed for the seniors as they belonged to the era of Amin Sayani-Binaca Geet Mala. The atmosphere was neither dull nor energetic, it was peaceful! The seniors were enjoying what they were doing and the caregivers were helping them out as per their need.

 

About TAPAS

Ms. Wadhavkar talked briefly about the journey of Tapas, the problems she faced and how she got overwhelming responses from some of the clients as Tapas has recently completed one year. Basically, Ms. Wadhavkar wanted to work for the elderly, and during the process of needs identification, she observed that there was no support system available for the elderly suffering from various mental disorders, the most prevalent among them being ‘Dementia.’ She decided to set up a care facility which was sanctioned under the Mental Health Act of Govt. of India. ‘Tapas’ is basically a paid care facility for older adults who are need of constant physical support and attention. There were about thirty patients residing in the facility at the time of observation. Infrastructure included a single four storey building with some open spaces and a basement converted into a common meeting place. A spacious elevator is also available for the wheel-chair bound patients to fit in along with their caretaker. Common kitchen is also available within the facility where food is cooked for each patient as per their nutritional demand.

 

The Team: Medical Practitioners and Care-givers

Primarily being a medical care facility, Tapas has a crew of renowned doctors spread across Pune, who visit the facility and provide consultation on a weekly basis. Physician, psychiatrist, physiotherapist, nutritionist, behavioural therapist and specialized geriatrician visit the facility regularly, said Ms. Wadhavkar. Apart from the visiting doctors, the nurses are available 24X7 and they work in shifts. These nurses are primarily recruited through bureau’s and through references from nearby villages. The criteria for selection is a willingness to serve the elderly and being commited to the cause, and not specifically specific skillsets such as geriatric care, nursing. For every 2 patients, there is one separate trained caregiver who supported the patients in their day to day activities. Most of the caregivers were trained on job. It is mandatory for every caregiver to attend review meetings, gatherings and celebrating various festivals together along with their senior friends. The caregivers were also given specialized training, and underwent counselling on a regular basis for stress management and emotional, physical well being.

 

Ms. Wadhavkar also described the typical pattern observed in case of dementia patients i.e., the progression of disease from early symptoms to the behavioural changes which are seen during the later stages of the disease.

 

Major Observations and Comments

  1. Most of the patients in the facility were bound to wheelchair. Older females were given a task of cutting the vegetables and older males were playing carrom.
  2. Each older person was carrying his/her own napkin with utmost hygiene being ensured across the entire facility.
  3. Caregivers were enthusiastic and had good social skills: active listening and speaking, thereby making the elderly patients comfortable and friendly. Ratio of caregivers to patient was almost 2:1.
  4. Grab bars were present around the staircase and in the washroom to assist the elderly in moving around the facility with utmost care. Security grills were present.
  5. Availability of doctors was appropriate and tie-up with variety of the hospitals was commendable.
  6. Counselling of the caregivers was being provided on a regular basis, which ensured they perform their role in the best possible manner,
  7. Conventional lock and key is used. No digital alarming system was observed. CCTV Camera were located and working!
  8. Colour combination was simple. Paintings were depressing. Too much noise of mechanical work should be avoided in any of the care facility, especially with the dementia patients as they might get aggressive due to the continuous noise.

 

Needs Identified:

  1. Floors were normal, not anti-skid, thereby increasing the risk of falls!
  2. Sofas in common area were not age-friendly with arm-rests not being present and the height being usual than normal for elderly population.
  3. Lighting were insufficient in the rooms, even though the size of the rooms was decent. Rooms did not have locks and door bells.
  4. Belts/assistive devices/use of technology could be utilized physically move the older person.
  5. Use of repositioning technology in the care home was needed to minimize the burden of the caregivers especially to prevent bedsores, which is a common occurrence.
  6. The sensitivity and accuracy of patches for pain relief hasn’t been established.
  7. Inclusion of memory enhancing techniques  for the patients was not observed
  8. Symptoms of dementia starts almost in early 40s and hence it is necessary to have diagnosis of dementia traits/gene/risk tests both at macro and micro level.
  9. Bathroom mats/chair/age-friendly bathroom unit is necessary, did not observe any of it in the facility.
  10. Comorbidity is seen with most of the dementia patients. Use of specialized spoons/cups etc. was not observed.

 

Overall Observation:

The facility has been well constructed with proper well thought strategies, and a decent influx of patients. There is a need for a few problems to be solved, which could reduce the inconvenience faced by the elderly patients. Ms Prajakta was clear in her understanding, that the model was primarily catered to the higher end segment with a clear financial model to earn revenue and break-even at the earliest.

 

She has set-up collaborations and networks have been set-up in place, with an intention to develop the facility as a research and policy centre for elderly needs in the country. Ms Prajakta did mention her interest of working with the leading players in this space, to learn from them highlighted by her collaboration with International Longevity Centre (ILC) and interactions with people in the MCI ecosystem.

 

The modus operandi and the vision she has for Tapas Healthcare is indeed commendable, but there is a need for the ecosystem for integrated-affordable models primarily catered to the middle and lower income groups.

Pune to Puri via Bhubaneswar…!

“Journey is more beautiful than the destination reached!”

It is indeed true for the beautiful journey called life! It was an awesome experience for all the SIIP fellows under BIRAC grant programme focused on “Geriatrics and health”. As a part of our immersion programme, our first workshop was organized by one of the partners; KIIT-TBI at Bhubaneswar, Odisha. The purpose of the three days’ workshop was clearly mentioned and all the objectives were fulfilled because everybody religiously followed the schedule given by the speakers.

Sixteen young souls from four states with curiosity in their eyes, full of enthusiasm and innovative ideas in their minds were assembled together to talk about the problems and challenges faced by the older generation. One of the main objectives of the workshop was to orient all the sixteen fellows on the basics of “Social Entrepreneurship”. The speakers were experts from various fields, Social, Political and Entrepreneurial backgrounds and all of them are currently faculty members of Tata Institute of Social Science (TISS), Mumbai.

It is usually said that ‘well begun is half done!’ It actually happened in our case as our first workshop was a package full of knowledge, practise, long-hour discussions, home-assignments and group presentations. The best thing scholars asked us to follow was the shuffling of group members so that all the sixteen fellows were grouped into four groups and every group has one member from each state. Initially everybody was awkward as no one knew the other person and every group was diverse and unique in its own sense.

Dr. Mujumdar from TISS conducted first introductory session in which he put forth the objectives of the workshop and expectations from the fellows and what exactly we were about to learn. Dr. Guha, a social scientist from TISS talked about the social aspects of an ageing society and why it is necessary to think about the geriatric challenges India is going to face in a decade because of increasing ageing population. The demographic and health profile from Census and NSSO made an impact on the audience as the fellows understood the gravity of the issue after the presentation by Dr. Guha. It was a wise decision to introduce the fellows to various aspects of ageing on the first day itself; Dr. Reji from TISS illustrated the role of environmental factors in the ageing process. He showed a clip of an interview of a caregiver daughter who shared her experiences in the context of dementia care.

At the end of the first day, all the four groups were given a task of presenting what they understood from the sessions. Each group presented a scenario of ageing through their observations and experience. From this interactive session all the fellows intermingled with each other and that helped to know each other better.

At KIIT-TBI, Bhubaneswar with the fellows, scholars and the organizers

Next two days were similar in nature where Dr. Mujumdar, Mr. Durvas, Dr. Guha and Dr. Reji conducted sessions on basics of social entrepreneurship. Being an interactive environment, all the fellows and the managers of all four groups got a fair chance to ask questions in between and express their thoughts on each of the component.

Gist of what we learnt from the WORKSHOP:

  1. ‘Innovation’ includes Invention (Newness), Adoption (Productive implementation) and Diffusion (Use of the idea in actual routine). Innovation is all about aspiration to find something new and an inspiration to pursue the goal even if you face failures.
  2. Innovator keeps on inventing new solutions, but an entrepreneur is someone who knows which solution must be provided in which setting and to which problem so as to have a sustainable business model.
  3. THREE Ps of Technology: a) Product b) Process c) PracticeProcess and Practice technology must be learnt and explored by both the innovator and the user. There are two types of technologies. One is upstream technology i.e. what is already present in the market. Second one is downstream technology meaning future products/technologies that would be coming into the market and are made by using the upstream technology.
  4. Studied basics of ‘Entrepreneurship’ through models like ‘Jeffry Timmon’s Model’, Kuratko’s framework. Entrepreneurship is a dynamic process and it is ‘opportunity driven’.
  5. In the context of ‘Gerontology’ which is a term coined by Metchinikoff in 1908, needs of people in the society should be considered by considering their backgrounds, culture, socioeconomics as these factors play an important role in the societal context.
  6. Environmental and political dimensions of old-age caring in India was taught by showing the most used frameworks like ‘epidemiological model of geriatrics’, ‘environmental press-competence model’ and ‘public health model of palliative care’ and so on.
  7. Two case studies were given to the fellows to understand about social entrepreneurship and which qualities an entrepreneur should have in him/her. Case studies given were of Dr. Narsimha Bhat (Manipal DotNet) and Ms. Neelima Mishra (Rural development through women empowerment).
  8. Role of every stakeholder (investors, co-founder, employees, and customers) is vital in entrepreneurship. An innovator should believe in himself and in the possibilities, only then he can become a successful entrepreneur.

Sometimes it is important to be together, be in a friendly environment and then people can be innovative as we all were creating our own stories for presentation. Even after studying for 9 hours, most of the fellows were enthusiastic about the home assignments. Personally, I enjoyed that feeling of being at hostel, studying in a group, enjoying local food and late night discussion with peers about not only future plans but also about nearby sights and blockbuster movies. I guess it is one of the best ways of learning i.e. learning together! I hope this bonding between the fellows would be helpful to explore the innovative solutions together!

After closing the session on the third day our team decided to visit Sun temple at Konark and Jagannath ji temple in Puri which is famous for its mystical wonders. We hired a car and visited both the temples at night. We enjoyed riding on that beautiful ‘marine drive’ road with canopies on one side and the ocean on the other. After taking darshan of Jagannath ji, we had dinner at “Panth Nivas” of OTDC and spent some time on one of the virgin beaches of Puri. Just before we reached Puri, first rain was already there. It was an amazing evening, converted into a magical night and it was a beautiful journey because I was travelling with my besties, I hardly knew them before the trip but one road trip has a potential to promise you a lifelong relationship! Now we certainly know each other and I am thankful to my manager for giving us this opportunity to be together and explore beautiful province of Odisha.

On 17th of March, we had a chance to visit Mangalajodi in Odisha, a village well developed into an ecotourism spot and they recently won the prestigious 14th UNWTO award in a ceremony held in Madrid, Spain for “Innovation in Tourism Enterprise”. It was an astounding experience of riding a boat in the wetland of Chilika lake, which is Asia’s largest brackish water lagoon was surrounded by flock of various water birds. What a moment when a pair of Ruddy Shelduck (Tadorna ferruginea) took a flight together! Speechless! What a beautiful colour combination! We observed various species of water birds such as Yellow Bittern, Black Bittern, Indian pond Heron, Grey Heron, purple Heron, Great White Pelican, Spot billed pelican, Yellow Bittern, Painted stork, Oriental darter, Pacific Golden Plover, Rufous treepie, kingfisher, Purple Swamphen and so on. Mr. Sanjib Sarangi, who has worked hard to achieve this grand success of ecotourism accompanied us throughout the ride.

Mr. Sanjib Sarangi, AVP & Head, National Rural Mission at Indian Grameen Services is an activist, an entrepreneur, an orator and a splendid person. He is the man behind the success story of Mangalajodi as he worked on his ideas by involving local communities and turned the heritage site into ecotourism model. Now Mr. Sarangi is working on scaling up of this project. Before meeting him we were looking at him as just a person who would be explaining us about the ecotourism and the migratory birds in the wetlands. However, after talking to him and knowing his inspirational story, I was so thrilled to see the steps he followed in his life were similar to what we learnt in the workshop. He is indeed an entrepreneur as he had a dream in his mind and he chased it in a way so that all the stakeholders; the government, the local poacher communities, the users and the young generation in Mangalajodi had obtained profit from his project. He believed in his heritage, he wanted to develop his village on a large scale so he targeted the key opinion leaders in the village, one of them was a poacher called Baabu aka Virappan (Due to his personality). This had a positive impact on the villagers because the leader was part of the village and the villagers respect him. Mr. Sarangi involved the Panchayat Raj at various levels. He made his awareness and promotion campaign through Gram Sabha so that the local communities agreed to be a part of his project and contributed in their own ways to develop the model. He built his team by taking dedicated professionals and the young minds. He himself did many of the courses and attended relevant workshops to find out what are the demands of current tourism industry and how he should do marketing of his ecotourism model to have maximum number of visitors from different parts of the world.  I learnt three important things from Mr. Sarangi. First, one should believe in his/her dream. Second, one should establish networks in diverse fields to expand his/her own world and get exposed to the real world through this network. The last and the most important is, work hard to involve all the stakeholders actively & do not underestimate their contributions even if it is little as compared to the others.

Mangalajodi with Mr. Sanjib Sarangi

It was like a meditation to be in that environment. Everything was so pure, so unique! After spending almost two and a half hour at Mangalajodi we headed to Bhubaneswar to catch our flight to Pune. Thankful to all the “stakeholders” for this wonderful trip!

Visit to Comprehensive Rural Health Project, Tal. Jamkhed, Dist Ahmednagar

The SIIP team visited the Comprehensive Rural Health Project (CRHP) and its associated Julia Hospital in Jamkhed on 30 September 2015.We were introduced to the project by Mr. Jayesh Kamble, who, for the past ten years has been a part of various initiatives by CRHP — mobile health team, adolescent boys initiative, farmers’ clubs, women’s groups, village health worker training etc. He described the conditions in Jamkhed when the project was started by Dr. Rajanikant Arole and Dr. Mabelle Arole and the interventions by CRHP to improve them. For example, the infant mortality rate was brought down to 17 per 1000 from over 200 per 1000 by providing access to medical facilities and by educating mothers about nutrition, breastfeeding, adequate birth spacing etc.

CRHP has a three-pronged system:

  1. Village health workers from the local community
  2. Mobile health team, which generally has a doctor, a nurse, a pharmacist and a lab technician.
  3. A hospital – Julia Hospital in Jamkhed.

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In addition to the routine pathology tests, malaria detection is also done at the Julia hospital’s pathology lab. CRHP also has an international internship program for students who are interested in working in public health issues. In addition, they also have a pre-school for about 60 children upto 5-6 years of age, where the malnutrition related issues are also tackled in addition to preparing the kids for regular school. Children attending this pre-school are mainly from the slum areas and the poor socio-economic bracket.

 

One day Campaign workshop on “Anti-Microbial Resistance”

A one day campaign workshop on Anti-Microbial Resistance (AMR) was organized by Venture Center, Pune on Saturday, 29th August 2015. This workshop aimed to bring together clinicians, social innovators and technologists to facilitate discussion on needs and intervention priorities in the broad field of antimicrobial resistance. This workshop was supported by DBT-BIRAC and the Social Innovation Immersion Programme at Venture Center. The detailed report of this workshop is available at: http://www.venturecenter.co.in/campaigns/amr/events/

One Day Campaign Workshop on Medical Electronics

20 June 2015: One day Medical Electronics Campaign Workshop

| Outline | Report |

Venture Center hosted the Medical Electronics workshop, with the aim of creating a platform to allow stakeholders from the electronics, healthcare industry and industrial design and government grant disbursement agencies to interact and network. Entrepreneurs both young and experienced were introduced to ground realities in the field of government run healthcare sector. Potential need statements that can be addressed through applied electronics were discussed. Young product designers and engineers were exposed to typical product development cycle in field of medical devices. Some of the safety concerns and safety design constraints were put forth on the table. Senior designers and entrepreneurs shared their life experiences and insights into the nitty gritties that go into building a medical device and the possible mistakes that have taught them well. Finally members from government grant disbursement agency BIRAC shared new grant schemes (IIPME) in the field of medical electronics. Specific selection criteria were discussed, a Q&A round was particularly useful in understanding the funding mechanism of BIRAC.

The introductory session was opened by Founder of Concept Integration, Arvind Savargaonkar.

With 30 years of experience behind him, he shared his understanding of medical device landscape, do’s and dont’s of product development and overview of product development cycle.

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Mr. Savargaonkar started his talk by identifying growth potential in the field of medical devices particularly in India, which has large scale unmet needs in the healthcare sector. About 75% of India’s medical device needs are supported with imports, further emphasizing on the proportion of medical electronics and consumables import proportion.

Sharing his experiences of visit to China, and how their strategy of back engineering and robust manufacturing machinery provides the conducive ecosystem for innovators to productize sustainable out-of-the-box ideas. Assessing if India can build and evolve into such a device development hub, highlighting constraints and bold steps that India government machinery and industry can take towards building such an ecosystem would be useful.

He highlighted that innovation need not always come from the product or the process itself but may come from the delivery of the product itself. Citing the business models of uber, whatsapp, he warned young entrepreneurs about how innovations like these cannot be sustainable in the long run.

He talked about the 4 Challenges that need to be addressed during the innovation cycle: Myths, Methodologies, Scale and Speed, Mortality. There is one myth which believes that innovation equals product, which is totally wrong. The pipeline in this case is research to technology to products and then manufacturing. Some ingredients and recipe include:

  • Identify unmet and undiscovered needs
  • Work on the technology
  • Scale up

There is also a need to Identify technical needs. Rationale for existence of products should be thought about. One should also understand the dynamics of turning idea into business. In addition to this, other important aspects include: deal making, valuation, negotiation, communications and focus on excellence in delivery. As speed and size is important, he advised on building this into the research plan. Also, he advised to pay attention to the mortality rate of any product. Also, there is a need for collaborations with clinicians/users to identify unmet and undiscovered needs, clinical inputs and voice of customer. In this regard, he discussed about the need for home dialysis machines, as patient’s load is too much to handle in a regular hemodialysis unit in the hospital set up.

Mr. Prakash Khanzode handled the session on Design thinking. He highlighted the 4 dimensions of connecting and leveraging: Brand and business, Product and service, User and culture, Technology and trends. Some of the disconnects/problems could be how to make holistic decisions. Thus, design thinking enlarges possibilities and helps in joining the dots in your thinking process. There is a need for empathic enquiry, iterative prototyping, abductive reasoning (need to understand circumstances, build scenarios, propose hypotheses) and creative visualization (helps in putting things in perspective using some models or visualization packages).

Session 2 started with a panel discussion on some of the pressing needs and new developments in the healthcare sector. The panel consisted of Dr. Aparna Shrotri (formerly Professor at the department of Obstetrics & Gynecology, B. J. Medical College, Pune), Dr. Dnyaneshwar Shelke (Chief Operating Officer for the Maharashtra Emergency Medical Services project [MEMS / “108 Ambulance”] at BVG India Ltd.), Dr. Sujit Jagtap (neurologist with over ten years of experience and founding member of Jagtap Clinic & Research Center, Pune), and Mr. Prakash Khanzode (Director and Principal Designer at Onio Design Pvt. Ltd., Pune) and was moderated by Dr. Niranjan Khambete.

Dr. Aparna Shrotri started the discussion, focussing on cervical cancer screening. She highlighted how a relatively simple test of visual inspection of the cervix under acetic acid could help detect cervical lesions even before they become cancerous, and thus potentially save lives. She also pointed out the need to collect data about high-risk pregnancies and track low birth weight babies.

Dr. Dnyaneshwar Shelke spoke next about the Maharashtra Emergency Medical Service (“dial 108 to call an ambulance”). He invited participants to visit his central control room sometime and check out their real time tracking system for ambulances and their protocols for providing prompt medical attention. He informed the participants about some facts and statistics regarding the service. He said that around eighty percent of Indians have access to 108 emergency services. In Maharashtra, around 1200 people avail of this service every day. Of these, around 30% are trauma cases and around 30-40% are pregnancy related emergency cases. Typically, for such emergency cases in a hospital, multiple personnel work together as a team to  stabilize the patient. However, this is not possible within an ambulance and some tasks have to be carried out by semi-skilled personnel who have not been exposed to training as that of physicians or nurses. These people can be greatly helped by appropriate automated medical devices to help supplement their skills. Dr. Shelke gave some examples of devices needed on these ambulances. He expressed the need for a device that helps with tying of a tourniquet, to the appropriate optimal tightness, so as to minimize bleeding but also not cause necrosis by cutting off blood supply completely. He urged entrepreneurs among the participants to consider development of this and similar other such devices.

Dr. Sujit Jagtap expressed a need for devices of Indian make that meet international standards. He compared the cheap and expensive versions of several devices and enumerated the pros and cons of them. A common theme seemed to be that Indian devices, though cheaper, are often of poorer quality and sometimes do not help in the diagnosis at all. On the other hand, foreign made devices, though of good quality, are very expensive, and getting them serviced promptly in case of malfunction is often difficult. He also suggested improvements in existing devices which would make them more convenient to use. For example, to correlate EEG findings with patient activity, there is a need to record a video of a patient while their EEG is also being recorded simultaneously. There is a need for a version of this system where the camera automatically tracks the patient if the latter moves.

Mr. Prakash Khanzode concluded the panel discussion. He stressed the necessity for doctors and engineers to work together and exchange information, in order to effectively design good devices.

The next item on the day’s agenda was a quick presentation by Mr. Pradeep Kolankari, who heads the Solutions team at IGATE corporation as part of their medical devices and healthcare practice. He discussed the various steps involved in commercializing medical devices and taking them to market from the idea / prototype phase.

This was followed by a presentation on medical devices and diagnostic needs in India by the Social Innovation Immersion Program (SIIP) team at Venture Center. Dr. Mugdha Potnis-Lele, the program manager for SIIP, started by giving a brief introduction of the program and of the four fellows under this program. This was followed by a presentation by the fellows based on the needs identified during their clinical and rural immersions as part of the SIIP. Ms. Amrita Sukrity spoke about the disease burden in rural and urban areas, and introduced the participants to systemic and infrastructural challenges that need to be addressed. Mr. Sarang Kulkarni spoke about the problems of malnutrition and pneumonia and related device needs. Mr. DSS Chaitanya spoke about the prevalence of avoidable blindness and what can be done to help curtail it. Ms.Apoorva Bedekar presented the reproductive health issues and needs about non-communicable disorders like diabetes, identified during the immersions.

Dr. P.K.S. Sarma, Head Technical (Discovery & Product Development) at Biotechnology Industry Research Assistance Council (BIRAC) started the next session where he talked about the innovation cycle and role of BIRAC in the form of various funding schemes. This was followed by a presentation by Ms. Sonia Gandhi, Program Manager, Investments at BIRAC, where she introduced the participants to the  Industry Innovation Programme on Medical Electronics (IIPME), a joint program of BIRAC and the Department of Electronics and Information Technology, Government of India. More details are available online at http://www.birac.nic.in/news_description.php?id=169 . Ms. Gandhi and Dr. Sarma also answered queries from participating entrepreneurs about BIRAC’s schemes.  Mr. Paul Belknap, Investment Manager at Villgro Innovations Foundation spoke next about Villgro and their funding policies. He also announced a Social Innovation Immersion Program at Villgro and encouraged participants to recommend it to interested candidates.

This session consisted of a question and answer session as well as panel discussion with several entrepreneurs and innovators. Panelists included Mr. Vivek Mohile (R&D at Persistent Systems), Mr. Arvind Savargaonkar (Managing Director, Concept Integrations), Mr. Gautam Morey (founder and CEO of Sofomo Embedded Solutions), Mr. Siddharth Chinoy (founding member, Embryyo Technologies) and Mr. Aniruddha Atre (co-founder, Jeevtronics). The panel shared their experiences with the participants. Mr. Savargaonkar expressed that innovations should not be restricted to one’s technological background and comfort zone and lamented that perhaps a broader outlook is beneficial. Mr. Morey advised the participants to be well prepared before meeting doctors for their inputs, and to make it clear to them that you are not actually trying to sell them something but rather developing a new product. Mr. Atre spoke about the various risks entrepreneurs face, and how to mitigate them. Mr. Savargaonkar expressed the importance of a business model over the approach of addressing things only when they become a problem. He also pointed out that while several other sectors may seem easier to get into, medical devices is a sector where once one becomes established, one can survive a long time. He suggested that entrepreneurs should not be afraid to attempt to solve complex problems, rather than routine problems.

The workshop concluded with a note on thanking the speakers for sparing their valuable time and the participants for their active participation.

Visit to Gaganbawada Taluka

Among the twelve tehsils of Kolhapur district, Gaganba wada is a nature lover’s paradise. Home to Malabar pied hornbill Tehsil of Gaganbawada is 55 km from Kolhapur. The population of 32,545 (lowest in Kolhapur district) Gaganbawada is served by 1 rural hospital, 2 public health centres and 9 subcentres of which 4 are in Nivade and 5 are in Garivade. The tehsil sees an inflow of migrating population during the sugar cane cutting season.

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Gaganbawada experiences second highest rainfall in Maharashtra of about 4000 mm, causing a few villages to cut off from the central health facility and skilled man power to address health emergencies and arrange for medical supplies.

The fellows were given a warm welcome and insights were shared courtesy Mr. Vikas Bhalerao tehsildar and executive magistrate. First on the list was a stop at the tehsildar and executive magistrate’s meeting hall, where a group of asha’s, anganwaadi sevika and rural hospital nursing staff were invited to share their views, everyday issues, experiences on the field and comments.

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Next on the stop was the rural hospital at Gaganbavada. The fellows were given feedback from Dr. Shreyas Juvekar and insight into the world of clinical management of emergencies.

The rural hospital has been able to handle vasectomy, hystertonomy, tubectonomy, emergency deliveries. The hospital is equipped with IPD facility, 1 ambulance, There is a shortage of specialist therefore, sterilization surgeries are planned in advance. Immunization for newborns and toddlers is successfully handled, apart from emergencies such as dog bite, snake bite and wolf bite.

The next stop was a residential school for girls who drop out from primary school. A zilla parishad run school Kasturba Gandhi Balika Vidyalaya. The fellows meet and interacted with the girls understanding their backgrounds, motivation and aspirations. There are about 118 residents from 6th grade uptil 10th grade. They are taught vocational skills along with state approved curriculum.

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The final destination on the agenda was a Public Healthcare Centre at Nivade. The PHC is well equipped to handle emergency deliveries, sterilization for men and women, temporary isolation of TB suspected subjects. The PHC reported 6 infants in the last year and 1 malaria patient.

Visit to KEM Hospital Research Center, Vadu

The SIIP team visited KEM Health and Research Center, located in Vadu (around 40 km from Pune). KEMHRC aims to extend healthcare to rural population through various means and collaborations. It is working in the field of health through various programs including: 1. Shirdi Sai Baba Rural Hospital, 2. Health and demographic surveillance system, 3. Vadu outreach program, 4. Pabal training center and a few others.

At KEMHRC, we met Dr. Juvekar who spoke to us about various aspects of healthcare and the day to day challenges faced by medical practitioners in given rural settings.

Neonatal health

KEMHRC is working towards the reduction of IMR and aims at reducing the rate to 2/1000 live births in coming years. The hospital is also doing a lot of data analysis to understand the various aspects of pediatric health and are also conducting vaccination trials for rotavirus and meningitis. They also have a plan for further vaccination trials for pneumococcal and RSV pneumonia. We spoke in length with Dr. Kawade on the topic of neonatal health who gave us insights on major hurdles and research priorities in this field. One of the major challenges faced at present is the prediction of birth asphyxia. Conventionally it is predicted through the measurement of optical density of amniotic fluid, however collection of the amniotic fluid is major challenge in itself. Also, in case the foetus passes meconium in mother’s womb, chances of survival of the foetus go down drastically. Another frequent cause of respiratory distress at birth is low amount of pulmonary surfactants in the lungs. This requires an artificial delivery of surfactants using the endotracheal tube, better methods are required in this aspect to reduce the IMR by large

Malshirus: An insight into community healthcare for women.

Malshirus, a village in the Purandar district of Maharashtra, is the field of work for MASUM. MASUM is a development group that is aimed at making women self reliant and aware of their rights, as well as to nurture their physical and emotional health.

We visited the village on 10th March 2015 and were escorted around and given an insight into the activities of MASUM by ‘Sadaphules’. We had an opportunity to observe the proceedings of village level samitis. There are three main samitis in function: 1. Jaagruk Mahila Samiti, 2. Aadhar Gath Samiti, 3. Aarogya Samiti. These samitis (each organised at the community level by local women of Malshiras) aim at creating awareness, financial independence and better health practices amongst the women. The Aarogya Samiti organises awareness camps for women on reproductive health, trains health workers to do initial screening of diseases and informs PHCs about pregnancies and ensure safe deliveries under skilled supervision.

There were several observations that we made while going around the village. Even though the maternal mortality and infant mortality rate of wasn’t high, the number of stillbirths in the village was alarming. The nurses (during our visit to PHCs) tried to convince us of a great decline in number of stillbirths but the opinion seemed to differ across different health workers. The PHC, well equipped with modern medical equipments and a pathology lab seemed in need of a little redemption. An obvious shortage of doctors, nurses, labour rooms and ambulances made us probe deeper into the availability and accessibility of health care to rural population. Although the government has done much in the field of community health, including diabetes and blood pressure checkup camps for elderly population and hormonal checkup camps for women, there is still a lot that remains to be done. The PHC had no working ultrasonography machine and patients were frequently being referred to the RH in Saswad for foetal health monitoring. The travel time between Saswad to Malshiras being more than an hour, or more depending on availability of an ambulance. Instruments in the neonatal department, such as incubator and phototherapy units, remained unused due to lack of skill and lack of proper maintenance. Further aggravation to these problems was provided by a load shedding schedule of 6 hours. The pathology department of PHC was well maintained and blood tests for various conditions such as pneumonia, malaria, sugar and anaemia were being carried out. However, a number of tests which required blood culture and analytical observations were not being performed.

There remains a lot more to learn about the health care area in Malshiras and we hope to do that in subsequent visits and observations during health camps.

(Opinions expressed here are author’s only and do not reflect the view of Venture Center, Pune)

Melghat: A region full of challenges and solutions

Melghat, a cluster of 320 villages spread over the area of 4000 sq. km is known for its scenic beauty, teak forests, exotic fauna and “malnutrition.”Our journey began when we reached MAHAN after crossing the sharp ghats in Satpuda ranges. MAHAN is an NGO, run by Dr. Ashish Satav. MAHAN works towards controlling mortality in the rural tribal population through its child care, deaddiction and nutrition programs. They also organize a number of eye care and surgery camps with the aim of bringing quality healthcare to inaccessible areas of Melghat.

Working around Power cuts and poor connectivity

The villages in Melghat are sparsely populated and lack basic infrastructure and transport facilities. The fact that really struck us was that inner villages at Melghat had no connectivity or telecommunication networks and hence emergency communication or calling ambulances at time was not an option for them. Power availability in this region is also extremely poor, despite constant attention of government and several NGOs. This gets worse during the rainy season and accessibility to these regions is completely lost. Under such circumstances, it is a challenge to run surgical and opthalmological camps.

Mesh of Health workers

Given the economic background of this area, we could also notice a serious lack of proper education amongst the local tribes. The literacy rate in this area is as low as 45%. Yet, MAHAN has managed to work with low level of education and lack of skilled workers in this area. MAHAN trains a large group of village health workers every year, who are then made responsible for health check-ups, monitoring and tracking pregnant mothers, providing ante-natal care, assisting with labour and delivery, coordinating for home based child care programs, deaddiction programs and other initiatives undertaken by MAHAN. The VHWs are extensively trained to counsel the villagers and promote health awareness in the villages.

Maternal and Child Health at Melghat

A special focus is given by MAHAN towards maternal and child health. Melghat has been long known for its high infant mortality rate and large number of cases of severe malnutrition. At an average more than 500 children between age 0-5 years die due to malnutrition in Melghat. In view of this MAHAN started working with severely malnourished children. A weekly home based child care regimen was established where regular anthropometric measurements are done and children are categorized based on their height, weight and MUAC. After the categorization is over, they are recommended to the RUTF program, where nutritional food (based on UN standards) is provided to children at several locations in the village. The RUTF is made locally using easily available resources such as jaggery, peanuts and pulses. MAHAN also trains local women on preparing RUTF for domestic consumption.

Apart from tackling malnutrition, MAHAN has also been able to achieve significant progress in ante-natal care. Trained VHWs go from door to door to promote awareness of pregnant mothers. Pregnant mothers are tracked and monitored and fetal health is also recorded by the VHWs.

Anthropometric measurements: a challenge?

Constant data is collected from the village. This data includes anthropometric measurements and disease spreads for HIV, typhoid, pneumonia, malaria and diarrhea (among others). On interaction with these health workers and other doctors at Melghat, we noticed several discrepancies in collection and reading of anthropometic data. An urgent requirement, hence, in this sector would be to have automatic measurement systems with electronic readouts or data consolidation mechanisms.

 

 

International Conference on Social Entrepreneurship and Sustainable Development

Summary report on International Conference on Social Entrepreneurship and Sustainable Development

The International Conference on Social Entrepreneurship and Sustainable Development was organised by TISS and DBS Foundation with the purview of discussing and assimilating ideas on facets of social entrepreneurship and their effects on sustainable development.

The conference explored academic perspectives on social entrepreneurship; outlined stories of pilot, seed stage and established ventures in the social sector and discussed corporate governance issues towards social development.

The conference was a great networking opportunity where we met social entrepreneurs from all spheres including agriculture, animal husbandry, healthcare and education. There were discussions on several dimensions of social entrepreneurship which included not just pitching and commercializing a product or service but also highlighted the challenges in reaching the bottom of the pyramid. The conference was an excellent opportunity to learn from the real life field experiences about what we must know to take a leap into social entrepreneurship.

As a SIIP fellow, of particular interest to us were a few topics as enlisted here:

  1. Community mobilization of sugarcane growers through participatory approach. This study was presented by Dr. Rajula Shanth from Sugarcane Breeding Institute, Coimbatore. She discussed the conditions of sugar mills and sugarcane farmers in Coimbatore area and how both- technological and community based interventions were used to revive the dying the sugar factories. To deploy higher yields in the available farmlands for sugarcane, the institute did sequential trials with more than 20 plant varieties out of which two were selected for cultivation. The motivation for these experiments was to increase the yield by increasing height of sugarcane and sucrose content in the plant.The presentation led to a good learning on carrying out community based studies and on how to convince communities to accept and acknowledge technical interventions.
  2. Rural health initiative for Primary Centers and Eye Care Centers in East India. This study was presented by Dr. Sachin Ganorkar from Alchemist Hospitals, India. The presentation, as given by Dr, Ganorkar, discussed a hybrid model of PHC and eye care clinic established in West Bengal, Bihar, Jharkhand and Orissa. Alchemist hospitals are currently providing free screening for primary health and opthalmological issues. Dr Ganorkar listed some major issues with the industry which were:
  1. i) Lack of infrastructure to provide medical support through telemedicine initiatives.
  2. ii) Issues in transporting samples to distance path labs and tertiary care units and getting reports on time.

iii) Poor licensing norms in most of the Indian states which reduce the quality of health care.

  1. iv) Expensive equipments for eye care facility.

At present Alchemist Hospitals have set up around 9 centres in East India at a cost of around 112 Lakhs INR/unit. Out of this around 50 lakhs per unit is the cost of equipment for eye care divisions.

During our personal interaction with Dr. Ganorkar he further explained that a major need for standardised and portable instruments are required in the field of refractory testing, CBC measurement, lipid profiling and thyroid testing. Other medical professionals present at the conference also agreed to the fact that portability of medical equipment is of major concern especially for needs of rural area.

 

Indo-UK joint workshop on Affordable Medical Diagnostics and Devices

13 Feb 2015: Indo-UK Joint Workshop on “Affordable medical diagnostics and devices: From ideation to commercialization”

| Outline | Report |

A joint workshop was organised by Venture Center, NCL Innovation Park, Pune, UK Science and Innovation Network and Association of British Scholars, Pune with the motivation of understanding various aspects of technology commercialization for medical devices. The workshop also aimed to explore potential industry, research and medical fraternity partnerships towards technology development and evolution.

Opening Session

An opening session provided a brief introduction to Venture Center, NCL Innovation Park and Science and Innovation Network, UK. This was followed with an introductory note from Dr. Sourav Pal (Director, National Chemical Laboratory) which outlined the importance of frugal innovations in Indian context and the importance of designing easy, reliable and non-invasive diagnostics. Dr. Sourav Pal called upon entrepreneurs to understand the regulatory framework involved in reaching the market and increase the fraction of ideas which get commercialized to sustainable products.

After the opening session, a brief background of the workshop was provided by Dr. Mugdha Lele which outlined the mission, objectives and agenda for the same.

Session 1: Affordable Devices and Diagnostics- UK Trends

The workshop started with initial panel discussion on UK landscape relating to medical technology innovations, chaired by Dr. Ramesh Paranjpe. As an opening remark, Dr. Paranjpe briefly spoke of the need of technology innovations in field of medicine and healthcare and talked about huge expectations of the market such as TB diagnosis test for INR 2-5 only. Ms. Sue Dunkerton gave a brief on the UK landscape and a broader overview of KTN (Knowledge Transfer Network). The life sciences sector in UK is worth 52 billion Euros and is fast growing in terms of funding and manpower resources. The emerging trends or hot research areas in life sciences from the UK perspective, include affordable medicine, personalised medicine, targeted treatments, minimally invasive surgeries, regenerative technologies and digital health management. There is also a major focus on rapid and Point-of-Care diagnostics for diseases such as TB, COPDs, sepsis and antimicrobial resistance. Currently KTN is bringing along people from interdisciplinary sciences and working across sectors to provide know-how, multi-stage fundings and to increase entrepreneurial spirit. Strength of the KTN group lies in Chemistry and Materials Sciences and Biotechnology. Ms. Himangi Bhardwaj then spoke of available opportunities in the healthcare sector by UK government  She talked about 4 broad areas of funding:

  1. Newton-Bhabha fund. This option focuses on individuals, research entities and foundations and has joint research calls in Maternal and Child Health, Mental Healthcare and substance abuse, Affordable Healthcare and Antimicrobial resistance.
  2. Industrial Research and Development fund. This funding is provided in partnership with GITA and InnovateUK with a major focus on affordable healthcare.
  3. Affordable Healthcare Axis-Wellcome Trust.
  4. Longitudinal Prize. The longitudinal Prize focuses antimicrobial resistance research.

Apart from these the UK government is also exploring possibilities of collaborations with Ministry of Health to fund several exchange programs for researchers and doctorates.

(Details of funding programs are as in the given link: https://www.h2020uk.org/funding-calls )

The session moved further to other aspects of the technology landscape such as collaborations in eHealth, obstacles in scientific developments and potential areas for research and development. Mr. Mario Giardini briefed about his projects and collaborations in opthalmic screening solutions developed for low-income countries and inaccessible regions. Dr. Richard Black further discussed on his work biomedical materials, their processing technologies, development of scaffolds and surface treatments of these materials. He cited that the major obstacles in development of biomedical materials lie in sourcing of these materials along with the required cells and antibodies (from the perspective of ethical considerations) and understanding surface topographies, bio-reactive technologies and the complete mechanism of interactions between biomaterials and living cells. The major focus of Dr. Black’s group lies in rapid fabrication of biomed materials and gel-based systems for better drug delivery. Dr. Bachmann focussed on concepts of personalised medicine and stratified medicine and highlighted that most areas in healthcare need to mimic and build upon the developments in oncology for providing better solutions.

Session 1: Questions and Comments

In India, as opposed to UK, the problem definitions in large-scale diagnostics transform based on availability of products, level of awareness, access to infrastructure (such as electricity and manpower). A key to tackling this problem would be to co-create solutions along with medical practitioners and health workers at the ground level. The medical devices to be developed must incorporate ease-of-use and should be accessible to most through minimal training. Along with co-creation, it is also important to horizontally deploy the proposed solutions in other sectors such as animal husbandry and agricultural technologies.

Another issue in developing a robust healthcare landscape lies in gaining the trust and feedback of patients where around half of patients don’t return for results after . This makes patient monitoring and adherence to drugs and therapy a major issue in healthcare market. The panelists discussed and debated on the definition of affordability, deployment of existing solutions to rural environments and sustainable technology models. Also, there was an unanimous agreement that affordable doesn’t necessarily mean low-cost and a target price must be given and roadmaps should be derived wherever necessary. Affordability can be brought in healthcare by early and effective diagnosis techniques which help lower the cost of treatment and drugs.

Session 2: Affordable Devices and Diagnostics- Emerging Needs in India.

The second panel discussion chaired by Dr. V Premnath focussed on needs and priorities for medical technology in India. The panel constituted of veteran medical practitioners, biochemists and biotechnologists and also new-age entrepreneurs working in the field of affordable healthcare. Mr. Nikhil Phadke (Founder, GenePathDx) explained the challenges with design and manufacturing of microfluidic kits and elaborated upon modular and low risk strategy of his enterprise. Presently, GenePathDx focuses on molecular diagnostics and aims to monetize each step in molecular diagnostics rather than manufacturing of complete kits.  Dr. Prasad Rajhans, intensivist at DMHRC elaborated on the urgent need to localise a number of low to high technology medical devices and consumables ranging from CPR mannequins to MRIs.  The panel also discussed about need of investment and innovations in technologies which are peripheral to healthcare, such as water sanitation and immunization processes. It was agreed that we as a country still need to collate a huge amount of medical data on Indian demographics, especially in the field of NCDs.

Session 2: Questions and Comments

Medical tourism has been a buzzword in the Indian healthcare market, since long now. People have from neighbouring regions have been visiting India for low-cost and affordable medical procedures. Market analysis of medical tourism does pose India as a favorable location. However, there is a difference in opinion on whether the diagnostic and medical device industry see a sudden growth in demand due to medical tourism. Though, a uniform opinion on this matter couldn’t be reached, it was agreed that coming years will see more competitors in the healthcare industry which will lead to reduction in prices. A number of labs in India are already accepting samples from other countries for conducting diagnostics tests and providing results via electronic means. This system needs to be made more robust and labs must be certified and standardised with international systems to encourage this trend. It is also important to look at innovations from process viewpoint rather than the viewpoint of manufacturing to further boost growth of medical devices industry.  On the other hand, medical tourism may also lead to increase in cost of healthcare in the long run due to better buying propensity of the market.

During the discussion, Dr. Niranajan Khambete (Clinical Engineer, Deenanath Mangeshkar Hospital [DMHRC]) pointed out that we are presently at the center of a huge mesh of problems and a major difficulty lies in prioritising them while developing solutions. This difficulty is enhanced due to the non-uniform structure of Indian market. The fragmentations in Indian healthcare industry pose a big challenge in developing diagnostic devices. this reduces scalability of solutions and also increase the cost of delivering the solution to masses. There is a need of policies by the Indian government that enables the marketing and distribution of low cost diagnostics and medical devices through government hospitals, laboratories and health missions. There was also a suggestion to try out the open source model for developing diagnostics where each innovator can benefit with the developments and advancements of another.

Session 3: Stories of tech developments and commercializations in diagnostics and devices.

During the third session, delegates from India and UK presented their stories of tech commercializations in medical technology. Dr. Bachmann presented his work on rapid diagnostics for infectious diseases with major focus on molecular in vitro diagnostics, biochip technology and medical microbiology. The Bachmann group are working on biosensing platform project, chronic wound care program and EIS (Electrochemical Impedance Spectroscopy) techniques for PoC devices. Several devices and IPs were developed as an outcome to these programs such as electrochemical sensors, detection platforms and handheld machine for wound care detection. Another technology developed by Bachmann group was ePCR which utilizes intercalation techniques for DNA denaturation. This technology provides an edge over PCR which is a relatively slower and complex process. Following Dr Bachmann, Dr Prodromakis also spoke about integrated bio-sensing technologies and the key challenges in achieving them.  Some of these challenges are sensitivity of the chemical sensing processes, encapsulation materials and finding appropriate bio-markers. He emphasized that contrary to popular belief, it is futile to integrate nanoelectronics with microfluidic devices as these add to the cost of fabrication and processing. Dr. Prodromakis’ group has developed several solutions such as hybrid chemical sensing platforms, disposable diagnostic prototypes and Lab-on-PCB devices. The Lab on PCB device uses a cartridge concept wherein trenches are etched in the PCB which are then stacked together to design the required channels. this system incorporates microfluidic sample delivery network, electrochemical biosensing reagents and reference electrodes. A key challenge for this technology lies in minimizing the drift of these reference electrodes. In future, his group intends to design customised user interfaces and integrate primitive logic to disposable cartridges. They also want to exploit the ossibilities of deploying these solutions to alternative markets.

Dr Black from the Department of Biomedical Engineering, University of Strathclyde elaborated on his team’s work in rapid manufacturing of tissue scaffolds. The rapid fabrication was achieved using electrospinning of PU dispersions and later functionalizing them through various means. His current research focusses on coronary artery diseases and development of artificial arteries which can be used as grafts; biomaterial surface functionalization for developing blood vessel substitutes, vascular bioreactors and perfusion bioreactors

The session on stories of tech development continued with stories of Indian entrepreneurs: Mr. Aniruddha Atre, Mr. Nishant Kumar, Mr.Sachin Dubey, Mr. Dhiman Sarkar, Mr. Mandar Gadre and Mr. Jayant Khandare, all incubated at Venture Center, NCL.

Session 3: Questions and Comments

There are a large number of adoption barriers in the Indian medical devices industry which include lack of a regulatory framework, lopsidedness of the market for imported devices, mistrust in new and cheaper technologies and clinical history based decision making systems. A good way of overcoming this hurdle will be to involve opinion setting customers early in prodcut development stage and co-create a prototype which is suited to the needs of medical practitioners.

Session 4: Collaborative technology development and taking ideas to market – Experiences and opportunities

This was the last session for the workshop and focussed mainly on collaboration opportunities and challenges.  An opening remark during this session was given by Mr. Satya Dash who gave a brief background of BIRAC, its focus areas, funding opportunities and programs. Major paradigms at BIRAC include affordability, quality and localisation. Mr. Dash also briefed about the recently started SIIP program grants available at PoC stage. After the opening remark, Ms. Sue dunkerton again emphasised on collaborative funding programs provided by UK government. She elaborated on InnovateUK which supports innovative businesses with a goal to improve wealth of the UK and provides funding for themed calls, technology inspired calls, industry academia partnerships and small industries. Ms. Sue also introduced to the audience H2020 programs that are more SME specific. The H2020 programs include Eurostars, SME instrument and FastTrack to Innovation. Mr Vishy Chebrol outlined the importance of finding the right customers to have sustainable developments. As an example, he quoted that most medical diagnostics can target low scale private clinics and doctors who cannot afford to invest into full-functioned high end equipments due to budget or space constraints. Mr. Chebrol also suggested to backlink the innovation happening in industry to academia so that research can take it further and frugal innovations may mature into advanced science. The panelists also discussed and debated on hurdles in collaboration which included difference in opinion between industry and academia, lack of interest in high risk solutions and challenges of IP protection.

 

Welcome to the Collaboratorium on Affordable Healthcare

Welcome!

This blog attempts to catalog and compile problem definitions relating to the most pressing and widespread healthcare needs of the masses in India. The initial emphasis and focus shall be on maternal and child health in India.

The hope is that if we can compile accurate problem definitions, “solvers”  from anywhere in the world can contribute solutions.

Join us in this effort.