Don't lose hope by Rama (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

I would like to share the difficult moments which we underwent during the treatment of my husband.  It was way back in 2012, when we were happily settled in Coimbatore after a hectic life in Mumbai where both of us were working.  We used to shuttle between Coimbatore and Bangalore, where our both the daughters were settled after marriage, to spend some time with our grandchildren.

In January, 2012, one day my husband suddenly complained of severe stomach pain and went to the doctor.  There the Dr. prescribed some pain killers and asked him to go for an ultra sound.  We then went to the family doctor who asked us to go for a ct scan immediately, though the pain had subsided by then.  The CT scan showed some mass in the gall bladder area and we consulted a senior surgeon who said that the patient has to undergo an operation for removal of the mass and further investigation.  So with the help of our family doctor, my husband underwent all the tests before the operation and he was found to be ok in all the tests.  On 30th January, 2012, he underwent an open surgery and even while undergoing the operation, the mass was sent for a pathological test and that gave me the shock of my life, my husband is suffering from cancer of the gall bladder.  The surgeon removed the gall bladder and advised us to see a oncologist for further treatment.  This news gave me a terrible shock, I started thinking why God has given me this again, 20 years back my father died of cancer.  But I was assured by the surgeon that things have improved a lot in the last 20 years and we should have a positive approach.  

Our next visit was to the oncologist.  He went through the reports and told us that my husband has to undergo chemotherapy once in 15 days for six months.  The oncologist was very positive and he assured us that he is confident of treating him and that we should also have a positive approach.  At this point, I should surely mention about the way my husband took the whole thing, he was very.......... positive and was so confident that he will be out of it.  The whole family, particularly my daughters and the sons-in-laws were so supportive.  They decided in consultation with their family doctor, that we will continue the treatment in Bangalore.  Thus started our visits to the hospital every 15 days for the chemotherapy.  One day before the chemo, he was asked to undergo blood tests. The oncologist was very helpful and the whole staff of the hospital were very cooperative.  We followed the instructions of the doctor strictly and the whole treatment went on very smoothly.  Sometimes he vomited and was little down at times because of the food restrictions and restrictions on his movement outside the house.  But we regularly went on our daily walks, we visited Coimbatore twice during the treatment.  My husband did not lose his hair and jokingly he used to tell people that he had to spend money for a haircut!!  After the six months chemo, the oncologist took a pet scan and we were very happy with the result, the cancer has not spread and he now requires only a regular medical check up once in three months.

We went back to our house in Coimbatore and resumed our routine.  My husband was very happy, back to his friends and his regular badminton.  We had our regular check ups and  slowly even forgot the chemos and other treatments.  We started visiting our family functions, marriages etc.  We even went on a holiday to Kodaikanal with our daughters, sons-in-law and the grandchildren.

After a period of 8 months since his last chemo, my husband suddenly developed itching all over the body.  There was no other problem, but the itching became unbearable.  We consulted even a dermatologist who said that it may be due to the dry weather of Bangalore.  We tried all sorts of lotions and creams.  Then one day in the mid of the night, after going to the toilet, he told me that he passed some blood.  We got worried with this development and next day early morning we called up our oncologist who advised us to go for a LFT.  I must mention here one thing, all the doctors inspite of their busy schedules, were always responding to us though we called them any time of the day or night.  Immediately my husband went for a LFT and the report showed very high level of bilirubin.  Then started our ordeal of visits to the doctors - oncologist, urologist, liver specialist etc.  Inspite of stenting two times, his bilirubin went on increasing and the sodium level went down.  The doctors said that it is due to a block in the bile duct - obstructive jaundice.  After the first two months during which time he was hospitalised 3-4 times, we could see that he was becoming weak day by day.  His daily routine got affected and was becoming quite irritated.  With even a slightest strain, he was developing high fever.  The bilirubin level was constantly on the rise.  During this time the oncologist asked us to go for a Pet scan, the report showed that the cancer might have resurfaced, the report was not very clear, but the oncologist felt that the disease has surfaced again, but is progressing very slowly.  The oncologist wanted to again try chemo for him, but only after the bilirubin level comes down.  But that did not happen at all.  My husband started having water retention in the body, his abdomen, feet were swollen, he was finding it difficult to move around.  The doctors pumped out the water from his abdomen, but that did not give him much relief.  We could see that his condition was deteriorating, our family doctor told us that his condition is worsening and nothing much could be done.  One day the surgeon who had operated him visited the patient in the hospital.  He told us since nothing much could be done at this point, better to go for palliative treatment.  We followed his advise.  My husband was brought home and we tried to make him as comfortable as possible.  Though he was getting a little frustrated as he started depending on us for even going to the toilet, yet he still had a positive approach to the whole thing.  Never he said that he is fed up with the treatment, only he was a little scared of the pain he had when they were piercing needles for the intravenous injections and the drips.  It is this positive approach which gave him and also us the strength to fight the disease.

  Then on 22nd September, 2013, his sister, brother and some more relatives had just left after visiting him, I insisted that he should  have a bath and eat his lunch.  He was reluctant for having a bath as he required help, which I was always ready to do.  He had his bath, ate his simple lunch and went to bed.  Around 3.30 pm he called me, said he wants to go the toilet, I helped him get up from the bed, he got up, but was not steady, he started collapsing.  I called my son-in-law who came and held him, but then my husband was breathing very heavily.  My daughter tried to get his pulse, but could not and we could see him passing away from us.  The doctor was called and he said that 'he is no more'.  Thus came his end at 3.50pm.  The end was quite peaceful.

All this experience of nearly 18 months has made me quite strong to face any adversaries.  If we are destined to suffer we have to.  In these trying times, it is the positive approach of the patient and the family support gives us all the strength.  What I wish to share with others who are in the same condition, don't lose hope, have a positive approach, follow the doctor's advise, have faith in the doctors and above all in the God almighty.  

What is Robotic Surgery by Dr. Arun Prasad. Senior Consultant Surgeon - Minimal Access Surgery, Apollo Hospital. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

Robotic surgery, computer-assisted surgery, and robotically-assisted surgery describe the technological developments that use electro mechanical systems to help a surgeon perform surgery.

The davincirobot which is currently the market leader is not Mr. Data from Star Trek performing precise surgery on the human body.

The general term "robotic surgery" is used to refer to the technology, but it is easy for people to get the impression that the robot is performing the surgery. Actually, the current Robotic Surgical System cannot run on its own. This is due to the fact it was not designed as an autonomous system and lacks decision making software. Instead it relies on a human operator for all input.

All functions- including vision and motor functions— are performed through remote human-computer interaction. The current system is designed merely to replicate seamlessly the movement of the surgeon's hands with the tips of micro-instruments, not to make decisions or move without the surgeon’s direct input.

In other words it is like a PS3 or an Xbox where you control the movements completely and hence the outcome of the ‘game’.

HISTORY OF ROBOTIC SURGERY

Robotically-assisted surgery was developed to overcome both the limitations of minimally invasive surgery or to enhance the capabilities of surgeons performing open surgery.

In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System.

According to the manufacturer, the da Vinci System is called "da Vinci" in part "because Leonardo da Vinci invented the first robot", and also because he used anatomical accuracy and three-dimensional details to bring his works to life.

HOW DOES IT WORK ?

The system consists of a surgeon’s console that is typically in the same room as the patient and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, act as a scalpel, scissors, bovie, or unipolar or bipolar electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from the console.

The surgeon sits at the console and looks through two eye holes at a 3-D and HD image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers.

It scales, filters and translates the surgeon's hand movements into more precise micro-movements of the instruments, which operate through small incisions in the body.

To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s robotic arms (depending on the model), which secures the instruments and a high-resolution endoscopic camera.

The instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements.

There are multiple safety features designed to minimize opportunities for human error when compared with traditional approaches.

At no time is the surgical robot in control or autonomous; it operates on a "Master:Slave" relationship, the surgeon being the "Master" and the robot being the "Slave."

So the decisions on what to cut, where to cut, how to cut, when to cut, where to stitch, how to stitch etc are all taken by the surgeon and robot just replicates the hand movements.

BENEFITS OF ROBOTIC SURGERY

This has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s ergonomic design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.

Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics. Robotic techniques are also associated with reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.

In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction.

DISADVANTAGES

However there are some downsides too. Surgical procedures performed with the robot take longer than traditional ones. Critics say that hospitals have a hard time recovering the cost ( Robot costs 1 million dollars to set up and a recurring cost of about 1500 dollars per surgery ).

A Medicare study found that some procedures that have traditionally been performed with large incisions can be converted to "minimally invasive" endoscopic procedures with the use of the Robot, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used.

CURRENT USES

Robotic Surgery has been successfully used in the following procedures:

General and Gastrointestinal Surgery: Cholecystectomy, Hernia repair,Appendicectomy, Nissenfundoplication for hiatus hernia, Heller myotomy for achalasiacardia, gastric bypass, adrenalectomy, splenectomy, small intestinal surgery, colonic and rectal surgery etc.

Bariatric Surgery: Gastric bypass, gastric sleeve resection and gastric banding.

Thoracic Surgery: Thymectomy, mediastinal tumor, lung resections, esophageal surgery.

Urology: Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy, ureteralreimplantation.

Gynaecology: Ovarian cyst, Hysterectomy, myomectomy and sacrocolpopexy.

Cardiac Surgery: Coronary artery bypass, Mitral valve repair, endoscopic atrialseptal defect closure.

Head and neck: Transoral resection of tumors of the upper aerodigestive tract (tonsil, tongue base, larynx), transaxillarythyroidectomy

SUMMARY

The computer-enhanced technology and robotic precision ensure a level of surgical precision never before possible. The use of robotics is changing medicine dramatically. As the technology continues to advance and patients experience the benefits of robotic surgery, the demand for robotic procedures continues to increase.

Apollo Hospitals is taking a major step to bring the benefits of this technology to cancer patients in India.

Compared with traditional open surgery and standard laparoscopic surgery, patients treated with robotic cancer surgery benefit from more precise and accurate surgery of the concerned region in addition to decreased blood loss. This leads to less pain, fewer complications, shorter hospital stay and faster recovery.

The greater precision and maneuverability allow the surgeon to perform complex robotic cancer surgery procedures in areas that may be beyond the reach of traditional or standard laparoscopic surgery.

It appears now that this is an option restricted to few select hospitals in the world. No one knows what the future holds and this is best illustrated by the following statement by Professor Douglas Hartree, Cambridge mathematician in 1951:

“All the calculations that would ever be needed in this country will be done on the three digital computers which are being built — one in Cambridge, one in Teddington, and one in Manchester. No one else, would ever need machines of their own, or would be able to afford to buy them."

An Experience in diagnosing Tuberculosis Correctly (and some lessons learnt) by Amit. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

Its an unfortunate truth that its increasingly difficult to trust the advice of doctors, in a time when most public hospitals suffer from long queues and sordid treatment conditions, while private hospitals and doctors let their commercial interests come in the way of honest and ethical practices. I’d like to share my story of having to go to 4 different doctors to settle on a diagnosis, with the hope that it will help you with your own experiences going ahead.

Background: My wife was running a very mild fever (called low grade fever) for a while, and felt frequently fatigued.

Consultation 1: After a few weeks of this, we went to a general physician at a private hospital in Bangalore. He conducted a battery of standard tests around malaria, typhoid etc, all of which turned out negative. At which point, the doctor told us that she should “eat healthy and have coconut water”, and that we should get back in touch if any more symptoms develop. As it turns out, this was a very irresponsible piece of advice.

Consultation 2: We had to travel to Delhi shortly afterwards, and decided to seek a second opinion. I asked around in my family and decided to meet a senior internal medicine expert at a leading private hospital. We are grateful that this doctor asked my wife to measure her weight, from which we realized that she had lost about 5 KGs in last few months. He asked us to run Tuberculosis (TB) tests (Montoux, TB Gold, Chest X-Ray and Chest CT scan). Montoux and TB Gold turned out to be positive, though both have less than 100% reliability. What we did not appreciate was that the doctor was very insistent that we do the tests at his hospital.. where it costs 40% higher than good third party diagnostic centres (we ended up going to Mahajan Labs who have terrific medical infrastructure). This doctor also asked for another expensive test (Hains first line test) that we later discovered was not needed at this stage.

Consultation 3: A little cynical after the experiences so far, we went to another private doctor who confirmed the prognosis as lung Tuberculosis. He also strongly suggested another test (again insisting we do it in his hospital.. to our amusement even telling which room number we should go to “right away”), which was also uncalled for (Bronchoscopy). This is an expensive test (Rs. 20,000), and he wanted to follow it up with yet another invasive procedure (costing yet another Rs. 20,000)!

Consultation 4: A little tired of the experiences in private hospitals, we finally did our own research and found out about the national institute of tuberculosis and respiratory diseases delhi. This is a super-specialty government run hospital. We went without any appointments and were able to meet a senior doctor (a Chief Medical Officer). To our surprise, the doctor asked us certain diagnostic questions that no one had asked yet (e.g. did she take TB medication ever in her life, and whether she has any joint pains etc.). He also looked carefully at all test results, and also checked her for nodules in the neck(for non-pulmonary TB). He also told us that bronchoscopy is not needed because it can also be unconclusive, and other tests are sufficient confirmation.

In the end, the advice from the TB institute doctor proved to be the most balanced. My lessons (and takeways from others) from this experience:

• Private hospital doctors are almost always cumpulsively inclined to recommend expensive tests. They may be good doctors, but they will invariably try and make you spend as much as they can.
• Public sector hospitals are not fun to visit, and it can be difficult to even get an appointment. However, their motivations are not commercial and so they will advice from an neutral perspective.
• One must go to at least 2-3 doctors (more if needed) especially in serious illnesses.
• Most importantly, you are in charge of your own treatment. Read up on the internet, compare notes, ask questions to doctors, consult friends and family… do everything with a logical and balanced mind to drive the process yourself.

India Today's feature on Hospital Guide Foundation October 2012

Indiritta Singh D'Mello

Going to the hospital or finding a doctor at a time when your body, or that of a loved one, is battling against itself can be confusing. Even if you find what you are looking for, you are likely to be preoccupied with thoughts of whether you are being prescribed the best treatment possible or being overcharged.

This is where Hospital Guide, a notfor-profit service that is currently only online, extends their hand. Since they do not charge for their service, they are unbiased in their recommendations to patients. Indiritta Singh D'mello's initiative Hospital Guide is an online guide that helps one connect with the best doctors in the city.

A not-for-profit organisation with a vision to revolutionise health care in India, Hospital Guide aims to make quality healthcare accessible across all sections of society without distinguishing between rich and poor. 

Indiritta says, "It's not only the poor, but the rich also that need to know the right doctor to consult with." She adds that the weaker section primarily is not able to access proper medical care due to financial difficulties but this does not give the richer class an upper hand as even they are susceptible to wrong diagnoses, medical negligence and hefty medical bills. 

Driven by three core values-ethics, competence and compassion, the initiative focuses on providing healthcare solutions by referring members to doctors that vouch for their values. "The doctors that are in our database are carefully chosen and have a proven track record," she says. Hospital Guide also provides support in cases of medical negligence and with the highly complex and continuously evolving health care industry, this forum is becoming an important platform for our country.

Indiritta Singh D'mello comes from a power packed background with a royal lineage. Her mother is a princess of Kuchaman, (Rajasthan) and is also the last descendant of Meera Bai. Her mother is currently involved in reviving the dwindling crafts of Rajasthan and her father, late Rudolf D'mello was an ambassador to Cuba and a politician who was actively involved in the freedom movement of Goa. Wishing to get the best of international education, Indiritta went to Oxford and studied Politics, Philosophy and Economics.

Taking it forward from there she returned to India and worked with several hospitals where she realised that a platform like Hospital Guide is a necessity to ensure quality healthcare in India. "My dream is to revolutionise healthcare in India" she says. She conducted a one-week data analysis in the emergency of a hospital, where she concluded that 46 per cent patients were consulting with the wrong superspecialty.

With the medical industry being immune to recession, an unbiased forum such as Hospital Guide has become a necessity. Hospital Guide has more than 21,000 members and is becoming a powerful tool online. Dr. Ambrish Mithal, Chairman and Head of Department, Endocrinology and Diabetes at Medanta Medicity says, "Hospital Guide is the first forum to give a voice to patients and suggest suitable options. As a doctor, it is a good way to understand a patient's perspective, which may be very different from what we imagine." 

Moving ahead with ideologies and making way for a one-of-a-kind initiative, Indiritta D'mello says that prestige and recognition for doctors is important. "While we do not intend to commercialise Hospital Guide, we understand the need for doctors to be known for their outstanding performances. Therefore, we plan to start a recognition program for doctors to acknowledge their noble work." 

The forum is catching on as a movement on Facebook where members are increasing. She also adds that many confuse Hospital Guide to be a breakthrough for emergency cases which is not the case because an online medium cannot be used in that manner. "We do not address emergencies and I would like people to know this. If you’re in a situation of emergency, you need to contact the nearest hospital, not us," she says. 

Turning her dream into reality through Hospital Guide which has 300 plus doctors registered in its database, Indiritta acknowledges that there is long way ahead. Her vision is to increase the network of doctors and make their services accessible across the country. "Maybe one day I would like to start a hospital with an exclusive R&D centre," she says, adding that the initiative is currently most active in Delhi, Bangalore and recently Assam but will also extend to other cities. Visit hospitalguide.in

With inputs from Ayesha Aleem.

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Read more at: http://indiatoday.intoday.in/story/indiritta-singh-dmello-hospital-guide-online-doctors/1/225351.html

Should doctors prescribe only generic drugs by Dr. Ambrish Mithal, Chairman & HOD Diabetes & Endocrinology. Medanta The Medicity. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

The issue of generic vs patented drugs has been featured in the media repeatedly of late. It has been made to sound by many (including Mr Aamir Khan) as if patented drugs are prescribed by doctors only because of the perceived doctor-multinational nexus, and one should only use or prescribe generics! I wish to make a few points in this regard..

A generic drug (generic drugs, short: generics) is a drug defined as "a drug product that is comparable to brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use.” It has also been defined as a term referring to any drug marketed under its chemical name without advertising. If there were no original molecules, there would be no generics!!

The original formulation is what is sold as a branded drug. Drug companies and scientists spend billions of dollars and 15-20 years to develop a molecule from bench to bedside. It is a laborious often frustrating task. These companies then have a right for a few years- (practically 10-12 years) to manufacture and sell that drug exclusively, during which time they recover their investment and make profits. Subsequently the drug can be made by any company, which substantially lowers the cost since their no cost in R & D at this stage. The key point here is the regulations regarding generics- there has to be strict quality control- in the US according to USFDA guidelines. This ensures that the generic is not only cheap, making it more accessible, but also of the same quality as the original. This is big challenge in a country like India, for reasons that we all know. Even our top companies have been found wanting by the FDA in this regard from time to time.

In India, because of different regulations, there is a third category- 'branded generics'. These are generics made by Indian firms, some of which are reputed and have international standing. So they are are sold by different names. The same drug can be available as numerous (sometimes >50!!) brands. One expects that the 'better' Indian companies (again a question of reputation- no objective criteria) would have strict quality control and ensure better formulations. There is huge variation in the price of 'branded generics'. They cost less than the original molecule, but more than the 'unbranded' generic preparations.

How should a doctor choose a drug? Let us presume for a moment that doctors actually want their patients to respond and recover. (Yes, that is true, despite what the current environment may lead us to think!!). One option is to go with the original, branded drug. There is a wealth of data behind that drug, backed by years of research, and numerous clinical trials. This leads to a certain confidence that your patient is receiving what you are prescribing. Cost, however can be a limiting factor. One could therefore choose to go with a branded generic- again from a reputed Indian company (subjective!!)-- the cost will be less, and one is more or less assured about the quality. The third option is to go for cheapest generics- either from lesser known companies or ones with no brand at all- just the chemical name. Great, and politically correct, except that it is based on the presumption that our regulatory authorities ensure quality control. 

It is big challenge in India to ensure quality control. We are still grappling with fake/spurious drugs, so there is no way we can ensure quality of generics at present. To be safe, doctors tend to prescribe either brands or branded generics. If the regulatory authorities are able to ensure that, like the US or UK, our generics are as good as the brands, doctors will have no hesitation in prescribing only generics. After all 'branded generics' do rule the roost in India- they are much cheaper than the original brands but the doctor has faith that reputed Indian companies will supply quality drugs. This is attributed to faith in the Indian 'brand', not to our regulatory authorities. It therefore becomes a matter of subjectivity and perception rather than quality control.

It is not unusual for us to have high ranking government and army officials request prescriptions for brands we trust, rather than the ones available to them through their sarkari sources. Often they themselves don't trust their supplies. On the other hand the affluent often want the original brand, not generic brands. It is difficult for doctors to figure out the patient's perception. I remember on old lady who visited me several years ago for her osteoporosis – I chose a particular injection for her. The original brand, which is the only one I had used till then- was quite expensive by Indian standards, and branded generics from leading Indian companies had just become available at half the cost. After some deliberation and discussion I chose to go with the Indian brand. By the evening I got a call from her aggressive sounding son from New York, as to why I was choosing cheap local brands for his mother. His words were "I do not expect a leading doctor like to you to prescribe local stuff- wonder why you did so.? " On the other hand, I prescribed the original brand to a very wealthy, leading lawyer, who called me back to say- "I found out that this drug is available for much lower cost under a different name- I did not expect you to put me on such expensive medication if alternatives are available.."..

And then there are those, where the cost really matters- one just goes for a reasonably priced branded generic for them. You will agree it is difficult to constantly figure out for a doctor which BRAND to prescribe, rather than which DRUG to prescribe. It is very subjective and you can't keep everyone happy. One can't truly figure out the quality of all branded generics, and there is no way to keep track of the prices...If the doctor was to prescribe by the actual chemical/generic name, it would give the chemist a free hand to dispense whatever he feels like. Is that preferable to the doctor choosing the drug for you??

Asian Age feature on Hospital Guide Foundation, 16th April 2014,A guide through complexity of India’s medical care

Amit Goel, a resident of Bordubi village in Assam’s Tinsukia district, was shocked when his son was born with two serious medical conditions. Amit’s son Darsh was not only born with a hole in his heart, he also had Down’s Syndrome. A relative told him about an organisation called the Hospital Guide Foundation (HGF), which provides free-of-charge guidance to people who are confused and are in need of medical guidance. After talking to the HGF, he was put in touch with two doctors in Delhi where he travelled to immediately with his three-month-old son for surgery for the heart condition. Later, Mr Goel was also put in touch with multiple hospitals in the capital to receive therapy for the child’s Down’s Syndrome as well.

“I was more concerned about Darsh’s Down’s Syndrome than I was about his heart defect. Almost every doctor had told me that there wasn’t much that can be done for a patient with Down’s. But HGF put me through at two very good hospitals in New Delhi and they suggested a few forms of therapy for Down’s. We were told about physiotherapy that would help with his condition. Thanks to the right advice from doctors, Darsh’s quality of life has improved by as much as 80 per cent thanks to the therapy,” said Mr Goel.

Yasub, a resident of Bengaluru, had been suffering from issue relating to hyper-acidity for a very long time. He had consulted many doctors, but no form of treatment had been successful in his case. Almost out of hope, a colleague told him about the Hospital Guide Foundation. After getting in touch with the HGF, he was advised to consider options other than allopathy. He was told that it was possible that homeopathy and naturopathy could be more effective in his case. “It was finally homeopathy that worked in my case,” he says. After that experience, he has told many of his friends and family about the foundation’s work and they have approached the HGF about issues ranging from chronic depression to orthopedic conditions.

In another case in Assam, a 53-day-old baby girl was born with a serious anorectal malformation called rectovestibular fistula. The couple, who do not wish to be named, got in touch with the Hospital Guide Foundation and were connected to a doctors in Bengaluru who managed to correct the malformation in the infant’s colon and rectum in a single surgery. The couple had been told earlier that at least two surgeries would be needed to fix the condition.

“I think it’s paradoxical that India is emerging as a hub for medical tourism and yet our own people don’t have access to proper medical care,” says Hospital Guide Foundation co-founder and director Indiritta Singh D’mello, an Oxford graduate who started the HGF with her husband Manu Tripathi. “We wanted to create a guide for healthcare in the country. A guide for the people who are looking for a specialist and have no idea who to ask. But most importantly, we wanted these services to be completely free and unbiased,” says Manu Tripathi who also works as a programme director for a major radio channel in Bengaluru. Hospital Guide Foundation was started as a group on Facebook with a handful of listed doctors. The foundation has now grown to register more than 700 doctors on its database and are serving in Delhi, Mumbai and Bengaluru. Indiritta and Manu have also started citizen journal’s forum with more than 50,000 members, including doctors. The purpose of this forum is to share experiences in the medical sphere, whether good or bad, says Indiritta. Members can seek opinions, suggestions on doctors in the forum. The forum also enables the HGF to get candid viewpoints from the patients about the doctors. “Once the NGO caught on, we were approached by many people with business proposals but Indiritta and I felt that it was best if we didn’t stray away from the original idea of forming Hospital Guide Foundation — to help people. We will stick to not having any commercial transactions with hospitals and doctors and not charging patients as this is a social cause and not a business for us. And to our delight many doctors are supporting this social cause,” explains Manu.

The patient starts off with the personal health request through the website www.HospitalGuide.in where they send a medical query. Then Ms D’mello makes sure she calls up each of the patients individually. She says that they manage to get a lot more information from speaking to the patient/attendant than through the query sent through the website. “For instance, there are times when people write to us wanting a doctor for the liver and when we talk to them we realise there is a bigger problem that needs to be addressed which is alcoholism. So the conversation with the patient/attendant is important as it helps them build trust in us and we get relevant information to guide them correctly. Of course this is kept confidential,” Indiritta explains. After this, the cases are referred to a panel of 3-4 doctors who decide on the course of action and they give recommendations for the specialists that the patient should be taken to, which is then communicated to the patient. The patients are usually given multiple references so they get a better idea of the condition and the treatment options they can pursue.

“It is extremely important that we remain completely unbiased because we couldn’t have a system where we are looking out for the best interest of the patients, if we were having any commercial tieups with hospitals or doctors,” Mr Tripathi explains.

But the HGF’s role does not stop with just guiding the patients to the doctors. “One of the best thing about the HGF is that Ms Indiritta, even after getting me the appointment with the doctor, made several calls to follow up on the treatment that was advised and she genuinely wanted to know how the treatment was progressing,” Yasub said.

“The problem is not only about affordability but accessibility. India has a dearth of doctors on the whole. And out of these doctors, only 26 per cent of doctors are present in rural area with 70 per cent of our population residing there. We want to address this problem in the rural areas by connecting patients to doctors through technology — tele-medicine,” says Indiritta.

Copyright © 2011 The Asian Age. All rights reserved.

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The Cancer Crusaders by Insiyah Vahanvaty. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

Two years ago, my in-laws went through a rough time- my husband’s uncle who had been fighting sarcoma (soft tissue cancer) for many years was finally told to go home. Being as close to the family as he was, he chose to spend his last days with us, rather than in Calcutta, where he then lived. Also, being financially drained by the illness, the decision made practical sense too.
However, he hadn’t considered the fact that medical care in Delhi would be so much more expensive than Calcutta. Also, the cancer had resulted in the amputation of one leg, rendering him immobile. So, apart from financial constraints, there was the added problem of finding a doctor who would come home to examine him. After trying every possible avenue that I could think of to no avail, I decided to check with Hospital Guide Foundation (HGF), an organisation that works towards connecting patients with the right doctors. I didn’t think anything would come of it, because, well, the facts of the case were indeed asking for a lot- we needed a doctor who would make home visits for a terminally ill, handicapped cancer patient, extend palliative care till the end of his life. The chances of finding such a doctor seemed very slim to me.
However, I decided that I might as well check with HGF, so I dropped them a message. The very same day I received a call from HGF, who informed me that they had found  an organisation which dealt with EXACTLY the kind of patient our uncle was. At HGF's recommendation, I got in touch with CanSupport, an NGO that works with cancer patients who cannot afford private care. They are a charitable organisation who don’t charge a dime for anything other than medicines, and will visit as often as 2-3 times a week, depending on the care the patient requires.
When I first called them, they were polite and patient, giving me all the information I needed, as well as scheduling a visit for the very next day. Once they arrived, they spent about an hour and a half with the patient and the family, discussing his illness and his physical as well as psychological needs. (The team that visits typically consists of 3 people- a doctor, a nurse and a counsellor.)
After that, the doctor called the patient almost everyday, even made a couple of unscheduled emergency visits, and completely gained the family’s trust. They were also sensitive enough to arrange for a male nurse to minimize embarrassment for the patient. The patient told me that he actually looked forward to their visits, and that talking with the counsellor and doctor made him feel stronger. The counsellor also spent time talking to the family, helping them deal with the eventuality of his death, and provided them with coping measures.
He has, since then, passed on, but I have to say that through his illness, dealing with scores of medical caregivers, this one really stood out. Many thanks to Hospital Guide Foundation for introducing me to them.

Hospital Guide Experience by Brian Carvalho. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

After a few days of strenuous working out at the gym, and more than a few days of even more strenuous running after our two-year-old, one not-so-fine Sunday afternoon my wife Devayani tore her anterior cruciate ligament (ACL) in the knee, rendering her immobile and putting her in great pain. We rushed to the neighbourhood hospital where a junior doctor on duty mumbled: “MRI”. With all the MRI scan centres shut, we waited it out till Monday when we rushed to the imaging centre, and then to meet the orthopaedician in the vicinity, an apparent authority in joint replacement and arthroscopic surgery.

Dr Ortho examined the wound gravely, looked through the MRIs, gave us a short lecture riddled with medical gobbledygook and promptly declared: “Surgery is the only option. And the faster you do it the better.”

Now we are not big fans of surgery—few people are. The thought of being knocked out and operated on wasn’t exactly appealing– the good doctor did mention that Devayani would be able to see the entire surgery as it happened but why did I get the feeling she would have preferred an episode of Grey’s Anatomy any day?

Ah yes, the good doctor did mention the cost: Rs 1.4 lakh, without blinking an eyelid. Now that’s a few months’ rent/two years’ school fees/many EMIs et al sailing out of the window in front of our eyes! But then if surgery was essential so be it, but I did wonder then whether the phrase ‘to pay an arm and a leg’ came from such situations.

It’s at such times you remember, if not god, your colleagues! I called up Ullekh NP who had written a piece on an NGO called Hospital Guide Foundation, which seeks to make quality healthcare accessible to all, which is a platform for people like us to interact with doctors, and which stresses that “at least two or three opinions in most cases should be taken from the medical fraternity to ensure that there is a fair chance in getting correct diagnosis, prognosis and treatment.”

A media report rarely meant so much to me – and believe me, given the job I am in, media reports do matter a lot to me. Ullekh promptly put me in touch with Indiritta Singh D’mello, the driving force behind Hospital Guide. Indiritta stressed on the need for a second opinion, and put us in touch with Dr Jitendra Maheshwari, an orthopedic surgeon at Sitaram Bhartia Institute of Science and Research.

We met him on Tuesday morning. Dr Maheshwari first looked at the knee; then a cursory glance at the MRIs (what makes me feel he could have done without them!); and then looked at my wife in the eye and said: “You don’t need surgery.”

My wife looked like she was ready to do a jig—well, almost. The long and short of Dr Maheshwari’s diagnosis was this: There’s no need to jump into surgery, unless you plan to run a 100 metre dash in a week (well, he didn’t exactly say that but something on those lines); for now, physiotherapy is a good option. And in six weeks if you are still in pain, and showing no signs of improvement, then we can consider surgery.

It’s now 10 days since the ACL tear. Physiotherapy is under way, and the knee seems to be on its way to healing. Of course we aren’t ruling out surgery, but we are just glad we are giving the knee a good chance of healing without it.

Hospital Guide Foundation -The beginning by Manu Tripathi (Founder)

The computer coupled with Internet seems to be the way to find solutions to absolutely anything. People have got Online to solve any kind of problem, right from finding the most amazing restaurant to the best in terms of shopping. Thanks to the You-tube becoming a rage and the How to videos that answer to any mystery in the world being just a click away, provided of course you have a reliable connection.The internet has now become the one place you want to go for any kind of answer, thank heavens the spiritually inclined still believe in Gurus, though online meditation classes are also now a Hit.

With so much in place or that is what we think! And then a sudden call by a close friend, who was quite hassled as he had now taken his ailing mother to a number of Doctors with absolutely no improvement in her health. All the tests hardly showed any problem. The only issue she had was she always felt exhausted and had a history of migraines. Her sugar at times would drop, causing severe dizziness and weakness.

As much as the symptoms looked simple enough to diagnose, the Doctors only ended up confusing my friend and his Mom. While I am not a Doctor, I patiently heard everything he had to say and had absolutely no solution to give him. I wondered if the Internet could help. After all people could build a rocket using the information from the internet, why could I not just solve a simple health issue?

So it started with me using Google the standard browser. With all its credibility and true to its worth within a few seconds of typing the few key words, lots of opinions began to appear. Right from links that said this could be the beginning of some terrible disease, to the fact that this was not a disease after all. As much as I appreciate a good search engine, this was crazy and more confusing. It is ok to have 4 opinions to a particular restaurant, when you want to have a good meal. But when it is health related, to have 4 different opinions can drive you totally crazy. Fortunately for me, I was searching this information for another person and not for me, otherwise I would be a sure candidate for Psychiatric help. Anyways, while I filtered the different search options with almost an expert rejection algorithm, I finally reached a couple of options that looked sane. I was not sure of the credibility but at least I had some answers that could remotely help.

And I wondered why should something like health care not have a good guidance system online. Something that is not commercial, something that truly wants to help people meet the right doctors.In this world of super specialization, even Doctors are confused about which specialty to approach. With this in mind I searched the Net again, this time with a more focused objective and what I found was disturbing. All the entities that even remotely catered to health care were totally commercial, either linked to hospitals or agencies. Some booked Doctor appointments from a random database like Just Dial, that vomits and spews hundreds of options.

This was it! With the experience my wife had working in healthcare and our passion to work and help people, we decided to have an unbiased online Guide in healthcare.

This would help people irrespective of their financial background, get advice from the best so that at least they could decide on the best course of action. Hence, we created Hospital Guide a forum that was totally free for all. And had no commercial or any other type of tie ups with any health care institution. This would help us make unbiased decisions to help as many people with respect to health issues.

While we thought of how this NON Business model would make sense? Why would any Doctor want to be a part of a movement that had no commercial interest for him? Why would people want to spread the word?

Today, 4 years later we have over 700 Doctors on our database from across the country (obvious that they are here for the cause). We at Hospital Guide Foundation (HGF) believe that the best of healthcare advice should be accessible to all, irrespective of economic background or financial status. Over 50,000 members on the Facebook forum and a website that has regular queries with the top Doctors of the country helping us out. I think my country surprised me,as we continue in this endeavor to focus on the best of health for all.

Currently, Hospital Guide Foundation has been helping people in Bangalore, Mumbai and Delhi with some instances in Assam as well..