19/01/2020
How to Improve Surgical Care in Rural Areas
To improve surgical care in rural areas I started a project called тАЬMy 75 inventions to make healthcare affordable to every IndianтАЭ
Most of the advanced therapies in Medical Sciences were just a dream to 99.9 % of Indian people as they cannot afford them. I am watching from my early MBBS days that the cost of medical equipment is steadily rising. The medical companies make a minor modification and increase the cost eventually. I thought that these products will get off patent and the cost will drop. But that did not happen. I learned from the newspapers and from scientific data that majority people could not afford therapies as the cost of medical equipment is high and beyond the reach of most of the people. For example, only 10 % people who need hemodialysis get it and 90 % are left to die because the machine cost Rs. 30 Lakhs. The cost of cardiac stent was exorbitant to the tune of Rs. 2 Lakhs, now Indian Government has put a cap on it and is now Rs. 30,000. The cost of artificial urinary sphincter and Cochlear implants are Rs. 5 Lakh each and very few such operations are done in India. Cost of Laparoscopy set comes to about Rs. 15 Lakhs which has limited its use in developing countries.
Because of this problem majority of people stay away from it and the morbidity and mortality is increasing in the society. People are living with disability and ill health and that is reducing the productivity of the Indian society.
The problem will not be addressed due to the greed of medical companies which design therapies to earn money and not to cure somebody. A patient cured is a customer lost to the pharmaceutical companies. An organization like mine or government-based companies are only likely to address this issue. People like me are never given research grants to develop any product to support affordable healthcare for the poor. The government hospitals and medical colleagues are too busy to handle the routine and have no extra money and resource for the research work. Indian government has negligible budget for bio medical research.
To bring this dream into a reality I decided to do research myself and reduced the cost of costly equipment in Medicine and Surgery about hundred times. The entire research was funded with my own money. 40 patents have been registered for these inventions in Mumbai office. This project is likely to have a huge positive impact on public health and going to revolutionize healthcare in India and other third world countries.
The scale of the problem was measured by looking at statistics in research papers and government data available on internet. I myself found out by visiting various government hospitals around my district place. My hospital in empaneled under the governmentтАЩs Mahatma Jyotiba Phule scheme. I have to take two camps every month in rural areas. When I visited rural hospitals, I learned that they were severely deficient in medical equipment. None of them have oxygen. Operation theaters are without many equipment.
The cost of equipment for laparoscopy equipment is very high and out of reach of most of the rural health care hospitals which do not perform laparoscopic surgical procedures. None of the primary healthcare centers I have visited had laparoscopy facility.
Annually two lakh people in India develop advanced kidney disease. 90% of these people in India die because of lack of hemodialysis facility. The hemodialysis machine costs Rs. 30 Lakhs and government can not afford to install in rural hospitals.
Endoscopy facility is very poorly available in rural hospitals. Most of the hospitals are without upper and lower GI endoscope, Laparoscopes cystoscopes etc.
Cataract surgery is amongst the commonest needed operation which has excellent prognosis. Fortunately, the artificial lens which was extremely costly has got quite cheaper. But the operation requires a large optical microscope for better results which is not affordable to most rural hospitals.
To address this problem of higher cost of medical equipment I started my own research. I studied the basics of most of the equipment and noted the costly components in them. I developed alternatives to these items and developed cheaper alternatives. I thus reduced the cost of costly equipment in Medicine and Surgery about hundred times. The entire research was funded with my own money.
My project started about 3 years ago and it is active till date. I wish to continue to work on it till the end of my life as the necessity and scope are infinite.
I consulted many people in related faculties which include technicians, engineers, doctors, social workers etc. I created a team of people which includes people from various faculties. I got my work done from them on outsourcing basis since I did not have the necessary capital and infrastructure. These people are the electronic engineers do the designing part. Electronic technicians who do the soldering job. The turners do job work on Lathe machine and make the endoscope handles. The cameras are imported from China, Japan. The laser engraving machine writes names over the products. In the end I take all the spare parts and assemble them in my laboratory in my hospital.
Some ideas were given to me by my colleagues on Facebook. I worked on those ideas and made them commercially viable. I did research collaborations with many doctors in India to develop some products. I am working with many doctors nationally on variety of projects. One of such projects is with Dr. Gnanaraj Jesudian a urologist from Coimbatore, Karunya University. They have medical grants for a project in rural area from Leeds university UK. I developed worldтАЩs first rigid video adult cystoscope for their project recently at just Rs. 40,000.
I wish to involve Indian government into this project where I can supply them hi tech medical equipment at manufacturing cost for their rural hospitals.
My doctor colleagues are planning a project where we can supply my flexible video laparoscope for Tubal ligation procedures in rural India. The Conventional laparoscopy set costs Rs 15 Lakhs in India. My laparoscopes with android device costs only Rs. 25,000.
My intervention was essentially for poor people and directed towards rural areas. I donated some products in rural areas and the doctors there could easily adapt it and used it properly.
My products are exclusive and unique in nature and are not available in national and international markets at any cost. Hence even big private hospitals want to buy them. Recently Lilawati hospital and D.Y. patil medical college have shown interest in buying them.
I motivated doctors into my project instead of patients as they can not use it themselves. Doctors co operated and bought in big numbers for the rural and charitable hospitals in their areas. Hence the patients are the beneficiary in the end.
My research was presented in front of pediatric surgeons in national pediatric surgery conference held in Agra on 14 th September 2016. It received a stand ovation and best paper award in that conference.
The project was presented in district IMA conference in Jalgaon with demonstration on 5 th August 2017.
The project was presented in Conference of association of rural surgeons of India in Nagaland on 16 th November 2017 with demonstration and received prestigious Antia Finseth National Award for my 61 inventions. The award is given by ARSI and the Leeds university of UK and Lancet Commission together.
The project was presented in Maharashtra pediatric surgery conference on 16 th July 2017 with demonstration.
My project is an ongoing research and is active till date. Every monthly I have new innovative ideas and I bring them into reality from time to time. Every yearly I am making 25-30 new health related innovations.
Because of my project many doctors who could not afford certain medical equipment stared to buy them. I was told by many doctors that they could not buy laparoscopy equipment due to its cost from last 10 years. Many doctors bought my laparoscopes and donated to their nearby hospitals. These hospitals were waiting for decades for this equipment.
My laparoscope is a three in one device in the sense that It is the combination of a telescope, Led light source and laparoscopic endo camera. It is equivalent to $ 10,000 as $ 4000 for optical endoscope, $ 4000 for endo camera and $ 2000 for Led light source are incorporated in it. With great hard work I have commercialized it with a cost of Rs. 20,000 which is the cheapest laparoscope in the market today. It is being distributed in India and world over through a no profit organization called Vigyan Yog Foundation founded by me.
Bronchoscopy is the examination of bronchi of lungs by endoscopes. It is mainly done for diagnosis of various lung conditions and for removal of foreign bodies in the bronchi. The equipment that is required for bronchoscopy is called a bronchoscope. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and the risk goes up dramatically because of it. An endoscope with rod lenses with forceps mounted on it can be put through the sheath for bronchoscopy, but it becomes a large assembly and does not pass through small diameter sheaths. To record the video, you have to attach this telescope with endo camera and the assembly becomes very bulky. The cost of this assembly is also exorbitant and out of reach of many pediatric surgeons. Indian children are small and malnourished and the size of glottis is small. Foreign body aspiration typically occurs in 6 months to 18-month age and the size of glottis is very small at this age. Bronchoscopic foreign body removal in a child is a very risky procedure and many pediatric surgeons avoid performing this procedure for the said reason. To overcome these limitations of the traditional equipment I designed my own equipment by my 15 years of experience of bronchoscopy.
Rigid Video Ventilating Bronchoscope with forceps is the first of its kind in the world, a video camera is fitted at the tip of a rigid tube made up of surgical steel and its 4 wires pass through the empty tube and connected to another end to video to USB converter. The device is an ingenious combination of bronchoscope sheath with attached forceps. The tube has holes on each side for ventilation during the procedure. A foreign body removing forceps is welded to the tube for removal of bronchial foreign bodies. There are no fiber optics and rod lenses, hence no image loss and it has excellent image quality. The product is easily worth Rs. 5 Lakhs but commercialized by in in just Rs. 40,000. It became an instant hit and more that 50 orders received in India and world-wide. Because of my innovations many pediatric surgeons have started performing bronchoscopic foreign body removal which is a life-saving procedure. Since the forceps is for the first time incorporated with ventilation, the risk of the procedure has dramatically reduced.
The doctors who bought the products were contacted by email and by phone. 92 % said that the product is excellent and 8 % said that it falls in good category. 83 % said that the product has dramatically reduced the risk of the procedure.
There were a lot of challenges before starting the project. I contacted many companies to commercialized my products. The companies refused to sell the products at a cost proposed by me. Their proposed cost was 10 times higher than mine.
Being a doctor, it was very hard to commercialize these products myself. But I had no choice. I could not afford to take a loan as the high interest rates were beyond my capacity to repay. I tried to get funds for my research by crowd funding but nobody gave me even five rupees.
Hence, I decided to outsource the spare parts from variety of vendors who had established workshops and laboratories. I also contacted many Chinese and Japanese vendors for high tech spare parts like cameras.
I consulted many people in related faculties which include technicians, engineers, doctors, social workers etc. I created a team of people which includes people from various faculties. These people are the electronic engineers do the designing part. Electronic technicians who do the soldering job. The turners do job work on Lathe machine and make the endoscope handles. The cameras are imported from China, Japan. The laser engraving machine writes names over the products. In the end I assembled all the spare parts in my laboratory in my hospital.
Certain technical problems were encountered. The first laparoscope I had made had its wire continuous with it. After 15-20 operations it got fused. I thought that the camera was fused. I did its post mortem and found out that the wire was damaged at the end where there is movement. I connected new wires and the scope was working once again. Next generation of scopes I gave a disconnector in the end and these scopes now easily completing 100 operations.
Another problem was giving guarantee and service of the products. Giving service in every part of India and world wide was impossible for me. I designed the products in such a way that no service would be required for a long time. Doctors recover the cost in 2-3 operations and next operations are kind of bonus. Doctors liked that idea and started buying without guarantee. Since the repairing costs are high and electronics items are not repairable world over the philosophy is to create products which are use and throw types. I used the same policy in my project. Guarantees are not given free by a company and huge cost is taken in advanced. I kept my products dirt cheap and if fused the doctor can easily buy a new one. In short, I created products which are disposable and still reusable. Technology is changing today so rapidly that what used to get outdated in 50 year now happens in 5 year. By the time your current product is dead you can buy a new one with far advanced technology with my policy.
I founded a research foundation called Vigyan Yog Foundation a no profit organization which dedicates itself for research in medical sciences and Yoga. The foundation does research and the commercial activities are seen by another company I set named Vigyan Yog.
My project is successful and I think I have to do it again I will repeat the same steps. Since my project is an ongoing enterprise I learn from the mistakes and make changes. Every 6 months there are major advances in electronics and I immediately incorporate them into my project. For example, six months ago I was getting a 4 mm diameter video camera wit 4 LEDs and 350 TV lines. Today I get the same camera in same cost with 4 LEDs and 750 TV lines.
My project has become a routine now. I have commercialized 8 inventions which are as follows.
USB Laparocam-the laparoscopic endo camera for Rs. 30,000. 8- and 10-mm rigid video laparoscopes for Rs. 20,000. 5- and 8-mm flexible video laparoscopes for Rs. 20,000. 8 mm rigid video laparoscope with 30,60, 90-degree mirror attachments for Rs. 30,000. Rigid video bronchoscope with forceps for Rs. 30,000. Led light cord for Rs.10,000. (Please refer to first attachment for details).
Since I can not afford advertisement I put the details on face book and emails to doctors from various faculties. They send me money by net banking and my products reach them by a courier service. The project is self-sustainable as my market cost is way below other players. In fact my products are unique and are not available in national and international markets.
I think that my results of my project will not be able to generalize as it is unique in nature. After me my son or a team of dedicated people can take it forwards.
All my inventions are original and unique. They are not a copy of any product. In fact products like my inventions are not available in the Indian and international markets. 18 patents are filed at Mumbai office for my inventions and another 22 are on the way.
My inventions are 50 to 100 times cheaper than the peers. Many of them have no peers to compare with. The rigid ventilating video bronchoscope did reduce the risk of bronchoscopic foreign body removal dramatically.
Following of my inventions are for the first time in history of medicine. Flexible and rigid video laparoscopes, rigid ventilating video bronchoscope with forceps, adult rigid video cystoscope, semi flexible thin video nephoscope , wireless laparoscopy and endoscopy device, laser tissue welding device, pocket ECG, EEG, EMG devices and life force meter. These are produced at a record low cost of Rs. 5000-10,000 each. Other inventions which are first made in India are, articulating video laparoscope, 3D laparoscope, Capsule endoscopy device, VR magnifying loops, hydrophobic nano silicone coating, worldтАЩs smallest video camera, video laryngoscope, laser lithotripter and laser cautery, Transcranial magnetic stimulation device(TMS), transcranial direct current stimulation device(tDCS), Intranasal lase therapy device, Machines for bronchial thermoplasty and Stretta procedure, Urodynamics and uroflowmetry device, C02 incubator, Portable and commercial O2 concentrators, Central vacuum machine, Digital Stethoscope, Pathology video microscope, Ophthalmic video microscope, Microscope for microvascular surgery, USB Spectrometer, muscle stimulator, nerve stimulator, Hemodialysis machine, Partial ECMO machine, Harmonic scalpel and ultrasonic lithotripter and led light cord,24 hour PH monitoring. I also set up stem cell laboratory and tissue culture laboratory at record low cost of Rs. 50,000. I have set up Gene therapy facility with American multinational Thermo Fischer Scientific for Crispr Cas9 Genome editing to be done in India for Rs. 50,000 instead of Rs. 6.5 crores in USA.
My future innovations are hands Free Robotic Camera Holder, Da Vinci Laparoscopic Robot like system, Cochlear Implant, Artificial Urethral Sphincter, A Digital Radiography system, Electron Microscope, A Laser Microscope with one million times magnification, Alternatives to antibiotics and antivirals, Tissue nano Transfection(TNT), Usb Pocket Ultrasound Machine, Cardiac catheterization Monitor ,Portable MRI scanner, ESWL Machine, Gamma Camera(scintillation Camera), Positron emission Tomography, Terahertz camera Imaging System, Terahertz Tomography.
