Amsterdam Capital Week – Meaningful connections. Time to make an impact.
Chennai, India: A city in which I have never lived, but whose ancient culture I'd moved across continents, worked for a behemoth investment bank and a . Five chairs are neatly lined in a row, empty except for a stack of magazines .. Mercer's quality of living survey highlights—global [monograph on the Internet]. APP · Magazine HIGHLIGHTS SR Vijayakumar, the Central Chennai MP of the AIADMK, said, "That's all false. During a global investors' meet, investors had said they weren't able to come to Tamil Nadu due to the high. The Global Investors Meet (GIM ) was on 10 September held in Tamil Nadu to by Tamil Nadu Chief Minister J Jayalalithaa at the Chennai Trade Centre. Highlights of the GIM Current Affairs Magazines.
Dr Raman also eagerly expounds on the aspect of yoga and lifestyle education interweaved into his clinic services. Only a decade ago, people walked more.
Activity was built into their lives: Herniated disks, osteoarthritis, carpal tunnel syndrome, chondromalacia. A lot of it, of course, is sedentary lifestyle and being overweight.
For these people, I do give allopathic treatment for the pain and swelling. I had half-expected an introductory discourse on Chennai's clinical epidemiology covering topics such as Pott's spine, leishmaniasis, and leprosy; my mind now shifts gears in the face of a medicine demographic echoing my patient encounters in the US.
Dr Raman turns to his computer and, with a few mouse clicks, brings me even closer to home as he pulls up the ubiquitous blue screen of a Microsoft PowerPoint presentation. Dr Raman looks up abruptly at the clock.
Let's see our patients.
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Their stories are featured in op-ed pieces and magazines: Bill W from California, denied health insurance because of a high PSA and suspected cancer, paying cash to receive a transurethral resection of the prostate TURP in New Delhi's Fortis Hospital for a quarter of the cost back home; Mohammed S from Kuwait, undergoing an eight-hour removal of a glioblastoma in Chennai's MIOT hospital only a few days after receiving his diagnosis at home.
Chennai's hospitals go to great lengths to attract this lucrative group of patients, offering city tours, swanky hotel rooms for guests, airport pick-up and drop-off, and hours of one-on-one time with staff physicians.
Examples include the first successful transmyocardial revascularization laser surgery inthe concept of magnetopexy in and the first successful heart-lung transplant into name a few. The private sector's starring role in India's health care stems from the dynamics of supply and demand: Private providers' domain encompasses services from x-rays and MRIs to treatment of childhood diarrhea and malaria to prescription drugs.
In contrast, government spending on health care actually decreased over the past decade. The woman is slightly heavyset, with salt-and-pepper hair loosely threaded into a braid and secured with jasmine flowers that have begun to brown in the midday heat. She absently pats these flowers as she looks up respectfully at Dr Raman. Her husband, a stocky, dark gentleman wearing a white dhoti and a rather ill-fitting button-down shirt, is carrying a bulky briefcase that he sets down before cupping his hands together.
It is only two words—hello, doctor—but the undertone of hope in his voice is almost palpable. Because there isn't an extra chair, I am trying to stand as inconspicuously as possible under the x-ray viewing box. I wonder what patients will think of my rather random presence as they discuss their aches and pains.
Would they request that I leave? Should I introduce myself—exposing my broken, American-accented Tamil—or wait for Dr Raman to take the lead? As I find out, introductions are apparently unnecessary. Patients seem to think that as long as Dr Raman accepts my presence, they don't need to know who I am, or what my qualifications are for listening to their concerns.
Throughout the rotation, I grow used to my place as a nameless physician-in-training, nodding in sympathy during the discussions of pain and suffering, hanging up x-rays on the lightboard, helping frail patients climb down from the table. Now, Mr Vasu launches into a description of his wife's agonizing back pain. A few sentences in, however, Dr Raman stops him.
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Both nod hesitantly, and Dr Raman motions to the lady. Mrs Vasu looks taken aback for a second, reaching up to her jasmine flowers for support. But she begins, after a moment, to describe the dull ache in her lower back that has disturbed her for the past two years, now intensifying to the point where she can no longer sleep.
Dr Raman nods in understanding and is already scribbling down something on a prescription pad.Australian representative on Global Investors Meet
Mrs Vasu looks at her husband expectantly; he readily pulls a large manila envelope from his briefcase. Across the front is stamped in faded gray print: Obtaining a computed tomography scan or x-ray is as easy as going into a neighborhood stall and paying a few dollars, depending on where the scan is obtained.
Meanwhile, if a patient is not able to afford these prices, Dr Raman has agreements with specific x-ray and MRI centers that will perform the tests free of cost.
Dr Raman and I look at Mrs Vasu's x-ray. He asks me what I see; I gesture, with weatherman-style vagueness honed during third-year rotations, over an area with joint-space narrowing. He nods thoughtfully, studies the scan for a few more moments and then switches off the viewing light. No TB, no infection. Take these medicines, and I will give you some exercises; it will become all right.
Dr Raman stands up. Dr Raman briskly continues as he hands her a card. You can make an appointment with her, and she will give you a diet. Then come and see me day-after-tomorrow. I will show you some yoga exercises to help the pain. Side Effects of Modernization: New Challenges to India's Disease Burden As the lifestyle of material success touches more of India's citizens, so also does the sobering impact of a new set of health conditions.
The Public Health Foundation of India notes: Where Indian residents once feared undernutrition, they are now caught in a growing epidemic of over-nourishment: In urban Chennai, high socioeconomic status was found to be an independent, statistically significant predictor of being overweight or obese. The Diabetes Prevention Program underscored the role of obesity, lack of physical activity, and poor diet in exacerbating cardiovascular disease and diabetes.
Urbanization has clearly transformed India's health, but new evidence suggests genes may also contribute to Indians' growing burden of chronic disease. Of note, India has a higher prevalence of diabetes and cardiovascular disease than other Asian industrializing nations. Factors hastening cardiovascular disease—high cholesterol, cell markers of inflammation, obesity and overweight, endothelial dysfunction disruption in the lining of blood vessels leading to formation of artery-clogging plaquesthrombosis clots which can block blood flow, leading to heart attacksglucose intolerance a precursor to dia-betes —affect a greater proportion of South Asians than Caucasians, with onset in Indians occurring 10 to 15 years earlier.
One study by the International Diabetes Epidemiology Group showed that Indians' risk of acquiring diabetes increased at lower levels of body mass index BMI compared with Europeans—and is more sensitive to smaller increases in BMI. Talking to various patients during my rotation, I gleaned that a typical middle-class Chennai household mean income INR 10, generally finds outpatient medical care at a government hospital to be affordable: First, as private tertiary care hospitals flourish in the wake of the medical tourism goldmine, state-of-the-art procedures and facilities demand increasingly prohibitive prices.
In contrast to times when disease treatment entailed an empiric course of relatively cheap chloramphenicol, today's urban diseases demand expensive antidotes—cardiac catheterizations and stents, a multidrug regimen of blood pressure- and cholesterol-lowering medications, coronary bypass procedures, and total knee replacements. Thus, staying healthy is getting expensive in urban India.
Patients here take these appointments very seriously. It is almost never the case that a patient will not schedule a follow-up appointment or fail to obtain the scans needed or ignore the prescriptions. They want to get better, of course, and they believe that will come from listening to the doctor. Dr Raman does very little explaining; the patients, in turn, question and challenge very little.
The inherent trust they place in Dr Raman's opinion is, perhaps, reflective of the prevailing cultural attitudes toward physicians. As a patient stated: The Future of Indian Health Care The opulent luxury of private-sector hospitals, juxtaposed with creeping improvement in basic health indicators, hints at the dichotomy of health care in India. Even as efforts abound to quash pathogens and parasites—the vestiges of underdevelopment and poverty—India's private health care industry flourishes, bringing with it the promise of profits.
This twin agenda operates at polar opposites of socioeconomic class, two seemingly disparate foci running in parallel. Is it sustainable—and equitable? This, in turn, portends a spiral of suboptimal health for the nation's poor and middle class, carrying somber ramifications for goals of public welfare and social equality. The dramatic changes in India's health environment and shift of the disease profile presage an economic and social transformation in health care delivery.
On the one hand, the nation's newfound riches promote certain types of health, effacing the disease-ridden India stereotypes of middle-school geography books and quaint Rudyard Kipling tales—where epidemics of cholera and polio consumed millions and curable infectious diseases terrorized the lives of city inhabitants.
But even as strides are made in the realm of hygiene and hospital infrastructure, new health challenges emerge in the shifting face of disease, cost containment, and health care access.
Such challenges carry relevance to health care in the developing world, as they represent the prototypical public health needs of a nation straddling the realities of persistent poverty and the heady success of breakneck growth. The Beginning of a Journey I am waiting for takeoff. It is pitch black outside—approximately 1: The dry Lufthansa cabin air keeps forcing me to sneeze, thwarting halfhearted attempts at sleep.
My mind also appears to be part of the plot to keep me awake, buzzing with a flurry of thoughts and impressions of a summer in India. Here lies a crucial area for future medical service in Chennai: I revisit the trepidation that pervaded my first bumpy car ride to Dr Raman's clinic.
I had wondered if any trace of my heritage—the culture that sparked my passion for art, music, and dance—might remain in this revamped, modernizing pantheon of software outsourcing. And, with quavering hope and resolve, I had entered this city with the goal of serving in a medical capacity, of understanding the city's unique health needs.
There were glitzy new stores, air-conditioned restaurants, new highways, the flood of bright matchbox Fords and Hondas. There existed a growing sense of empowerment: Multistorey hospitals towered over dilapidated clinics; clean public restroom facilities emerged as reliable fixtures in malls and restaurants. Complex surgeries no longer necessitated expensive trips abroad; instead, medical tourism now brought thousands of foreigners and a steady stream of profits to Chennai's hospitals each year.
And yet, in Chennai much remains the same. The ancient temples I had visited on trips past are still as ancient as ever. The homemade palgova and cardamom milk from my favorite non-air-conditioned dairy store still tastes as divine as I remembered it, and unfortunately is still as fattening. Cows still lazily ruminate as they always have on pot-holed side roads, unperturbed as surrounding cars unleash a blaring cacophony of honks.
The unique aroma of incense, spices, humidity, car exhaust, roasted peanuts, and coffee powder still hangs in the air—it's simply mixed with more exhaust fumes. Chennai's health also sadly carries echoes of the past. Beggars still cry for food on street corners; slums still spill human filth and suffering.
Public health initiatives have mitigated—but not eliminated—once epidemic communicable diseases. India still carries the world's greatest burden of patients with tuberculosis, and must face the challenge of emerging multidrug-resistant strains. The battle to provide fundamental public health needs is still not won, and it must not be ignored in favor of the haute trend of elite health care.
India's paradox of constancy and change—epitomized by its health care—serves as Chennai's major theme. As a student in Dr Raman's clinic, I interacted with a truly diverse socioeconomic, cultural, and religious cross-section of Chennai society, many of whom were crippled by pain exacerbated by a sedentary lifestyle, excess weight, and poor dietary habits.
Often, patients had no idea that they were overweight—or that lifestyle could potentially undermine their health. The plane revs up its engines in preparation for the final rapid acceleration before takeoff. As we rise smoothly above the twinkling lights of Chennai, I peer out the window, straining for a final view of the city and its roads which are, even at this hour, packed with carsexhaling a wave of nostalgia as the city lights fade, covered by growing patches of clouds and mist.
I press my face against the cool window, imagining I can still see a twinkling light or two. As the last visible light disappears from view, I realize it is only a matter of time before I return. For the past month has introduced me to a challenge—a medical need that speaks to my interests in public health, service, and culture—that I am determined to revisit and tackle as a physician.
Even with all its chaos and inefficiency, Chennai somehow, miraculously, inexplicably, stubbornly, still works. It's reassuring, for I know it will still be working when I fly back at some point in the future into the humid air surrounding Anna International Airport.
I wave goodbye one last time before pulling the window cover shut. Dreams of Living Men If there is one place on the face of earth where all the dreams of living men have found a home from the very earliest days when man began the dream of existence, it is India. Census Data [table on the Internet]. Tamil Nadu 33 [tables on the Internet].
Tamil Nadu attracts mega investments at Global Investors Meet - The Economic Times
Office of the Registrar General and Census Commissioner. Government of Tamil Nadu; [updated ; cited Feb 10]. Los Angeles city California. Census of Population and Housing; Nov [cited Feb 14].
Healthcare Radius Magazine - Aligning business and healthcare in India
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The Hindu Business Line. Apr 2 [cited Feb 10]. McKinsey Global Institute; May. Chennai moves into the big leagues [monograph on the Internet]. Asia Times Online; Mar 8. Economy and Business—Tamil Nadu [monograph on the Internet]. Gurgaon HaryanaIndia: India Brand Equity Foundation: Confederation of India Industry. South Asia economic report [monograph on the Internet].
Commenting on the report, Dr. The report has shed light on many cracks in the system that affects the proper diagnosis and treatment of cancer in our country. While I am glad that our city according to the report ranks higher on satisfaction while choosing a hospital than the other regions, it is still imperative that we listen to the patients and provide better access to oncologists and counselling to help them deal with emotional stress.
I sincerely hope that this study creates awareness and helps the eco-system in India understand the gaps to create a better path to recovery for cancer patients. The findings are an eye opener and by all means revolutionary for all stakeholders in the healthcare delivery space. These numbers are alarming and require collaborative action at both individual and collective levels to make big strides in the fight to cure cancer. We are making a beginning towards serving the unmet needs of patients by creating a pathway, ensuring better patient experience.
Through the findings from the research commissioned by us, we will use it to make necessary changes in the way we practice, both clinically and non clinically. Through such initiatives we need to demonstrate control strategies to spread awareness for early detection of cancer and reduce its devastating impact. A comprehensive sample of cancer patients and survivors were kind enough to be a part of this study. Insights and feedback was collected through in person interactions with cancer survivors between the ages of years old.