Sir Ganga Ram Hospital

Sir Ganga Ram Hospital
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Vol. 9 No. 3
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visit us at: www.sgrh.com
The 51st Founder’s Day Celebrations
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July–September 2005
Ninth Sir Ganga Ram Oration
Health priorities and economic
reforms: Some policy issues
From left to right: Dr P.K. Khanna (Vice-Chairman, Board of Management), Dr S.K. Sama
(Chairman, BoM), Dr S.R. Rao (Scientific Advisor to the Minister of State for Science &
Technology, Ocean Development, Government of India), Dr Bharat Ram (Chairman, Board of
Trustees), Shri Tej Ram (Vice-Chairman, Board of Trustees)
The 51st Founder’s Day of Sir Ganga
Ram Hospital was celebrated on 13
April 2005. Dr S.R. Rao, Scientific
Advisor to the Minister of State for
Science, Technology and Ocean
Development, was the chief guest.
Dr Rao said that today SGRH enjoys
high-level brand equity for excellence
in the country. The hospital has 2000
outpatients, nearly 700 inpatients, and
the largest and most comprehensive
postgraduate teaching programme. It
has emerged as a model for those who
are philanthropic and humanitarian,
and wish to serve people who cannot
afford hospital care.
The passing of the Patents Bill in the
Lok Sabha recently will have many
implications in the drug and
pharmaceutical industries. This
market is about Rs 37,000 crore in
India. India has been supplying 67% of
exported drugs to developing
countries. This situation has changed;
we cannot copy, and we cannot reverse
chemistry any more.
Government encouragement in
terms of technical and financial help is
needed. The Department of Science
and Technology has a budget of Rs 150
crore for drug development.
SGRH, with its state-of-the-art
research facility, has the opportunity
for biotechnology and clinical
research. It is the right place because it
has all the infrastructure. High-class
research in terms of modern
biotechnology and biology needs to be
started. Another area is Stem Cell
Biology. SGRH has an opportunity to
blend intensive research with the
frontier area of Stem Cell Biology.
Dr Rao concluded by saying that
SGRH will find a place on the global
map with research intensification, and
congratulated the hospital on its organ
donation programme, as well as
members of the BoM and staff.
—Dr S.R. RAO
The concerns regarding the
economic reforms approach
are that they neglect health
issues. There is much discussion as to whether the
govern-ment should withdraw from
areas in which there is a possibility of
capable private sector response.
There is a large role for the private
sector in providing quality health care;
this must be facilitated and encouraged.
Sir Ganga Ram Hospital is an example.
The booming private sector in the
health industry could bring people from
around the world here to seek ‘high
quality but low cost health services’.
Health is an area where the public
sector cannot withdraw from the system
completely; it has a major role to play in
defining certain objectives which will
not be achieved without government
support. The system should thus
encourage both the sectors.
GOVERNMENT INTERVENTION
IN HEALTH
Health is not a purely private good.
There is a strong externality and decisions cannot be left to the individual.
Health is also a merit good—somebody else’s enjoyment of it does not
affect one; nevertheless, one feels
morally that health is good for someone
else to have. Therefore, there should be
greater social commitment to provide
essential health care services.
People do not have enough information about health. When they fall ill they
do not know the best cure. From the
point of view of prevention there is a
huge information gap which must be
filled.
A system that provides medical
(Cont. on page 7)
SGRH Annual Report 2004–05
Sir Ganga Ram Hospital is a
unique model of a selfsustaining
charitable
hospital in India. With no
government aid and no
philanthropic institution to fund us, we
have managed to serve millions of the
ailing with world-class medical
facilities at a very affordable cost. At the
same time, we have managed to save
funds to ensure our own growth and
expansion. Our achievements in the
past 12 months reflect the spirit of our
fight for survival, our pursuit for
medical excellence and our commitment to the cause of humanity.
650
621
Research activities
• DNB reasearch
• Drug trials
• SGRH publications 2004
—Chapters in books
—Paper presentations
—Abstracts
34
30
31
179
141
operational. Renovation and upgradation of facilities in the old building has
started.
Modernization and expansion of
existing facilities has continued through
the purchase of high-tech equipment,
addition of newer departments and
eminent faculty. A digital X-ray
machine has been added to the X-ray
300
1900
1800
600
1700
1724
1750
1800
250
243
200
516
495
493
499
150
1500
509
1200
1999
2000
2001
2002
2003
2004
Fig. 1. Bed strength
50
1296
1998 1999 2000 2001 2002 2003 2004
25,000
237,585
24,000
0
1998– 1999– 2000– 2001– 2002– 2003– 2004–
99
03
00
01
02
04
05
Fig. 3. Consultants’ strength
2,000,000
253,905
1,862,939
22,000
21,077
21,000
1,800,000
1,590,395
1,600,000
19,526
20,000
18,774
19,000
23,000
1,400,000
224,196
216,725
22,000
207,785
800,000
1998 1999 2000 2001 2002 2003 2004
Fig. 4. General OPD attendance
1,109,381
963,596
Consultants honoured
• Dr P.K. Chowbey was elected as
President of the Asia Pacific Hernia
Society.
• Dr Randhir Sud was honoured with
Master’s in Endoscopy Gold Medal by
the Indian Society of Gastroenterology
and appointed as Visiting Professor,
University of Texas Medical Branch,
USA.
• Dr Anupam Sachdeva has been
conferred with the Dr B.C. Roy National
Award.
• Dr T.D. Chugh was awarded Life
Membership of the National Academy of
Medical Sciences.
19,466
17,768
16,581
16,000
15,000
15,586
1998 1999 2000 2001 2002 2003 2004
1998 1999 2000 2001 2002 2003 2004
Fig. 5. Total laboratory investigations
To mark the 50th year of our existence, the postal department brought out
a first-day postal cover. This was
released by Justice B.N. Kripal, former
Chief Justice of India and our Chief Guest
at last year’s Founder’s Day celebration.
His Excellency Dr A.P.J. Abdul Kalam,
Hon’ble President of India inaugurated
the new Super Specialty and Research
Block on 16 July 2004. The facilities in
this block include 20 world-class operation theatres, 44-bedded ultramodern
ICUs and superspecialty laboratory
services.
A multi-level parking to accommodate about 200 additional cars is now
2
1,374,959
18,000
17,000
1,000,000 840,958
21,000 204,545
20,000
1,260,751
1,200,000
221,019
192
140
Fig. 2. Staff strength
26,000
180
100
1450 1463
1300
450
166
1514
1400
266
218
1600
550
500
department. Rs 15 crore have been spent
on the purchase of new equipment for
various departments. Five new clinics
were started and the executive health
check-up services revamped.
The Academic Department has
conceived the Stem Cell Research
Department. SGRH has facilities to
preserve and store stem cells and we
handle about 2200 live-births per annum.
Dr Shail Sharma, Senior Consultant is
presently on a joint collaboration with
Nobel Laureate Marshal Nirenberg on
the Indo–US Project on ‘Immortalization
of human fetal neurons’, at the National
Institutes of Health, Bethesda, Maryland.
Fig. 6. Surgical operations
SGRH is now a full-fledged institution
of patient care, postgraduate training
and research. The Departments of Gastroenterology, Genetics, Haematology,
Microbiology are already collaborating
with international organizations on
various research projects. At present, 64
research projects are in progress.
The hospital has been recognized to
conduct the FRCS and MRCP examinations.
The Academic Section, which was
earlier housed in two small rooms, has
now been relocated in a separate
Academic Wing which consists of four
rooms along with a seminar hall and a
SIR GANGA RAM HOSPITAL NEWSLETTER
July–September 2005
Academic activities
• 32 eminent guest faculty members
visited the hospital and delivered
lectures on current topics.
• 62 CMEs/ conferences/ workshops
were organized.
• 9 international conferences were
hosted.
well-stocked library, with more than
2000 titles apart from lecture CDs. Our
hospital is probably the only private
hospital in India to subscribe to 90 fulltext journals online.
The US Government has chosen
SGRH for the admission and treatment
of their VVIP bureaucrats and
politicians during their visits to Delhi.
We now have two ethics committees.
To conduct and participate in many
prestigious and landmark international
multicentric drug trials, a separate
ethics committee for drug trials has
been formed which has on board scientists and research workers of national
repute. Hospital waste is disposed of
strictly in accordance with international regulations and requirements. We
have started harvesting rainwater in the
new as well as old building.
A world-class Hospital Information
System after customization is being
implemented. The computerized
records are research-friendly and will
Our hospital has taken over the
management and running of a 100bedded City Hospital. The hospital
has started functioning under the
name and style of City Hospital
affiliated to SGRH. The hospital is
ready to receive both in-patients
as well as out-patients. This
hospital will provide us with muchneeded 100 extra beds.
Charitable work by SGRH
• Over 5000 patients were admitted in
the free wards.
• A total of 120 free beds.
• Over 2700 operations were performed
• 600 deliveries were conducted.
• 3.5 lakh free investigations were done.
• 2,53,000 patients were seen free in the
general OPDs.
• 34,000 patients availed of free casualty
services.
give further impetus to clinical research.
Encouraged by an increasing number
of international patients and the prospects of significant health care tourism
to India, the hospital has initiated
networking with prospective international clients. To further strengthen this
effort, a marketing committee has been
created and 3 PROs have been appointed.
—Dr S.K. SAMA
Chairman, Board of Management
Expanding Horizons
Expansion programme of Sir Ganga Ram Hospital
The Operation Theatres, ICU and
Histopathology laboratory were
relocated in the new Super Specialty
and Research Block, thus vacating the
ground floor, first floor of the CD block,
and the adjoining laboratory and
patient-holding areas. Outpatient
services have seen a marked increase in
patient flow and hence a need was felt to
add a new consultation area on the first
floor of the CD block. Besides improved
facilities and services, the new OPD area
will provide improved accessibility and
patient flow. Other support areas such as
registration, billing, sample collection
centre will be clustered along the
outpatient area on the ground floor.
Consultation rooms with a minorprocedure area will be created to
enhance the efficiency of patient care.
Spacious waiting rooms will add to the
comfort of the patients. All consultation
chambers will have secretarial access
and attempts will be made to
computerize the OPD functions and
records. The centralized airconditioning, piped music, and pleasing
décor and interiors will provide a
soothing environment. In all, this area
will house 23 consultation chambers.
The maternity unit and the IVF
laboratory will also move into this area.
Among the features of the new
maternity unit are the two labour,
delivery and recovery rooms (birthing
suites), and a specially equipped
surgical room for emergency caesarean
sections. The close proximity of all
these facilities will ensure quality care
to patients in labour.
The IVF unit will now have all
components of care with dedicated
areas for each. Special care has been
taken to provide supportive and caring
surroundings to the patients and their
spouses. With more space being
available now, a number of additional
services will be started.
—Dr B.K. RAO
Honorary Secretary
Board of Management
Human energy field (HEF)
The past few decades have seen large
advances in the field of complementary
and alternative medicine (CAM). There
are protocols in place to rigorously
examine the efficacy and safety of these
treatment modalities so that they may
be incorporated into the modern health
care arena. However, the common
complaint of practitioners of CAM is
July–September 2005
that the clinical research being carried
out to test their validity takes no
account of the mechanism involved. The
majority of CAM therapies involve an
energy component as part of the healing
or treatment process. Omitting this
intertwined variable could explain why
many research papers have erroneous
and often conflicting results.
Based on such concepts, there now
exists a whole body of medicine termed
energy or vibrational medicine. This
approach acknowledges the non-physical
(subtle energy) make-up of the body and
seeks to treat disease by releasing energy
blockages and imbalances. This, in turn,
helps to rebalance and sustain the
physical/emotional health of the body.
SIR GANGA RAM HOSPITAL NEWSLETTER
3
PIP Energy Field Imaging
(Courtesy: Centre for Human Energy Field Research)
Before healing
During healing
After healing
Self-healing: Notice ‘low’ red congested energy around the throat, which reduces after self-healing massage.
HEF is the elliptical lattice of
vibrational frequencies that emanate
from the human core and permeate the
physical body. Understanding variations in this HEF gives us the tools to
build a bridge between science and
spirituality. Scientific mapping of HEF
has continued for many years but has
remained a mystery due to a lack of
objective equipment to measure its
parameters.
HEF is the interface between effective
medical diagnosis and efficient noninvasive treatment. There are several
important aspects of the anatomy of the
HEF. There are nine layers of the energy
field.
The energy field not only surrounds
the outside of the body but permeates
through it. Yet with photography it is
only possible to achieve a twodimensional image. Thus we take a
series of views around the body and
compare colour symmetries, shapes and
patterns.
There is a growing scientific interest
in the search for objective, valid and
reliable methods of measuring the bioenergetic health status.
PIP ENERGY FIELD ANALYSIS
Polycontrast interference photography
(PIP) is a new scanning system that is
already internationally recognized as an
effective ‘energy field imaging system’.
It reveals the interference of light
patterns at and beyond the visible
spectrum and shows energy dynamics at
work.
PIP is used in many ways around the
4
world—from medical and clinical
research to energy field assessment and
validating healing techniques. It
highlights areas of well-being and
disease with clear patterns and colours.
The system shows similarities and
differences within the body and energy
fields.
HOW DOES IT WORK?
Through specially developed software,
PIP looks at photon (light) interference
and its changes in and around the body.
The innovation is in the computer
programming, which allocates a number
to reach a specific grade or frequency of
light and then re-codes every number
into the visible light range so we can see
it. PIP uses software on a PC with a
video feed and takes a scan of energy and
light interference. An image is displayed
live on a monitor where signals from
the video camera are graded into
clearly visible colours. Energy intensity
differences can be distinguished which
would otherwise be impossible to see
with the human eye. We do not see the
difference in energy absorption with
our eyes because we use heuristics that
generalize colours, patterns and shapes
so that we can better distinguish borders
and objects.
WHAT DOES IT SHOW?
Scanning a client enables a practitioner
to make an energy field assessment,
which leads to a better understanding of
the health trajectory. Areas of wellbeing are indicated by a mixture of
lighter, brighter, balanced and more
harmonious patterns, symmetry and
colours, with diseased and stressed
areas showing as distorted, darker and
congested pools of energy. When used,
the operator and client can uncover the
root disharmonies of the disease; PIP,
therefore, enables effective ongoing
monitoring of a client’s condition.
When the body’s endocrine system/
chakra is out of harmony, the gland
becomes a transponder, in that it
functions both as receptor and
transmitter of signals, receiving and
radiating vibrations. If an area is
balanced, in harmony, one colour will
predominate.
The PIP system also comes with
various colour sets, filters and graphic
enhancers that distinguish differing
energy patterns in varying light
conditions. These filters accentuate
different aspects of the subtle and
physical energy fields. The colours and
patterns on PIP reveal a great deal about
an individual’s well-being and energy
levels.
CONCLUSION
PIP is only an analysis; it is a preventive
health care tool and can be effectively
used for assessment of stress, and
secondary affections of diseases such as
hypertension and diabetes.
Sir Ganga Ram Hospital has created a
facility (Centre for Energy Studies) for
studying the PIP scan of patients undergoing evaluation.
—Compiled by Dr NALINI KAUL
Director Medical
SIR GANGA RAM HOSPITAL NEWSLETTER
July–September 2005
Health Update
Neurology and the stem cell debate
Stem cell biology is in its infancy and its medical application
not around the corner. We have little understanding yet of how
to induce human embryonic stem (ES) cells to become one
somatic cell type versus another. Among the many subtypes
of a neuron, we presently understand how to generate only
two—dopaminergic and motor neurons. Moreover, even
when a desired cell type is generated from ES cells, its isolation
to appropriate levels of purity is not straightforward. Only
genetic tagging strategies have so far permitted the isolation
to nominal purity of the desired cells from the larger population.
But these approaches too are neither foolproof nor readily
scalable from experimental to clinical use. If the desired cells
are not isolated from the larger pool, remnant undifferentiated
ES cells can persist. These, in turn, can generate a variety of
tumour types, most notably teratomas; the persistence of
undifferentiated ES cells in any number will effectively
preclude clinical transplantation. And that is not all. Once cells
of a desired phenotype can finally be derived and purified from
human ES cells, the limitations of the adult tissue environment
and that of the disease environment will pose daunting
challenges. For instance, human ES cell-derived motor
neurons will need to be introduced at multiple segments
throughout the neuraxis, they will need to survive within a
poorly understood and potentially hostile disease environment
and the axons will need to regenerate from the spinal cord to the
distal musculature. As a field, we have only recently begun to
appreciate how little we know about the disease environment in
amyotrophic lateral sclerosis (ALS), and about axonal extension
and targeting in the adult CNS. The acquisition of purified motor
neurons from human ES cell cultures will thus represent only the
beginning of a long process of experimental evaluation.
The rate of clinical translation in stem cell biology will depend
on the advances in fundamental, disease-oriented neuroscience.1 Overstating our current capabilities or concealing our
current limitations can jeopardize the credibility of the field, and
ultimately risk the loss of public goodwill and support.
Reference
1. American Academy of Neurology and American Neurological
Association. Position statement regarding the use of embryonic
and adult human stem cells in biomedical research. Neurology
2005;64:1679.
—Dr P.K. SETHI
Images
A 36-year-old male presented with painless swelling of both the eyes of six months’ duration. The MRI revealed homogeneous intra- and
extraconal lesions in both the orbits with multiple, enlarged, discrete nodes in the neck. These finding were suggestive of orbital lymphoma.
A 36-year-old male patient with painless
swelling of both the eyes
T1W & T2W axial images show homogeneous intra- and extraconal lesions in both the orbits
which display iso-intense signals to the muscles. In addition, bilateral proptosis is noted.
T2W coronal image shows the
homogeneous signal, well-marginated
masses in the intra- and extraconal space
Fat-suppressed T2W axial image shows the
masses encompassing both the eyeballs
July–September 2005
T1W sagittal image shows multiple, enlarged,
discrete nodes in the neck (arrow)
SIR GANGA RAM HOSPITAL NEWSLETTER
5
Hospital News
Pak boy receives first bloodless liver transplant
Update on acute pain
management
The Department of Anaesthesiology, Pain
and Perioperative Medicine organized an
Update on ‘Acute pain management’ on
15 May 2005. The Update was attended
by 210 registered delegates. The faculty
was drawn from SGRH and all the major
private and government hospitals of Delhi.
The Patron, Organizing Chairperson
and Organizing Secretary of the Update
were, respectively, Dr V.P. Kumra,
Dr Jayashree Sood and Dr Pradeep Jain.
The Update was inaugurated by
Mr Santosh Bagrodia, Rajya Sabha MP.
Dr Nalini Kaul, Director Medical, SGRH
was the guest of honour.
The Update highlighted the current
concepts and recent advances in the
management of acute pain. A stimulating
and lively discussion ensued at the end
of every scientific session.
There was an enthusiastic response
to the workstation demonstrating the
latest equipment and techniques used in
acute pain management. This was
followed by a thought-provoking,
stimulating and informative panel
discussion on ‘Acute pain management in
the peripheral set-up’. This type of CME
was the first of its kind organized
anywhere in the subcontinent and
received an overwhelming response.
Doctors successfully performed the country’s first-ever bloodless liver transplant.
The recipient of their efforts was a four-year-old Pakistani boy, Safi Khan. He
received one-fourth of his paternal uncle’s liver in a surgery performed on 9 April
2005. Liver transplants usually involve considerable blood loss after which blood
transfusion is required. Doctors keep 20–50 units of blood booked during a liver
transplant surgery, and use about 10–25 units. However, in this pioneering effort,
both blood loss and blood transfusion were avoided.
Doctors from Karachi get training in Delhi
A team of surgeons from the Jinnah PG Medical Centre, Karachi visited Sir
Ganga Ram Hospital to gain knowledge about Minimal Invasive Surgery
(MIS), which is the latest trend. The surgeons, who have been visiting
places such as Singapore, Hong Kong and Britain, find India a better option
to get further training. ‘India is our next-door neighbour, so why visit other
far-off countries. There are many experts in this field of surgery here and the
instruments and machinery are also very modern,’ said Dr Muhammad
Ishaque.
Delhi Chapter Meeting: Hospital Infection Society (India)
The Department of Clinical Microbiology, under the auspices of the Hospital Infection
Control Committee organized the Delhi Chapter Meet of the Hospital Infection Society
(India) on 28 May 2005. Dr C. Wattal, Chairman Clinical Microbiology was the
convenor. A panel discussion on ‘Cleaning and disinfection of endoscopes’ was held.
Dr P.K. Chowbey, Chairman MAS, Dr Anil Arora, Consultant Gastroenterology,
Dr N. Jain, Chairman Pulmonology, Dr J.K. Oberoi, Clinical Assistant Clinical
Microbiology, Dr Shalabh Sharma, Consultant ENT, Dr S. Khanna, Sr Consultant Urology
and Dr V.B. Bhasin, Consultant Orthopaedics were the distinguished panelists. The
panel was coordinated by Dr Vijay Arora, Chairman Surgery and Dr C. Wattal.
The function was inaugurated by Dr S.K. Sama, Chairman, Board of Management
as its Chief Guest. Dr B.K. Vohra, Chairman Department of Urology and Patron HICC,
and Dr K.P. Jain, Chairman Department of Medicine and HICC were the Guests of
Honour. Dr Geeta Mehta attended in her capacity as the Vice President of the Hospital
Infection Society (India).
More than 100 delegates attended the Meet. The proceedings of the panel
discussion containing the consensus guidelines will be printed.
New Entrants and Promotions
Sir Ganga Ram Hospital fraternity welcomes the following new members and
congratulates those promoted
NEW ENTRANTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Dr V.M. Kohli
Dr Arun Maheshwari
Dr Arup Kumar Basu
Dr B.B. Aggarwal
Dr Sujata Sawhney
Dr Praveen Suman
Dr Sunita Kapur
Dr Sunit Ojha
Dr Manish Vaish
Dr Dinesh Khandelwal
Dr Rakhi Mehta
Cardiac Surgery
Cardiac Anaesthesia
Pulmonology
Surgery
Paediatrics (Rheumatology)
Paediatrics
Acupuncture
Nephrology
Neurosurgery
Neurology
Obstetrics and Gynaecology
Senior Consultant
Senior Consultant
Senior Consultant
Associate Consultant
Associate Consultant
Junior Consultant
Junior Consultant
Junior Consultant
Junior Consultant
Junior Consultant
Junior Consultant
30.05.2005
20.04.2005
01.04.2005
19.05.2005
23.03.2005
23.03.2005
19.04.2005
26.04.2005
05.05.2005
18.05.2005
16.05.2005
Dental
Associate Consultant
23.05.2005
PROMOTION
1. Dr Anupama Sethi
6
SIR GANGA RAM HOSPITAL NEWSLETTER
July–September 2005
(Cont. from page 1)
services free does not provide the
treatment one wants. If one has to bear
the costs then insurance becomes
important. In traditional societies the
family shares the costs. However, the
social structure is changing. This
dimension is important and relevant for
policy.
Ageing presents special health problems.
In the US, 80% of the cost of health care
during a lifetime is incurred in the last 3
years of life. This calls for pooling of
resources across the population—
whether family or insurance.
ROLE OF THE GOVERNMENT
As a provider of health care services, the
government can pay for and the private
sector provide these services, or the
government can operate the services
itself. The government could simply act
as a regulator for setting standards and
the private sector can supply health
services.
In a mock appraisal of the Tenth Plan,
an assessment of the status of various
health targets was made. In some targets
there is progress but not in others, such
as reduction in maternal and infant
mortality.
The proportion of chronically undernourished children and women with
anaemia remains very high; this has
implications for health even though the
cause may not be health system-related.
HIV/AIDS is a new challenge that can
have catastrophic effects on the population. Complacency would be dangerous
and this must be focused upon.
SUPPLY OF HEALTH SERVICES
The reach of the health services is very
poor. The most important indicator of
the status of health care is the maternal
mortality ratio. Pregnant women do not
have skilled birth attendants. The
existing facilities need to be doubled to
provide basic health care. The public
health care system, particularly in rural
areas, is characterized by very poor
care, inadequate facilities and
unavailability of medicines in many
clinics. There is a substantial degree of
non-utilization of facilities due to nonfunctioning of the health care system.
Private expenditure on health in India
is high. The inadequate availability of
July–September 2005
From left to right: Dr B.K. Rao (Secretary, Board of Management), Dr S.K. Sama (Chairman,
BoM), Dr M.S. Ahluwalia (Deputy Chairman, Planning Commission, Government of India),
Dr Bharat Ram (Chairman, Board of Trustees), Dr D.S. Rana (Hony. Joint Secretary-cumTreasurer, BoM)
the public health system pushes people
to access private services.
A substantial increase in the amount
of money spent by the public system to
promote health is required. Over a
period of 5–6 years, public expenditure on health should be increased from
under 1% to around 2% of the GDP; it
must be ensured that this expenditure
actually leads to improvement in health
services.
The government has recently
announced the National Rural Health
Mission to restructure the health
delivery system so that in the first phase
In 20 years, India will make the
transition from being a lowerincome to middle-income country.
The demand for health care will
increase and we will see a lot of
changes in the health sector.
better community involvement is built.
Panchayati Raj institutions must develop
village health plans and strengthen the
network between the PHCs, CHCs and
district hospitals. Different states have
been using innovative ways of bringing
in the private sector at this level of
health care. The responsibility of the
government of supervision must be
transferred to Panchayati Raj institutions.
Sanitation and access to clean
drinking water are important for the
good health of the population. More
expenditure will be needed to ensure
that clean drinking water and sanitation
are provided.
In urban areas, secondary health care
(district hospitals) is structured and the
private sector plays a substantial role.
Almost 75% of the hospitals are in the
private sector. In the public sector, the
provision of tertiary health care seems
to be operating on the assumption that
user charges be kept very low. The
solution is to have a system of insurance
where the government subsidizes insurance for categories that deserve subsidy.
The Planning Commission has
suggested that the Central Government
Health Services (CGHS) becomes a
provider of services and competes with
the private sector by charging fees. We
need to expand the insurance industry.
The insurance industry can also inform
people of good choices to make from the
health point of view and to take preventive care.
Reforms mean taking a comprehensive look at the health sector and finding
ways by which private–public partnership can make it easier to reach a larger
number of people, and provide cheaper
and better health care.
In 20 years or so, India will make the
transition from being a lower-income to
middle-income country. The demand
for health care will increase and we will
see a lot of changes in the health sector.
We should manage that change so that
both the private and the public sectors
play their respective roles.
SIR GANGA RAM HOSPITAL NEWSLETTER
—Dr MONTEK SINGH AHLUWALIA
Deputy Chairman
Planning Commission
7
Case Report
An interesting case of post-gun-shot arteriovenous fistula
A 25-year-old male presented with a
history of bullet injury to the left groin 14
years ago. The patient had been treated for
the same—the bullet was removed, the
left groin sutured and a split-thickness
skin graft (STSG) taken from the right
thigh (Fig. 1). The patient has been
symptomatic since then. Two months
back, he developed pigmentation with a
non-healing ulcer over the left ankle and
complained of pain in the leg on walking.
Local examination revealed the
following:
• A scar from the previous surgery in
the left groin
• Non-pulsatile swelling with a thrill
on the medial aspect of the left groin
and thigh
• Varicose veins over the left thigh with
a palpable thrill
• Audible machinery murmur present
• Non-healing ulcer over the medial
aspect of the left ankle.
Fig. 1 Split-thickness skin graft (STSG) taken
from the right thigh
After Doppler study, the patient was
diagnosed as a case of arteriovenous
(AV) fistula and operated under epidural
anaesthesia.
SURGICAL PROCEDURE
A left vertical groin incision was made
and the left common femoral artery
(CFA), superficial femoral artery (SFA)
and profunda femoris artery (PFA) were
exposed and slinged. The left femoral
vein was also slinged, proximal and
Fig. 2 A thrombosed and calcified pseudoaneurysm of the left femoral vein
distal to the AV fistula. The site of
fistulous communication between the
SFA and femoral vein was dissected.
There was a large, thrombosed and
calcified pseudoaneurysm of the
femoral vein (Fig. 2). The proximal
femoral vein was occluded. The defect
in the arterial wall was sutured by a vein
patch using prolene 6-0 sutures after an
embolectomy was performed (Fig. 3).
As the proximal femoral vein was
occluded, end-to-end anastomosis
between the saphenous vein and the
distal femoral vein was done by prolene
6-0 sutures. The distal end of the long
saphenous vein (LSV) was ligated. The
pseudoaneurysm was excised. The subcutaneous tissue sutured by vicryl, and
the skin was sutured using ethicon 3-0.
—Dr R. PARAKH
—Dr SANDEEP AGARWAL
—Dr TARUN GROVER
Department of Vascular Surgery
Fig. 3 After repair
Founder Patron
Patron:: Late Shri D HARMA V IRA
Patrons: Dr S.K. S AMA , Dr K.C. MAHAJAN • Chairman: Dr P.K. K HANNA
Advisor: Dr V IJAY A RORA • Editor: Dr C. W ATTAL
Editorial Board: Dr P.K. S ETHI , Dr P.K. P RUTHI , Dr L ALIT D UGGAL ,
Dr P RADEEP J AIN, Dr A NIL SHARMA, Dr A NUJ S HARMA
Guest Members
Members:: Dr SUNIL JAIN, Dr SHIRISH KUMAR, DR SANDEEP AGARWAL
Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060
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8
SIR GANGA RAM HOSPITAL NEWSLETTER
July–September 2005