Healthcare Delivery Public Health

Shot through the heart: How heart troubles are complicating the India story

My grandmother always used to tell me that working hard 9-5 and having a good night’s sleep were the secrets of a healthy heart. And she also told me that heart problems were a 60’s thing (people in their 60’s)

Her statement could not have been truer as she remained healthy her working life and dies at the age of 65 as you could have guessed of an heart attack. But times have changed.

Today 30 is the new 60’s.

According to statistics from the WHO, India has the largest cardio vascular burden in the world. 1 in 5 Indians die because of cardiovascular diseases. By 2020 the figure will jump to 1 in 3. Currently there are about 45 million heart patients in India. Obviously this figure is much greater as many in the rural areas don’t have the infrastructure to detect heart ailments.

There are two key reasons why such data has come out in the open.

  1. There is a key shift in mortality due to non-communicable life style diseases. So about 50 years ago while malaria and typhoid would have killed many people, today it is Diabetes, Hypertension and Cardiovascular diseases. So clearly mechanization and urbanization has its own perils.
  2. There is increased awareness and screening.  Many more people have been empowered by the media and other social sites. These people read articles like the one you are reading now and become aware of the situation and proactively reach out to care providers to undergo screening.

A combination of these two factors see’s India as the diabetes capital of the world. Indians have the tendency to develop diabetes a good 10-15 years ahead of their western counterpart. The average Indian develops the condition at the age of 45 years.

As the world celebrates ‘World Heart Day’ on the 29th of September I have decided to do a three part series beginning with this post. The second post in the  series would look at what is the government doing to face the challenges posed by cardiovascular diseases and the third post would look at how the private healthcare sector is working on innovative strategies to counter the issue.

I will be back soon and till then comments and suggestions are always welcome…



How the humble Idli can solve the nutrition problem in India


Idli or rice cake could solve some problems of wellness and nutrition in the country.

According the the recent breakfast survey done at 4 major metros in India, Idli-sambar came out on tops as the most nutritious breakfast. This combination won over other traditional foods like Parathas and Modern additions like Bread. A mix of rice and urad dal (White Lentil) , the Idli is an ideal mix of protien, fat andcarbohydrates with the Sambar providing vitamins and minerals.

Needless to say Chennai (madras) came out tops as the city where almost 60 % of those surveyed consumed breakfast. Interestingly most of the nation did not consume breakfast or did not consume enough of it.

Food from Kolkatta was considered too high in Maida, while the one from Delhi was high in Oil. Mumbai does not have traditional breakfast and most people consume bread.

The research was sponsored by Kellogg s who have been trying for last 20 years to get some foothold in the Indian breakfast table.

Interestingly Tamilnadu chief Minister Dr Jayalalitha inaugurated a corporation run restaurant earlier this year which would serve Idli-Sambar for Rs 10. 13 such outlets were opened in February and there were plans to open 100 more in the year. For more on that story please read here.

Historically Idli was first mentioned by the Kannada historian and King Someshwara III in 1170 AD. It seems to have been influenced by the Indonesian style of steam cooking.

For those keen to learn how to cook this dish do check out this You tube video.

So can the humble idli solve our nutrition issues? Should the north adopt this super star of the south Indian kitchen ?

as always comments and concerns welcome….


Healthcare Technology

Intex launches a phone for the visually impaired


India has more than 37 Million visually impaired citizens. Almost 50 % of them have this condition due to cataract and refractive visual impairment. This segment has often been ignored by most products and they do depend on others for their daily needs.

But now thanks to Intex the visually impaired can communicate on their own. Intex recently launched ‘Vision’ a phone for the visually impaired that has braille digits on its key pad and the keys call out the numbers while being pressed.

There is also a provision to store upto 4 emergency numbers, which can be accessed by pushing a button behind the phone.

In addition the phone has a toech, FM radio, MP 3 player and hearing aid ear piece.

For more on the technical specifications of the phone please visit the Fone Arena site here.

Now for my take on this new product.

I believe this would mark the beginning where the commercial companies would start targeting the section of the population with disabilities. This is an unexplored market in India and as this is a first of its kind product it should do well. So in my opinion this is a unique product and will help expand the market for this section of the society and for other manufacturers as well.

Launching this product with the National Association of the blind is a good idea as well. And ideally traditional distribution channels may not work. I would ideally look at hospitals like Narayana Nethralaya or Aravind Eye Hospital as an ideal partner to distribute these phones.

My other concern is the lack of traditional distribution channels in the rural hinterland, where these phones would be a boon for the visually impaired. So maybe exploring a tie up with an FMCG player should help ? I know it sounds ridiculous but just trying to think out of the box.

Finally the pricing seems to be perfect, at Rs 2,500 this is a affordable phone and should put the market size at roughly at Rs 92,500,000,000. That is assuming all of the visually impaired can afford a phone, which is going to be very unlikely.

So this is my opinion on this new product, would love to know your views on the same.


Healthcare Delivery

Most doctors in Urban India are quacks…not surprising.


A recent report by IMS Health India puts the number of quacks in urban India more than qualified MBBS doctors.

A quack according to IMS Health is someone not have an MBBS degree but still prescribes Allopathic medicines. So there are basically three categories of quacks. the first category is those who have no degree at all. These form a big chunk of those prescribing medicines in cities.

The second category are those with Ayurvedic, Yunani, Siddha, Homeopathic degrees but prescribing Allopathic medicines.

And the final category are those with Integrated Medicine, Alternative Medicine and Electro homeopathy degree.

All three categories are not allowed to prescribe Allopathic (Pharmaceutial) medicines, but do so in the cities.

Mostly the doctor pay in the cities is very skewed towards the super specialists with Oncologists (cancer), Cardiologists / Cardiac Surgeons(heart) and Neuro surgeons/ Neurologists (brain) who make most of the money. Almost 4-5 times that made by the middle layer that is made up of Ophthalmologists (Eye) , Pediatricians (Childcare) and Gynecologists.

The bottom layer of qualified doctors are dentists, general physicians and  internal medicine practioners. Also as the costs are high this gives a scope for the quacks who charge a fraction for the same services.

So on one hand the Govt wants to send new MBBS doctors to rural areas while our own cities are filled with quacks. Also the charge disparity between the various specialists.  Fore more on the report please visit the IMS Health India site. 

Healthcare Delivery Public Health

In defense of newly graduated MBBS doctors


Friends, Indians, Countrymen

I am here to bury the new MBBS doctors and not to praise them.

But before I do that, please do hear me out…

The Indian government wants to make it compulsory for the freshly graduated MBBS doctors to serve 6 months in a rural posting, in order to be eligible to sit for Post- Graduate exams. Noble thought indeed, but is it well thought through.

Well first and foremost, it will create a huge market for fake certification of rural posting, which some very innovative (Jugadu) graduates will resort to, in lieu of actually serving in that area. Such schemes always breed corruption as we have seen in the past.

Second, why do people think that doctors have to forego all in service of humanity? Why not ask the other graduates like Engineers to serve in rural areas as well? Maybe in order to be eligible to write CAT, GMAT or GRE ?

Don’t tell me that rural India does not need any engineers and architects to build its roads, schools, colleges, hospitals and dams. please don’t tell me they don’t need electrical engineers to lay power lines to light up the villages and mechanical engineers to set up industry.

Just asking the MBBS doctors to do this is being partial to a profession that has lost the brightest to the IT industry and the lure of western civilization.

Thirdly 80 % of the healthcare infrastructure is in the cities. What are these fresh graduates going to do when they don’t have the basic diagnostic equipment?

And finally with all senior doctors serving as specialists in the cities, these young doctors will do more damage than good, without proper guidance…

As usual I would like to hear from you and all comments are welcome..