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ALL’S WELL THAT ENDS WELL

- An Indian doctor’s efforts to improve trauma care in the country

When Americans, impatient with the pace of reforms in India or with the slow implementation of schemes already approved in New Delhi, complain to Prime Minister Manmohan Singh in Washington this Friday, he should simply refer them to Navin Shah, a self-made Indian medical doctor in their midst and let him narrate his experience in trying to change Maharashtra, the state where he was born.

A decade ago, Shah was travelling in a taxi along a Mumbai street when he noticed some commotion on the opposite side of the road. He was told by the cabbie that a fatal accident was the cause of the ruckus. Four hours later, Shah was returning along the same road and was disturbed to note that the dead body from that accident was still at the same spot on the road.

The incident triggered his professional interest in digging for information about trauma care in India and comparing it with conditions in the United States of America, which he was already familiar with as a doctor in Maryland. The statistics which Shah’s research threw up were shocking. On an average, 1,000 persons die every day in accidents across India. Some eight persons are killed daily in railway accidents in Mumbai alone, adding up to a total of 8,600 deaths annually in the city from various accidents.

Shah is a urologist, not a specialist in treating accident victims, so when he came back to the US, he talked about his findings to Thomas Scalea, one of America’s top trauma surgeons, and to Manjari Joshi, an alumna of New Delhi’s All India Institute of Medical Sciences, who has worked with the University of Maryland’s Shock Trauma Center for 30 years. Scalea and Joshi connected Shah to Amy Hildreth, assistant program director and specialist in emergency surgical critical care at the Wake Forest School of Medicine in North Carolina.

They all agreed that many of the Indian lives lost every day in accidents could be saved if only these victims could be rushed to the right hospitals for speedy diagnosis and quick treatment. Shah then discovered that Mumbai has four trauma centres attached to four medical colleges in the city, a woefully inadequate number of accident care facilities for a population officially put at 12 million and unofficially at 16 million and above. Alarmingly, not one of these four trauma centres has even one qualified trauma surgeon.

It was after such disturbing discoveries that the Indian origin urologist embarked on a campaign that would make those Americans who have gripes about India’s slow pace of change and want their disappointment conveyed to the prime minister truly sit up and marvel at how Shah brought about change the Indian way through patience and perseverance.

Ten years ago, Atal Bihari Vajpayee was the prime minister and he had appointed a man from his sangh parivar as ambassador at large globally for non-resident Indians and persons of Indian origin based in New York. In addition, the Bharatiya Janata Party had a history of carefully cultivating NRIs, and they in turn, had stood by Vajpayee’s government during the trying period after the 1998 Pokhran-II nuclear tests.

Using that entrée, Shah decided to approach Vajpayee and succeeded in getting a meeting at 7, Race Course Road, the prime minister’s residence, without much ado. He made his case for urgent steps to upgrade India’s emergency medical services that could save thousands of precious lives every year. Shah explained that he was a co-founder and past president of the American Association of Physicians of Indian Origin, the most influential lobbying organization of Indians in the US. Many of the 65,000 Indian doctors in America were ready to chip in with their services in making that upgrade possible, he offered. Vajpayee gave Shah a patient hearing and was supportive of his plans, but that was it. Nothing happened.

Shortly afterwards, the Central government changed and Manmohan Singh replaced Vajpayee as prime minister. Shah knocked at the gates of 7, Race Course Road, got an appointment with the new prime minister and went through the exercise all over again: depressing statistics, state of medical services, lack of emergency care, everything that he had told Vajpayee.

Singh listened with palpable concern and promised Shah full support in his endeavours. But the good doctor, an alumnus of B.J. Medical College in Pune, had become wiser after his brush with India’s officialdom and political culture.

He thanked Singh for his expression of support but said that was not enough. “Sir, please designate someone from your office to be a nodal person for this task, someone to whom I can turn to when I run into problems.” The prime minister promptly called T.K.A. Nair, then his principal secretary, and tasked him with helping to realize Shah’s plans.

Days turned into weeks, weeks into months and subsequently years passed. Despite interventions from the most powerful office of the land in the persona of Nair, the idea of modernizing emergency medical services remained an idea in the folders that Shah periodically carried from the US to the offices of successive health ministers at the centre and in Maharashtra, to the cabins of bureaucrats in New Delhi and in Mumbai and to major hospitals.

It was not that anyone was against the project. Not at all. Sometimes a goal appeared to be within striking distance after a lot of painstaking work, but at that stage, the Union health secretary would be moved out in a bureaucratic reshuffle or the additional chief secretary of the Maharashtra government in charge of health would be changed. Shah would then be forced to restart his effort almost from scratch.

At one stage he approached a representative organization of Indian industry for help, but he was turned away with the reasoning that they were not a charitable organization but one dedicated to advancing corporate interests. So much for the much-advertised corporate social responsibility of the so-called captains of industry.

However, there is an illuminating lesson for those Americans who have only tales of frustration about dealing with India that Shah’s decade-long struggle to transform trauma care in India had a happy ending recently. The Central government has just sanctioned Rs 1,000 crores for establishing 47 trauma care centres in Maharashtra with the goal of making all them fully functional by January 2017.

A total of 927 ambulances are to be bought and fitted with state-of-the-art equipment and staffed by qualified personnel to be deployed all over Maharashtra to rush accident victims to these trauma centres. A command centre for trauma care in the entire state has already been established and officials are hoping that their state’s experience will be a model for the rest of India in due course.

This plan and time-table were drawn up after Shah, along with the American specialists, Scalea, Joshi and Hildreth, spent 11 days in India in June. In Mumbai they worked with 100 doctors from the state chosen by the Maharashtra government and provided pioneering training in caring for accident victims (picture). Scalea and T.C. Benjamin, the state’s senior-most public health official, signed a collaboration agreement for taking their joint efforts forward. For a start, two scholarships are being offered for surgeons from Maharashtra to be trained in Maryland and North Carolina.

Meanwhile, back in Washington, unlike an Indian industry organization in New Delhi which gave Shah the boot, the US-India Business Council, with the support of the Indian embassy, has accepted in principle Shah’s proposals for a physician exchange programme with India. The proposals will be taken forward at a meeting on October 18.

The American Professional Exchange Association, which works with the US State Department and the American Medical Association, has already begun accepting applications from American physicians to work in India as volunteers sharing their knowledge and expertise. All is well that ends well, says Shah, whose only prayer is that if there is a change in government after the 2014 general elections, he should not be required to start from scratch again.