Dr Valiathan receiving the Honoris Causa DSc degree from President Pranab Mukherjee on the convocation day at Besu and (right) the Chitra heart valve (Gopal Senapati)

It is possible to indigenously design and develop cost-effective medical aids that are accessible and affordable to the poor. Dr Marthanda Varma Sankaran Valiathan, recipient of Padma Vibhushan, a cardiologist and cardiac surgeon, had demonstrated this way back in the seventies when he developed the Chitra heart valve, a mechanical heart valve with a tilting disc design that has saved countless lives in India. Thirty years on, Valiathan still feels not enough is being done in the field of bio-medical devices in the country. A Telegraph Howrah interview

How did you come to develop the heart valve?

Chitra Valve development happened in the late 70s. In a small institute in Trivandrum with limited resources, we could demonstrate that it could be done. By resources, I don’t mean just money but technology resources, like different types of materials, textiles, fine fabrication techniques, all these were available in India. Only thing is you had to shop around, and find them, integrate them and then only you could make a device. We showed that this was feasible. We transferred technology, went into commercial production, and our institute, the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, got royalty.

Apart from the heart valve, you also developed a number of other medical devices ...

A blood bag on which the whole transfusion process depends, that was the first technology that we developed and transferred for production.

All that has happened 40 years back, we can cheer and be proud of ourselves. But the bad news is that of all these hi-tech items in practice of medicine, 90 per cent are still imported. The Indian Science Academy reported this heavy dependence on exports a few years back. They did a study on instrumentation in India and they pointed out this heavy dependence on exports for hi-tech items. The Indian industry makes some low technology items which they are exporting. They don’t have any incentive to invest in hi-tech items.

Why is that?

They don’t feel the need for it. For example, the pharma industry wasn’t making any investments in R&D till India signed the WTO. They were in a protected environment, they were protected from competition but once the WTO was signed they knew they would have to find new molecules otherwise they would be finished and started making heavy investments. That kind of stimulus is not there.

So is the Indian government providing any kind of incentive for bio-medical research?

The Indian government has a plan and the Department of Science and Technology (DST) has drawn up the National Technology Mission for Medical Instruments. The whole picture has changed in instrumentation today, compared to 20-25 years ago. All the big manufacturers, Philips, Siemens, Hewlett-Packard have set up shop in India.

Today, they no longer need an Indian partner. If we develop something, we have to compete with them, which is very difficult. There is no longer that protected market. So what are we going to do? Are we going to continue importing 90 per cent of the hi-tech items?

What is the social cost?

Ten per cent of the imported items is accessed by only 10 per cent of our population. For the MNCs, it is a huge market, Rs 120 million. But we have a 1.2 billion population, if we want to give them access to such items, we need to develop them ourselves. The Sikka commission of DST has decided there should be a technology mission. They will identify an Indian consortium, of engineering and technology academic institutions, medical institutions, national laboratories, central universities and Indian industry and they should identify one or two class of instruments that can be indigenously developed. Its not possible to have self-sufficiency in all class of instruments. So maybe, we should concentrate on analytical instruments or imaging instruments like ultrasonic scans etc. And then, in one class of instruments, there will be 2,000 components. Parcel out these components to various industries and somebody should integrate it. But it is a slow process in the Indian government. They say it is scheduled in the 12th Plan Period but I am not too sure.

But I have seen great revolutions happen in India, like Kurien’s milk revolution, the green revolution happen through individual effort, India’s leadership in poultry did not happen through planning by the Government of India. So, India has this tradition of finding unconventional things when the challenge is severe.

Valiathan with Dr Charles Hufnagel from Georgetown University

So are we going to see some innovation on the part of individuals?

I have met two or three engineers. They are young people, they have worked in MNCs. One has developed ECG machines. But they got fed up of working in these companies because all the credit went to the companies. So they have set up their own businesses. This is a very interesting development. They have fewer people, have set up base in a small town where the costs are low, they know what the world is doing and they want to be one step ahead. They stress on quality, innovation. One is working on cardiac monitoring machine. This reminds me of Germany’s Mittelstand companies, small and medium-sized enterprises that business and economic historians say have turned around the German economy in the beginning of the 20th century. Seventy per cent of private employment in Germany is provided by Mittelstand companies.

So you are betting on Indian Mittelstands to do a turnaround?

They don’t make quarterly profit, but they have long term plan. They are family-owned, but they are up-to-date in quality, innovation, reliability. Its a very different culture. But they need to avoid intellectual isolation. They need to communicate with academic institutes like IITs. They need some kind of intellectual linkage. They don’t need money. What we need is a model where the old IITs and 15 or 20 such Indian Mittelstands are connected to them, I think we will have a very good change in India. I hope the National Mission succeeds, I am a cheerleader but I have a feeling that these Indian Mittelstands are perhaps the answer to India’s problems.

How did you come about developing the heart valve? You were abroad, what made you come back and do this in our country?

I spent several years abroad, if I stayed there I could have made money, I could have written papers. But where 10,000 papers are being written, mine would have been lost. In 2003, there were 5,000 medical instrumentation patents in US, while in India there were just three. If you stayed there and did something, there would be no impact. But here, one single success in a place like Trivandrum means a lot. You set up the whole cardiology department, blood bank, diagnostics, the entire thing. That was very exciting, it was not easy but it did happen.

What was the greatest hindrance you faced?

The greatest hindrance was that Indians never believed that heart valves could be made in India. We have built this wall of negativity around us. Medical colleagues were very negative. That belief that we are incapable of doing it, that is the biggest hindrance here.

Did you get assistance?

I was gifted with many friends. I had come to IIT-Kgp for a year before going to Trivandrum. I was operating in the Railway Hospital and I was a visiting professor in bio-medical engineering in applied mechanics. There I found, to my surprise, you cannot develop any heart valve. You can only teach. You can teach aeronautical engineering in IIT but you cannot develop a model. Their whole culture is teaching. I wanted to make a kidney-shaped ring to do a plastic repair of a real mitral valve. I thought it could be made with unconventional machining and so I went to their workshop. But they said we are far too busy with students’ classes etc. So I left and moved to Trivandrum where my student in IIT Madras helped me out. I got help from ISRO, National Aeronautical Lab, Bangalore, for plastic things, I went to NCL, Pune, polyester fibre from the south. So a number of these people helped me out but I couldn’t give them anything. The state government gave me a lot of freedom to work.

Who inspired you?

I worked with Dr Charles Hufnagel from Georgetown University and Dr Vincent Gott of Johns Hopkins University, both of who were pioneers in bio-medical materials, devices development. So I developed a deep interest in these things. When I came back to India I found that day-to-day devices had to be imported. So, I decided to make them.