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सही सिस्टम से ही सम्भव है सुरक्षित इलाज

श्री स्वदीप श्रीवास्तव,

सूचना तकनीकी के इस दौर में भी जब बात स्वास्थ्य समस्या की आती है तो अक्सर हम खुद को असहाय महसूस करते हैं। जानकारी का अभाव और अनुभवहीनता न सिर्फ मरीज की तकलीफ बढा देती है बल्कि उसके परिजनोँ को आर्थिक रूप से भी बेहाल कर देती है। कई बार तो महीनोँ अस्पतालोँ के चक्कर काटने और दर्जनोँ टेस्ट कराने के बाद पता चलता है कि दरअसल कोई समस्या थी ही नहीं। वही कुछ मामले इलाज में देरी के चलते बिगड भी जाते हैं। इस तरह की दिक्कतेँ न आएँ इसके लिए हमे सही सिस्टम विकसित करने की जरुरत है। सुरक्षित इलाज के 7 चरणोँ को सही मायने में उपयोग में लाना होगा। जो इस प्रकार हैं:

  1. लीडरशिप सपोर्ट यानी विशेषज्ञ से सलाह: अगर मरीज को समस्या का अंदेशा होते ही उसे कोई ऐसा व्यक्ति या प्लैटफॉर्म मिल जाए जो उसकी समस्याओ को सुनकर न सिर्फ उसे सही सुझाव दे बल्कि सम्बंधित विशेषज्ञोँ की मदद से उसे आगले चरण के लिए दिशानिर्देश भी से। ताकि मरीज को अपने लक्षणोँ और उनके निराकरण के लिए जांच व इलाज आदि की जानकारी के लिए इंटरनेट या आधी-अधूरी जानकारी रखने वालोँ पर निर्भर न रहना पडे।
  2. मल्टीडिसिप्लिनरी कोलैबरेशन यानि सम्बंधित व्यक्तियो की सह्भागिता: समस्या का पता लगाने या इलाज के लिए कौन से डॉक्टर या अस्पताल में जाना उचित रहेगायह जानकारी मिलने के बादवहाँ का अपॉइनमेंट तुरंत मिल जाना, वहाँ तक पहुंचने की प्रक्रिया आदि की जानकारी मिल जाने से मरीज को इधर-उधर भटकना नहीं पड्ता है।
  3. अर्ली आइडेंटिफिकेशन यानि समस्या की जल्द पह्चान: सही प्रक्रिया की जानकारी होने से मरीज जल्द सम्बंधित डॉक्टर के पास पहुंचता है और तुरंत जांच से उसकी समस्या का शुरुआती दौर में ही पता लगाना आसान हो जाता है, जो कि आगे सफल इलाज में काफी महत्वपूर्ण भूमिका निभाता है। उदाहरण के तौर पर आजकल न सिर्फ हार्ट और ब्रेन से सम्बंधित बीमारियो बल्कि कई तरह के कैंसर के मामले में भी शुरुआती दौर में इलाज होने से मरीज की जान बचाना सम्भव हो गया है।
  4. ट्रांजिशन प्लानिंग: इलाज, के लिए मरीज को अगर एक अस्पताल से दूसरे अस्पताल या एक शहर से दूसरे शहर में ले जाना हो तो परिजनोँ के लिए बडी समस्या खडी हो जाती है। बात अगर अजनबी शहर में जाने की हो तब तो दिक्कत और भी ज्यादा होती है। ऐसे में वहाँ बडे अस्पताल की भीड्भाड के बीच सही मुकाम पर पहुंचने के साथ-साथ इस बात की भी चिंता रहती है कि अपने बजट में और अस्पताल के करीब ठहरने, खाने, यातायात व अन्य सुविधाओँ का इंतजाम कैसे होगा। ऐसे में अगर कोई संस्था आपकी जरुरत और बजट के हिसाब से नए शहर में सब कुछ पहले से तैयार करके रखे तो कितनी सहूलियत होगी इसका अंदाजा लगाया जा सकता है।
  5. मेडिकेशन मैनेजमेंट और रिकवरी:अस्पताल में इलाज की प्रक्रिया पूरी होने के बाद मरीज की रिकवरी भी उतनी ही मायने रखती है। अक्सर देखा जाता है कि अस्पताल से छुट्टी मिलने के बाद मरीज के परिजन दवाएँ व खान-पान से सम्बंधित सुझावोँ को समझ नहीं पा रहे हैं\ मरीज की हालत ऐसी है कि खुद उसका सही देखभाल नहीं कर पा रहे हैं या किसी खास दवा के लिए पूरे बाजार में भटक रहे हैं। ऐसे में उन्हे मेडिकल कॉन्शियर्स की जरुरत महसूस होती है जो उनके लिए डॉक्टर की हैंडराइटिंग को सही से समझ कर उनको गाइड कर सके, उनके लिए नर्स, फिजियोथेरपिस्ट या ड्रेसिंग आदि के लिए मेडिकल प्रोफेशनल की व्यवस्था करा सके। कोई दवा नहीं मिल रही तो डॉक्टर से उसका विकल्प पूछ सके। इमर्जेंसी में जरुरत पड्ने पर डॉक्टर का अपॉइनमेंट लेकर फॉलोअप करा सके।
  6. पेशंट एंड फैमिली ऐक्शन/एंगेजमेंट यानि परिवार की भूमिका: मरीज की रिकवरी में उसके परिवार की भूमिका सबसे अहम होती है। ऐसे में उनकी क्या भूमिका होगी इस सम्बंध में परिवार के सदस्योँ को जानकारी दी जानी चाहिए। मगर काम के दबाव के चलते अधिकतर डॉक्टर परिवार की काउंसिलिंग में समय नहीं दे पाते हैं। मेडिकल कॉन्शियर्स यह भूमिका सही ढंग से निभा सकते हैं।
  7. ट्रांसफर ऑफ इंफ़ॉर्मेशन: सही सूचनाओँ का आदान-प्रदान भी बेहद महत्वपूर्ण होता है। कई बार देखा गया है कि मरीज समस्या को डॉक्टर के सामने सही ढंग से नहीं रख पाते हैं और काम के दबाव के चलते डॉक्टर भी उन्हे भरपूर समय नहीं दे पाते हैं। ऐसे में अक्सर बीमारी पकड में नहीं आ पाती है। दूसरी तरफ मरीज और उनके परिवार वाले भी डॉक्टर की पूरी बात और उनकी हैंडराइटिंग न समझ पाने की स्थिति में दवाएँ आदि सही ढंग से नहीं लेते हैं और समस्या कम होने की बजाए बढ जाती है। सूचनाओँ के आदान-प्रदान की इस खाई को मेडिकल कॉन्शियर्स के जरिए सफलता पूर्वक भरा जा सकता है।

    मैनेजिंग पार्ट्नर, वर्चुअल मेडिकेयर कान्सीएर्श

Coronary Artery Bypass Graft (CABG)

  1. What is Bypass surgery & when is it performed?

Heart bypass surgery, also known as coronary artery bypass surgery, is performed to replace damaged arteries in the heart muscle. The damaged arteries are repaired by taking blood vessels from another area of the body. These arteries supply oxygenated blood to the heart. The heart doesn’t work properly if these arteries are blocked, or if blood flow is restricted. This can lead to heart failure. A certain type of bypass surgery is recommended basis the number of blocked arteries.

  • Single bypass: only one artery is blocked
  • Double bypass: two arteries are blocked
  • Triple bypass: three arteries are blocked
  • Quadruple bypass: four arteries are blocked

Risk of getting a heart attack, heart failure, or another cardiac issue depends on the number of arteries blocked. Surgery may take longer or become more complex if there is blockage in more arteries.

When a material in blood (plaque) builds up on arterial walls, less blood flows to the heart muscle. The muscle is more likely to become exhausted and fails if it is not receiving enough blood. This mostly affects or damages the left ventricle, the heart’s primary pump. Doctorsgenerally recommend a heart bypass surgery when coronary arteries become so narrowed or blocked leading to a high risk of a heart attack.

This condition is known as coronary artery disease, or atherosclerosis. Doctorsgenerally recommend a bypass surgery when the blockage is too severe to manage with medication or other treatments. The operation can save your life if you are having a heart attack or are at a high risk of having one. If you have ongoing angina and shortness of breath from diseased heart arteries, elective coronary bypass surgery is highly effective at eliminating or reducing discomfort. You can get your life back with a coronary bypass surgery.

  1. Bypass or Angioplasty- which one should be performed?

During cardiac catheterization, images of the inside of the coronary arteries are examined by the doctor. If plaques in these arteries (coronary artery disease) are causing areas of narrowing, you may need treatment. Treatment options depend on various factors including:

  • Severity and extent of coronary artery disease
  • Symptoms, such as chest pain and shortness of breath
  • Overall heart function
  • Other medical conditions, such as peripheral artery disease, diabetes or prior stroke or heart attack

Medications and lifestyle changes may be the treatment of choice for some people.

In other cases, angioplasty or Percutaneous coronary intervention may be recommended for opening the clogged arteries. Angioplasty may especially be recommended when you experience chest discomfort (angina) due to reduced blood flow that has not responded to medication and lifestyle changes.

During angioplasty, a tiny balloon at the site of the blockage is inserted and then expanded to widen the narrowed artery. Your doctor may then implant a stent (small metal coil) in the clogged artery to keep the artery open and hence reduce the risk of it narrowing again. It is possible to even have angioplasty during cardiac catheterization, if your doctor thinks it is the most feasible treatment option for you.

In a case where arteries are narrowed or blocked in multiple areas, or the left main coronary artery is narrowed, your doctor may recommend coronary bypass surgery. Some studies and researches show coronary bypass surgery may also be an appropriate treatment if you have diabetes and have multiple blocked or narrowed arteries.

During bypass surgery, surgeons take a sample of healthy blood vessels usually from inside the chest wall or the lower leg and attach it above and below the blocked artery. This permits blood to bypass the blocked area and flow to the heart muscle.

While angioplasty is a minimally invasive scheme, of widening a coronary artery where a balloon catheter is used to widen the artery from within and a stent is placed inside the artery to keep it open. Anaesthetic is not needed (although the patient may be suggested sedation), and patients can go home same day or the next day.

The recovery time for angioplasty is quicker than heart bypass, but patients having CHG are not advised to go for angioplasty. People who have triple-vessel disease are suggested to have heart bypass, and if one has diabetes, heart bypass gives better survival outcomes. Angioplasty is usually used for people having less-severe coronary artery disease.

  1. What to expect before, during & after bypass surgery

Before the procedure:

  • One should not take any drugs having aspirin for three days before the surgery. These drugs can cause bleeding more than usual.
  • One should quit smoking. People who have a habit of smoking have more mucous in their lungs and is hard to remove after surgery.
  • One needs to have someone to stay with them after getting home from the hospital.
  • One can also hire a home health aide but these services can prove to be costly.
  • One may require blood while in the hospital. Anyone can donate their own blood, after telling the doctor.
  • One may not be allowed to eat or drink anything after midnight before the surgery. Take your normal pills with a small sip of water. If diabetic, check with the doctor about your diabetic medicines.
  • One needs a chest X-ray, a urine test, and ECG of your heart and blood tests before surgery. These tests may be done at an outside facility or in the hospital the day before surgery.
  • The day before surgery, one needs to scrub the abdomen and legs with a soap to kill germs.
  • One needs to bring all the pills to be taken with and show them to the nurse.
  • Do not bring any valuables, such as jewellery or money to the hospital.
  • The doctor would explain the surgery to you and give u a consent form for signatures.
  • One should meet other members of the team involved in the surgery, such as the anaesthesiologist, etc.

During the procedure:

  • If one is in the hospital, day before the surgery, one would have the time to see their loved ones before the surgery.
  • One is asked to remove dentures and non-permanent bridgework, hair clips, jewellery and nail polish before going in to surgery.
  • In the morning of the surgery, your chest, groin and legs will be shaved.
  • Nurse will start an IV in the arm to give you fluids.
  • One might also receive drugs to help you relax and have a facemask to breathe oxygen.
  • One will be asked to go to the washroom five to ten minutes before the surgery as during and immediately after the surgery, a small tube is inside the bladder to drain urine.
  • The room for operation might be cool and you may have a blanket if you wish.
  • One will receive drugs to put to sleep and to block pain so that one is not be awake during the surgery.
  • The surgeon divides the breastbone and spread the ribs to get to the heart. The heart-lung machine will take over the work of your heart and lungs.
  • The surgeon then removes a small length of blood vessel from your leg or chest and he will begin sewing it to your heart vessels.
  • Once this is done, the surgeon will start your heart and turn off the heart-lung machine.
  • Your breastbone is wired shut and the wound is closed with stitches or staples.
  • One may have two or more small pacing wires on the chest. These wires will be used to help control your heart beat if needed. They will be removed before going home.
  • One will have two or three tubes in your chest which will be hooked to a machine to drain the extra air and blood. These tubes will be taken out in about a day.

After the procedure:

  • One is taken to the Cardiac Surgery Intensive Care Unit.
  • One will have a breathing tube inside your windpipe. The nurse uses a small tube to remove mucous from the lungs and mouth to prevent any build-up in your lungs.
  • This procedure can cause pain, make one cough and hard to breathe, but drugs may be given to treat these symptoms.
  • On waking up, one will be weaned from the machine that is helping to breathe. Once this happens, the tube in your windpipe is taken out.
  • One will have a mask on their face to give oxygen after the breathing tube is removed,.
  • The facemask is taken off and will have a small tube under your nose to provide oxygen.
  • When in pain, tell the nurse, who can give you drugs to ease the pain.
  • One should take deep breaths and cough for 10 to 20 times per hour to prevent any fluid build-up in the lungs. (You will learn to use a small gauge, called an incentive spirometer, to see how depth of your breath and to train to breathe deeply.)
  • After the surgery, one should get up as soon as you can and talk with family and friends. This might speed up your healing and helps family and friends feel less worried.
  • One can walk, with help, the day after surgery.
  • If vessel for the bypass surgery was taken from your leg, onhee may have some swelling in the legs.
  • After a day or two, one will be moved to the Cardiac Progressive Care Unit, where one will be kept for three to five days.
  • One will have an IV, oxygen and a monitor to check your heart.
  • One may have a chest X-ray, blood work, or other tests, as needed.
  • One may have anaemia after the surgery, which is normal but will make you feel tired.
  • The dressings over your chest and leg wounds will be taken off after a day or two.
  • Most stitches are inside and will dissolve over time while the staples would be taken out in about five to seven days after the surgery.
  • One may also have small paper strips on your chest and legs, which will slowly peel and should be taken off after one week you get home.
  • One can talk to a dietician about the kinds of food need to be eaten and avoided.
  • One can slowly start walking more, begin exercises to help heal and learn what to do when you get home.
  • One also needs to see the surgeon about four weeks after going home.
  • One should arrange a follow-up visit with one’s own doctor.

 

  1. What are the risks involved in Bypass surgery & complications

They may include the following:

  • There is a huge risk of bleeding from the graft and other sources and near about 30 percent of patients require blood transfusions after surgery. Very rarely the bleeding would be severe enough to do any additional surgery.
  • Another risk is that of Heart rhythm problems where Atrial fibrillation (a condition where the upper chambers of the heart quivers rather than beating properly) is a frequent complication of coronary bypass surgery and can lead to blood clots that forms in the heart and which can travel to the other parts of the body. Some other forms of heart rhythm problems are also possible though less common.
  • Also there may be chances of Blood clots, if formed, they can lead to a heart attack, stroke, or lung problems.
  • Infection at the site where the chest gets opened for surgery can also happen. This complication is also rare, but can occur in only about 1 percent patients.
  • Post-Pericardiotomy syndrome is a condition occurring in near about 30 percent of the patients starting from a few days to 6 months after the surgery. Common symptoms are fever and chest pain.
  • Kidney failure or renal, failure is another risk that may damage the functioning of a patient’s kidneys, though often temporary.
  • Many patients report difficulty in thinking after the surgery. This problem improves in about 6 months to an year. Researchers are finding its cause, though one theory says that use of the heart-lung machine dislodges tiny bits of fatty build-up in an artery that travels up to the brain.
  • People can have adverse reactions to anaesthesia including difficulty in breathing while asleep.
  • Death is a very rare risk but can happen after the bypass surgery caused by heart attack or stroke.

Surgical Risks of Bypass

Every surgery has risks and holds the potential for small to serious complications. Some of the possible surgical risks involved for bypass surgery include:

  • Spiking high fever
  • Developing a bad infection
  • Bleeding from the site or some infection at the incision
  • Having adverse reaction to anaesthesia
  • Loss of a lot of blood
  • Developing blood clot affecting the lungs

Some more risks likely to occur during bypass surgery include:

  • Having a sudden heart attack or stroke
  • Dying during the bypass surgery
  • Infection in the chest
  • Abnormalities of heart rhythm; this is called arrhythmia
  • Chronic pain of breastbone towards the wound site
  • Severe Pneumonia
  • Difficulty in breathing
  • Kidney or Renal failure
  • Difficulty with cognitive function and thinking
  • Chest pain with fever that may live up to six months

 

Now customized knee for Indians

By Vinod Kumar

Total Knee Replacement surgery has been a boon in alleviating pain and disability in patients suffering from arthritis. Orthopedic surgeons of the city say most of the knee replacement implants so far have been designed according to the anthropologic measurements of the Western people, these implants sometimes tend to mismatch when used in Indian patients. Knee size and body size differ in Asians compared to Western counterparts. As a result, an Asian’s knee might not fit these prostheses.

According to Prof. (Dr.) Raju Vaishya, Sr. Consultant Orthopaedic & Joint Replacement Surgeon, Indraprastha Apollo Hospitals, New Delhi, “Indians require a higher flexion for most of their daily habits and customs. They also have poor bone mass and poor bone quality, due to delayed referrals and osteoporosis. Hence in these patients excessive bone cutting is associated with more post procedural complications.”

In India, over the last few years, the volume of joint replacement procedures has increased dramatically due to increased level of awareness and improvement of technologies. Treatments of joint and knee problems have improved significantly and newer therapies and methodologies including the very exciting biologic disease modifying drugs and procedures like arthroscopy and joint replacements have made a tremendous impact on our ability to treat the various Arthritis. With the help of these therapies, patients are now able to live a fuller, healthier and more active life, no matter what is their age. They can still reach for the stars and realize their dreams.” said Dr.Santosh Kumar, Founder of Poorva International Orthopaedic Foundation. and Head of Department of Computer Assisted Joint Replacement Surgery, Belle Vue Clinic, Kolkata.

Newer instruments and technologies enable the surgeons to consistently achieve results that are far more accurate than via conventional methods. As the accuracy level is very high, it also helps increase the life of the implants, and it also results in less blood loss during the surgery.

Orthopedic experts believe that obesity and changing life style need to be blamed for the rise in joint problems. “More knee replacements are being performed in younger population than before due to obesity, sedentary lifestyles & other forms of arthritis.

Prof. Surya Bhan, who is a Former Head of Orthopedics Department, Chief of Emergency Services and Chief of Trauma Centre, All India Institute of Medical Sciences (AIIMS) said that it is a common misconception that diseases affecting joints, such as rheumatoid arthritis (RA) and degenerative osteoarthritis only affect the elderly. Statistics show that both the young and active can also suffer from these debilitating conditions.

As the number of younger patients with arthritic knees increases, the emphasis should be given to prevention, and improvements in surgical techniques and implants which will lead to better long-term outcomes when joint replacement with Indian Specific Joint is performed, said Prof Surya Bhan.

Now a days arthritis of the knee and other joints is striking at younger ages but shedding a few pounds if you’re overweight may reduce your risk. As people become more aware of the facts leading to joint pain they are more inclined to seek help. Many people believe that only the elderly suffer from arthritis but I treat patients of all ages in my practice. Often they are misdiagnosed because some doctor ruled out the possibility of a patient having some form of arthritis as they are too young, and the elderly don’t seek treatment as they believe there is nothing that can be done now,” explains Dr. Santosh Kumar.

Early diagnosis and aggressive treatment are critical in minimizing the devastating effects of these diseases. Evidence suggests that disease control as soon as possible after onset determines the subsequent disease course and long term outcomes, which suggests there is a therapeutic window of opportunity.

“The treatment for Arthritis varies from patient to patient depending on the type of Arthritis they suffer from as well as their individual profile. We use a combination of symptomatic treatment such as anti-inflammatory drugs and disease modifying drugs to treat these diseases. We also recommend exercises to help improve a patient’s general health, improve mobility and to strengthen muscles. The type of exercise will vary according to the patient and the type of Arthritis they are suffering from. The daily stresses of life may also aggravate, and can trigger a flare of symptoms, so patients are encouraged to reduce stress,” opines Dr. Santosh Kumar.

Brain Stroke: A Medical Emergency

Dr Rahul Gupta

A Brain Stroke is a disruption of blood flow to a part of the brain, causing it to stop working properly and damaging brain cells. A stroke is a medical emergency that requires immediate treatment. Symptoms usually occur suddenly but will vary depending on the part of the brain that is affected.

Brain Stroke

A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.

Causes of Brain Stroke

A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Read more »

Indian Scientists Developed An Indigenous Hemoglobin Test

A group of Indian scientists have developed a new device to instantly test hemoglobin in blood.

The device is portable, low-cost, and easy-to- use, and capable of testing hemoglobin from a single drop of blood in less than 30 seconds. In a conventional set up to measure hemoglobin, a clinician is required to draw blood for testing. The sample has to be transported to a lab where test results are accessible to a doctor after almost 4 hours.

With the new device, researchers say, the test can be performed in a clinic itself and results obtained immediately. Hemoglobin testing important to detect anemia particularly during pregnancy as it can increase the risk for preterm delivery. The device can be useful in rural areas where lab facilities may not be available.

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‘Skill For Life, Save A Life’ Initiative To Promote Health Skills

Health and Family Welfare Ministry has launched the ‘Skill for Life, Save a Life which aims to upscale the quantity and quality of trained professionals in the healthcare system. Under this initiative various courses are planned to be initiated targeting specific competencies for healthcare professionals as well as for general public.

Ministry is initiating its’ ‘Skill a Life, Save a Life’ program by launching First Responder course for professionals as well as general public, to be conducted in Central and State government training institutes from the next month across the country in each district, to empower every single citizen of the country to be the first person to provide first aid and initial care in case of an emergency.

According to a government note, India is working towards the attainment of the global mandate of Universal Health Coverage (UHC) for providing affordable, accountable and appropriate health care of assured quality to the fellow citizens, which is possible through substantive and strategic investment in the health workforce. This is part of a larger plan and program for ensuring Universal Health Coverage. This program will provide trained and skilled people by broadening the base to include the community.

India enjoys a demographic dividend as more than 65% youth are below the age of 35 years and the Government is determined to seize this opportunity by providing adequate skills and employability to the youth for a strong foundation for continued and sustainable growth. ‘Skills for Life, Save a Life’ Initiative’

Skilling the youth enhances the employability and skilled India will help the nation reap rich dividends. This shall reduce the gap between expectations of employment of the youth and the actual job they get.

India as a Hub of Medical Tourism

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Medical Tourism in India

Long promoted for its scenic beauty and cultural heritage, India now occupies an enviable position on the international map as a haven for those seeking quality and affordable healthcare. The country is growing in popularity as a medical tourism hub due to its abundance of hi-tech hospitals coupled with certified and experienced healthcare professionals.

Every year, millions of people from the United States fly over to exotic locations in India for a rare blend of affordable medical treatments and exciting holidays. India has innumerable top-notch hospitals that offer world-class treatments in nearly every medical specialization like joint replacement, cardiology, pediatrics, neurology, plastic surgery, dentistry, psychiatry, organ transplants, ophthalmology, urology, and Ayurveda, to name a few. It is expected that the medical tourism industry in India will experience an annual growth of 30% to reach the $8 billion mark by 2020. India is just beginning to take steps towards becoming a world leader in Medical Tourism however, as dollar gains value, health care costs will continue to rise in the west and healthcare facilities shall continue to be even more unaffordable than before. With such a plausible scenario at hand, India stands to benefit; this would present a great opportunity for India to prosper further on the medical tourism front.

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A Companion in Patient Care

A professional service like Hospital Companion, who handholds the patient and his family members throughout the treatment journey in an alien city and country is the need of the hour, says Dr. Tarun Sahani, Advisor, India Virtual Hospital

With tertiary care treatment limited to metro cities like Delhi, what are the challenges faced by domestic and international patients?

One of the most lacking aspects of Indian healthcare system is the multiple coordination challenges faced by patients and their family members during their patient treatment journey in an alien city or country. Unfortunately, almost no one has acted upon to mitigate these challenges comprehensively as they are not directly related to medical services but is a huge challenge for patients and their attendants.

Right from the time when a patient is advised for operation or procedure in a metro city,

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