On 8 March, the Bhoomi puja was performed to commence work on yet another pioneering venture: the first special economic zone in the country for a unique medi village. Renowned cardiac surgeon K.M. Cherian is conceiving this one-of-its-type comprehensive healthcare facility on a grand and innovative mode.

We have heard of medi cities promoted by large corporates like Escorts and Apollo in metros or large cities. Cherian has chosen to locate the facility at a rural centre, Elavur. This village, 45 km north of Chennai, is devoid of any major infrastructure at present. Located on the national highway to Kolkata, in the entire stretch upto Nellore, AP, doesn’t have any modern health care facility. Cherian considers this important; not to overcrowd and duplicate facilities in cities which are already well-served but to provide healthcare access to hundreds of villages not presently receiving quality healthcare. Cherian also emphasises a different mission: corporate hospitals focused on a growing bottom line; he held that healthcare is an industry, but care of the sick is NOT.

The SEZ advantage...

The SEZ is developed in co- operation with the Tamil Nadu Industrial Development Corporation Ltd (TIDCO). This association has enabled Frontier Mediville( FM) to get the clearances fast.

But why a SEZ spread over 55 acres?

Cherian points to the enormous savings on taxes and duties that a SEZ is entitled to: cement will cost just Rs185 per bag against the market price of Rs 270. Steel, glass, aluminum… will be available likewise at such duty-free prices. FM will import these from China where the prices are much lower. Since the hospital already earns foreign exchange from the patients who flock from overseas, paying for such imports can be managed. Cherian estimates a 40 per cent cost advantage in setting up the project as a SEZ. Such advantage will extend to expensive, state-of-the-art diagnostic and other imported equipment.

Rich facilities at the Medi Village

In the context of the increasing cost of medicare, such an approach should bring about handsome reductions in the cost of medical research, diagnosis and treatment.

I described the concept as grand. Look at the components of Cherian’s dream:
A National Medical Science Park: unlike other similar ventures starting with a hospital with commercial prospects, FM will start with a medical science park where basic science research, education, training and the manufacture of sterile medical products will be taken up.
Farm and Animal Lab: FM will have a modern animal house. Pure breeds of buffalo, pig, sheep ….will be bred in this animal farm for extensive experiments on xenografts.
A large convention centre in the shape of a flamingo to seat 1500 will be got ready for the international convention of cardiologists to be held at medi ville next year.
A 1000 bed bio-Hospital will be part of FM. Cherian said that by 2010 globally there will be just 18 such bio-hospitals with 5 of these in the U.S. FM’s will be the first such in India.
Medical University / Research & Training Centre: Cherian referred to plans on a comprehensive medical university with focus on medical research and experimental surgical facilities. The plans include setting up a regional centre for nursing and paramedic training with Australian collaboration.
Tie ups for research already exist with renowned institutions in Australia, Japan, Korea... There is thus the promise of collaborative research with neighbouring countries.
Sterile Bio-Medical Corridor & Training Centre: FM plans a sterile biomedical corridor to facilitate the manufacture of consumables, disposables, pharma products… required at the hospital and research laboratories. Cherian said that this corridor will further strengthen the pioneering work done by Frontier Lifeline in developing tissue engineered products and stem cells and further move into the research and application of nano-technology and bio-informatics.

Exotic trees, a sandalwood forest and a herbarium

Cherian is a naturalist. He talks with passion on developing his dream project with a host of well-selected and well- nurtured greenery. Hundreds of sandalwood saplings and thousands of bamboo saplings have already been planted. The Arjuna Tree Forest will have 600 exotic varieties of trees. Cherian pointed to temples in the south having sthala vrikshas and plans to plant these. There are also special trees each for the 27 stars of the devout Indian faith. He goes systematically to access saplings of these species and plant them at Elavur.

What remained for centuries as barren land thus has the promise of getting transformed into a vast expanse of greenery. The Pulicat lake bordering the mediville will be supplemented by a huge artificial lake inside the village. A sprawling golf course and a vast herbarium will also form part of this holistic concept with vast potential for medical tourism.

The Frontier herbarium is again an innovative concept. Cherian has been stressing on the need to integrate the traditional Indian systems of medicine like ayurveda, siddha and unani in his dream project. Understandably he would like to pursue this passion. 50 acres of land have been earmarked for developing an exotic herbarium in technical collaboration with the Asia Pacific Bio-Resources Consortium, in which scientific companies from South Korea, Singapore, Japan and China are members.
The herbarium will house and develop genetically engineered plants and medicinal plants, from which molecules responsible for therapeutic treatment will be extracted, said Dr. K Sadasivan Pillai, a renowned scientist who has recently joined FM and is in charge of Frontier Tissueline( FT).

Focus on contract research

Frontier Tissueline is to be developed as a contract research organisation (CRO) at the mediville. FT plans to cater to the research and testing needs of pharma and traditional medicinal companies, medical devices, bio prosthetics and botanicals, bio technologicals, agro chemicals and industrial chemicals.

Pillai brings with him rich experience of working with the R&D division of Orchid Pharma. He is passionate about FT evolving as a one- stop-shop for contract research. FT will also provide testing services and quality assurance programmes. The laboratory will be designed to international standards conforming to WHO, USFDA, GCP and GLP standards, said Pillai.
The facilities of FT, set up over a 70,000 square feet area, will include a state of the art animal house, test rooms and laboratories for analytical and clinical chemistry, pathology, genotoxicology, ecotoxicology, entomology and invitro with support facilities. There will also be an agronomy division. FT will train villagers around in organic farming providing farmers with the needed materials.

Biological grafts for use in heart operations

Frontier Lifeline has done original work of outstanding value in the area of biological grafts(xenografts) as cardiovascular implants. Imagine FL implanting 429 bovine( from buffalos) pericardial patch as cardio vascular patch material, 69 bovine jugular veins and 88 porcine (from pigs) pulmonary artery conduits as cardio vascular conduits. Such work, developed from scratch through extensive research and development, has been unique in the entire Asia. The cost of these is just around a fifth of synthetic grafts imported from the US and European countries.

Dr. Soma Guhathakurta, Director - Research, has done phenomenal original work in this rarified research area. A cardiothoracic surgeon with credits for hundreds of heart surgeries, she is passionate about tissue engineering and strives to acquire in-depth knowledge on nano technology coating of tissues and other expertise in mechanical engineering . She registered for research with the mechanical engineering department of IIT - M and won her doctorate in just two years!

Importance of xenografts...

Guhathakurta explained: “cardio vascular implants play a major role in correctiong cardio vascular abnormalities.14 out of every 1000 new born children have irregular or missing pulmonary arteries. Corrections are made through cardio vascular implants and great advances have been made in these areas through organic and synthetic replacements. Homografts are done by harvesting and grafting such parts form the dead ( cadavers); these are not easy to obtain – the harvesting of such parts have to be done in good time after death; there is also the issue of getting the cadaver to match the age of the patient.

Synthetic grafts (heart valve prostheses or conduits), have limited use in infants and children as they do not have the potential for growth. Thus the focus is on tissue engineering to develop wall prosthesis and cardio vascular implants that combine durability with physiologic blood flow pattern.

“Limited durability, lack of growth and insufficient availability are major problems coming in the way of cadaver transplants. Synthetic implants are expensive; they have the disadvantages of difficult manoeuvrability and other side effects. Thus cardio vascular implants of biological tissue origin are the preferred conduits.”

Bovine and porcine grafts...

Guhathakurta has thus been experimenting on bovine and porcine tissue grafts. At the Ticel BT Park FL’s research team has been engaged in perfecting the preparation of such xenografts, processing these from bovine and porcine parts.
Guhathakuta explained that the harvesting of the materials are done from the animals slaughtered from the freshly inspected export oriented abattoirs. The required materials are collected in sterile condition and are processed further in the laboratory.

A measure of the care bestowed is evidenced by the absence of calcification, thrombogenicity or other complications in the human implants. Many small children and infants could be operated thanks to the smaller sizes of the conduits that matched the vessels’ sizes.

This is high quality research work of great relevance in terms of its indigenous content, easy access to copious sources of supply and modest cost. With this research expanded manifold at the Elavur facility, tissue engineering has great scope to take global stage just as the IT sector. Guhathakurta points to other promises of several more useful products like tissue engineered vascular grafts, amniotic membrane for burn dressing, etc and on expanding research on stem cells.

The promise of lower costs through Swadeshi solution...

With the proven success of the work done, there is need to bring together research scientists from much wider disciplines to achieve quicker and greater results: heart diseases take a heavy toll and the expernsive treatment can be afforded only by a few. The promise of bringing about quantum reduction in costs through xenografts needs to be exploited fully.

A great institution builder...
Cherian brings with him a great reputation for building institutions. He has worked with the government sector (the railway hospital, Perambur) and Vijaya Health Centre and the Madras Medical Mission. He brought new concepts in setting up thePondicherry Institute of Medical Sciences. He has built the Frontier Lifeline Hospital and the Cherian Heart Foundation from scratch. In close to four decades the creative genius of Cherian has helped explore new frontiers in medical research, education and treatment. FL has set up a M Tech course at the IIT-M and collaborates with the SASTRA University-Thanjavur, BITS - Pilani and the Meenakshi Medical College. He believes in combining education with training, presently not widely done.

The bio hospital will become the hub for SAARC and other Asian countries. The stress should be on offering quality education and medicare at prices that are affordable by large sections of society. This is possible only through unconventional thinking. Cherian believes that his medi village will precisely attempt this.

Elavur getting ready for big change...
The tiny little village of Elavur is already getting ready for this change. Girls in and around Elavur are already receiving training in medicare. Cherian pointed to trained Chinese girls brought over on temporary visas to suture imported valves from the US and Germany. There is vast scope for tapping the traditional, centuries’ old skills of Indians in crafts.

A measure of the connect of Cherian to grass roots should be evident from the medi village adapting the Elavur railway station. Cherian also talks of a helipad that would facilitate the quick transfer of foreign patients from the Chennai airport.
This famous surgeon is credited with performance of thousands of heart surgeries and is confident of his medi village rapidly becoming the hub of biomedicine in Asia.

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