“With the large population experiencing increasing life span, chronic disease burden is increasing at a rapid pace. Diabetes, heart ailments, cancer and kidney related ailments are rampant. One out of every four Indians suffers from one of these,” said Dr Rajan Ravichandran, founder - trustee of Balaji Medical and Educational Trust.

This noted nephrologist, who works as director, Miot Institute of Nephrology, MIOT and founder of the trust in 1997 along with Dr P B Sivaraman, pointed to the average age of an inpatient in an ICU as more than 60 and to the increasing cost of healthcare: “a lot of resources are needed to treat the elderly and most people cannot afford this. The plight of the poorer sections can be imagined. The costs of investigation and treatment are increasing. Often there is excessive investigation leading to excessive treatment,” said Dr Ravichandran.

The problem is assuming serious proportions.There are an estimated 30 million kidney patients. A WHO report estimates this to increase to over 80 million in the next 20 years when India will account for the highest number of such patients. The treatment involving painful surgery, regular dialysis, transplant and life long medication and treatment involves an expenditure of over Rs.20 lakh spread over 10 - 15 years and it is an endless torture. Obviously, such high costs can be afforded only by a few.

Awareness, the key

On 15 March, the Balaji Medical and Educational Trust launched the Early Disease Program (EDP) to spread awareness about chronic kidney disease (CKD). Dr. Ravichandran said that by a simple test, kidney dysfunction can be detected and appropriate intervention and monitoring can be done at modest cost.

This noted nephrologist explained: “CKD is non symptomatic. Once it becomes chronic it is irreversible. The kidney has millions of nephrons. If these get damaged, proteins escape through urine. It is possible to detect it early with a simple urine test and look for proteins and albumin.

“Such detection is simple and can be done even in small villages at a modest cost.“At this stage it is easy to treat the patient and help him avoid the disease developing into a chronic one demanding expensive, prolonged treatment and life style modifications.”

Dr Ravichandran pointed to diabetes and hyper tension as the major ailments that lead to CKD. And the prevalence of these two diseases in India is widespread and expanding. There is thus the imperative to expand awareness for regular medical check up that would help in early diagnosis and correction. The specialist pointed to WHO recommendation to focus on prevention rather than on treatment in the public healthcare system: “preventive medicine is an age old concept. Medical practitioners should be provided basic training to listen to patients before deciding on treatment. Detailed counselling on diet and life style are also important,” he said.

Dr Ravichandran pointed to the several man-made diseases that can proliferate post-surgery: “a heart operation, for instance, necessitates special tubes to feed the patient, to make him breathe. Catheters are inserted. Often the patient runs the risk of infections leading to other diseases like pneumonia.

“Treatment today is becoming increasingly technology and protocol driven. One witnesses average uniform treatment and not excellent treatment.

“With the proliferation of nursing homes and 24 x 7 polyclinics, it has become difficult to introduce standardisation and quality control. There is need for stricter enforcement of standards and a higher degree of regulation. I look forward to Chennai having a few hundred hospitals adhering to strict quality standards,” he said.

Prevention : the mantra

Dr Ravichandran stressed again on prevention: “USA is getting back to focus on prevention. We should start on this early. With intense education we make the citizens responsible for their health. They should be taught basic health issues.”
Launching the EDP, US consul general Andrew T Simkin referred to the need to bring together policymakers, univer-sities, research institutions, medical professionals and philanthropists to address basic healthcare issues. N Ram, editor-in-chief, The Hindu released a booklet on kidney care. He cited the National Family Health Survey to point to the far from satisfactory level of public health even in the better performing states that report slippages in providing basic health services.

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