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Both NH and RTI also organized outreach camps for cardiac diagnosis and care. Each weekend, two buses were sent out to rural areas, up to 800 kilometers away from the hospitals in Bangalore and Calcutta (see Exhibit 14 ). Each bus was staffed with at least three doctors, including an experienced cardiologist and two technicians trained to perform echocardiograms. In order to ensure that the best possible diagnosis could be made on-site, the buses were outfitted with echocardiography equipment, a treadmill, a defibrillator, ECG machines, equipment needed for resuscitation in emergencies, and a generator to ensure the machines could be used in rural areas with irregular power supply. The first two mobile diagnostic labs were donated by the family of Mr. K. Dinesh, one of the founders of Infosys Ltd.
The outreach camps were organized by local associations (e.g., the Lions Club or Rotary Club) that advertised the daylong event in advance and arranged for patients to attend. On average, each camp screened 400 people a day, none of whom was required to pay either the hospital or the organizers. When a diagnosis indicated that the patient required medical intervention, he was advised to visit NH or RTI, where the procedure was performed at or below cost with help from the NH charitable trust.
In addition to their clinical work, the doctors at NH were actively involved in training the next generation of specialists. NH ran 19 postgraduate programs for doctors and other medical staff, including diplomas in cardiac thoracic surgery, cardiology, and medical laboratory technology. The hospital also offered the country’s only formal training program for pediatric cardiac surgery, reflecting the rich expertise of NH’s doctors in pediatric care.
In 2005, NH was scheduled to offer India’s first diploma in cardiology, in collaboration with the Indira Gandhi National Open University (IGNOU). This program was Dr. Shetty’s solution to bridging the gap between the 18,000 doctors graduating from India’s medical schools each year and the 180 newly trained cardiologists and cardiac surgeons each year. Aimed at producing intermediate-level specialists, the program would require MBBS-qualified doctors (the Indian equivalent to an M.D.) to spend two years training at NH or at 50 other recognized heart hospitals in India.
“India’s current situation for training in cardiac care is equivalent to saying you need a degree in automotive engineering to repair cars,” said Dr. Shetty. “Obviously if that were the case, we would not have any moving vehicles since we don’t have that many engineers!” By equipping GPs with skills to handle emergency and nonintervention cardiology, the program would enable a higher proportion of the population to have access to cardiac care.
A higher supply of cardiologists was expected to drive the costs of care lower, a concept Dr. Shetty believed was extendable to other areas of health care. In nephrology, for instance, the requirement for trained nephrologists to operate dialysis machines was part of the reason that treatment was expensive. If India were to allow trained technicians to operate the machines (as was the case in the U.S.) or (as Dr. Shetty envisioned) offer a diploma in nephrology that would provide intermediate training, more doctors would be able to offer treatment to patients, thus lowering the cost of access to treatment.
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