A 11-year old recalls scenes from the medical camps his grandfather used to organise deep in the tribal areas of the country. He was too young to be of any help except at ferrying medicines from the stores to the various make-shift wards but what stuck with him was the sheer dedication to service.
His grandfather, still energetic at 77 years, already managed successful sugar mills but driven by an urge to give back to society, had started a considerable number of philanthropic pursuits in the educational space. The lack of care in the rural hinterland spurred him to add a hospital attached to a medical college as he felt that this would contribute to the cause of increasing access to healthcare facilities by educating more doctors and nurses.
More than three decades later, the grandson is laying the ground work to take this vision to the next level. As Chairman and MD of the $250 million Godavari Biorefineries, the present day avatar of the sugar mills his grandfather set up, Samir Somaiya is also the President of Somaiya Vidyavihar, the umbrella for a plethora of educational institutions across the country.
More importantly, he is Chairman of the Board of Trustees of Somaiya Trust which was formed in 1959, when his grandfather, who had only studied up to the sixth class, felt that ‘vidya dan’ (the gift of knowledge) was the best legacy he could leave and thus started an educational complex, Somaiya Vidyavihar. Today, the Vidyavihar Campus in the Central suburbs of Mumbai lends its name to the suburb and has come to define the area as a hub for learning and education across multiple streams.
Samir Somaiya recalls that his grandfather lived his life by a shlok which translates as: “Neither do I long for Kingdom, nor for heaven, nor do I desire to be free from rebirth, I only wish to remove the sufferings of all beings afflicted by pain.”
Laying the foundation
| Entrance to Somaiya Ayurvihar – Asian Insitute of Oncology and waiting area for patients and relatives |
So from 1975 to 1981, KJ Somaiya identified the most needy of India, and started with an eye camp, and then moved on to organise multi-speciality health check up camps. Amarkanthak in Madhya Pradesh, Bagidora in Rajasthan, Mesra in Jharkhand in ertswhile Bihar were some destinations where the family patriarch convinced the best doctors of Mumbai to visit and treat a steady stream of patients, sometimes a few thousand people per day, who would flock from the nearby villages to be treated. Samir Somaiya still has vivid memories of those medical camps: living in tents, seeing huge quantities of food being cooked and served to the patients and their attendants, under the supervision of his grandmother.
These experiences culminated in the setting up of the KJ Somaiya Medical Trust in 1991. The 22.5 acre Somaiya Ayurvihar Complex, once again in a central suburb (Sion) rather than in the more elite South Mumbai locale chosen by most philanthropic educationalists, was an extension of this same urge to serve, which has persevered down three generations of the Somaiya family. Samir Somaiya as the present day scion of the family and the Chairman of the Trust, says that the Trust aims to serve the people who are undeserved, who cannot afford to pay.
At the same time, the 500-bed teaching hospital on the same campus, the KJ Somaiya Hospital and Research Centre, imparts practical training to students and today 23 years later, has grown into a well acknowledged institute in its own right.
The old world charm of Somaiya Bhavan, the fulcrum of the family business in the heart of Mumbai’s Fort area seems like another world from the Ayurvihar Campus off the busy Eastern Express Highway but this is where plans are afoot to take the Founder’s dream to the next level.
| Karamshi J Somaiya serving food at the Surgana, Nasik Camp in Maharashtra (January 1975) | Sakarben K Somaiya serving food at the Kukma (Kutch) Camp in Gujarat (January 1981) |
But having the vision is one thing; actually investing in it takes commitment and planning. And going by the amounts invested steadily over the last decades, there is no doubting the dedication to the cause. Over the years, the investments have been primarily to build infrastructure and secondly, to fulfill the service mission.
Looking ahead, the investment will be to build on four fronts: social, healthcare, teaching and research. The Trust would welcome support from like minded organisations and individuals to support their efforts so that the impact can be multiplied many times over. The effort is to increase community participation so that the Trust’s initiatives can become more integrated with and responsive to society.
Fostering disruptive change
| Samir Somaiya, Chairman, Board of Trustees, Somaiya Trust |
Looking back over the past two decades, Samir Somaiya realised that the best teaching hospitals of the world, like the Memorial Sloan Kettering Cancer Center, New York or the Dana-Farber Cancer Institute in Boston, Massachusetts, are attached to the best centres for tertiary care. In India, this is sadly not so as patients who can pay prefer to avoid the public healthcare system.
Any attempt to change this mindset would be akin to turning the existing model on its head but the Somaiya Trust decided to test their hypothesis and fashion a centre which would provide a higher standard of care and service, for all sections of patients, and yet retain their service model and social obligation. A patient who could afford to pay, might get a better room but the standard of care would be the same, across all sections of patients. “We will not waver on the values,” emphasises Samir Somaiya.
And this was the idea behind the partnership with the Asian Institute of Oncology (AIO), in March this year. Working with a group of topnotch doctors, the Trust decided to create new centre of excellence for cancer care, research and education. Initially carved out from within the existing premises, AIO started operations with 80 in-patient beds but in the next three years, the Trust aims to build a separate complex within the same campus, with over 200 beds in all sub-specialities areas of oncology.
This kind of disruptive change takes place incrementally and takes time, especially if it has service as its mission. Samir Somaiya believes institution building takes time but is determined that it can be done.
Building on complementary strengths
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Speaking about the partnership, Dr Ramakant Deshpande, Executive Vice Chairman, AIO, explains how the two entities complement each other. The Trust, which as a philanthropic body runs almost 34 institutes across the country has an educational spirit whereas the AIO is a professional group of doctors, formed in 2002, comprising more than 40 fully trained cancer specialists, in various speciality areas like paediatric, thoracic, lung, neck, abdominal cancer, urology etc.
Most of the members of this group have earned their spurs over the past two-three decades at Tata Memorial Hospital (TMH), which is the country’s apex cancer institute. This experience of serving in a public hospital setting, striving to achieve the best results in a resource scarce situation, coping with the sheer volume of patients at hospitals like TMH has honed their skills to an uncommon degree.
After having completed 20-25 years of service, when the group left TMH, they formed AIO and started working as a group. Cancer treatment requires comprehensive care across multiple systems as the disease progresses. Thus AIO aimed to provide seamless care to patients.
AIO initially was based at the Wellspring Clinic of Piramal Healthcare. Relating the journey, Dr Deshpande says, “We then realised we need a lot more in terms of resources, post operative treatment etc than what was available so we entered into an agreement with Raheja Hospital in 2002. We worked there for a decade but since the ideology of Raheja Hospital was to create a general rather than a specialised hospital, we had to move on. We then entered into an MoU with the Somaiya Group, started working on this project in 2012 and in August 2013, we commenced operations out of Somaiya Ayurvihar.”
This is the first phase of a 250-bedded standalone comprehensive cancer care hospital, with around 80 beds across all categories, including general wards (called comfort wards), triple, double- and single rooms as well as two suites. The Institute offers all specialities like chemotherapy, plastic surgery and reconstruction, etc except radiation therapy. The latter too will be on offer once the second phase takes shape as a standalone complex which will come up on the adjacent one acre plot. The complex will have around 150,000 sq feet, with around 250 beds and is scheduled to take shape in the next 36 months.
Raison d’etre
But why did AIO decide to set up another institute for cancer care? Could they have not continued to function out of existing hospitals and lend their expertise to make these even better?
As Dr Deshpande reasons, “The increasing incidence of cancer is leading to an increasing number of patients, many of whom cannot afford care. There are not too many institutes across the country that can offer world class care. We would like to take it to the next level. And Somaiya Ayurvihar offers us the framework of a successful institute to set it up so we thought it was a good idea to do good here. Secondly, each of us as individuals, have our own practice and patients, with the revenue flow, reputation, etc but as an institution you can do a few more things than as an individual. For example, clinical research, clinical teaching cannot be really done in the case of an individual practice.”
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Main lobby of Somaiya Ayurvihar Hospital
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Dr Deshpande lists another reason for their choice. If they had continued to work individually, “there would no continuity of experience. For example, a person develops expertise over 20-30 years which does not automatically get transferred to the next generation. But within an institution, an entire generation of individuals can transfer that knowledge to the next generation, and disseminate it across the country further. So we realised that if we want to do that, we need an institution. This is not a nursing home or a private hospital. It is an institution that will focus on research, education and clinical service. All three are equally important. That is the ethos of this institution.”
Not yet a year old and the Institute is already getting requests to train hospital staff from other states like Madhya Pradesh as well as neighbouring countries like Nepal. As Dr Deshpande says, this adds to the stature of not just the Institute but also the country because you expose them to an experience which is at par with the best in the world. Almost echoing the philosophy of K J Somaiya, Dr Deshpande says, “We teach more people, we end up in a better world so it’s better for everybody.”
| Waiting area and corridor at Somaiya Ayurvihar-AIO |
Today as treatment evolves to the next level, the team would like to contribute to spreading awareness about myths associated with cancer. For instance, Dr Deshpande points out that a few decades back, recovery from TB was almost unheard off but today it is a fact. Similarly, hypertension cannot be cured but today there are medicines which help you live with the disease and keep it under control. So the hope is that with cancer too we can hope for the same evolution of treatment. Treatments like aggressive chemotherapy, targeted therapy etc do exist which may not cure but can certainly change cancer into a chronic condition.
For the rural population, which makes up 80 per cent of the country, the Institute has educational programmes through various media to educate about cancer, self check ups, etc and cancer detection camps in both rural and urban centres, so that if the detection is early, the prognosis is better. We would like to touch the minds of as many people as possible. The ability to pay is between the patient and the insurer but once we accept the patient, the clinical care is the same, emphasises Dr Deshpande.
Philosophy of AIO
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Echoing Dr Deshpande’s view, his peer Dr Deepak Parikh, Prof and Chief, Department of Head and Neck Surgery, and Director, Dept of Laser Surgery, says, “Treatment is dependent on the stage of the cancer, not on the patient’s paying capacity. Almost 43 per cent of the beds are at a concessional rate.”
Dr Deshpande says, “Apart from this we also have a Foundation called Asian Cancer Foundation which actually helps people who cannot afford to pay anything at all. We do a due diligence and decide on which cases deserve help. Besides this, non-monetary activities are also conducted like rehabilitation of children who have suffered from cancer, awareness camps, as also arranging entertainment for such children, etc.”
Following the ethos of spreading knowledge and care, common to both the Somaiya Trust as well as AIO, Dr Parikh indicates the way forward when he says, “We are already looking at tying up with other hospitals. We have colleagues working in various part of the country working in similar set ups so we are trying to coordinate with them in terms of having integrated treatment protocols, etc. We are in talks for tie up with institutes in Patna, Kolkata, Ahmedabad and Bangalore.”
Designed by oncologists
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Nursing station
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The sheer volume of patients has often discouraged doctors from keeping records but Dr Parikh reveals that AIO has developed a complete electronic medical records (EMR) system entirely designed and developed by them. This this where the doctors’ decades of experience kicks in because they realised that with oncology, the successful treatment of one episode does not necessarily mean that the chapter is closed. Unfortunately, the same patient will most likely come back with a recurrence. This is where having EMRs will help doctors access past records and shape treatment accordingly.
In fact, at AIO, the EMR system is designed to also incorporate the medical history of the family members with the ultimate aim of trying to develop a genetic profiling unique to the Indian sub-continent. This is more true of cancer than other disease conditions as most cancers are known to recur in generations of the same family. Dr Parikh says that they also have a genetic counselling centre for such cases and the ultimate aim is that once such procedures are standardised, they can percolate the system down to tier II and III cities as well.
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The other advantage of EMRs is that patients get a password to their files so that they can access them and continue the treatment in their home town, with the treating doctor recording his treatment notes as well. As of today, more than 60 per cent of patients are from out of Mumbai, some from overseas locations like the Middle East, Africa, Bangladesh, etc as well as spanning the length and breadth of the country, this would be a major benefit to patients.
There are other in-built add on features as well: alerts on drug-drug interactions, patient sensitivity to certain drugs, as well as smoother and faster check out procedures, thanks to a seamless integration of all billing activities across departments. An additional benefit is that all surgeries are being recorded and archived in a library, ready for use at the teaching campus, Thus students too can benefit from seeing the skills of the surgeons in action. The main building too will have around 20000 sq ft allocated for teaching and academics. The plan is to have hands-on training workshops, simulations labs etc for the resident doctors, says Dr Parikh. On the research side, once the main building is operational, there are plans for a genetic lab, tissue culture, etc and for this AIO is coordinating with the relevant societies.
A spring board to the future
| Care with comfort at Somaiya Ayurvihar-AIO |
Speaking about the support given by the Somaiya Trust, Dr Parikh mentions how the prohibitive cost of land in Mumbai, makes most such projects unviable because 60 per cent of the project cost would have to be a ‘dead investment’ , i.e. locked up in the cost of the land itself. But in the case of the Somaiya Ayurvihar-AIO project, thanks to the support of the Trust, the oncologists did not have to spend on the land they could use the funds to put in place the latest equipment, etc. This has been a big boon and the reason why the project could be started is such a relatively short period of time.
After literally hitting the road running, the AIO remains true to its philosophy of giving state-of-the art oncology care at an affordable cost to the needy, as Dr Jagdeesh Kulkarni, Prof of Urology (Oncology) and Robotic Surgery, Dept of Urology, Somaiya Ayurvihar – AIO sums up. The Somaiya Ayurvihar campus offers a medical college so that the treatment is complemented by education and both clinical as well as translational research. The first aspect may be easy to do but for the latter two, it requires a medical college and that is why AIO chose to set up here.
As far as treatment model goes, Dr Kulkarni believes that India needs a blend of the aggressive path that is favoured by US-based oncology centres as well as the more balanced view tended to be taken by the UK and Europe based centres. In the course of their long careers, AIO’s oncologists have trained on both sides of the Atlantic and seem therefore well placed to adopt the best practices of both philosophies. Of course, taking care of the cost factor will be the most important aspect of this hybrid model.
Choosing to add capacity phase-wise has proved to be the sustainable way forward, so that recurring costs are met by the current patient loads. As the project successfully scaled up from the initial 40 beds to 80 and now gears up to go to 250 beds in a couple of years, Dr Kulkarni is very satisfied with the response so far and feels that they have already made a mark. KJ Somaiya would no doubt agree and be more than satisfied that his legacy is in safe hands.