Bhubaneswar: Boomtown for Healthcare

Industrial and infrastructural development has boosted the healthcare market in Bhubaneswar, attracting corporates to set up base in the temple city. Rita Dutta checks out the exciting developments Dotted with 600 temples and replete with history, Bhubaneswar has been a favourite tourist destination for ages. However, despite being the capital of Orissa, healthcare in the temple city was quite dismal, until recently. The Dark Age The healthcare facilities of Bhubaneswar were confined to doctorowned nursing homes and Government hospitals that provided at best only secondary care. Even the medical college hospitals were located outside the capital; SCB is in Cuttack, VSS in Sambalpur and MKCG is in Behrampur. The city and the state lacked super speciality treatment even in early 2000, except for Kalinga Hospital, Bhubaneswar. Despite contributing 3-4 per cent of the current 25 lakh cancer patients of the country, the state did not have a comprehensive oncology care facility, even five years back. The state, where poverty and malnutrition are overwhelming hurdles, has also been grappling with increased incidence of TB, malaria, and high infant and maternal mortality rates. People from this state travelled all the way to Delhi, Chennai, Hyderabad or Visakhapatnam seeking super speciality care. Says Dr PK Mishra, Medical Superintendent, Aditya Care Hospital, Bhubaneswar, "The only option for treatment for patients requiring renal transplants, which is acute in this coastal belt, was outside the state. While those unable to afford cardiac treatment went to AIIMS, those who could afford it went mainly to Apollo, Chennai. For ophthalmology, patients mainly preferred to go to Chennai's Sankara Nethralaya or Hyderabad's LV Prasad Eye Institute. And for oncology, people mostly chose Tata Medical Hospital, Mumbai." The state did not have cutting edge technology for diagnostic purpose. "One exception was that SB Medical College Hospital was the first hospital in Eastern India to install a CT Scan even in 1960s, but that was being used for the department of neurology," says Dr Mishra. Now, why did a state with a 40 million population not develop its healthcare facilities, even in its capital? Lack of good infrastructure and slow industrial growth acted as an impediment for investment in healthcare. Abundant natural resources like iron ore and coal in the state also made healthcare investment look less lucrative. As Dr MP Tripathy, Medical Director, Aditya Care Hospital, puts it, "Healthcare is not seen as a very profitable venture in comparison with other industries. What makes it worse is the long gestation period of five to seven years. Thus, local industrialists are always more interested in tapping the state's natural resources and earning a fast buck than investing in healthcare." Lack of professional managers and good clinical acumen (as most Oriya doctors preferred to work outside the state) also thwarted any good intention of starting a multi super speciality hospital in Bhubaneswar. Opines Dr Saheb Sahu, MD, Kalinga Hospital, Bhubaneswar, "Other deterrents are reluctance of doctors/professional managers to shift base from other parts of the country to a tier II city like Bhubaneswar and banks not

being forthcoming in giving funding to hospitals." Shifting Horizons

"This change has been powered by investment flow, rising employment opportunities, and other factors"

- Bipul K Jha Industry Analyst Healthcare Practice, South Asia & Middle East Frost and Sullivan "Government initiatives have paved the way for corporate healthcare groups to venture into Bhubaneswar"

However, recent industrial, infrastructural and educational development in Bhubaneswar, has made the city, considered to be one of the cleanest and planned cities of modern India and one of the fastest developing cities of India, the epicentre of healthcare revolution in Orissa. Says Bipul K Jha, Industry Analyst, Healthcare Practice, South Asia & Middle East, Frost and Sullivan, "This change has been powered by the huge investment flow, rising employment opportunities, and increasing foothold of service-based sectors, which has in turn led to rise in purchasing power and increased standards of living."

Bhubaneswar, now being dubbed 'the rising star of the East', has attracted a whopping Rs 6,00,000 crore investment from across all industries like IT, technology, steel, aluminium, tourism, health and education sectors. Huge capex by the large industrial houses in the core infrastructure sector has witnessed a rise of 11.5 per cent in - Dr Bidhan Das Managing Director the last two years. The per capita income of the state has Octavo Solutions shot up from Rs 10,567 in 1999-2000 to Rs 16,149 in 2007Delhi 08. The population has grown by nearly 8 per cent in the last decade; the metro area of Bhubaneswar has mixed culture population base of 19 lakh, housing almost 11 percent of the urban population of the state. "Moreover, one corporate hospital (Kalinga Hospital) has set an example for other players by being an early market entrant and doing good business," says Jha. It is a highly under-served market with its ratio of beds per 1,000 population being twothirds of the national average of 0.86. What is attracting corporates like Apollo, AMRI, Narayana Hrudayalaya, Vedanta Aluminium, Asian Heart and Global to set up base here is the untapped potential. Says Dr K Ravindranath, Chairman, Global Hospital, who is setting up a 200-bed hospital in Bhubaneswar, "Our hospitals in Chennai and Hyderabad have always been getting a steady stream of patients from Eastern India, which constitutes one third of India's population. Eastern India is also frequented by patients from Nepal and Bangladesh. So it makes complete business sense to foray into Bhubaneswar, before anyone else does." Explains Dr Ramakant Panda, Vice Chairman, Asian Heart Institute, Mumbai as why he has planned a hospital in Bhubaneswar. "There is a dire need for hospitals with good infrastructure in Bhubaneswar. Moreover, being from Orissa, I want to do my bit for the State." Adds Harihar Rath, Deputy General Manager, Marketing, Apollo Hospital, Bhubaneswar, "Lacunae of healthcare services and the rising disposable income of people of the regions are the main reasons for healthcare investment in the area. With more IT and BPO firms setting up offices in Bhubaneswar, the paying populace has also increased."

Kalinga Hospital is the first corporate hospital of Orissa

LV Prasad Eye Institute has a comprehensive eye cancer programme for children

Apollo Hospital has installed Orissas first 64 slice CT scan

Aditya Care has pioneered Orissa's first EP study and RFA

Hemalata Hospitals is the only centre in Orissa to have a linear accelerator

AMRI is coming with a 300-bed hospital in the temple city

Desun is coming with a tertiary care hospital in Bhubaneswar

Naryana Hrudayalaya has also planned a tertiary care hospital

Government Impetus

The present Chief Minister, Naveen Patnaik, has played a crucial role in giving the much-required thrust, according to Dr Bidhan Das, Managing Director, Octavo Solutions, a consultancy firm that has done some projects in Orissa. "The Government's efforts to improve infrastructure in the city have induced private realtors like DLF to invest. The entry of retail chains like Reliance, Big Bazaar, and Pantaloons has helped the Government to support the economy of Bhubaneswar. The uplift of the economy has attracted corporates to invest in healthcare," says he.

"Bhubaneswar is in dire need for hospitals with good infrastructure"

- Dr Ramakant Panda Vice Chairman Asian Heart Institute Mumbai "Electro physiology

An important step to extricate the state from the healthcare study and primary CABG are still not morass was taken by the State Assembly in December that widely available 2008, when it decided to spend nearly 49 per cent of in Orissa" Government funds on development of healthcare infrastructure. "The Government has also extended support to medical institutes encouraging research activities, - Dr PK Mishra undertaking different Public-Private-Partnership projects to Medical Superintendent Aditya Care Hospital meet the growing needs of health services which include reBhubaneswar enforcement of National Health Programme for eradication of malaria and TB, accreditation of private NGOs for institutional delivery of health services and introduction of Janani Express providing free transport to pregnant mothers to city hospitals for quality care. Various initiatives of the Government paved the way for corporate healthcare groups to venture into Bhubaneswar due to its location, planned civic infrastructure, rapid industrialisation and urbanisation," adds Dr Das. The Impact From a city that lagged behind in diagnostic procedures, today hospitals in the city have radiology procedures like 64 slice CT, 1.5 Tesla MRI, 3-D ultrasound and digital mammogram. The cath labs are flat panel, while OTs have laminar air flow and HEPA filters. All 50 speciality and super speciality treatments are available now in the leading hospitals. The city's first corporate hospital, Kalinga Hospital, now offers kidney transplantation, LV Prasad Eye Institute has taken the lead in dealing with complicated ophthalmic cases, while high risk cardiac cases are dealt with by Kalinga Hospital, Aditya Care and Apollo Hospital. With Hemalata Cancer Hospital now providing all three branches of oncology treatment, especially linear accelerator with IMRT and CT stimulation, the high cancer burden of the state has been taken care of. In the current scenario, while existing hospitals are introducing cutting edge technology, scaling up and even planning larger hospitals, corporates are rushing in to grab a pie of the market. Diagnostic giants like Dr Lalpathlabs, Ranbaxy and Piramal Diagnostics have set-ups there. Even stem cell banking, a relatively new concept, is picking up here. Cryobanks International India, which deals in umbilical cord blood stem cell banking, has opened a collection centre in Bhubaneswar. As many as three private medical colleges (HiTech Medical College, Sum Medical College and Kalinga Institute of Medical Sciences) have come up in Bhubaneswar in the last few years. Even a slew of nursing colleges have also been set up to fulfil the skyrocketing demand. The healthcare boom has paved the path for many NRI doctors (both Oriya and non Oriya) to show willingness to work in Bhubaneswar, a trend that is a recent phenomenon.

Early Movers
"We are setting up a multi super speciality hospital at an estimated cost of Rs 80 crore"

Here's a look at the players who powered the change. Kalinga Hospital: It would be no exaggeration to say that it was Kalinga Hospital that took the first initiative to change the healthcare firmament of the state. The hospital was conceived and promoted by 62 non resident Oriyas, who are mostly doctors by profession, based in the US and the UK. With an aim to provide the latest medical technology to the people of the state and to stop them from going outside the state seeking treatment, the doctors pumped in Rs 30 crore to start Kalinga Hospital located at Chandrasekharpur area of Bhubaneswar, with 160 beds in 1998.

- Sajal Dutta

CMD Desan Hospital

"Our hospitals in South have been getting patients from Eastern India. So, it makes business sense to foray into Bhubaneswar" - Dr K

Today, the 250-bed Kalinga Hospital spread over 10 acres is the first hospital in Orissa to do regular cardiac cath, open Ravindranath heart surgery, dialysis and kidney transplant, advanced Chairman Global Hospital neuro surgery, gastro-intestinal surgery and cosmetic surgery. It is the only recognised centre in the State for kidney transplantation. Says Dr Saheb Sahu, MD, Kalinga Hospital, "We have the distinction of having the first advanced operating microscope for neurosurgical operations in Orissa. Additionally, we have conducted the state's first open heart surgery, started first cardiac cath lab, first neuro surgery, first renal transplant, first medical ICU and introduced first 1.5 Tesla MRI. "Special neurosurgical investigations include neuropathology, electroencephalography, 4 vessel digital subtraction angiography's carotid doppler. Under the Smile Train project, the hospital has completed over 3,000 free cleft lip surgeries. The hospital is keen on getting into phase III trials in clinical research. "Considering this hospital as a hub, we want to build a slew of 100-bed hospitals in Northern Orissa," adds Dr Sahu. LV Prasad Eye Institute: This hospital, set up in July 2006, has taken the city's ophthalmology care several notches higher. This not-for-profit institute, that conducts 35 per cent of all care at no cost to the patients, has a unique ocular prosthesis laboratory that offers cosmetic eyes tailored to the patients' needs. The institute started the state's first community eye bank for corneal retrieval and transplantation. Named 'Drusti Daan', the eye bank is housed on campus, but serves all of Orissa. Several surgeries that it has pioneered in Orissa are Infiniti cataract surgical system, constellation vitrectomy system and radio frequency devices offering bloodless eye plastic and orbit surgery. Dr Taraprasad Das, Director, LV Prasad Eye Institute, reveals, "High-end diagnostic equipment at the institute, not previously available in Orissa, includes electrophysiology for detection of retinal and visual pathway disorders, Orbscan for evaluation of corneal contour, Retcam for retinal evaluation of neonates and small children, IOL Master for precise estimation of intraocular lens power, and specular microscope for accurate counting of corneal endothelial cells." The institute has a comprehensive eye cancer programme for children and an integrated low vision and visual rehabilitation service that offers final help to less sighted individuals with tailored visual aids and teaches lifestyle management to incurably blind people. The institute is engaged in both clinical and basic research. It was the first to report

Microsporidia epidemic keratoconjunctivitis in the world from patients in this part of the country. It has completed clinical trials on new drugs in uveitis, diabetes, age-related macular degeneration and corneal infection. "Currently, we are engaged in one clinical trial, in retinal vascular disease. We have received one Department of Science and Technology (DST) grant for basic investigations on Staphyllococcus infection of the eye," adds Dr Das. Aditya Care Hospital: Hyderabad's Care Hospital started this 100-bed cardiology hospital on a leased property near Municipal Kalyan Mandap at Chandrasekharpur in September 2007. The list of procedures that the hospital has pioneered in Orissa include EP study and RFA, Paediatric Cardiology Intervention and CRT. Besides, the hospital has taken a lead in doing PTCA with stenting and ICD in cardiology, CABG multiple grafts and paediatric cardiac surgery like VSD closure, ASD closure and PDA in cardiac surgery, haemodialysis, laparoscopic surgery and joint replacement surgery. "The hospital will be scaled up to 300 beds, for which 3.92 acres of land has been obtained from the Government of Orissa," adds Dr Mishra. Hemalata Hospitals and Research Centre: This super speciality hospital focusing on oncology is the state's only comprehensive cancer hospital in the private sector that offers medical oncology, radiation therapy and cancer surgery under one roof. This 100- bed unit, with a built up area of 80,000 square metres, was set up in 2005. The project was conceived by Dr Arabinda Rath and funded by TDB. This is the only hospital in Orissa with a linear accelerator. Says Dr Arabinda Rath, Chairman and MD, Hemalata Hospitals and Research Centre, "The digital linear accelerator installed in this centre was the first one with IMRT and CT simulation facility in Eastern India. The RT department here is very important as the regional cancer centre in Cuttack does not have a linear accelerator and one needs RT at some point of cancer treatment."
"Currently, we are engaged in one clinical trial, in retinal vascular disease"

- Dr Taraprasad

Das Director LV Prasad Eye Institute, Bhubaneswar

"Reluctance of doctors and professional managers to shift base to a tier II city like Bhubaneswar pose as a challenge - Dr Saheb Sahu Managing Director Kalinga Hospital, Bhubaneswar

Simultaneously, the hospital has installed the first integrated CT simulator in the country which is a highly sophisticated and state-of-the-art unit that creates a 3-D model of the cancer patient and pinpoints the tumour or the target volume that has to receive the radiation and simultaneously ensures that the critical structures and normal or healthy tissue are spared. "Through a powerful computer system called 3D treatment planning system, it then creates a treatment plan using the 'Inverse Planning Algorithm' that maximises the dose to the tumour and spares or minimises the dose to the normal and critical structures," Dr Rath adds.

Hemalata Hospitals and Research Centre was the first in the state to start the super speciality OT with HEPA filtration and laminar flow for prolonged and infection free surgeries. "The fully air-conditioned hospital was the first to have day care chemotherapy, critical care and pain clinics, and high end diagnostics for cancer in the city," he adds.

In the pipeline is one more linear accelerator and addition of the department of neurooncology with a neuro OT. "We also want to start paediatric oncology, transfusion and transplants," says Dr Rath. In the long run, he plans to consolidate current regional dominance as well as enter the national arena by starting green or grey field projects in oncology in other parts of India. Apollo Hospital: In March this year, Apollo Hospital inaugurated the city's largest tertiary care hospital in Bhubaneswar with 150 beds, expandable to 350 beds. This Rs-150-crore project is spread over two lakh square feet in a sprawling campus of 7.5 acres, providing over 50 specialities. The hospital has installed the State's first 64 slice CT and paediatric cardiology unit. It also has a telemedicine facility. For a state with an alarming Infant Mortality Rate (IMR) of 69, one of the highest in the country, it is good news that this hospital is focusing on neo-natal retrieval system, whereby newborns within 50 kilometre radius would be retrieved and revived by the hospital. The hospital's paediatric interventional cardiology department would fill a longstanding demand of the region, as other hospitals in the State are lagging behind in this facility. In the Pipeline There are many more hospitals in the pipeline. AMRI Hospitals: A joint venture between Emami and Shrachi Group of Industries, Kolkata-based AMRI Hospitals is coming out with a multi-speciality hospital at Khandagiri Square, a prime location in Bhubaneswar. This is AMRI's first project outside Kolkata. Says DN Agarwal, Executive Director, AMRI Hospitals, "This Rs-120-crore project with 300 beds spread over five acres would have an FSI of 3,50,000 square feet. This is likely to be commissioned by August 2010." Sparsh Hospital: Sparsh Hospital, which runs an 80-bed hospital and claims to have pioneered procedures like Chemoport insertion and Hicman's catheterisation in Bhubaneswar, has planned a 250-bed set up in the Chandrasekharpur area of the city. The new project, built at a cost of Rs 40 crore, would house all super speciality facilities under one roof. Says Dr Ghanashyam Biswas, Director, Sparsh Hospital, "The construction for the new project will start by 2011 and will be completed by 2013." Care Hospital: After achieving success with the JV project Aditya Care, the Care group has planned a multi super speciality hospital of 200 beds in Chandrasekharpur. The 4.5 acres were acquired around 18 months back, but due to trespassing, construction has not begun yet. Ayush Hospital: This group, which runs a 120-bed hospital at Acharya Vihar Square in Bhubaneswar, has drawn up a plan for its second multi-speciality hospital in the city at an investment of about Rs 200 crore. The proposed hospital would be equipped with over 500 beds and it is expected to be operational by 2012. Says Dr Ashok Acharya, MD, Ayush Hospital, "The land is being identified for the project and construction work for this hospital is expected to start from next year." Global Hospital: Hyderabad-based Global Hospital is building a 200-bed hospital. This

project, built at an estimated cost of Rs 100 crore on a leased building, would be focusing on tertiary and quaternary care (specially renal transplants). Says Dr K Ravindranath, Chairman, Global Hospital, "This is a JV project with a local group, whose founders are my patients. This is their first venture in healthcare. The hospital would be known as Global Hospital." He added that the cost of equipping the hospital would be borne by Global Hospital. Construction is expected to start by November this year and commissioning is likely by the end of next year. Narayana Hrudayalaya: Bengaluru-based Narayana Hrudayalaya is coming up with a 750-bed health city at Dum Duma at Khandagiri Square. The hospital, spread over seven acres, would provide multi super speciality treatment. Says Dr Ashutosh Raghuvanshi, Vice Chairman, Narayana Hrudayalaya, "The first phase of the hospital with 250 beds is being built at a cost of Rs 80 crore. We would start construction of the hospital after the monsoons, this year. We would commission the first phase by 2012." Desun Hospital: Kolkata-based Desun Hospital and Heart Institutive has planned a hospital on Bhubaneswar Cuttack Road. The 250-bed green field project is slated to be commissioned by 2013. Says Sajal Dutta, CMD, Desan Hospital, "This multi super speciality hospital is being set up at an estimated cost of Rs 80 crore." Vedanta Aluminium: Fulfilling the need for a full-fledged trauma centre, Vedanta Aluminium is setting up a 100-bed state-of-the-art trauma care centre near Gangapada on National Highway 5. This Rs-75-crore project is coming up on 10 acres of land. Asian Heart Institute: Mumbai's Asian Heart Institute (AHI), established by Dr Ramakant Panda and a few other cardiologists, has also announced plans of opening a state-of-the-art multi speciality hospital in Chandrasekharpur. Spread over 1,50,000 square feet, the 400-bed hospital is expected to come up with an investment of Rs 150 crore. Says Dr Ramakant Panda, Vice Chairman, AHI, "We have a start-up plan for 200 beds at an estimated cost of Rs 70 crore. We would eventually expand it to 400 beds, spending Rs 150 crore." About the significance of the project, he says, "AHI has set a benchmark in providing quality care in the country. Our project in Orissa would be built on the same principles as AHI, Mumbai and would offer the patients the same treatment and care at world class standards." It will have 12 ultra modern operation theatres, 100 intensive care units, fully equipped modernised pathology services, radiology, imaging services, blood bank, 24-hour pharmacy services and cardiac ambulance services with mobile cathlab. Though the foundation stone of the hospital has been laid, progress was stalled by some dispute regarding the land. "As the land being sought for the project is a Government land, hence acquiring it is a little issue," says Dr Panda. UIMS: A group of non-resident Oriyas have joined hands to set up Orissa's first nuclear medicine centre- Utkal Institute of Medical Sciences (UIMS). AIIMS: The upcoming All India Institute of Medical Sciences (AIIMS) at Bhubaneswar will have a 978-bed hospital. Besides, 15 super speciality and 18 speciality wards have also been proposed. The State Government is supposed to provide 100 acres of land free at Sijua on the outskirts for the prestigious institute. According to a review meeting, while 93 acres have already been transferred for construction, the rest will soon be handed over. The State Government had already provided road connectivity. The much-hyped project is

scheduled for completion by 2012. To be Overcome Lack of professional managers, paramedics and nurses has always been a sore point for development of healthcare in Bhubaneswar. Several specialities like critical care, accident & trauma, burns care, stem cell and organ transplant, IVF and cosmetology are still trailing. In oncology, there is still no PET and PET/CT scanner for molecular imaging available in Orissa. Some procedures are still not widely available. "Cardiac transplantation is still not available, while electro physiology study, primary CABG and primary PTCA are not that widely available," informs Dr Mishra of Aditya Care. Experts point out factors like endemic corruption among doctors, mainly 'cut' practice for referrals, and problems in land transgression, that pose hurdles. However, a key drawback is lack of quality initiatives by hospitals. None of the hospitals has NABH or NABL accreditation, though hospitals like LV Prasad and Aditya Care are in the process of getting it. The Road Ahead As more hospitals are being set up, more state-of-the-art technology will be introduced and more choices will be offered to patients. To address the dearth of paramedic and nursing staff, hospitals are keen on starting paramedical and nursing colleges. During inauguration of Apollo Hospital, Bhubaneswar, Dr Prathap Reddy, Chairman, Apollo Hospital Group, pleaded to the Government regarding land for a medical and paramedical college. Kalinga Hospital, which started GNM nursing school in 2004, is scaling up its intake from 50 to 100 students a year. Some are optimistic that the city would become a Mecca for medical tourism for countries like Bangladesh and Nepal. With big moolah pouring in, a steady infrastructure and active support from the Government, it can only be sunshine!
rita.dutta@expressindia.com