Medindia spoke to Dr. S. Suresh, Director of Mediscan Systems, one of the largest referral centers for ultrasound in Asia. A pioneer in ultrasound diagnostics and training in South India, Dr. S. Suresh along with his wife Dr. Indrani Suresh, contributes to extensive research in fetal malformations, prenatal diagnosis and fetal therapy through their non-profit Fetal Care Research Foundation and more recently, by establishing their own Birth Defects Registry of India that has set out to systematically collect information on the incidence of birth defects and assess their prevalence in India, thereby aiming to achieve the goal of evolving management strategies of birth defects all over India.
Q. A lot many doctors we interviewed in Chennai for Medindia said they couldn't have achieved so many milestones without the support of Mediscan, especially in their initial years. How did you hit upon this idea of a scan center which must have been almost unheard of, in South India when you started in 1982?
A. To be very honest with you, my biggest passion was to become a surgeon. I stood first in the subject at the graduate level, was an honorary surgeon for six years at the Voluntary Health Service (VHS) and attended interviews to do my post graduate study in Surgery. In those days there was only an Interview and no written examination at the entry level. I attended six interviews and was rejected each time citing the government reservation in favor of other castes and finally I decided to do something different. I read a lot and came up with this idea of a medical scan center which was nowhere in South India at that time. Many medical professionals who returned from abroad encouraged me to take it up as it could prevent a lot of human suffering and death by accurate medical diagnostics- especially prenatal diagnostics to determine abnormalities such as Down syndrome and Mucopolysaccharidoses (MPS).
Prenatal Diagnosis for an Outreach Program
The initial years involved challenges that ranged from persuading Dr. Hemant Shah in Mumbai to train me in the field, to applying for huge bank loan for equipment that were unheard of in those days. My parents were from an economically modest background and nothing came easy. My father however, believed in my vision and invested in my venture. Initially I made the scanning facility free of cost to all patients in the Kasturiba Gandhi Governmental Hospital for 3 months and crosschecked reports with the regular diagnosis by doctors who agreed that ultrasound scanning was indispensable for prenatal diagnosis and fetal therapy. Mediscan was born on August 15, 1982. My wife Dr. Indrani has ably assisted me in my mission to make a breakthrough in providing accurate medical diagnostics and standardized reports with the latest equipments in the world.
Q. Some of the current projects you are working on at Mediscan and your future projection for Mediscan?
A. Mediscan established a non-profit charitable trust Fetal Care Research Foundation (FCRF) in 1993 with the objectives of planning and evolving strategies for preventive, curative and supportive care of children with birth disorders. In August 2003 we inaugurated a Support Group for children affected with a congenital metabolic defect called Mucopolysaccharidoses (MPS).
Dr. Suresh Checking on a New Born Baby
The MPS support group has grown in number and the parents meet regularly to exchange notes and learn more about coping with children with MPS, from medical experts. The Support Group also helps the carers create awareness about such disorders in their environment such as school, neighborhood and relatives. The sufferers' morale is boosted when they are treated with understanding and compassion. We arranged with a company that made available mechanized wheel chairs at subsidized rates and we are planning to facilitate such support groups for those affected with various other birth defects.
Dr.Suresh with a newborn baby
Inaugurating a new Mediscan Facility
Dr.Indrani Suresh discussing scans with students
Dr.Suresh addressing a South Asian Regional Conference
Dr.Suresh interacting with Semester at Sea students
Dr.Suresh teaching a class
Birth Defects Registry of India (BDRI) is another venture that FCRF has undertaken since 2001 to systematically collect, store and report congenital anomalies. As a first step Birth Defects Registry (BDR) assessed the problems caused by birth defects in Chennai city and many nodal centers have come up all over Tamil Nadu. In its first phase the BDRI plans to ascertain nationwide baseline prevalence of birth defects. The mission for the second phase is to reduce the incidence of birth defects and help to form support groups for many congenital disorders.
Prenatal Screening for Down Syndrome - Video
Q. Prenatal diagnostics for sex determination is punishable by law and yet aborting the girl fetus following sex determination is widely reported in many parts of India. Any suggestions to curb the evil practice of selective abortion of girl babies?
A. I was part of the Parliamentary subcommittee that drafted the Pre-conception and Pre-natal diagnostic Techniques (Prohibition of Sex Selection) PCPNDT Rules, to prevent prenatal diagnostics for sex determination. The Act was passed in good faith and the administrators agreed that they would follow the spirit of the law and not the letter of the law. I wish to make some pertinent observations to explain this matter.
First, money drives people to do abhorrent things. People who disclose the sex of the baby for selective abortion using prenatal diagnostics are criminals. There was a heart-rending case of a woman who came to me with her severely deformed male baby. She was earlier refused prenatal diagnostics for sex determination by Mediscan and many others in Chennai. Her family took the pregnant woman to Calcutta, where a scan center did it illegally and told them it was a male fetus and the mother-in-law said she can have the baby because it was going to be a boy. She delivered a deformed boy baby and is struggling to bring it up. If only the scan center that did it illegally had gone that extra length and informed the family of the deformity it would have been easier on the family.
Having said this, I must say that it is not the machine that aborts the girl child. There are doctors willing to do it for a price. So while thePCPNDT Rules are being implemented, loopholes in the Medical Termination of Pregnancy (MTP) Act also need to be plugged to curb female feticide.
Ultrasound is a modality that is necessary in every branch of medical diagnosis—not obstetrics alone. Sometimes, arbitrary implementation of the PCPNDT Rules puts a huge strain on regular diagnostic centers that meticulously fill dozens of forms fulfilling government norms and yet get shut down for a flimsy reason and cause undue hardship for doctors and patients. Also there is no uniformity in the implementation of PCPNDT Rules and it is used in some cases to wield bureaucratic clout over scan centers. Case in point is the scanning facility that was closed down in a Pune hospital for a few months and deprived many patients of a genuine necessity for ultrasonography (USG).
Q. There is widespread allegation that some doctors accept cutbacks from scan centers for expensive investigations that are often unnecessary. What is your opinion on this?
A. It began originally as interpretation charges which were genuine payment made to a doctor when radiologists were not available. Unfortunately, money drives the world. Just as the pharmaceutical industry influences the medical profession by offering freebies to doctors, it is not surprising that it figures in the area of medical diagnostics as well. Some scan centers are run by private companies with a profit motive and there is currently more supply than demand for scans. The competition this entails could be one reason for newly sprung medical scanning centers to pay doctors to send patients. Such practices erode the image of a doctor in the collective public consciousness and the noble service is ripped of its sheen and made to appear as if the medical profession is yet another means of livelihood. If doctors refuse these charges it will serve to greatly reduce the patient's medical bills.
The government can step in to curb the malpractice by outsourcing its bulk of patients in government hospitals to nearby scan centers at a nominal cost so these machines that are better manned and maintained can be put to good use and also serve the larger public who throng government hospitals and burden the very few outdated scanning machines and manpower available there.
Q. You constantly travel within India and abroad. What are some of the healthcare problems that are peculiar only to India? Your suggestions to tackle these issues?
A. Delivering affordable healthcare to all sections of society, given India's huge population is a big challenge. Decision makers, health personnel—at the public and private level, health officials and the general public need to share the responsibility to ensure that healthcare service is rendered in a comprehensive manner throughout India.
'Semester at Sea' Students Trained by Dr. Suresh in Ultrasound
Health is not given due priority even by educated people, unless some serious health concern hits them. There is very poor documentation of health records both by doctors and patients, barring a few. I know of people who come to another doctor withholding the investigative reports of a previous doctor, hoping the second doctor will say something different. Previous investigative reports are invaluable to a doctor to know what has been done and decide what has to be done next.
Affordable quality healthcare eludes most patients. Apart from the poor awareness about disease conditions in many people, the pharmaceutical industry, the investigative industry and other paraphernalia make a huge dent in the patients' pockets. Abuse of antibiotics and noncompliance of the prescribed intake because of the high cost of medicine is prevalent among people.
We need more and more reliable health surveys that are continuously updated with results analyzed and made available to the public. Dissemination of health information could perhaps lead to healthy public debates in the media and spur decision makers to result-oriented action.
Public healthcare implementation does not progress rapidly and effectively because many governmental policies lack continuity and health services fail to finally reach the patient. Some bureaucratic procedures alienate people from the health system. There is no uniformity in the implementation of policies across India and government health executives need to go beyond personal and petty prejudices to facilitate healthcare services for everyone. A healthy private-public partner support can lessen the staggering public healthcare service for our large populace that the government is struggling to manage. Private doctors can lend a helping hand on a day-to-day basis to help sick people rather than holding occasional health camps and melas. I am sure the medical fraternity will gladly spare the time if the government properly harnesses their service and coordinates to enable them to provide healthcare without hassles.
Our policy at Mediscan has always been to help needy patients with free scans. We facilitate free scans for patients from low income groups in Women and Children's Hospital, Institute of Child Health, KG Hospital, Kilpauk Medical College Hospital, RSRM Hospital, Government General Hospital, Government Royapettah Hospital, ESI Hospitals and many government and private hospitals. We also do free scans for poor patients referred by private practitioners.
Q. Your memorable moment at Mediscan...?
A. I treasure the moments when people convince me that I have made a difference in their lives. For instance, some years ago when scanning for prenatal diagnosis was still a rarity in parts of South India, a doctor from Salem phoned me about a poor fruit vendor's wife who was carrying a baby that needed blood transfusion and needed to be constantly monitored. The mother was Rh negative and the baby was Rh positive. We arranged for the couple's transport to Chennai, arranged for blood transfusion for the fetus and monitored the progress till the lady delivered a healthy baby boy. The boy is now 13 years old and travels with his parents each year to Chennai and we celebrate his birthday with our staff at Mediscan.
There are many incidents like this where we have gone beyond our call of duty and strengthened people with hope, courage and our service. Apart from giving me immense soul satisfaction, I believe when I go that extra mile to support a patient, it serves to restore public faith in the medical system, especially in these days when people's faith in doctors is being eroded and the medical fraternity is sometimes getting disconnected with society in all its entirety.
"The mind must see visual achievement of the purpose before action." Mack R. Douglas.
Speaking from Mediscan Center that is equipped with state of the art ultrasound equipment and a matching experienced team to perform all types of ultrasound examination, Dr. Suresh confessed that his foray into ultrasound was a huge leap in faith and there were moments when the future "seemed hazy" because at the time when he began, a career in medical scanning was like navigating uncharted waters.
Medindia wishes him all success in his endeavors especially in facilitating the formation of support groups and his Center's research on birth defects and subsequently developing strategies for the preventive, curative and supportive management of birth defects.
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