NIHR GHRG-ST visit to India February 2018

Only one week passed after we arrived back from the Sierra Leone visit the month before we back on the trail, this time heading for India. A contrasting land to Sierra Leone, but one that in parts shared many of the same challenges and opportunities. This time, we visited India for 2 weeks. The first week was dominated by clinicians and engineers from Leeds co-hosting an Innovation Workshop at the engineering and science university, Karunya University, in Coimbatore, Tamil Nadu. This 3-day workshop, co-hosted with Leeds GHRG-ST, Karunya and Harvard Programme for Global Surgery and Social Change (PGSSC), set out to teach the university’s engineering students the principles of clinical need identification, concept development and pitching solutions. 12 teams of students presented their concepts and will be supported to develop these projects further, all with the aim of improving healthcare for underserved populations in India. Before we left Coimbatore, we visited a local medical device manufacturing company called Stann Biomedical and saw how our partners could collaborate with industry to provide devices and equipment for underserved hospitals.

After the workshop, we ventured to the North East of the country, some 4 hours by air. Along the way we witnessed our in-country partners undertake ‘surgical camps’ to deliver surgical care to those in need. The North-Eastern states are some of the most underserved in the country and have very weak healthcare systems with severely limited surgical care provision. Our main focus is in the state of Arunachal Pradesh, on the Indo-China border. We spent vast amounts of time driving between the states in the North East, as the roads are extremely poor and distances take significant time to cover.

We spent time in the capital of Arunachal Pradesh, Itanagar, where we had meetings with one of our collaborators at the Director of the Tomo Riba Institute of Health & Medical Sciences. It is associated with the state’s biggest government hospital, some 250 beds, which is functioning rather well and can provide a broad range of surgical services. He plans to establish the state’s first medical college here with an initial intake of medical undergraduates in the Autumn of 2018. He has worked hard to identify key faculty members and has secured funding from central government to deliver his vision.

We spent the remaining few days of our trip visiting district hospitals and primary health centres to establish the state of surgical and diagnostic services in the Western district of the state. We witnessed further surgical camps including the provision of gasless lift laparoscopic (keyhole) surgery (GLLS), designed to reduce the cost of this minimally invasive technique and give thousands of patients access this surgical option. We saw key diagnostic facilities to provide services to peripheral populations and discussed how these could be harnessed within a referral pathway to larger district hospitals.

A truly fascinating visit, India is a land of extremes with some populations severely underserved. The people endevouring to establish a brand new medical college, and those delivering surgical care to some of the most remote populations are inspiring. From the visit, the main areas of focus for the groups work include contributing to the education and delivery of the newly established medical college and undergraduate trainees, establishing Tomo Riba Institute of Health & Medical Sciences as a centre for laparoscopic training, and creating an evidence base to inform the wider adoption of GLLS for underserved patients across India.

Figure 1 Outside Tomo Riba Institute of Health & Medical Sciences Hospital
Figure 2 Fracture Management at Tomo Riba Institute of Health & Medical Sciences, Itanagar Hosptial

Figure 3 A PHC in the remote regions of Western Arunachal Pradesh
Figure 4 Challenging roads in the Hymilain foot hills





This research was commissioned by the National Institute for Health Research using Official Development Assistance (ODA) funding.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.