The Khaleej Times,UAE – Dec 14, 2013
Dr Prathap Chandra Reddy turned 80 years old this year, and Apollo Hospitals -founded in Chennai- marked its 30th anniversary. His is a remarkable story of starting life at 50.
It was at the age of 50 that Dr Reddy decided to give up a flourishing practice as a cardiologist in the United States and move back to India. His father felt that he should contribute to his country.
That was when Dr Reddy decided to transform India’s dilapidated healthcare system, which had been previously reliant on government hospitals and philanthropic institutions. He created the country’s first private-sector hospitals, a model that has been widely followed since.
Today, Apollo has more than 54 hospitals in its system. From India, Dr Reddy is branching out to the UAE and other parts of the world.
Pranay Gupte, a veteran foreign correspondent formerly with the New York Times, Newsweek and Forbes, and a distinguished author and historian, tells the spellbinding story of how Dr Reddy went about pursuing his dream against all odds.
In Healer: Dr Prathap Chandra Reddy and the Transformation of India, he also examines in trenchant detail how Dr Reddy’s changing of the healthcare scenario came against the backdrop of India’s evolution from a moribund economy driven by socialist shibboleths to one where the License Raj came to be dismantled.
Healer has fascinating characters, in addition to Dr Reddy. Leaders like Indira Gandhi and her son Rajiv are portrayed, as are scores of people who work unheralded in the healthcare sector.
The book launch will be on the occasion of annual awards of the Asian Business Leadership Forum where Dr. Reddy is being honored at the event.
Dr Girinath is a handsome man, and looks every bit as distinguished as the top cardiothoracic surgeon that he is. He is Chief Cardiothoracic Surgeon, Department of Cardiothoracic Surgery. I was surprised that his office at Apollo Chennai was tiny – I would have expected something more spacious, but there was just a working table, and a desktop computer. It was a tidy office, as befitting a surgeon renowned for his meticulous methods in the operating theatre.
He grew up in Mumbai and Ahmedabad, received medical degrees from the All India Institute of Medical Science in New Delhi, and had been practicing at AIIMS since 1969.
His achievements are staggering: Dr Girinath was the first to apply heart, lung machine-supported coronary angioplasty in India; he was the first surgeon to repair a complex congenital heart defect in a child below one year; he participated in the first multi-organ transplant in India (heart, liver, kidneys and cornea); he has been at the forefront in establishing coronary bypass surgery as a standardized and safe procedure in India; he has performed scores of surgeries on ‘beating hearts’; he has trained more than 30 surgeons who, together, perform 20% of all cardiac surgeries done in the country today. He has presented nearly 300 papers at important medical conferences in India and abroad. And Dr Girinath is the recipient of many national awards including the Padma Bhushan.
Dr Girinath considers Sir Brian Gerald Barrett-Boyes of New Zealand as one of his heroes in medicine. Dr Girinath, in fact, had wanted to go to New Zealand to train under Sir Brian, and when he went there was startled to find that whereas at AIIMS four to five heart operations were done during the course of a month, in New Zealand Sir Brian’s team performed at least that number on any given day in Auckland. Dr Girinath spent the next two-and-a-half year learning from Sir Brian in New Zealand. He had assumed that his old job at AIIMS would be waiting for him when he returned to India.
What was waiting was a job that paid a pittance – Rs 800 a month. Dr Girinath then joined Bombay Hospital in Mumbai, and then signed up with Indian Railways in Chennai in mid 1975, where important cardiac surgery was being performed. Indian Railways had 1.6 million employees at the time – about a fourth of New Zealand’s population. He worked there for nine years before Dr Prathap Chandra Reddy persuaded him to come to Apollo Chennai. However, Dr Girinath seemed a bit reluctant, something that Dr Reddy sensed at once. ‘Why don’t you want to join me?” he asked Dr Girinath. ‘Don’t you realise that if you join Apollo the sky is the limit?’
‘I have certain reservations about the private sector,’ Dr Girinath said, noting that 25% of the work he did at Indian Railways was for poor people not associated with the behemoth.
Then Dr Girinath added: ‘Cardiac surgery is not a one-man job – it needs a team.’
‘Bring your team over,’ Dr Reddy said.
That was just a few months before Apollo Chennai had opened in September 1983. In February 1984, Dr Girinath brought across five members of his cardiac team from Indian Railways. The day after they arrived at the hospital on Greams Road, Dr Girinath and his team performed their first cardiac surgery. It was done in the gynecological theatre.
‘It was chaos in the initial years, nobody really understood how hospitals functioned,’ Dr Girinath told me. One frustrated surgeon left Apollo and went to the United States. There was also the question of billing patients. Dr Girinath told me that he had a ‘railways mentality’ where medical costs were cheap at the Indian Railways Central Hospital in the Perambur section of Chennai.
‘When we moved in, Dr Reddy had no idea what to charge for a cardiac operation,’ Dr Girinath said.
‘How much do you plan to charge for a heart operation?’ Dr Reddy asked Dr Girinath.
‘Fourteen-thousand rupees,’ the surgeon said.
Dr Reddy laughed.
‘If you charged such a low figure, people will think that you are a second-class surgeon,’ he said, presently.
Apollo eventually decided that patients would be charged the equivalent of $3,000 per surgery. That figure stayed constant for nearly 30 years – until it was lowered to $2,800 in 2013.
‘Politicians are always telling you to make surgeries cheaper – but politicians don’t have to answer to patients and their families,’ Dr Girinath told me. ‘When you are handling lives, you can ask patients for money – and most will give. But at the end of the day, you have to live with yourself.’
‘We have tried to always keep our social obligations in mind,’ he said, adding that he talked to a Reddy friend, an industrialist named V. L. Dutt, about setting up a foundation to assist poor patients. Doctors contributed Rs 50,000 each to the foundation, and some 40 patients received cardiac treatment each year as a result.
‘None of my doctors talk to patients about money,’ Dr Girinath said. ‘So the patients have great faith in the institution. They know from the start that they will receive the best treatment – that the treatment is not based on their ability to pay. Similarly, doctors aren’t put in the position of discussing business with the very people they would be operating on. I firmly believe that the practice of medicine must be kept separate from the business of business.’
He has observed with keen interest the evolution of Dr Prathap Chandra Reddy from ‘an astute doctor to an astute businessman.’
‘I’ve watched him develop from a struggling businessman to a corporate giant,’ Dr Girinath said. ‘It is a story to be studied by anyone who wants to know how knowledge, will-power, determination, foresight and intuition can be put to work in the pursuit of an ideal.’
‘And you can’t bluff Dr Reddy – he knows the ins and outs of the medical business,’ Dr Girinath said. ‘He’s also undergone a remarkable change as a physician – in the old days, he was mostly interested in the success of operations involving arterial grafts, on bringing down the mortality rate [it is now less than 1%, down from 2.5% in 1984]. Now, through programmes like ‘Billion Hearts Beating,’ he’s increasingly focusing on prevention – no smoking, lowering blood pressure and cholesterol. He knows that in India, we can do 300 bypass surgeries per million of the population, while in the United States the figure is 3,000 per million. You can’t bridge that gap by just putting up more hospitals.’
That’s why preventive care is important. Dr Reddy is looking at the larger picture. There’s absolutely no money to be made in prevention, yet Dr Reddy is focusing on national health in the public interest. At Apollo – where only 10% of cardiac patients require surgery, the rest being treated through medicines and dietary and exercise regimens – there’s a discernible shift from theatre services to prevention programs.
In the early years of Apollo’s existence, Dr Girinath and his team performed about 600 surgeries annually in two theatres. Now the figure has risen to 4,000. Pediatric heart surgeries on children are performed at Apollo Children’s Hospital. At the new cardiac facility at Apollo Ahmedabad, more than 15,000 heart surgeries are performed each year. Dr Girinath trained some 80% of the cardiac surgeons in Ahmedabad.