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Reports of events from the Sai Baba Ashrams


Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore
First anniversary celebrations on January 19, 2002

The first anniversary celebrations on January 19, 2002 saw an exchange of information and ideas to make healthcare accessible to all

A panel of eminent personalities shared their thoughts and ideas in the afternoon. Dr A S Hegde, Chief of Neuro Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore and Dr Shekar Rao, Head, CTVS, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore were the moderators.

Dr A S Hegde, in his opening remarks said that while life expectancy was going up, a large section of the population are not touched by this. This large section is most likely to be passed by as nations develop and move with these times of globalisation. The burden of inequality, poverty and ill health is heavy on this section. The WHO has envisioned two concepts -health development (including water & sanitation) and preventive medicine. Baba's institutions have worked on these very fundamentals.

Dr Shekhar Rao said primary, secondary and tertiary care are equally important and are simultaneously needed. The fact that over 68,000 patients have sought treatment here for neuro and cardiac illnesses illustrates this point. For many in the country there is no hope. This is very demoralising for them. Therefore it is important for the morale of the nation that they feel assured that every sort of hi-tech care is available to them. Tertiary care upgrades a medical structure.

Here are the highlights of the presentations made by the panelists:

Honourable President Of INDIA


I have been thinking of what to share with you for the next ten minutes. This morning, for first time, I happened to hear a Divine Discourse by Baba. I had prepared a talk but after hearing the discourse, I discarded it. I am not going to speak to you about any ideologies, but of an experience.

A cardiac surgeon and I work together. Between us, we have extended the preventive area I thought of sharing with you. I was traveling to Bhopal and on the way somebody told me, "I have two cardiac stents in my body". Out of three arteries, he had stents in two. The man was just an upper division clerk in Aligarh. He used to feel a pain quite often and went to one of the famous medical institutions in Delhi. They told him he needed to get an Angioplasty done that costs Rs 1.5 lakh. The cardiac stents cost another Rs 75,000. The total medical bill amounted to Rs 3 lakh. He could not afford it. He has two children and he just put up with the pain quietly for some time.

Now there was our fast forward program. We have a stent that we developed out of a ferrite free bio-compatible material. A team of Prof. Somaraju, his doctors and my colleagues reprocessed a material -ferrite free and bio compatible, and made a stent out of it. After a series of tests it went into production.

Now that is our cardiac stent. We are very happy there is a patient who is carrying a cardiac stent like this. At a conference attended by many medical professionals, physiologists and cardiac patients, it was said that even after an Angioplasty or bypass surgery, reoccurrence of the problem still takes place. Around 15 patients reported that reoccurrences took place 5 to 7 years later.

I had a good friend called Dr Selva Murthy. He runs two institutions. The Institute of Physiology and the Institute of Psychology. This morning we heard that the treatment given here was not just for the body, but for the mind. Can we treat the mind? I read a famous book 'Man the Unknown'. The author is a noble laureate. The point he makes is that the doctors treat patients like they are machines. How do you treat the pain created by the mind? That is a key issue.

Dr Selva Murthy and I went to Mount Abu. At that time I was not aware of the great work that you are doing here. In Mount Abu, there is the Brahma Kumari Academy. There is an allopathic doctor there who believes that you have to treat both mind and body. It is very rare for an allopathic doctor to believe in this fact.

There, in the Academy, we enlisted 80 patients who had instances of reoccurrence. The treatment started. We call it a three-dimensional treatment. This three-dimensional treatment involves a vegetarian nutrition, meditation and aerobics - specific aerobics. In the course of this treatment on the 80 patients, we found the blockages of the arteries started dissolving. Still there were some who did not believe this phenomenon. So we decided to expand the base to 400 patients. In the last one year 400 patients have been treated. The records of 350 patients show that either the blockages have dissolved or are dissolving.

I am telling you of this today to covey a message we get out of this experiment. It is possible to design and develop indigenous technology in this country. To give you an example, how did I develop the stent? Prof Somaraju wanted me to develop a stent. He came to my laboratory one day and said, "Kalam, what are you doing? You are creating pain". With missiles, according to him I create pain! "You remove the pain", he said. He took me to his place and showed a stent costing Rs 1.5 lakh and said as soon as we put our stent in the market the cost would come down. That is another phenomenon which has taken place.

In any super speciality hospital, 90 per cent of the equipment is imported. I believe that a movement to develop indigenous technology by doctors should start here. In this campus any movement you start will work. We must use our own technology. If you start a movement towards that, it will be great.

We prepared a 20-volume document two years ago. 'How to transform India into a developed machine?' One of the documents, the Health document dealt, with how to provide healthcare. What is healthcare? Healthcare is not medical care. Medical care is one of the components of what you are all doing. Actually, healthcare is medical care, education and nutrition. Healthcare happens only when all these three are combined. You are doing that in both Puttaparthi and here. You are treating the mind. You are providing good water. You are doing all the three.

I was telling some friends of mine today that an antiballistic missile has been launched by Bhagawan Baba against poverty. How does this missile work against poverty? Through water, education, and healthcare.

Chairman, Nobel Family Society


I have been asked to speak about medical technology and its impact on healthcare, and I think it is safe to say that medical technology has seen more progress over the last 30 years than in all history. This is mainly due to the arrival of digitisation and the advancement of computing power. The wealth of information available today to the referring physician is simply overwhelming. In diagnostics the physician can choose from a plethora of procedures unknown to him a few decades ago.

As you know Magnetic Resonance Imaging, Ultrasound, Positron Emission Tomography, Digital Subtraction Angiography, Electron Beam Tomography, all provide new and additional insights into the human body. The doctor can also order sophisticated laboratory procedures including exhaustive chemical analysis of the patients' body fluids. There are new chemical markers for tumour and mental illnesses. There are protein and enzyme identifying agents that help him diagnose hereditary diseases and so forth. The progress in medical technology offers doctors an added insight. We have also seen the replacement of often painful and potentially harmful examinations. You might remember at one time, coloured liquid or air would be injected into a patient's brain. With non-invasive and non-harmful procedures such as the MRI and Ultrasound, Arthroscopy and Myealography have practically disappeared in the Western countries.

In treatment, research and technological developments have been equally impressive. In the case of cancer, for example, because it's a huge field, the traditional three methods of radio beam therapy, chemotherapy and surgery have been complemented by superior treatments. In treatments such as Brachiotherapy, radioactive micropellets are inserted, some times coated by liposomes, into the tumour and are subsequently released by external heating. We have the hormone therapy, the gene therapy, and the focused ultrasound where the tumour is burnt. We have the cryotherapy where it is frozen. We are starting to see the arrival of cancer vaccines and the enhancement of the body's outer immune system by the release of heat shot proteins through hyperthermia. All of these offer exciting avenues of medical technology development. In cardiac treatment, for example, Jarvic artificial heart implant with immuno suppressive drugs have shown increasing promise together with more advanced research projects such as gene altered cloned pigs, growing body parts including hearts which can be transplanted into humans without fear of rejection. Stem cell technology is another area of increasing interest as we have seen in the mass media. Particularly, in the area of treatment for mental diseases. Permanently clogged up areas of the brain, diseases such as the Parkinson, Alzheimers / CP, and multiple sclerosis can now be potentially restored by the use of these cells.

Diagnosis through tele-medicine and distance learning of medical technology is growing through the use of the Internet and satellite communication channels such as those provided by our company Worldspace. One thing is for sure. All these technological advances that I have mentioned in medicine will certainly not make healthcare less costly for the State or the individual. Presumably, quite the contrary. Tremendous increase in healthcare budgets makes it less available to the under-privileged sections of society. We heard this morning, for example, a MRI examination costs between Rs 30,000 and Rs 45,000 in the USA [625 and 830 USD]. A light ion accelerator for cancer treatment [less harmful to the patient as compared to the traditional linear accelerator], is now being installed at the Karolinska Hospital in Stockholm. Do you know how much it costs? It costs an unbelievable Rs 1 billion [21 million USD approximately]. A simple fluid electrolyte replacement I had to undergo in Chicago cost me Rs 90,000 [1,875 USD] and surely, I will get more bills. This is beyond what many people can afford in India as elsewhere and always in the end, it's the man on the street, taxpayers, and the patients who have to foot the bill. It is therefore so rewarding to encounter a true phenomenon here in Whitefield. As hospital that offers the latest state-of-the-art medical technology without charging anything for it. I think we need hundreds more hospitals like this in the world to offer the poor the same facilities as the wealthy. But again the very relevant question, where do we find a hundred Sai Babas.

To accomplish even a fraction of this the world needs an increased sense of compassion among those who have the resources towards those who do not. To do that we need the teachings of Bhagawan Sai Baba distributed worldwide. Our company offers its world communication channels to do that.

A disadvantage of the modem healthcare system is the risk that patients tend to become numbers in a computer file rather than individuals. This has happened in the West and I hear from a local doctor that this seems to be a trend in India also. Computerised archiving communication systems allow the doctor to access the complete past history of the patient who is identified by his code or personal identification number. Today, the overburdened healthcare systems only allow most doctors a few minutes with each patient, enough to make a prescription or to refer him to a diagnostic procedure. So the patient becomes a biological specimen or even a pathological state. The doctor thinks, 'now here comes the diseased kidney', or, 'here comes the torn ligament', rather than Mr. Smith or Mrs. Jones.

What is lacking in the hi-tech electronically oriented Western society is the aspect of spirituality i.e. the synergistic effect - mind together with the physical health. The positive mind on the patient's health. The patient's belief system does not enter into the healthcare consideration in Western Europe except of course when it comes to psychiatric illnesses. So I was very surprised, being a Westerner, the first time I visited the hospital here, to see the large number of photos of Bhagawan Sai Baba displayed. Most hospitals abroad might have one picture, perhaps of the Head of State in the reception room. I was informed that it was the patients who needed them for spiritual support and the assurance that Baba was present to lend his support to the healing process. The psychological belief of the patient that a higher being will get him well is largely ignored in the West. But history abounds with examples. In the two world wars, for example, soldiers after being cured in hospitals and told that they would have to return to the inferno at the front simply turned their faces to the wall and died without any physical cause or reason for their death.

The impressive hospital created by Bhagawan Sai Baba is thus the combination of the state-of-the-art technology, healing powers of His presence installing in the patient the firm belief that he will get well, and all this offered for free. This is something I believe the Western healthcare would do very well to consider also. I would like to call for a serious study comparing identical treatment procedures to identical patient groups with or without spiritual guidance and reinforcement and subsequent belief enhancements. A significant difference shown in such a study could well change the way we look at cure and healing, away from a purely empirical and rational view.

Chairman and CEO, Worldspace


This is not simply an anniversary. It is a celebration because we rejoice today at the first year of the Sri Sathya Sai Institute of Higher Medical Sciences. A year of service and a year of loving kindness. Over the past one year, we have heard that thousands of men, women and children, without money and often without hope, have come to this remarkable Institute, and left with their health and spirits restored. As we celebrate today let us praise the medical professionals of the Sri Sathya Sai Institute of Higher Medical Sciences who have demonstrated skill, caring and devotion in the practice of their healing arts. We should also praise volunteers in India and the world over who serve here with dedication, devotion and humility. And most of all, we praise Bhagawan Sri Sathya Sai Baba himself. The magnificent, world-class medical facility we see before us is an embodiment of Baba's great vision. The outpouring of the kindness and the healing energy so evident here today is a gift Bhagawan Baba in his boundless love shares with all of us.

I want to address the subject of corporate responsibility in the delivery of healthcare services. Today, when someone says 'corporate', we often think of large office buildings. We think of financial statements, and of men in expensive blue suits. But the superficial trappings of these corporations distract us from the deeper meaning. Actually the word 'corporate' in Latin, which comes from 'corpore', means to make into a body. Every corporation is nothing other than a group of people formed together in a body to get something done. By their nature, corporations focus on themselves. But in truth, all corporations are really a part of the larger body. Nearly 400 years ago the English poet John Donne wrote, "No man is an island entire unto him himself. Every man is a piece of the continent. Every man is a piece of the mainland". His words are ever truer for the corporations than it is for individuals. Today's dominant corporations such as Microsoft have thrived by creating a web of interdependencies and business connections that have supported the world. As Microsoft has proven, the more the corporate is involved with others the more likely it is to succeed. Conversely, the surest path to the death of a corporation is isolation. Yet the illusion of separateness persists. Corporates use the law to limit their liability.

Liability is a very narrow legal concept whereas responsibility is the universal requirement for a principled human life. The author Alien Massey put it beautifully, "we are responsible for actions we perform in response to things we are not responsible for". For example, corporations do not cause disease, but surely, as they are connected to society they are responsible for contributing to public healthcare.

Many corporations support the health of their employees and their families. But that is just an appropriate first step. It is not as much as what is needed. Western corporations would do well to follow some of the examples here in India. My colleagues from Worldspace, Bangalore tell me it is an emerging trend for corporations in India to sponsor healthcare for a whole village or locality. There is so much that corporations can contribute to treatment, research, and education. Whether large or small there is an important role for every corporation. Healthcare needs are so great that a corporation does not need to look far to get involved. Worldspace actually came into being in response to a public health crises. In the mid 1980s I had read about the spread of the AIDS virus and how it was affecting Africa because there was no infrastructure available there to inform people about the epidemic. I realised that people were dying due to ignorance. This realisation changed my life and I quit my profession to found Worldspace Corporation to pursue, what at that time seemed an unattainable goal, which was to put up a big satellite in the sky over Africa that would deliver information to the entire continent. That vision then, as now, was to create information wealth by directly broadcasting to small receivers that would be inexpensive, from satellites that are in a geo-stationary orbit. We were guided by this vision and now operate two satellites to serve all of Africa and Asia with information that is being delivered in the form of entertainment and education. Our end obviously is to deliver information because at the core of our vision we believe that everything is reducible to information. If you look at the human being, he is reducible to a DNA information package. The chair we sit on, this dais we are on, the wealth that we have at the end of the day, is reduced basically to bits and bytes or to information. If you look behind the wealth of a nation you find a wealth of information and when you look at the poverty behind a nation you find a lack of information. Malaria, for example, may not kill me because I have a doctor who knows how to deal with it. But it may kill some one in a village simply because that person does not have a doctor who knows how to deal with it. What makes a doctor capable is not the individual but simply the information that is in that individual. In a very real way, information equals health. Our system to provide information to maintain health and well being for vast populations has been used over the last few years and it is beginning to show some results.

While it is not possible for every locality in India to have a facility as splendid as the Sri Sathya Sai Institute of Higher Medical Sciences, with systems that can deliver information remote villages can get the information that empower them with values, spirit, and health. We can deliver the information substances behind such institutes, but even more importantly we can deliver the spirit of love and generosity that animates this wonderful Institute. I am actually very proud to tell you that Worldspace is doing just that. On the occasion of Baba's birthday last November, the Sai Global Harmony Channel began broadcasting on Worldspace to all of Asia. We now expect to take it all over South Africa and Europe in probably the next two or three months. It's wonderful for us to broadcast the Sai Global Harmony Channel because all great things originate with beauty of spirit.

Undeniably, corporates have a responsibility in healthcare. The question is, with what spirit will they face that responsibility. Is it going to be a grudging sense of obligation or is it going to be a loving awareness of being able to serve one and all? Spirit ultimately shapes reality. As our beloved Bhagawan Baba has taught us, if there is righteousness in the heart there will be beauty in character. If there is beauty in the character there will be harmony in the home. If there is harmony in the home there will be order in the nation. If there is order in the nation there will be peace in the world. Corporations that nurture a sense of righteousness and enjoy service will help in peace and health in our planet.

Head, State Task Force (Health and Family Welfare), Government of Karnataka


I started my work 21 years ago, inspired by Swami Vivekananda. I have been involved in integrated tribal and rural development in Alandur and T Narasipur Taluks, where we are trying to show an alternate low-cost technology in primary healthcare. In the last one and half years, the Chief Minister has given me an opportunity to serve the 52 million people of Karnataka. I look into the entire health sector and make recommendations. I also had the opportunity of working at the national and international levels. I am not an expert in healthcare. I am not an academician, but I have some experience and based on this experience, I want to share some of my thoughts with you on rural healthcare. There is a rural and urban divide. I am referring to three issues - equity, quality and integrity. In India we have 72 per cent living in the rural areas and 28 per cent in the urban areas. In Karnataka we have 66 per cent living in the rural areas and 34 per cent in the urban areas. While the rural areas are considered very important and needing attention, the urban areas cannot be neglected. The urban poor are more neglected than the rural poor. We need to understand this. The slum dwellers in the urban areas have no primary healthcare. So we need to look at the problems of urban poor also.

In terms of primary healthcare in the rural areas versus the tertiary care available in the urban areas we have a divide. There has been an inequity in terms of resources being pushed to tertiary care. By and large, the public sector is spending mostly on primary health in Karnataka and India. What pains me is that even after 54 years of independence, while we have people doing heart transplants, people here die of simple hook worm anemia. No facilities are available in primary healthcare and people are dying. We don't have a simple diagnostic laboratory in the primary health centres. If you have a good microscope, a technician and a few rupees worth of chemicals, you can diagnose leprosy, tuberculosis and malaria. Even that facility is not available in 50 per cent of our primary health centres in India. This is a national shame. We have MRIs, CT scans and all the latest technologies and this inequity cannot be tolerated any more. We must provide basic primary healthcare to the people of India.

We also have the problem of caste inequity. How it is related to health? The gender inequity is a major area. In the population of zero to six, the population of the girl child has drastically come down all over India. In Karnataka, sex determination and terminating the female foetuses, a heinous crime is happening. We also have the problem of quality. I just attended a laparoscopic camp. A simple instrument is poked into the abdomen and it will do tubal ligation. It is very simple. It takes 3 to 4 minutes. I have seen them being sterilised with a spirit swab. They just wipe it with a spirit swab and poke it into the next abdomen. This is an example of the quality of standards in the public sector, sometimes in the private sector also. It is also an example of the quality of care, not only in terms of physical cleanliness, in the surgical standards and the humanness in the treatment.

We have given a report to the task force concerning integrity. In the report to the Chief Minister, we have identified 12 major issues. One of the major issues that we have mentioned is corruption. Many of the people advised us not to put it at the top. People said that corruption as a major issue cannot be presented to a Government, especially when you are presenting it to the Chief Minister. But I thought, if we cannot tell the truth to the Government, who else can? If we, and those in the voluntary sector do not have the courage, who else will tell the truth to the Government? So we didn't compromise and put it at the top. We have to learn in the presence of Baba, the value system that He spoke about so lucidly this morning. There is no value in the system. Bringing back values is a challenge.

We have to take low-cost technology to the rural poor. The neglect of public health is a major problem. There are implementation gaps. Another problem is the 'ownership' factor. No one 'owns' hospitals in the Government sector. There are beautiful buildings and equipment, but no one 'owns' it. Here, every devotee and volunteer 'owns' the hospital. The Government needs to get into partnerships with the private sector and voluntary organisations such as this. Better healthcare leads to a better economy.

Homi Babha Senior Fellow


Tertiary healthcare depends on two things for excellence. One is efficiency. Efficiency includes knowledge, skills, and attitudes. The second is compassion. Efficiency and compassion are the two components for success or excellence in tertiary healthcare. In India, in the last 25-30 years, tertiary healthcare has expanded dramatically. A large number of institutions have come up in the private and public sectors. Here, you get two types of institutions. In one, you find a great deal of efficiency, run extremely well but there is no place for compassion there. You see them in urban centres. Then there is the public sector where there is neither efficiency nor compassion. There is one solitary example in the whole country where compassion and efficiency can be seen in equal measure and that is in this institution [Sri Sathya Sai Institute of Higher Medical Sciences]. That is why, speaker after speaker was overwhelmed by what they are seeing here. This is something we do not see elsewhere. In India Divine people come. They show us a model and we expect them to do everything for us. We do not do everything ourselves. This is a mistake because the Gita says, 'you remember me, but you work'.

In India, tertiary healthcare particularly, in cardiac surgery about which I am more familiar, is available to not more than 60 million people, which may be an exaggeration. The other 940 billion people have no access to cardiac care. The US Department of Commerce published some figures in 1998. In exports of medical equipment to India, they have shown the Indian market as worth 80 million people. The rest of the population of 900 million people simply doesn't exist.

These people are going to be ignored. In the Health Ministry's projections, there is an increased allocation for health and all of it goes, and rightly so, for primary healthcare. The emphasis is different and there is nothing being said about these people even with all the prevention that we can do. In spite of basic measures such as not smoking, better nutrition, physical activity, you are still going to have heart disease. Children will continue to be born. We do not know how to prevent congenital heart disease. A large a number of children are born with crippling congenital heart diseases. These diseases can be corrected. Dr Shekhar is doing this remarkably well here and they have a healthy normal life later. So you need facilities for cardiac care. How are we going to make this available 900 million people? We may not succeed in replicating this model because we are nowhere near the Person who inspired this. But we can go halfway, we can go a quarter of the way. That is the kind of effort which we should make after listening to Him this morning and I feel some new thinking is required. I am reminded of a mundane example. In the US, if you want to travel from one place to another, say from Detroit to New York you can take a regular airline and pay 250 dollars. But there is something known as a 'no frills airline'. That is the South West Airline. Here you can cover the same distance paying only 80 dollars. They do not compromise on safety, they do not compromise on punctuality but on everything else. No food is given, and no fruits are offered, it's a 'no frills airline'.

We can have a 'no frills cardiac hospital'. It means you need to have new kinds of institutions based at district levels. You have to standardise the kind of procedure they will do. 70 per cent of the cardiac procedures are straightforward whether it is a septal defect in the child or a value replacement. The risk is very low. Only such procedures should be tackled at that level and the capital investment for a centre like that may not be more than Rs 10 crore.

If we have one such centre for every 10 million people in India, we are talking about 100 centres over a period of 10 years. This kind of money is very little for the Government. The Government of India today spends only 0.9 per cent of the GDP on health which is less than what many African countries are spending. If the Government can spend 2 per cent over the next 2 years [and this 2 per cent of the GDP, you will be surprised to hear, is Rs 38,000 crore], we are talking about Rs 100 crore per year. Over 10 years, these centres can be set up with different functional targets. Then we need an insurance system. For those below the poverty line, the Government should buy the insurance. It is not expensive, far less expensive than running the health services today. So based on an insurance system, while for those below the poverty line the Government buys the insurance, others can buy it for themselves. Then, nobody will go without cardiac care.

This is one of the things we must do and the insurance must be tied to quality. There must be an accreditation system. We are capable of setting up an independent accreditation system. Such a system should accredit their district-based centres. I know the reaction immediately would be, "how can we do it?" This is a general kind of reaction. A bit of cynicism has crept into our blood and I am reminded of a story that I must relate to you. We marvel at Japan's progress. Japan had shut the doors to their country for two centuries. They never allowed anybody to go out and come in for two centuries. In the 19th century they slowly started opening their doors and allowed a few Japanese - very intelligent people - to go to Europe to find out what were the changes taking place there. One of the men sent was Masang. He went to Paris which was the centre of Europe then. When he reached Paris, he wrote letters to his friends in Japan. He was overwhelmed by the splendour of Paris. He wrote to his friends saying, "there is no way we can ever catch up with these people. They are way ahead of us. What can we do?" He wrote despairing letters to his friends. While he was in Paris, there was a war and right before his eyes the whole of Paris was ransacked by the Germans. The tragedy boosted Masang's morale. After all, what he had marvelled at disappeared overnight. Maybe it is not all that great. His tone had changed when he came back to Japan. He was one of the authors of the famous ten-volume 'Japanese Plan for Development'. In that he wrote in the introduction, "for the industrial development of the nation three things are required -capital, a road map, and the will". Then he went on to say, "if I have to award scores for these, I would give one mark for capital four marks for the road map and five marks for will. Because capital and road maps are immobile and they will move only with human will". Where does human will come from? It comes from faith. And faith is the evidence of the unseen. It is the substance of things hoped for. It is that which moves mountains, which Baba here radiates for all of us. I hope this kind of faith will animate in us, in what we hope to do in the next ten years.

Director, National Institute of Mental Health and Neuro Sciences (NIMHANS)


I just saw the hospital [Sri Sathya Sai Institute of Higher Medical Sciences] and asked the person who was taking me around, "is it a hospital or a temple?" The impressions I get is, yes it is a hospital. There are patients, though the structure is like a temple. Everywhere we see Baba's photographs. Can every hospital, every institution in this country be a cohesive model of both a hospital and a temple? That should be our goal.

We heard many views on primary and tertiary healthcare. I want to talk about accountability. I would like to look at health as a spectrum rather than as primary, secondary and tertiary entities. Because tertiary healthcare evolves out of a system of good primary and secondary healthcare.

When we mean tertiary, we are talking about medical colleges. We are talking of apex institutions. The role of the tertiary care is to deal with complex and complicated problems. When I sit in the out-patient department, do I function like a tertiary neurologist, or am I a primary health doctor? I wonder because NIMHANS receives 3 lakh patient in a year. A person with a mild headache has to ravel 500 kms to see the doctor for 2 minutes in a busy OPD, and get a prescription. The cost of the drug may be just about Rs 5/-. Why did the person have to travel all that way for just this? It is a tragedy. Can we decentralise most of the primary care to the district level and the tertiary hospitals can take care of the bigger problems, conduct research, develop new methods and new strategies of diagnosis and treatment. This is what the tertiary centres should be doing.

The private sector should be linked to the Government sector. Prevention should be an inherent component of tertiary care hospitals. Can we do something that many institutions like NIMAHNS is doing? We train up the doctors at the periphery. In neuro surgery, psychiatry or neurology, and there is a continuous feedback and feedforward of information. Feedforward i.e. from the periphery to the centre and feedback i.e. from the central tertiary hospitals back. So it is not a one-time contact.

We heard about the communication systems and the corporates' responsibilities. If these communication systems improve, the neuro surgeon or cardiac surgeon sitting in Bangalore can direct how the peripheral surgeons situated at the periphery should tackle a problem. Could be by distance education or distance management. Small experiments have started in the country and it should become a massive movement. Then the tertiary care system can work.

When the number of patients are restricted, many of us will be very efficient under any system. But, if the system is bogged down by huge numbers, the quality will suffer. The doctor-patient time interaction will be less inspite of the best efforts and dedication of the doctors. We should have more institutions of tertiary care with modem technology and equipment.

Now is it out of context? Yes people die of malaria and diarrhoea. But I remember when we were undergraduate students, brain tumour surgery was a big. People had to go abroad for cardiac problems. Today, all types of postgraduate courses and services are available in the country. How many people access them is the question. There are the marginalised people and the poor. I would classify women in a marginalzed group in a way. We have seen statistics of out-patients and inpatients, and conducted community based studies. How many women access healthcare? You will be shocked. Foe every 2-3 men, only one woman accesses healthcare.

Then there it the question of time. Doctors say that patients come late to tertiary hospitals because of a lack of awareness. They cannot come early because they don't have the information of the referral system. So, the tertiary care centres, apart from offering healthcare, have to do a lot about awareness and education too.

Vice Chancellor, Rajiv Gandhi University of Health Sciences


After 54 years of independence, lets look at the overall development in this country. In the 11th report of the Human Development Index, our country has been bracketed somewhere between 110 and 120. It improved over the 10th report for India as a result of the contributions many by the information technology industry. Thanks to Bangalore and the contribution of Karnataka. Its praise worthy that in the WHO report on health responsiveness for the year 2000, India is again recorded as 120. In the case of the Human Development Index, the parameters of life expectancy at birth, literacy parameters, the buying capacity of the common man of his daily requirements, and the general development index are not good enough. However, the most important aspect of human development is the human governance index. That is, the contribution and accountability of the political leadership, accountability of the bureaucracy, accountability of the professional and ultimately the accountability of the community itself. All of us have an equal role to play. To say that human development has taken place only in urban areas and neglecting rural areas is not answering all the questions. We have to find out what the rural development index is. What are the developments in the areas of the vulnerable sections of society, women, children and the elderly? By the time we reach 2016 we are going to have more than 100 million people who are above the age of 60 years because longevity of life has increased.

We say primary education and primary health are the fundamental rights of every human being. Just 6 per cent of the people have access to higher education in this country. We talk about universal higher education. When we say universal higher education or universal health what kind of quality of health are we going to get? This has to be kept in mind. Higher education is always for self and self-reliance. Higher education is always an investment for self-development or the future development of himself, his family or the country, and let's not forget that higher education is a catalyst for social and economic changes in society. For a developing country, higher education, including professional education should be a catalyst for socio-economic change. This we have to bear in mind.

Now, when it comes to healthcare we are talking about tertiary healthcare. Tertiary care and prevention is a continuation of primary care in the natural history of the disease. The natural history of disease signifies the way in which the disease evolves in the absence of intervention. What is usually seen in a hospital is just one episode in the natural history of a disease. One has to go beyond the walls of the hospital and into the community to understand this concept. Healthcare should not be professional or doctor-oriented. It should be patient-oriented. And as you proceed further, in any healthcare at any level, there are certain things we have to remember. The first one is to make it available. The second important point is the accessibility of healthcare. We also need to go into the reasons why people are not accessing healthcare. Is it the distance? Is it the fear? Or affordability? Unless people can afford to pay for the services, whatever the hi-tech facilities you are going to offer will reach only a microscopic minority of the people.

People these days talk about the high technology. We are talking in terms of nuclear medicine, virtual reality and we have to understand that what is important especially for a developing country is the appropriate technology and not just high technology. What is appropriate for Bangalore need not be appropriate for Shillong or Manipur. What is appropriate for New York need not be appropriate for Bangalore. This has to be kept in mind always. Professionals say they can't perform well because of lack of machines. They need to be adaptable. We have to adapt to the situation. Whether you are working in a primary health centre, secondary care centre, tertiary care centre or in an institution where you have access to higher technologies, you should be able to adapt to the conditions.

Ultimately the important point is the accountability. He may have the equipment, buildings, and people, but something is missing. That is the attitude and compassion. Baba has preached in the morning that it is not enough to say that I have the highest knowledge available in the world and I have acquired the highest skills. To practice this knowledge and skills in an appropriate manner, and in a very compassionate manner, your attitude has to change. That is all about medical ethics. In every area from education to practice, attitude and compassion are vital. Apart from accountability, medical ethics is the most important thing, especially in tertiary care. In terms of accountability first of all you are accountable to yourself. Then you are accountable to your conscience, to your chief executive and to God. But first, try to be accountable to yourself.

As far as tertiary care is concerned, it is not that the country has no ideas about these things. We have the Srivatsava Committee report and we are supposed to have in a district of 3 million, 2500 beds. It's called the '3 millions plan'. It does not mean that tertiary care should be made available only in apex centres. What is required is that every area with a 3 million population should have access to tertiary care. The problem arises when we ask who has to do it. Only 0.9 per cent of GDP is available for healthcare in this country. Only 3.5 per cent is available for higher education and naturally we always fall upon what is called private initiative. In medical education and healthcare, 80 per cent is always private initiative. Private initiative need not be commercial initiative. Social marketing is different from commercial marketing. It's a very thin line sometimes. We always try to cross that line and say all private initiative is commercial. What are required are partnerships. The partnership is the most important one of the linkages we have to develop. If the Government is not in a position to pay, somebody else has to pay for tertiary care. You have to find out who that somebody is. You should have system where Medicare to nearly 50 - 60 per cent would be available almost free. Maybe to 20 to 30 per cent it could be on a social marketing or social rate - what normally the middle class would be pay. The 20 per cent in the high income bracket should pay the most. At the end of the day the paying patients will be able to take care of the non-paying patients.

I would like to emphasize here the Government alone cannot do this job. There should be a joining of hands. That's what is called unity for health. A developing country has to move towards unity for health with social accountability. That kind of accountability is not personal accountability; it's called a social accountability. Social accountability of relevance. The social accountability of quality of care. The quality of care has to be actually identified. Any healthcare should have total quality management. It is not enough to look into just the equity because you have to give a large section of society, quality care. It is not good enough to say only a small segment has the best treatment in the country. Lastly, the cost effectiveness. To give the highest quality of service to every individual in the world is not possible. We need to have a kind of a balance. The most important parts of healthcare are the coverage of the care and its quality. Unless we cover a large populace, whatever we do will only be for a small percentage of people. In this I really appreciate the contribution of the Sri Sathya Sai Institute of Higher Medical Sciences. This institution has been offering free service. While people are not expected to pay, I hope they will be very generous to come back and say let me contribute to this hospital so that it will be able to serve many more poor patients. Let's not use this hospital just because Baba is offering free service. Nobody should exploit this Institute. Those who can afford to pay should pay so that this hospital can serve the neediest and grow.

Vice Chancellor, Manipal Academy of Higher Education


Let me tell you of the effect of Bhagawan Sri Sathya Sai Baba on all of us. I call it the 'Bhagawan effect'. Has any one of you seen the Bhagawan effect? There is an American poet called Christina who wrote these two beautiful lines: 'Who has seen the wind? Neither you nor I. When the trees dance and bend, the wind is passing by'.

Who has seen the Bhagawan effect? Neither you nor I. The multitude of people who come here like a stream and go back contented tells us what the Bhagawan effect is.

The most important difference between the hi-tech West and the poor East is the epidemics of diseases. Diseases in the West are totally different from those in the East. The major epidemic diseases in the West are suicide and divorce. Not cancer, not heart attack. We do not have these two diseases here because we have a lot of the 'Bhagawan effect' on all of us. When people tell me under the guise of being scientists that God does not exist, I always tell them that God cannot be seen. God cannot be measured but God can be felt. Materialism took the West to an end where materialism has no end at all. You can buy the costliest bed available but can you buy sleep with it? To sleep, you need peace of mind. How do you get that? When you get frustrated with materialism, if you surrender yourself to a higher power like Bhagawan Sri Sathya Sai Baba, your difficulties melt away. Your frustrations disappear. Your depression lifts and that is what is keeping most of us going.

Depression is the cause of heart attacks, cancer, and every known major killer disease in the world. Ayurveda, the ancient Indian wisdom that goes 1,000 years back has this stanza that says, 'if you have a pleasant mind, if you have a soul which is absolutely pure, you will never ever suffer from any illness. Health will be yours for the asking'. The West has realised this now. A recent study of people working in the White House and in Scandinavia showed very clearly and unequivocally, that the most important risk factor of heart attack is frustration and hostility. When you hate somebody, that is the time blood clots inside your blood vessels blocking it and giving you a heart attack. It is not the block in the vessels that the doctors show you in the angiogram, for cosmetic reasons that kill you. What kills you is not what you eat. It is not the cholesterol. What kills you is what eats you - the negative thoughts in your mind. Studies have shown that greed and hatred have an effect on the heart. Frustration and depression can lead to cancerous growth and anger can cause a stroke. This brings us back to Ayurveda that has talked about spirituality. 'Eat in moderation. Work very hard. Never tell a lie, backbite, cheat, and hate'. You may say, I don't hate anybody but somebody hates me. Forgive him for he doesn't know what he is doing. Ayurveda prescribes what Bhagawan has been saying all through, 'treat everyone in the universe as your near and dear ones, diseases will never come anywhere near you. Ayurveda also explains why we get diseases. 'Every single disease comes from the mind'.

The latest in quantum physics tells us if you split every human being, we all become small, little, jumping leptoquarks. A leptoquark is small particle. A human being is just a bundle of jumping leptoquarks that never stop. Though you look solid, there is nothing solid about you because every leptoquark is bombarding around its nucleus. Now that is what Shankara said -you and your neighbour are not two people. It's an illusion. You are the same. Jesus said Love thy neighbour because you and your neighbour are the same.

No doctor can actually heal a disease. A doctor can probably give you a medicine, but the healing has to be done by your immune system. The immune system gets provoked by compassion. What kind of compassion? Universal compassion. When you love someone and want to do something for someone, if you check your CD4 T cells - an index of your immune system - the CD4 T cells would have gone up. The minute you think of helping anyone sincerely, your CD4 T cells go up. When you want to destroy somebody your CD4 T cells go down. So, health is in your hands. What does health require? A mind that is evolved, clean drinking water, and good food three times a day. You must go to the villages and see. They drink the water from a pond in which children ablute and women wash clothes. How can you have good health there? 80 per cent of the gastro-intestinal diseases come from polluted water. Have you heard of hospitalism? Before 1854, a large number of people who went into a hospital in the West, never came back alive. Going to a hospital was like performing your last rites! This was called hospitalism. Florence Nightingale asked the British Government to build the St. Thomas hospital in London across the Thames. She said, "I want a pavilion court and a high ward where there is cross ventilation". She just gave the patients clean air and good food. Before she introduced the cleanliness, wounds often turned into sores and many of them led to gangrene and caused the death of the patients. She changed that and brought the high hospital mortality rate down.

Healthcare should not depend on doctors and hospitals. Healthcare should depend on the simple needs of healthcare. It has nothing to do with medical care at all. When healthcare fails, we require medical care. Medical care is the quickfix that you make to mend a broken glass. It does not make the glass normal again. Healthcare is something that preserves health. There is a difference between the two. What we need is more than all the infrastructure is a change in the mind. This change in the mind can be brought about through the education system.

Our education system sows the seeds of anger, frustration and pride in children. We need to change it and make it very simple. It should be subsidised with internal intuition based subjective education, which is simply, who am I? Why am I here? Whither I am going?

One definition of spirituality is sharing and caring which is identical in every religion. Religion is not what we need. We need spirituality. And spirituality is alive every one in this world. Now most of us meditate in the morning and then in the rest of the 23 hours in the day, we only think whom to cheat. All the good that you get after meditating for half an hour is undone. You can meditate all the time if you follow the path of universal compassion Baba has been selling to the world. If you think of compassion as your being, your breathing changes. When you are angry, you breathe fast. When you are filled with love you breathe slow. Just bringing down your breathing rate has shown to improve the condition of advanced heart patients.

We need to give our children, the future generation, a good, compassionate education, and provide the society with water, food, smokeless houses and create economic empowerment among the masses.

Source: http://www.srisathyasai.org.in/sssihms/Pages/Events/speech.htm

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