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A one-stop state of the art, non-profit healthcare facility in ,

In 2001, a non-profit healthcare facility was founded in Pune India, providing low and middle income group patients with treatment, not only at a minimum cost, but of a quality which bears the stamp of approval by the Royal College of Surgeons of England. Mr Vasant Oswal, an integral figure in the evolution of the hospital, speaks to other key members involved in its development.

eenanath Mangeshkar Hospital (DMH) is a 1000-bed hospital in Pune, India, with a 25,000 square Dfeet dedicated postgraduate study centre which has established several surgical training courses. In recognition of their high educational quality, Royal College of Surgeons (RCS) has awarded the facility accreditation as ’a Centre of Surgical Education and Training’ making it the first centre to achieve this status in India. The RCS has also approved the first overseas RCS Senior Clinical Fellowship at the laryngology department of the hospital for a period of three years. Inauguration of Vasant and Nirmal Oswal Centre for Postgraduate Training. From right to left: Prakash Jawadekar, Union HRD From left to right, Dr Sachin Gandhi, Mr Paul O’Flynn, Mr Vasant Oswal, Minister, Government of India presenting bouquet Mr Prakash Javadekar, Dr Jay Kelkar. to Nirmal Oswal.

Dr Dhananjay Kelkar, (52 neonates and 12 paediatric) caters for Medical Trust to establish, administer and Medical Director, critical care. Robotics and an extension of the promote the healthcare facility, with the stem cell transplant facility is in the pipeline. aim of providing a one-stop state of the art Hospital, Near Mhatre Bridge, Erandawne, Pune, diagnostic, therapeutic and intensive care 411004, India. Background facility at an affordable cost to the lower The Jnana Prabodhini (JP), established and middle income group (LMIG) patients. in 1962 and located in Pune, is the brain So, how did we make a start? Legendry child of educator and visionary, the late Ms - a household name Dr VV Pendse. Jnana Prabodhini means for her melodious singing voice in the ‘awakener of real knowledge’ in . world-famous Bollywood film industry Deenanath Mangeshkar Hospital is the It is an organisation of a conceptual social - proposed, along with the rest of the largest non-profit multi-specialty hospital, movement. Its doctrine is ‘motivating , the development of a founded in 2001 in Pune, India. Its focus is to intelligence for social change’; its aim, to medical facility as a memorial to their late provide state of the art diagnostic, therapeutic overcome socioeconomic, religious and father, Deenanath Mangeshkar, who passed and intensive care facilities at an affordable political dogma and develop physical, away in 1942 in Pune. We were confident cost to the lower and middle income group mental, intellectual and spiritual qualities clientele (LMIG) in a one-stop medical centre. that the community would support the of the youth from all socio-economic The advanced medical facility includes joint cause when we had a clear goal in mind. A strata of the society. A school, called Jnana replacement surgery, paediatric cardiac famous axiom of Mahatma Gandhi, ‘find Probhodini Prashala, was established to surgery, liver transplant, voice clinic, shoulder purpose, the means will follow’, could not create a congenial atmosphere, enrolling and sports clinic, and bone marrow and stem intellectually gifted boys and girls. The be more apt. Six acres of land was made cell transplant unit for leukaemia patients. resultant titre was an even-minded, available, at no cost, by the Government The hospital has a capacity of 1000 beds, 500 balanced and dedicated body of workers of India. Nearly one third of the budget of which are super-specialty beds. Annual who would competently overcome any flowed in from a multitude of donors - rich overall outpatient attendance is 300,000 contingency and bring about a desirable and poor, commoners and distinguished, with 50,000 admissions keeping 20 operating change in humanity. The former students Indians and foreigners - inspired by the theatres busy six days a week. An intensive of this unique institution came together concept and promoted by their beloved care unit (ICU) consisting of a total of 105 beds under the banner of Jnana Prabodhini ‘Queen of Melodies’, Lata Mangeshkar.

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promotes and implements clinical and biomedical research in diverse areas. Current international collaborations include: the Department of Pediatrics, University of California, Los Angeles (UCLA), USA; the Department of Clinical Biochemistry, University of Aarhus, Denmark; and genomic profile of betel nut / gutka chewing-associated oral cancer in collaboration with UCL Cancer Institute, UK.

Our message We feel that our successful model of Inauguration of phase one in 2001 by Mr Bajpai, former Prime Inauguration of second phase of Deenanath Mangeshkar Minister of India. Hospital in 2014. Front L-R: Lata Mangeshakr and her sister, high-quality treatment at an affordable . Behind L-R: Mr Narendra Modi, Prime Minister of cost, research and education will be an India and Dr Jay Kelkar, Medical Director, DMH. inspiration for our profession here in India and many other countries to follow.

Department of Laryngology

Dr Sachin Gandhi, Chairman and Director of department of Laryngology, Deenanath Mangeshkar Hospital, Near Mhatre Bridge, Erandawne, Pune, Maharashtra 411004, India.

Prime Minister of India, Mr Narendra Modi, delivering a talk at the inauguration of phase two in 2014. Behind him L-R Lata Mangeshkar’s brother, Pandit Rhudaynath Mangeshkar; sister, Asha Bhosle; and Lata Mangeshkar herself.

The Green building technology eagerness to ensure standards, we followed The laryngology department in DMH has protocol of the RCS who provided much In designing the facility, we were cognisant several facets: support. This led to an award of ‘centre of the extant buzz word: ‘eco-friendly’. Phase Outpatient and surgical facility: In any accreditation’ for surgical courses run by the one accommodation uses natural light and clinical set-up, an accurate preoperative DMH, a quality assurance to all our patients ventilation, thereby minimising energy costs. diagnosis forms the backbone of the irrespective of their ability to pay for the Phase two, the super specialty wing, is built management strategy. High definition video high-quality care. DMH is the only medical with green building technology. It generates laryngostroboscope, computerised speech facility in the whole of India to receive this electricity from compressed natural gas. The labs, digital swallowing workstations, prestigious award. Our ultimate ambition heat generated from this electricity is used Transnasal Oesophagoscope (TNO) and is for DMH to become an international for vapour absorption and cooling to reduce high-speed cameras – the ultimate in centre for FRCS examination, research air conditioning costs. There is a dedicated technology – give us a high degree of collaboration and resident exchange sewage treatment plant for the recycling, precision in diagnostics for airway and programme. purification and distribution of water and swallowing disorders. This is further solar energy for water heating. supported by on-site imaging with digital Academic activity scans and PET. We are a tertiary referral Revenue generation Deenanath Mangeshkar Hospital centre, with an annual workload of over Being a non-profit facility, we never turn Research Centre (DMHRC) is housed in 1200 new referrals, drawing patients from away the patient on the basis of care not an area spanning over 25,000 square all over India and surrounding countries. being affordable. How do we do this? feet. It also accommodates the Centre A quarter of those are in the paediatric We recover full costs from 60% of the for Postgraduate Education and Training. age group. Nearly 50% of all new patients patients. Surplus is then diverted to provide The research centre regulates, facilitates, need surgical procedures; a rather high treatment to 20% at zero cost and to a proportion, due to tertiary referral status. further 20%, at a subsidised cost. All our anaesthetic colleagues have undergone specific training to provide Quality assurance “The DMH project and expertise for our cases. This means that we Our initial project was to provide a state the education are an can provide 24-hour high-standard surgical of the art facility for patients’ services and cover for critical patients at any hour from needs. However, a concept of teaching and example of what can be our vast patient coverage all over India and academic activity as a hallmark of high surrounding countries. We do not undertake standards evolved and was embraced by the achieved when willingness, office-based therapeutic manipulations medical staff as stamp of their professional opportunity and direction due to patient non-compliance. Operating integrity. A number of departments suites are fully equipped with UltraPulse established teaching courses. In our come together.” carbon dioxide lasers, high frequency jet

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ventilation and diode lasers. In common with the valued the individualised supervision during the universal trend, early glottis cancers undergo skill-based exercises. On the recommendation surgical excision as primary modality. Dedicated of the panel, the council awarded accreditation AUTHOR histopathologists provide frozen section reports as ’a Centre of Surgical Education and Training’. and expert evaluation of accurately oriented This is the highest award to the institution as a excised specimen. whole for the provision of a portfolio of courses. DMH is the first centre in India to achieve the Postgraduate education and training accreditation. The RCS looks forward to a long We run a postgraduate training programme collaborative relationship with the DMH. with an intake of four students per year. We also have two fully funded university-accredited annual fellowships in advanced laryngology. Additionally, we have run two-week courses for Mr Vasant Oswal, MB, MS, surgeons seconded by Iraqi Government. Apart Prof Paul O’Flynn, FRCS (Eng), FECS (Ed), DLO, from ongoing teaching, we also run intensive MBBS, FRCS, FASE(RCS), DORL, three-day hands-on annual training courses, Emeritus Consultant Consultant ENT / Head and Otolaryngologists, H&N Surgeon, accredited by Maharashtra Medical Council Neck Surgeon; RCS Council James Cook University Hospital, on voice, airway and swallowing disorders. The member; Chair of RCS England Middlesbrough, Cleveland, UK. hands-on surgical training is provided in an QA and Accreditation; Hon Professor, Deenanath E: [email protected] advanced simulation and surgical training lab, Mangeshkar Hospital, Pune; Regarded as pioneer in laser surgery equipped with laser, microscope and simulation FRCS examiner. in ENT in the UK, Mr Oswal has written lab. As part of the centre accreditation awarded to widely, authored and edited three DMH by The RCS, our laryngology courses are also books on lasers in ENT, and trained accredited; a testimony to the high standard we hundreds of surgeons in Cleveland International Laser Courses for over strive to maintain. The RCS has also approved the 25 years. He was at the helm of ‘ENT fellowship programme in laryngology for a period News’ as Editor in its formative years of three years. This is the first overseas RCS Senior As Chair of RCS England QA and Accreditation, during 1993-97. He took a major Clinical Fellowship to have been approved by The I acknowledge the devotion of the staff of the initiative in developing a world-class facility in laryngology in his home DMH to education and training undertaken RCS anywhere. town in Pune, India in a non-profit in a superb dedicated postgraduate centre. 1000-bedded hospital, the very first in Laryngology – an expanding super- The clinicians work entirely as honorary India to receive accreditation, ‘Centre administrative board members and derive for Surgical Education and Training’ by specialty? Royal College of Surgeons of England, their income only from their clinical work as We believe so. In the past 20-odd years, high- who also awarded him Fellow by per schedule of charges. The DMH project and Election in 2014 for his contribution tech instrumentation and equipment in this the education are an example of what can be to academia, spanning over half a field has done much to better our understanding century. achieved when willingness, opportunity and and management of this important functional direction come together. This is especially organ of the body. Dedicated airway, swallowing laudable when the facility is formulated on a and voice centres are being set up in lower and non-profit basis. middle income group countries (LMIGC). With On a personal level, I commend Vasant our advanced centre, and The RCS approval of Oswal’s untiring input over the past 15 years. our training courses, we are well placed to play From its very inception, he supported this an active role to support development of such hospital in his hometown Pune. He has been centres by training the trainers, to facilitate instrumental to bringing it to the forefront of accreditation processes by Laryngology and technology, innovation, quality education and Voice Association (LVA), more suitable for training, and particularly the most advanced LMIGC. laryngology set-up, comparable to any reputable establishment around the world.

Salim Nazir, Head of Quality Assurance and Accreditation and member of the RCS England Panel, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London, WC2A 3PE, UK.

We visited the DMH on two occasions. We were impressed by the significant expertise of the faculty. The training – both formative and summative – was the key strength. The trainees

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