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R Research Visible Signs of Life and flow in the Media intelligence is a critical cornerstone to understanding and prominence of managing corporate reputation. Reputation drivers are found different issues, the everywhere; and as media becomes more complex and increase suggests that health fractionalised, the ability to understand media exposure and issues have become a permanent benchmarking become increasingly important. We will be analysing fixture on the national agenda. As health media exposure across the country, in each issue of Rx Ramble, to care has become big money and big league understand the predominant trends in media with regards to health politics, news media coverage has followed suit. related policies and issues. Chart 1 : Health-related media coverage by year Media Analysis: Is editorial space for health issues in Indian Media on rise?

The last few years have seen large investments in several healthcare facilities and health infrastructure. Since the First five-year Plan, efforts were made to build up primary, secondary and tertiary care centres and to link through an appropriate referral system. National programmes for combating major public health problems were created and implemented. ’s achievements in the health front are significant, particularly in attainment of development indicators i.e. reduction in birth rate, death rate, infant mortality rate and increase in life expectancy. 2. The nature of the health stories have moved from being issue based to lifestyle based Our aim in this research was to analyse whether this increased attention on health issues translated into elevated media interest The health stories have evolved from being issue driven towards in the same. We have researched the health coverage for last four soft features on Chart 2 : Nature of health coverage years across a selection of media. This included 8 major national lifestyle diseases 2003-2004 English dailies (, , , (Chart 2). Many Economic Times, , , Midday and Deccan have Chronicle), 8 language dailies (, , Amar introduced health Ujala, , Anandabazar Patrika, Thanthi, Dainik Jagaran, columns recently, ) and 3 broadcast network (NDTV, Aaj tak, CNBC) . which focus on Following are some of the key findings: ‘wellness and 1. The amount of coverage devoted to the big health care healthy living’. The issues increased over time. focus is on There has been a quantative increase in the number of stories featuring the devoted to health issues (Chart 1). While there is always some ebb ‘pleasant’ news.

1 The issue-based coverage is primarily driven health has increased suggests that health by irregularities in various healthcare systems issues have gained a firm foothold on the R Speaks and also on various diseases. For example media agenda. Due to the HIV/AIDS have got a substantial amount of multidimensional nature of healthcare Congenital heart coverage in recent years. Other major news and the lack of specialists, news healthcare stories are related to Government organisations need to focus on the quality disease is curable Policies (6 per cent) and industry or disease of the coverage. Nearly 150,000 to 180,000 children are born (18 per cent). b. The focus is rising on the CSR with Congenital Heart Disease (CHD) every year in India. Of these, nearly 60,000 to 3. Corporate Stories are business programmes, which will play an important 90,000 suffer from critical CHD requiring driven part in the company’s communication early intervention. However, only 10% of strategy in near future. The community Media coverage on corporate houses or the children are operated on in a year! This based organisations and community healthcare providers are largely business- is because parents are mostly not aware of gatekeepers will have an increasing voice oriented stories, which focus on expansion, facilities available with in the country and in campaigns touching the society at large tie-ups, new investments etc. Corporate many physicians are not aware of the recent developments in the specialty. Social Responsibility (CSR) programmes are c. A greater focus on the ‘wellness’ stories also a key focus area . by the media will open opportunities for What is Congenital Heart various small players in the domains like 4. Broadcast focuses mainly on Disease (CHD)? health, fitness, alternative therapy etc. ‘wellness’ stories Although pediatric cardiac care in India is to gain media attention. However, the still in its infancy there have been several There are some differences in the way print advantage will be for the first movers. encouraging developments. Congenital and broadcast media cover health issues. heart diseases (CHD) refers to structural or d. The communication strategy for large Broadcast news is less likely to cover patient functional heart diseases, which are corporations in the healthcare space care than national newspapers, and a little primarily seen in neonates, infants and needs to focus on their campaign goals, more likely to cover lifestyle health stories children. (In our country it is not uncommon strategies and key messages, keeping in and the irregularities. Wellness and fitness to see adults with uncorrected CHD). The mind the existing media opportunities. issues are covered by all mediums but more burden of congenital heart disease in India is likely to be enormous, due to a very high on the broadcast medium. e. Corporates need to look at crisis birth rate. The incidence of CHD is about 8 communication plans more seriously 5. Corporate story possibilities are per 1000 live births. Most of these children given the large number of reportage on relatively higher in print mainline can benefit from surgery even if the defect irregularities. The health care sector is is severe. Given correct diagnosis by a As the research shows in Chart 3, the deeply mired in crises related to safety, pediatric cardiologist, 95% of those possibilities of corporate stories are quality, cost and access that pose serious diagnosed with heart defects can survive relatively higher in the English print media threats to health and welfare. It is vital with a good lifestyle and life expectancy. than any other form of media. for the companies to develop a clear-cut There are an assortment of defects that communication policy for any crisis range widely in their severity and effect on Chart 3 : Coverage of each topic by Media scenario. normal daily activity. Defects vary in severity from simple problems such as hole in the f. Media campaigns can be heart to more severe abnormalities such as effectively used to build up public the complete absence of one or more opinion and healthcare companies chambers or valves. 2-3 per thousand should look at the opportunities to infants will show signs and symptoms of develop forums to build national heart disease in their first year of life. Out discussion on subjects, which are of these 100 can be diagnosed at the pre of national interest. For eg. natal stage. Medical and surgical advances Spearheading a campaign against now allow many of these children to survive spurious drugs. into adulthood. The specific cause of CHD is unknown but research has proven that the 6. Health coverage follow the trend We have a new website! The data suggests that overall, coverage of health care issues follow rather than lead We are pleased to announce the launch of our new website. In an ever changing world of healthcare national discussion and debate. communication this website will serve as an anchor, a reference point for future trends, happenings, and much more. The interactive website will serve as a forum for the healthcare community with What’s there for you? the facility of uploading articles, receiving updates, and answering queries. a. The fact that the number of stories on Come visit us @ www.imprimispr.com

2 causes are incidental and have a 3% by anxiety, hyperventilation, and a sudden are non-invasive tests and 99% of the reoccurrence rate. increase in cyanosis. patients do not need an angiogram. An echocardiogram, or ultrasound of the heart, The common forms of acyanotic CHD are Types of congenital heart is a test that uses sound waves to create those where there is a defect in one of the disease images of the heart. From this test, much walls separating the chambers of the heart, can be learnt about the heart’s structure and There are many types of congenital heart or obstruction to one valve or artery. the blood flow within the heart. There are no defects. The main types are categorised into Ventricular septal defect (VSD) is a hole in known risks from exposure to ultrasound either acyanotic or cyanotic categories. the partition, or septum, between the two waves and it takes 20 to 45 minutes.The Cyanotic Heart Disease occurs when there is lower pumping chambers (ventricles) of the oxygen saturation test, which measures mixing of pure oxygen-rich blood with venous heart. This is the most common acyanotic oxygen in a child’s blood, is entirely painless. blood. Infants suffering from cyanotic congenital heart defect and is common conditions usually have blue nail beds and among children in India. How are they treated? lips due to the excess deoxygenated blood in Children with a VSD often will have a loud their systems. One symptom is cyanosis, Recent progress in diagnosis and surgery heart murmur after the first month of life. usually seen as a bluish discoloration of the makes it possible to repair most defects in the Early in the newborn period, the pressure in lips, fingers, and toes. Some children have heart, even those once thought to be incurable. the lungs and the right ventricle are higher dyspnea (breathing problems) and adopt a As a rule, serious heart defects are diagnosed than usual. This high pressure in the right squatting position after physical activity to in infancy. However, some defects may remain ventricle prevents a lot of blood from crossing relieve breathlessness. Others have hypoxic undetected till the later stage. the VSD in the first days and weeks after the spells, where their bodies are suddenly baby is born. The heart murmur at this time Surgery is recommended if congestive heart starved of oxygen. These are characterised may be very soft, or absent, and the baby failure persists or the baby does not gain Echocardiograms available in India may not have any symptoms. When the lung weight well even on maximal medical Fetal Echocardiogram: an ultrasound of and right ventricle pressure begin to fall to treatment; persistent high pressure in the a baby’s heart done while the baby is in normal to low levels, more blood will cross lungs due to the VSD is likely to cause the mother’s womb. A fetal the VSD and the heart murmur will get louder. permanent damage or there is no evidence echocardiogram may be done any time Additionally, the baby may have the following that the hole is closing by itself. The surgery after the 18th week of the pregnancy. Prior signs: can be traditional i.e. open-heart surgery or to this time, the baby’s heart chambers ! Difficulty in feeding and sucking catheter angioplasty. The former always are too small to take clear pictures. needs to be used for a combination of lesions Transesophageal Echocardiogram ! Sweating i.e. a hole with a block to blood flow (e.g. (TEE): a special ultrasound test that uses ! Inadequate weight gain Tetralogy of Fallot’s). Over 500 infants, sound waves to take pictures of the heart. ! Increased heart beat This type of echo can take clearer pictures children and adolescents undergo surgical of the heart than regular ultrasound ! A ‘thrill’ felt when a hand is placed on the correction of various heart defects every year. especially in older children and adults. It baby’s chest, In addition over a hundred children undergo is also used during heart operations to help ! Difficulty in breathing non-surgical treatment of various heart guide the surgeon. ! Recurrent chest infections defects using the newer modalities of device Intracardiac Echocardiogram (ICE) closure, balloon dilatation and stents. ICE is performed for specific procedures What are the tests for to facilitate non-surgical (i.e. diagnosing a heart defect? Reason for hope interventional) closure of a hole in the heart. This is a specialised procedure An echocardiogram, X-ray and the oxygen Heart disease in children need no longer have performed invasively for better saturation test, which are now widely the morbid tag that it held several years ago. visualisation of the defect and its 3-D available all over the country, can readily Parents need no longer fear surgery as it structure and relationships. confirm the presence of a heart defect. These offers much greater chances of survival. Some of the pediatricians especially in rural and semi urban areas still believe that a child Interface with ventricular septal defect can only be Deepalaya is a community-based organisation committed to the operated after he or she attains a weight of welfare of street children through various programmes such as 10 kg. However, the latest advancement in Indian medicine has allowed the pediatric non-formal and formal education, vocational training, health check cardiologist to cure newborns weighing 1.7 ups and recreation. Deepalaya’s current programme reaches out kgs! Today even a one-day baby can be to 13,000 children in New Delhi. Deepalaya believes in the right of every child to have a treated for CHD. childhood, complete in all aspects - where he/she has the right to survival, protection, development, respect, opportunities and participation in his/her growth and development. The safety of corrective surgery even in these small babies exceeds 95 per cent. It is vital You can contact Deepalaya at: to remember that treating heart disease in 46, D Block, Institutional Area, Janak Puri, New Delhi - 110058 children needs a dedicated team of specialists Phone: 91 11 2554 8263/90347/ 2559 0348, Fax: 91 11 2554 0546 including a paediatric cardiologist, pediatric e-mail: [email protected], website: http://www.deepalaya.org cardiac surgeon, pediatric cardiac anesthetist We request you to reach out to them … and paediatric cardiac intensive.

3 on its hands. The media will contend that Research shows that this creates a vicious R Tools the hospital should have taken steps to circle: Anger often motivates patients or ensure safety. And, isn’t it is easier to survivors to file medical malpractice suits, Medical Melodrama! place blame on a faceless organisation thus attracting negative publicity. rather than a person? Aman Gupta This makes it critical to enhance This is where effective communication can The numbers of cases on malpractices communications between physicians and play a crucial role in defending reputation. in healthcare have been growing steadily patients to establish credibility. Active each year. Malpractice may arise from a An organisation has to look at sustained communication with patients will bring professional’s misconduct or failure to communication on a broader perspective patient expectations in line with reality, use adequate levels of care, skill or to deal with the impending crisis. Firstly reduce patient anxiety and result in a diligence in the performance of his duties they need to create an effective reduction in both the frequency and the that causes harm to another. This gives communication policy about its safety and severity of professional liability claims. rise to a media crisis for both the care initiatives. This should be Good physician-patient communication physicians and the medical institution. incorporated as part of the company/ also enhances patient autonomy, promotes Can keeping communication channels hospital policy right from the start. a better exchange of information, helps to open help the healthcare providers tide Extensive training sessions should be build trust and to avoid medical errors and over the crisis? carried out with safety experts, trainers, litigation, involves a patient in his or her lawyers, supervisors and executives to Medical malpractice is an act of own care, and enhances patient health imbibe “safety” into the work culture of commission or an act of omission. It outcomes. It is time to make good the organisation. From a communication occurs when there is “deficiency in duty communication part of your culture. One towards patients resulting in physical and perspective, involvement of the senior needs to recognise that malpractice issues mental damage or financial loss to patient management is vital in developing these are essentially issues, which are concerned or relatives”. safety policies and procedures and with the quality of medical care delivered. messages thereafter. A planned PR approach, which includes Recently, the Supreme Court directed law measures such as improved enforcement agencies not to proceed In addition, it is important to minimise communication with patients, better record against doctor’s accused of rash or the impact of negative media coverage keeping or consulting with colleagues, will negligent act or omission without through timely communication of the also improve the quality of care provided obtaining an independent and competent organisation’s stand. The organisation medical opinion to support the charges. should encourage an open line of for patients. It is far better to address However this does not help the medical communication and transparency and safety issues before they arise than to institutions in defending themselves shouldn’t be perceived as stonewalling scramble for a position while lawyers and against reputational burden that they information. Many a times, hospitals reporters are waiting in the lobby. would have to carry from any negative fearful of reporters, shy away from candor, press coverage. All it takes is one medical often enraging patients and relatives by (Aman Gupta is the CEO of Imprimis accident, and the company has a disaster offering only basic explanations of errors. Life)

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