Children Need Children's Hospital

Globally, how did paediatrics originate as a speciality? How does India compare in terms of primary and tertiary care in paediatrics?

Paediatrics as a speciality has been in existence for over 400 years. The first paediatric hospital globally, Hôpital des Enfants Malades, was started in Paris in 1802 and was taking care of patients up to the age of 15 years. Currently, children’s hospitals worldwide are of substantial size in terms of beds, with 500-600 beds in the larger ones and 150-200 beds in mid-sized ones. In the United States, there are 250 children’s hospitals — one children’s hospital for every 20 adult hospitals. As much as 97 per cent of all children’s operations in the United States are done in children’s hospitals, including complex procedures like heart surgeries, brain surgeries and organ transplants for children. 

In India, paediatrics as a speciality has come up in the last few decades. In the early days, children’s hospitals were mostly run by trusts or the government sector. In the last two decades, a visible trend witnessed is that of paediatric-focused hospitals and also mother and baby boutique hospitals in the private sector. These hospitals have come up mainly in metro cities across the country. However, children’s multi-speciality focus to address the tertiary and quaternary care is still in the nascent stage even in the large metro cities. While paediatric hospitals in the government or trust segments continue to serve a large number of paediatric patients from all sections of society, they clearly have not progressed in offering complex multi-speciality care as well as quaternary care for children. 

The government could start pushing primary care under preventive care, and by infusing technology and expertise to secondary care, hastening the process of upgrading secondary care into tertiary care.

What prompted your decision to choose paediatric care in your medical practice?

Hailing from a village of Southern Andhra Pradesh and having spent my formative years there, I witnessed children being taken to Chennai, which was around 150 kms away, either by ambulance or any other available mode of transport. Even so, the number of children were restricted owing to logistical reasons. 

Paediatric care was never a prime focus and was always seen as a unit of multi-speciality hospitals. This could partly be due to the low finan￾cial viability of such a dedicated care centre. All this gave me a glimpse of children’s sufferings and the need of a dedicated children’s hospital in the neighbourhood. 

Post my education, when I started working at the Royal Free School of Medicine, King’s College Hospital and Great Ormond Street Hospital for Children, London, I got a deep insight into what could be expected from a children’s hospital. This strengthened my resolve and triggered in me the desire to start a chil￾dren’s hospital back home in India. 

As children are the future of any country, we cannot afford morbid￾ity and mortality to affect them owing to lack of appropriate dedicated medical facilities. The better medical care accorded to needy children, will help the nation in the long run in building a healthy society. With this vision, I ventured into starting the Rainbow Children’s Hospital in Hyderabad. 

Would you say that you have achieved the objectives you set out for?

My experience of working with the National Health Services, UK for a long period, and also having worked in one of the world’s best children’s hospitals like Great Ormond Street Hospital for Children in London, has given me a deeper understanding of the concept of child healthcare. We conceptualised a multi-disciplinary approach with a team of well qualified doctors working together on a full-time basis, coupled with a child-centric environment with advanced medical infrastructure and trained paramedics. This resulted in delivering great care to salvage many sick new-borns and children. We further envisaged building multi-speciality paediatric services to make it a comprehensive paediatric multi-speciality hospital. This was our fundamental core philosophy of building the Rainbow Children’s Hospital and this concept strengthened over time with newer innovations and finally, we are able to today offer quaternary care services like heart surgeries, brain surgeries and paediatric organ transplants like liver, kidney and bone marrow transplantation. We have worked as a team on these fundamentals and were able to build a robust children’s healthcare model and also, we realised the need for perinatal services to integrate within the children’s hospital to address neonatal medical and surgical problems seamlessly without any delay.

The model which Rainbow adopted to build its robust children’s multispeciality care is very similar to the best children’s hospitals in developed countries like United States and Europe. The predominant feature which makes children’s hospitals unique is the multi-disciplinary approach and 24/7 consultant-led services, because children’s hospitals are always an emergency-based healthcare service. Congenital heart diseases account for ten out of every 1000 births, so more than 200,000 babies are born every year with congenital heart disease and approximately one-fifth of these infants are likely to have a serious birth defect, requiring intervention during the first year. We, therefore, set up Rainbow Children’s Heart Institute, an exclusive cardiac centre for children, at Hyderabad. Based on our learnings, we are keen to strengthen training programmes at our hospital chain for paediatric surgery, paediatric anaesthesia, paediatric neurology and other paediatric specialities. 

As adult multi-speciality hospitals grow significantly to the increasing needs of multi-speciality for adults, the focus on children is always left behind. As children’s medical needs grow multi-fold, right from problems of new borns to genetic, congenital and many acquired diseases have to be addressed very differently. Therefore, the world has recognised this and built children’s hospitals for children-only healthcare needs. 

What we envisage is to integrate perinatal services within the children’s hospitals to make them comprehensive multi-speciality hospitals so that they are able to address all their medi￾cal needs, beginning from the unborn child to adolescents.

Rainbow was started over 20 years ago and is now a hospital chain with over 1,600 beds and 640 doctors. Today it successfully discharges over 70,000 patients per annum, of whom over 12,000 very sick patients from the NICU and PICU and are doing 14,000 low risk and high-risk deliveries together. We are performing paediatric surgeries of which 85 per cent are laparoscopic. Children are able to feed within six hours of these surgeries. 

The push for making the women and children segment the forte of healthcare in India can come from the private sector, trusts and governments. All the three structures combined might be able to do better justice than a push in bits and pieces.

How is a children’s hospital different from other multi-speciality hospitals, in terms of facilities and technology?

A child is not a miniature of an adult. The first three years of life are the most vital for human development. As much as 97 per cent of the brain grows during this age. Their acquisition of the learning and development milestones, psychological and emotional development etc. are at maximum pace during this age. Any infection or disorders at this stage will have a serious impact on the rest of the life of the child. In children, many genetic and metabolic conditions that manifest predominantly in the first two years of life and their vulnerability to infections are different to those of adults. Therefore, paediatric medicine evolved as an independent medical speciality to treat children. Children’s hospitals are built very differently from multi-speciality hospitals, as a child-centric environment becomes the essence of the hospital. Its design and settings are kept friendly for children to feel comfortable. 

The doctors and nurses are trained to examine the children in an informal and playful way. The doctors at children’s hospitals don’t wear coats or aprons and their attire is completely civilian. All this is done to create an environment in the hospital that is acceptable to the child. In a children’s hospital all the clinical gadgetry is completely child-focused. Many technologies are different from those in adult hospitals, right from the beds to essential equipment, everything is specialised.The children’s equipment is size appropriate and caters to the specialised needs of a child. Technological solutions are often expensive in a children’s hospital as the technology is finer and superior compared with those of adult hospitals. It is very difficult to integrate children’s centres in a multi-speciality hospital due to the dominant adult environment. 

Would you like to tell us about the research and development that Rainbow Children’s Hospital is undertaking?

Rainbow takes pride in delivering great care to save the sickest of children and the tiniest of babies and also in training young doctors in sub-specialities. We are investing in human capital, with many of our doctors doing exceptional work. Training plays a major role in a developed country like ours. Rainbow runs one of the largest paediatric training programmes within the country for DNB paediatrics programme and fellowship programmes in intensive care services as well as paediatric super specialities for over 200 trainee doc￾tors as of September 30, 2021.

We do a lot of scientific research as well. Our doctors regularly publish their research papers in peer reviewed national and international journals and have published 115 research papers since 2019. We have made huge progress with 85 per cent of our total surgeries being laparoscopic even in tiny new borns. I am happy to say we have largely moved towards advanced laparoscopic surgeries to lessen the post-operative pain and babies can be fed as early as six hours after surgery.

The hospital chain has been consistently investing in and striving to develop technologies with an eye on improving outcomes. I take pride in the fact that a device invented and patented by Dr Koneti Nageswara Rao, Director, Rainbow Children’s Heart Institute, addresses critical heart conditions in children. The device, called KONAR- MF– Nitinol Occluder, is used to close ventricular septal defects and other holes in the heart and abnormal ventricles. This device is being utilised in more than 60 countries across the world to treat patients with congenital heart defects.

What are the expansion plans of the Rainbow Children’s Hospital chain in the near future?

Rainbow Children’s Hospital comprises 14 hospitals and three clinics in six cities, with a total capacity of 1,630 beds. Our paediatric services under ‘Rainbow Children’s Hospital include new-born and paediatric intensive care, paediatric multi-speciality services, paediatric quaternary care (including organ transplantation); whereas our women care services under ‘Birthright by Rainbow Hospitals’ offer perinatal care services which include normal and complex obstetric care, multi-disciplinary foetal care, perinatal genetic and fertility care, along with gynaecology services.

The company follows a hub-and-spoke operating model that is successfully operational in Hyderabad and is gaining traction in Bengaluru. The endeavour is to replicate this approach in Chennai and across the Na￾tional Capital Region. Rainbow intends to significantly expand its presence in existing cities by fortifying hubs and adding additional spokes. Subsequently, Rainbow intends to expand into tier-2 cities of Southern India in the states of Andhra Pradesh and Tamil Nadu. Rainbow is also exploring an opportunity to open a hospital in North East India.

How do Indian medical professionals fare globally?

Across the globe today, Indian doctors are among the most competent and respected medical community for their skill and commitment. Indian doctors have occupied key positions in some of the world’s best hospitals and are also engaged in research and innovation. The robust Indian healthcare would not only address our fellow Indians but also address many of our neighbourhood and developing countries, which depend on our healthcare system. I personally believe that we have a huge responsibility as a nation to offer our superior, yet affordable medical services not only to our country but also to several other developing nations, dependent on Indian healthcare services.