Medical professionals are in God's mission

[Guest guest]

Following is the text of the President, Dr. A.P.J. Abdul Kalam's

Address and interaction with the students of Kurnool Medical College

on the occasion of ITS Golden Jubilee Kurnool :

President's address and interaction with the students of Kurnool

Medical College on the occasion of its golden jubilee, Kurnool

Kurnool, India

Removing the pain is a great Mission

" Medical professionals are in God's mission "

I am indeed delighted to participate in the Golden Jubilee

Celebrations of Kurnool Medical College and interact with the

students and faculty members. I congratulate the Kurnool Medical

College community both present and past who have built a robust

educational framework for medical education during the last five

decades. My greetings to the principal, faculty members, doctors,

nurses, para-medical personnel, support staff, medical students and

distinguished guests.

Dear Graduating students, when I see you all, in front of me, a scene

of our country appears which links the new doctors and their role in

the national mission. What is that scene? In our country, 700 million

people live in 600,000 villages equivalent to 200,000 panchayats. We

have 2020 Vision Document prepared by TIFAC, which mentions about the

typical disease pattern which will be faced by the country in 2020.

It is expected that HIV/TB combination, water borne diseases, cardiac

diseases will be the predominant diseases and we have to find

solutions for diagnosing and treatment. Also there are challenges for

researchers for discovering molecule leading to drugs for various

diseases such as diabetics, cancer, allergic diseases, inflammatory

diseases, and certain type of new pattern of diseases in the tribal

sector such as sickle cell disease. Many of you may take up

practising healthcare in various fields and some of you may opt for

research and development. The opportunities for you in the country,

will be challenging equally both in the urban and rural areas. With

the development of electronic connectivity and knowledge

connectivity, and the spreading of health care centres and quality

education we should be able to provide quality health care to our

rural citizens. I am sure many of you will find working in rural

areas to be really challenging.

For example, tele-medicine is a new area, you may find being used in

large number of places for diagnosis and advice. Another area which

is knocking at our doors is preventive healthcare. Some of you may

participate in the research, development and use of vaccines against

HIV, malaria and even against the cardiac diseases. There are several

other avenues such as application of stem cell therapy for many

ailments like treatment of heart failure and diabetics. Students

should be aware of such developments taking place in the country and

elsewhere. I have selected the topic for discussion " Removing the

pain is a great Mission. "

Tradition of Research and Vision

Recently, I met Dr. Cummings, of the s Hopkins University

Board and his team. I asked him, a question which was in my mind, " Dr

, What made s Hopkins a world class medical research

institution in addition to its cherishing societal missions? " His

answer was, " it is due to a great tradition, and it started with a

number of visionaries simultaneously with value system, focused

missions and the nature of working together. The most important

aspect is the research, research base and the quantity of clinical

data added everyday. This tradition continues even now " . Indeed it is

a great message from Dr. . I am sure, every medical

institution in the country should imbibe this culture that comes out

of research tradition, leading to the results of the research

reaching the people in the form of medi-care, medicines or vaccines.

I recall, in India one of the leading institutions in Hyderabad L.V.

Prasad Eye Institute has set a tradition of providing quality eye

care particularly with social commitment of 1:1. 1:1 implies one free

eye care service for every paid eye care service provided by the

Institute. Also, they have a tradition of excellent research in

Ophthalmology and they are spreading the mission to various parts of

the country particularly their research in stem cell which has led to

the restoration of eye sight to 300 patients with burn affected eyes.

Health status of India

India has made considerable progress in its health status since its

Independence and particularly during the last fifteen years. At the

time of Independence, the life expectancy of an Indian was less than

thirty years. Between 1991-2006, the life expectancy of Indians has

gone up from 58 to 64.35 years, infant mortality has come down from

87 to 60 deaths per 1000 live births and population growth rate has

decreased from 1.9% to 1.4%. Still infant mortality is very high. We

have to bring infant mortality to less than 1%.

I would like to briefly talk to you on some of the diseases and

actions proposed and future need. Our experiences will definitely be

shared with the third world developing nations in order to provide

healthcare for all.

Drug for faster cure of tuberculosis

The entire country has been brought under the Revised National

Tuberculosis Control Programme (RNTCP). This will ensure that maximum

number of Tuberculosis cases are detected every year and brought

under direct surveillance. The treating agency must ensure that at

least 80% success in fully curing the disease is achieved within the

year. If this regime is followed continuously for over ten years our

tuberculosis load will come down to less than ten per one lakh of

population. It is essential to work faster on the development and

clearance of new drugs which are in the pipeline. Educational

institutions should also participate in this mission.

India has also made significant contributions in developing drugs

that are critically required for India. One of the achievements comes

from a laboratory of the Council of Scientific and Industrial

Research (CSIR). CSIR lab has developed a new therapeutic molecule

for Tuberculosis. This molecule has shown the potential to cure TB in

around 2 months, as against the standard treatment of 6 to 8 months.

This breakthrough is very important. After completing the pre-

clinical studies, the molecule transformed into a drug called Sudo-

terb is undergoing clinical trials in humans. This development has

been done as a public-private partnership involving the Lupin, the

three CSIR Laboratories, namely, Central Drug Research Institute,

Indian Institute of Chemical Technology and National Chemical

Laboratory, and the University of Hyderabad. It is hoped that the

drug will be in the market soon after the clinical trials. In

addition to the above, there is also a need to develop a more

effective vaccine against tuberculosis. The combined action of

surveillance, detection and disciplined treatment have to work

together to ensure faster cure of existing cases. Prevention of

future cases has to be achieved through R & D efforts of developing

new breed of vaccine and medicines. The collaborative action is

needed between healthcare personnel, academicians, doctors,

researchers and the pharmaceutical companies both in the private and

public sectors to accomplish this mission.

Malaria

Incidence of Malaria has reduced from 22 lakh to 18 lakh in the

period 1998-2006. However, the death cases has increased from 644 to

943. I understand that the conventional medicine used for treatment

of Malaria namely Chloroquin has become resistant to Falciparum which

causes cerebral Malaria. Our scientific community has developed and

produced a drug named Arteether from Artemisinin which has been found

to be an effective cure for cerebral Malaria. I understand that this

drug is being exported to over forty countries. Also, Ranbaxy has

acquired a malarial drug molecule and they are progressing towards

clinical trials. The fully developed drug will be available in the

market soon. This will be another important milestone in the

treatment of Malaria.

Over the years, I find that in spite of our efforts there is no rapid

reduction in the occurrence of Malaria cases in the country. While

taking up new projects, it is essential to have multi-faceted inter-

sectoral collaboration between various partners so that the impact

assessment of the project on new type of diseases can be foreseen and

suitable preventive action taken to contain the disease. In addition

to this, we have to improve the surveillance, develop rapid

diagnostic kit and use the conventional prevention methods of

spraying to control the vector. International Centre for Genetic

Engineering and Bio-technology in collaboration with Bharat Bio-tech

has developed a vaccine for Malaria which will go for toxicity trials

on animals. There is a need to speed up such projects so that they

will benefit the entire community who are affected by Malaria in

different parts of the world. KMC can participate in such missions.

Now, I would like to present HIV /AIDS control.

HIV/AIDS Control

Today in our country, all age groups put together have an incidence

of 5.7 million HIV cases. 163 out of 611 districts in the country

have a high proportion of HIV cases. The scientific community had a

very important mission of determining the genetic nature of HIV that

will lead to its cure. The genetic nature when studied had some

surprises. The retro virus is RNA based and not DNA based. Most retro

viruses have only three genes, whereas the HIV virus had nine genes,

with 9200 base pairs. With this understanding of the genetic nature,

a number of drugs have come in at least to control HIV in as it is

where it is condition. This intervention extends the life of HIV

affected persons. The typical drug which has been developed and

produced abroad is AZT, based on DNA synthesis. It halts the spread

of the disease. Another medicine found is INDINAVIR with equally good

results. A foreign University has tried a combination of AZT-

INDINAVIR and 3TC, for some patients, which gave unique results fully

suppressing the HIV AID virus. Of course research is continuing. I am

sharing this with the young students, to convey that there is a

possibility of controlling HIV and extending the life of patients.

However, the cost of the medicine was so far prohibitive. Indian

companies have already brought down the cost of first line treatment

to an AIDS patient from 12,000 US dollars to 300 US dollars per year.

Similarly, the cost of second line treatment has also been brought

down through the development of medicines such as Viraday a

substitute for Atripla from 12,000 US dollars a month to 110 US

dollars a month. Medical community assembled here should make use of

these medicines so that further cost effective methods can be evolved.

Development of Anti HIV Vaccine

Apart from the HIV control protocol, the most important mission for

the country today has to be the prevention of the spread of HIV

further. There is no other way other than developing and leading to

production an effective anti-HIV vaccine.

Phase one clinical trials of an imported Adeno-Associated Virus based

HIV vaccine was initiated at the National AIDS Research Institute,

Pune in early 2005. Thirty volunteers that were enrolled in the study

and given HIV vaccine will complete follow up in January 2007. The

vaccine has been tolerated well by volunteers and safety is good.

Immunogenicity studies were carried out during the follow up. Results

will be decoded and analyzed after follow up of the last volunteer is

completed. In the event of the successful completion of Phase-I

trials, technology transfer to an Indian company will take place.

Another Phase-I vaccine trial was initiated last year at the

Tuberculosis Research Centre for the Modified Vaccinia Ankara (MVA)

based vaccine developed from the Indian HIV-1 sub type C virus genes.

This vaccine has been developed by Indian Scientists in collaboration

with a US company under the ICMR-NACO-LAVI programme. These two anti-

HIV vaccines have to be completed with a time bound mission mode, as

it is very important for India's HIV control programme. It is also

essential to take up a third fully indigenous anti-HIV programme as a

collaborative work between educational institutions like KMC,

research laboratories and traditional medicine practitioners.

Management of Cardiac Diseases

Multi-dimensional solutions are available for management of the

diseases based on my discussion with experts. The solutions include

medicinal treatment using Statins, which lowers the cholesterol in

the blood by reducing the production of cholesterol by the liver.

Statins block the enzyme in the liver responsible for making excess

cholesterol. However one has to be careful about the side effects and

take adequate precautions while treating the patients. The second is

through angiography and angioplasty using stents. I understand that

very soon we may have bio-degradable stents. The next generation

stents may be nano-stents. If the heart blockage is severe, valve

defect and death of cells in the heart due to less blood supply etc.

surgical intervention will be necessary or it may lead to treatment

using stem cells.

Non-invasive treatment for Coronary Artery Disease

Today, I find that cardio vascular treatment moving towards a totally

non-invasive treatment using EXTERNAL COUNTER PULSATION (ECP), a

truly non-operative, non-pharmaceutical, safe and effective treatment

which is being used in many countries. In India also a few centres

have come up. This is a ripe area for research of the faculty members

and students of KMC, Kurnool.

Conclusion

Human disorders can be classified into three broad categories. They

are genetic disorders, disorders due to cellular function deficiency

and disorders arising out of certain pathogens. I recommend intensive

research for developing and producing cost effective treatment regime

for the above categories of disorder through

(a) Gene therapy and gene chip research

( Stem cell research and

© Combination vaccine and pathogen specific antibiotics

This could lead to cost effective and safe treatment for the needy

and improve the quality of life of mankind on this planet. KMC can be

a partner in some of these research areas.

Recently, there was a meeting of cured patients, their doctors and a

few social workers. One important point emerged during the

interaction was that the relationship between the patient and doctor

extends to patients' family. This in turn, transmits effective

messages from one family to another family on advice to prevent

diseases, necessity of periodic checks, the dietary habits and the

need for life style changes including exercise for good health.

Actually, I believe this good contact between the doctor and patients

is very valuable. I request every doctor of KMC to play the role of a

teacher in advising every family on disease prevention and methods to

lead a healthy life. This message should also be given to all the

students graduating from KMC so that they will find time to put this

noble action into practise during the medical career.

Giving quality health care through continuous acquisition of

knowledge, upgrading diagnosis and treatment, providing care and

counselling particularly to the unreached should become the life time

mission of each one of you graduating from KMC. Thus you will

contribute effectively to the mission of developed India 2020.

My greetings to all the members of KMC Kurnool during their Golden

Jubilee Celebrations and my best wishes to the students and faculty

members of this college in their mission of developing quality

healthcare professionals for nation building.

May God bless you.

Five Point Oath for Medical Professionals

1. We the medical professionals realize that we are in God's mission.

2. We will always give part of our time for treating patients who

cannot afford.

3. We will treat at least 20 rural patients in a year at minimum cost

by going to rural areas.

4. We will encourage the development of quality indigenous equipments

and consumables by making use of them and assisting in enhancing the

quality and reliability of the products.

5. We will follow the motto " Let my brain remove the pain of the

suffering humanity and bring smiles " .

Question and Answer Session

1. How can we promote the interdisciplinary sharing of knowledge to

bring out the best in the Medical Field as far as India is concerned.

- Dr. J. Raghu, P.G. Student in M.D. (Pulmonary Medicine) , Final

Year Kurnool Medical College ,Kurnool

Ans: Hospitals need to create a culture of sharing which alone will

promote inter-disciplinary of sharing knowledge among the

professionals. To promote interdisciplinary sharing of knowledge, it

is necessary to have a common meeting of all the doctors of different

specialities in the hospital. In addition, there can be a common

website in which the special cases of diagnosis and treatment are

brought out by different specialists in a hospital. This will promote

sharing of interdisciplinary knowledge. With the electronic data base

storage, all the doctors can be connected and share the knowledge

about a particular patient based on their specialization. This is

also another tool by which inter-disciplinary sharing is possible.

For integrated healthcare, it will be useful to have doctors from

Allopathy, Homeopathy, Siddha, Ayurveda and Unani in the

samehospital. They can collectively examine the patients so that the

patient can get the advantage of best from all systems of medicines.

Such a scheme I have found in taking place in some parts of India.

2. May I know from you various modalities by which we can encourage

youth of India to take " Research as career option " so that India

becomes a Superpower.

- S.V. Naveen Prasad, Internee, Government General Hospital, Kurnool.

Ans: I have already suggested a science cadre be created which will

enable the prospective students and their parents to appreciate the

importance research as a career. Also, there is a need for the senior

scientists to emphasize the value of science among the students right

from school. Thirdly, the students must be made to enjoy the bliss of

science in small doses so that he can get attracted to science as a

life time mission.

3. May I know how we can apply advances in Technology in the field

of " Genetic Engineering " without affecting the " morality " of the

people?

- Dr. G. Hareesh Kumar, 9th semester U.G. Student, Kurnool Medical

College, Kurnool.

Ans: When we go for high technology, we have to draw the lines

through a well defined legal framework and conventions so that we do

not intrude upon individual privacy.

4. May I know your vision for Medical filed & recent advances in the

field of Medicine.

- Dr. K. Keerthinmayee, P.G. Student in General Surgery, Final Year,

Kurnool Medical College, Kurnool.

Ans: Some of the recent advances I have already discussed in my talk.

Stem cell research and convergence of technology(IT, Bio-technology

and nano) will play a major role in the field of medicines during the

21st century.

5. May I Know from your Excellency , How can advances in

Nanotechnology be made a useful tool in Medical Field.

- S. Lakshmi Sravanthi, Internee, Govt. General Hospital, Kurnool.

Ans: Nano-technology in Drug delivery has already shown promising

result in directing the drug to the affected spot in the controlled

doses. Nano-technology can be used for cancer treatment in such a way

while destroying cancer cell, life cells are preserved. There are

several uses of this nature on which researchers in India and abroad

are working.

6. Your Excellency, how the advances in Technology can be applied for

the betterment of rural health care?

- Dr. M.Swarnabala, 5th Semester, U.G. student, Kurnool Medical

College, Kurnool

Ans: Mobile clinics can reach the rural areas and provide health care

at the door step of the rural citizens. For higher level of

healthcare tele-medicine, tele-ophthalmology, tele-radiology are

technological tools which can enable the diagnosis and advice to

reach the rural area with the help of experts located in district and

state level hospitals.

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