30 Minute Interview

'Critical Care Needs to Improve in Rural Areas'

Criticare 2008, the 14th International Congress of Indian Society of Critical Care Medicine (ISCCM), equipped medical practitioners with an opportunity to network and share their most recent experiences, evidences and knowledge that have helped and can help in improving the outcome of critically ill patients. The five-day event was held from February 13 to February 17 at Noor-us-Sabah, Bhopal, Madhya Pradesh (MP). Dr RK Mani, President, ISCCM, spoke to Aashruti Kak and Manjusha Morgaonkar about the success of the event. Excerpts:

Dr RK Mani President, ISCCM

Please brief us about ISCCM.

Criticare is an annual national conference organised by the Indian Society of Critical Care Medicine (ISCCM), a non-profit association of Indian physicians, nurses, physiotherapists and other allied healthcare professionals involved in the care of the critically ill. This was the first time that Criticare had set its feet on MP soil, and was also the first time that MP had hosted an international event of such magnitude. The theme of the event, 'Evidence guidelines and enforcement', was chosen in a bid to overcome the challenges faced by the healthcare community at the dawn of the new millennium, and to discuss the present scenario in order to find ways to counter the shortcomings associated with the above three links of improvement.

The event saw eminent leaders and veterans in the field of critical care medicine discussing the global successes and the shortcomings in the super specialty field. About 1,500 delegates from India and abroad had attended the conference. Also, international faculties from various countries and more than the best national faculties were the major attraction and contributors of the event. The scientific programme comprised plenary session lectures, panel discussions, workshops, orations, poster presentations, and free papers. A multi-dimensional scientific exhibition had also been organised, showcasing different companies dealing in medical and non-medical products, instruments, etc. The conference included the pre-conference CME, pre-conference workshops, distinguished international faculty, plenary session, thematic sessions, pro-con debates, and symposia. Pre-conference workshops covered subjects such as airway management in intensive care unit, intensive care nutrition and infection control.

How has ISCCM evolved over the years?

ISCCM was established in 1993 in Mumbai, with the commitment to promote and progression of intensive care as a specialty in India by facilitating education and training of physicians and nurses, setting best practice standards for the care of critically-ill patients and their families and promoting research. In a short span of time, ISCCM has grown and expanded its various activities worldwide and is currently an apex body of nearly 4,000 members, with about 27 city branches in India. The society also publishes the 'Indian Journal of Critical Care Medicine', and has been organising Criticare, its national conference, since the past 14 years.

What was the objective of this conference?

Criticare means when a patient is at a critical stage how do we as a doctor cure him or bring him safe from danger situation. At Criticare, we share our knowledge base, our understanding of various diseases, and we also get an opportunity to meet the original leaders in the field at an international level. Currently, our focus is on propagating services to the community the right way through education. As far as ISCCM is concerned, it has a two-year fellowship programme by the name of Indian Fellowship in Critical Care (IFCC), which is equivalent to post graduate training in critical care offered by the DNB or by similar courses abroad. And for those who are interested in a shorter training course, it has a one-year ISCCM certificate course in critical care, now known as Indian Diploma in Critical Care (IDCC) if they are MD/MS/DNB candidates, and two years if they have a diploma in anaesthesiology/diploma in tuberculosis and chest diseases or equivalent candidates. But, so far, the Government has neither recognised the fellowship programme, nor has it registered the ISCCM certificate course. This is where the Government comes in. There is a dearth of associations between the Government and society. Only such partnerships can form a well-administered unit.

Critical care practices in India have evolved significantly over the past decade. In its initial stages, critical care was provided as a service in major hospitals only. But with the inception of ISCCM, the growth and development of this specialty has become swifter. With the emergence of regular conferences, updates, continuing medical education programmes (CMEs) and workshops and the development of various post-doctoral training programmes, critical care has really improved over the years. But there are still certain challenges that the segment faces, for instance underdeveloped guidelines, incomplete or half-hearted training activities and research on the outcome of critical tropical problems. Anomalies in the healthcare segment are entirely reflected in the field of critical care.

How is critical care set-up in rural India?

Although, it is a good thing that even the small cities have started providing critical care services, what is most unsettling is the extremely unsatisfactory quality of services that are being provided. We have projects and programmes to spread awareness in rural areas, but their reach is not enough. More public awareness systems need to be made. Resources need to be made accessible because a lot of times we have the time but we do not have the resources. But, the Government is slowly realising that if there is public awareness, it will speed up the process of lifting critical care to an entirely different level.

What the challenges for providing good critical care facilities?

Issues that seems to bother the healthcare sector is a practitioners right to be legally protected. When a doctor is in charge of an ICU, he has a huge responsibility on his shoulders. If the infrastructure does not support him then he becomes lost, there is nothing that can encourage him to save more lives. So, apart from adequate infrastructure, he should be encouraged in the form of well defined regulations, training and protective laws because the profession is not at all glamourised and it is not his fault if a patient dies because of lack of proper infrastructure.

An individual doctor needs to be protected for his well intended actions. In critical illness, one always faces the prospect of death, and a doctor's actions can be misconstrued and if a well intended action does not produce the results, the family of the patient can be up in arms. So, there have to be legal guidelines that protect a doctor's rights. Influencing the legal approval for good guideline is also a major focus of ISCCM. On one side, there lies the issue of accreditation of the ICUs and on the other side lies the issue of inadequate training (immediate or long term) of junior and senior doctors, as well as nurses, paramedics, basic cardiac life support (BCLS) etc. The structure of training is very inadequate; hence we need to intensify the training process. The systems need to be so well organised that there should be no scope left for an error. The training has to come down to the ground level, because it is just not in sync with time. Limited availability of ICU beds and the rising costs of critical care are also other issues in concern.

What is the future of criticare in India?

Critical care has a wide scope. The exciting thing is that we are in the midst of a great change. We should accept it as an opportunity rather than failure. And that is how we can grow.

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