Dr Manoj Kumar
Prof. and Head, Department of Forensic Medicine,
Institute of Medical Sciences, Banaras Hindu University

Highlights Of Healthcare Services And Medical Tourism In India

According to a report by FICCI and IMS Health – India has nearly 18 percent of the global medical tourism market. The MVT was pegged at USD 3 billion in the year 2015 and is estimated to grow at a CAGR of 15 percent. The private sector which was very modest in the early stages has now become a flourishing industry equipped with the most modern state-of-the-art technology at its disposal.

Medical tourism is fast becoming a worldwide, multi-billion dollar industry. Over 50 countries have identified medical tourism as the national industry. The reason patients travel for treatment may be case specific. Many medical tourists from the United States, Canada, and UK are seeking treatment at as low as one-tenth of the cost at home, avoiding frustrations due to long waiting times and also relaxing and recuperating at exotic locations thereafter.

Some of the pertinent facts are:

  • Medical tourism could account for 3-5 percent of the total healthcare delivering market;
  • India is rated among the world’s must see ten destinations by Conde Naste (an international magazine)
  • Health procedures across the world show 200-800 percent cost difference; and
  • After the implementation of the Indian Surrogacy Act, 2016 foreigners are not allowed for womb leasing (i.e. surrogacy) in India at any cost. Previously this was a major attraction for medical tourists to visit India and buy the womb in exchange of dollars.

The private sector which was modest in the early stages has now become a flourishing industry equipped with the state-of-the art technology at its disposal. It is estimated that 75-80 percent of healthcare services and investments in India are now provided by the private sector. The total expenditure on health by the center and states together is only 1 percent of GDP. We should raise it to 25 percent in 2020.

Blood bank

While the Indian health sector has made some noteworthy achievements over the last 50 years, it has not responded satisfactorily enough to meet the national goals on blood-transfusion services as is witnessed by the substantial negligence to blood-banking services in the country. In India, blood transfusion relies on very fragmented blood-supply systems, where control is exercised by different layers of the government, making it difficult to assure the quality of blood and blood products. Two parallel systems are in place to monitor the blood-safety programs in India—NBTC/SBTC and NACO/SACS.

The existing blood bank is up to mark in providing its services to the concerned hospital and catered population by it. By application of gel technology, the blood grouping and crossmatching have become very fast and accurate. Due to efficient and recent advanced blood component separation equipment and storage techniques, the consumption of blood components is  increased in comparison to whole blood. In this way, this center has been successful in achieving its target.

This blood bank center has also maintained the internal, external as well as additional quality management. The internal quality controls are managed for reagents, manpower, modern equipment, and blood products (RBC, FFP, and other cellular products). External quality control is approved by the National Institute of Biological (NIB), Noida. The license number of this blood bank is I.

Additional quality management is done to detect professional donor by CCTV camera and within a span of 15 years more than 15000 professional donors are detected. This blood bank is confirming to the prescribed blood policy and it is in the race for its recognition as a model blood bank.

Medical instruments of forensic significance

In the early 1900s, gas chromatography (GC) was discovered by Mikhail Semenovich Tsvett as a separation technique to separate compounds. Porter Martin laid the foundation of the development of gas chromatography (GC with or without ECD/FID) which is useful in identifying the individual elements and molecules present in a compound, it has been applied in forensic pathology to determine which fluid and compounds are present inside a human body after death.

This is vital in determining whether or the person was intoxicated either from alcohol or drug abuse at the time of death or indeed whether there is any poison or other harmful substance present in their body. The sample solution injected into the instrument enters a gas stream which transports the sample into a separation tube known as the column (helium or nitrogen is used as the so-called carrier gas) The various components are separated inside the column.

For post-screening confirmation, gas chromatography/mass spectrometry (GC/MS) is generally recognized as the gold standard. Unlike individual screens that detect the presence or absence of a target set of substances, GC/MS can separate out, identify and measure virtually any component in a sample; the primary constraint being that the sample must first be vaporized.

The separating action takes place in the GC column, a fused silica tube 25-60 meters (83-200 feet) in length with an inner diameter measuring only tenths of a millimeter (1 mm = 0.0054 in). The inner wall of the column is coated with a material (the stationary phase) that interacts with the sample components as they travel through the tube propelled by a flow of carrier gas. The entire column, in a coiled form, is placed inside the GC oven, and heated to progressively higher temperatures.

A sample is injected into a chamber at the head of the column. Alternative sample introduction methods include solid phase microextraction (SPME) – evaporation from a special sampling rod, or headspace sampling – drawing the vapors above a liquid sample directly into the column. Interaction with the stationary phase coating differentially retards the forward progress of the sample components, causing them to become separated.

The portable X-ray was discovered by WC Rontgen and works upon electromagnetic radiations or X-ray work on the absorption of low-level radiation by parts of our body with higher density, making the radiation not absorbed hit the photographic plate to form a negative image. It is used in the detection of fractures and bullets in the body. It reduces the tedious job of searching a bullet which leads to unnecessary mutilation of the body. The exact location of the fracture also helps in the precise determination of the cause of death by locating the bullet.

X-ray machines are used in health care for visualizing bone structures, during surgeries (especially orthopedic) to assist surgeons in reattaching broken bones with screws or structural plates, assisting cardiologists in locating blocked arteries, and guiding stent placements or performing angioplasties and for other dense tissues such as tumors. Non-medicinal applications include security and material analysis.

Atomic absorption spectroscopy was first used as an analytical technique, and the underlying principles were established in the second half of the 19th century by Robert Wilhelm Bunsen and Gustav Robert Kirchhoff. Atomic Absorption Spectroscopy (AAS) is based upon Beer- Lambert’s Law. It has served the forensic community for over 40 years and continues to work effectively for such diverse applications as gunshot powder analysis and toxicological examination in suspected heavy metal poisoning cases.

Over sixty elements can be determined in any matrix by atomic absorption. It can detect heavy metals in body fluids and in foodstuff or soft drinks and beer. Atomic absorption spectroscopy and atomic emission spectroscopy (AES) (AAS) is a spectro-analytical procedure for the quantitative determination of chemical elements using the absorption of optical radiation (light) by free atoms in the gaseous state. Atomic absorption spectroscopy is based on the absorption of light by free metallic ions.

In order to analyze a sample for its atomic constituents, it has to be atomized. The atomizers most commonly used nowadays are flames and electrothermal (graphite tube) atomizers. The atoms should then be irradiated by optical radiation, and the radiation source could be an element-specific line radiation source or a continuum radiation source.

The radiation then passes through a monochromator in order to separate the element-specific radiation from any other radiation emitted by the radiation source, which is finally measured by a detector.

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