Passage to India: Physicians give back to their homeland
■ Doctors build a medical school and a hospital in an underserved area of their native country.
By Myrle Croasdale — Posted May 10, 2004
Sudarasana Rao Akkineni, MD, and Mani Akkineni, MD, aren't as quick to buy a new car as they used to be. Major purchases require careful consideration. And they could end up postponing retirement as they use some of the money they could have saved to build a medical school and hospital in India.
To date, the physicians, who are husband and wife, have given $500,000 to fund a new medical campus in southeast India.
Two dozen of their friends and colleagues, almost all from the same region of Andhra Pradesh in southeast India, are also helping fund the new hospital. It's the brainchild of five friends who came together to fulfill their dream of bringing quality, affordable health care to the people who live in the place where they grew up.
Prasad Neerukonda, MD, an anesthesiologist in Chicago, said the group wanted to give back after succeeding in the United States.
"There are medical services for the people who have money, but for the poor it is tough," Dr. Neerukonda said of the people from his home region.
The physicians want the hospital to fill the void between government hospitals that treat the indigent but don't have the funding to offer high-tech medicine and the private hospitals that offer many advanced medical procedures but aren't charged with the mission of treating the poor. Their hospital, they dreamt, would provide more than just the basics.
They wanted a world-class facility with CT scans and MRIs. They also decided to build a medical school and offer training for nurses, midwives, medical technicians and other health care professionals, most of which are in short supply in the region. They also hope area physicians will take advantage of the medical center's seminars to keep up with the latest in treatments and diagnosis.
To get the project started, each of the five physicians put in $100,000. They also started reaching out to other physicians from Andhra Pradesh who might want to get involved.
AppaRao Mukkamala, MD, the point person for the project in the United States, said people in Andhra Pradesh rely mostly on public transportation, which puts most advanced health services more than half a day away.
"Right now in the region where I grew up, if you needed a CT scan you'd have to drive 100 miles, the same thing for an ultrasound exam," said Dr. Mukkamala, clinical professor of radiology at Michigan State University College of Human Medicine and radiology department chair at the Hurley Medical Center in Flint, Mich.
The Non-Resident Indian General Hospital, which has been open for a year, is changing that. Located between the cities of Vijayawada and Guntur in Chinna Kakani, the hospital puts such services within 10 miles and 30 minutes of many of the 2 million people in the medical center's catchment area. It's equipped to take on high-risk pregnancies or provide chemotherapy, and its services are free to the indigent, which make up at least 90% of the hospital's patient base.
Building a project of this scale on the other side of the ocean has been a challenge.
"It was overwhelming at first," said Dr. Sudarasana Rao Akkineni, an anesthesiologist in the Chicago area.
His task was to get the certificate of need for the medical school after it became stalled in a morass of government bureaucracy. Construction on the medical school had yet to start at the beginning of 2003, and the first students were scheduled to be admitted that fall.
The certificate normally takes a year to obtain, but Dr. Akkineni flew over, visited his political contacts and was able to get it in three months. Construction on the medical school, much of it done without the benefit of heavy machinery, began that spring. The hospital opened first, followed by the medical school, with students arriving just as the government inspectors gave the school the OK to proceed.
Much more work lies ahead, with students scheduled to begin residencies in 2008. The hospital, now at 350 beds, is slated to grow to 750 by the end of this year. Its patient load is expected to double or triple as word of the hospital's offerings expand and the public transportation system adds more connections to the hospital.
Some 400 to 500 outpatients come through its doors each day, and the inpatient census is between 150 and 200. The 24-hour emergency department is up and running, and the hospital has its own ambulance service.
When the hospital is completed, it will have departments in cardiology, oncology, obstetrics, gynecology, orthopedics, neurology and neurosurgery. Separate intensive care units are planned for neonatology, pediatrics, cardiology, general medicine, surgery and neurology. Eventually, the hospital's benefactors hope it will have the staff and facilities to perform organ transplants and produce original research.
Up and running
The 50-acre medical campus includes student and faculty housing, and 100 students are in their first year of the six-year program.
Word of the school has even sparked interest among U.S. students of Indian origin. Two members of the first class are from the United States. The next class is slated to have 150 students. Roughly 90 faculty members have been hired, with 30 to 40 more to go.
Dr. Neerukonda said hiring had been particularly difficult because more than 30 new medical schools are opening across the country, all competing for faculty. Basic science teachers are particularly hard to find, he said, because the government has a set cap on the number of graduates in this field, which has not expanded to coincide with demand. The salaries the NRI Medical College can offer, along with the prestige of working with nonresident Indian physicians, has helped it recruiting position.
Facilities of this size and scope do not come cheap. Dr. Mukkamala reports that the U.S. physicians have spent $10 million of their own money to date. The final bill is expected to reach $17 or $18 million. Eventually the enterprise is projected to break even, but until then the physicians are committed to keeping it subsidized. One physician has returned to India permanently to work with the school, and others are expected to follow as they reach retirement. In the meantime, several of the doctors travel to the school six or so times a year to make sure all is going as planned.
"You can't take a break now," Dr. Sudarasana Rao Akkineni said. "Not until it can run by itself, and it may be five or six years before it's that established."
Eventually, he and his wife hope to spend half their year in India.
For the future
Dr. Neerukonda said the potential impact that their efforts could have keeps them committed, despite the demands of traveling to India multiple times a year, spending countless hours passing government inspections, developing the curriculum, equipping the hospital, and coaching the students and newly hired faculty.
All this works toward their goal of making NRI Medical College and General Hospital a world-class medical center.
"In five to 10 years we hope to be a major institution," he said. "Twenty to 30 years from now we will be helping millions of people. That's an emotional thing."
The group wants to offer the physicians of Andhra Pradesh access to ongoing training, as well.
Dr. Mani Akkineni is making her contribution. The obstetrician-gynecologist will give a seminar on fetal monitoring to the hospital's staff when she goes over this spring, and she envisions a high-risk obstetrics service at NRI that mirrors the best in the United States.
Other endeavors planned for the future include electronic medical records and video conferencing to bring in expertise from oversees. There are also ongoing talks with Michigan State University regarding the possibility of student and faculty exchanges. Next year the Indian physicians hope more seminars like Dr. Mani Akkineni's will be taking place using the talents of their non-Indian U.S. colleagues.
"I think the potential is enormous," Dr. Sudarasana Rao Akkineni said. "At least 400 or 500 doctors have said they'd want to go."
When they arrive, they'll find a medical center focused on serving patients, said Edward Hill, MD, an American Medical Association trustee who visited the medical center in December 2003.
"Physical plant-wise it was very stable, not fancy, but adequate," Dr. Hill said of the campus. "The teaching faculty for the school was very impressive with their credentials, and the enthusiasm of the students was exciting. The hospital was not fancy, but quite functional. Construction there, even multistory buildings, is done by hand."
He was struck by the compassion of the medical staff.
"One thing they really did was care for the indigent," Dr. Hill said.
"As a family doctor who practices in rural America, it gave me a warm feeling to see what these people are doing. We ought to take a lesson from them," said Dr. Hill.