In our first episode, we are honored to have Dr. Raj Shankar Ghosh, a physician with three decades of public health experience in primary health care, managing infectious diseases, and delivering vaccines.

Dr. Ghosh shares his experience of working in the public healthcare sector in India and explains the unique features of the Indian public healthcare ecosystem.

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You’ve tuned in to Badlav for Better. A podcast by B Medical Systems -Saving lives through reliable and innovative technology hosted by Jesal Doshi.

Jesal Doshi

Hello and welcome to our first episode of Badlav for Better. We are very excited to have you here. Badlav, as you all know means change and Badlav for  better means a change for the better, why are we doing this podcast? Because we believe that simple conversations can create multiple ripples that can bring in a real change AKA Badlav. Through this podcast, we want to explore the journeys and the views of various stakeholders of the Indian healthcare ecosystem, Badlav for Better brings a mission of healthy India at the center of the conversation and invites discussion on what are the challenges the blind spots. What was the past? What is the future? And most importantly, how we are changing the face of the Indian healthcare industry for the better. This is a podcast where we aim to focus on the positives on the multiple successes that the Indian healthcare ecosystem has delivered over the decades. As I sit here in this studio, I read a very nice saying, says be a voice and not an echo. And that’s what we intend to do with. Badlav for Better. As a quick introduction, this is your host, Jesal Doshi. I have spent many years working in healthcare across the world and one of the things I realized is that Indian healthcare, despite all of its flaws, is probably the most sophisticated and the most advanced system in the world. Today in our first episode, for me it is a great pleasure and an honor to have Doctor Raj Shankar Ghosh, who is a doyen of Indian public health care, having spent more than three decades in the Indian public, healthcare ecosystem. Doctor Raj Shankar Ghosh very, very,welcome to our podcast. We are indeed very indebted to you for accepting to be our first guest on Badlav for Better. Welcome once again.

Dr. Raj Shankar Ghosh

Thank you, Jesal. It’s my pleasure and honor to be part of this podcast. As you rightly said, India is in a very exciting journey in terms of health. And particularly in the in the post COVID scenario, we are in a trajectory in terms of the health journey in which people are becoming the center of the entire health delivery process.

Jesal Doshi

So, with that, my first question is you joined Indian public healthcare way back  in the early 90s. Yes, what really prompted you to make that move back then?

Dr. Raj Shankar Ghosh

Great question, I think Jesal. So,this is a story which began in my childhood. My father was a surgeon. He had returned from England doing his, you know, Surgery fellowship at the Royal College and somehow, because probably in those days there was a lot of nationalistic feelings. He immediately returned and joined the government service and chose to go to a very remote district in India, Darjeeling district and Jalpaiguri district. That is where I was born in Jalpaiguri district. Now he spent a lot of time there. They took an intern. So, I was in around Class 7 at that time. So the question that was asked to him is what is your biggest accomplishment in the healthcare in these districts you have spent so many years. So when this question was asked, I was sitting in front of the radio and immediately I thought of, you know, which case is he going to discuss about he had saved so many lives, through so many complicated surgeries, and all of those. But what he told me, you know, surprised me at that time as a child, he told that his biggest contribution and honor was to have worked with health care workers to eradicate smallpox from the district and ultimately the global eradication of smallpox. So later on, he and I had a conversation. I asked him, you know, why did you talk about smallpox eradication? Because I know that he used to go in the field. And but you have done so many surgeries and you know you have saved so many lives. Explain to me public health, as one should explain public health to a child about the impact that public health has. How a disease if not eradicated from that tiny district, Jalpaiguri, children in Africa, children in Norway would still have lived in that risk of the disease. So, he explained, public health. And I thought. that this is such a wonderful work, and he built a lot of fun elements into all of that. He talked about, you know, how working in public health he was, you know, visiting remote places, how the food there was excellent, how in the evening. You know, he used to play football with the villagers. How there was a lot of Music and things that they used to hear when they used to have the camps in the villages, and I thought that this is the life that I want to live. So, after I got my MBBS degree, and I told my father that I want to go into Public Health. It was not that he was super excited about it, but I reminded him that, you know why I wanted to go- his stories and ultimately, you know, he kind of gave me the permission and I joined public health. And the journey has been forward.

Jesal Doshi

Well, that that’s truly fascinating and not just yourself, but also your father. And I think a great learning for youngsters who are looking to join public health. Just moving forward, I mean, now having spent 3 decades,you’ve certainly accomplished a lot. India has accomplished a lot and one of the biggest milestones, for example, is the global eradication of polio, which has happened during the time you spent in public health. But what really drives you even today? I mean, what makes you turn up for it for the next morning and to keep continuing? In public health.

Dr. Raj Shankar Ghosh

Right. That’s a wonderful question. Three things you know Jesal the first thing is that every day I get up. I just think about, you know, the kind of work that I will do on that day and that work is an unfinished work. For example, if I give an example of, you know, vaccines on which I have been working for a pretty long time, vaccines and infectious diseases. The children, who have not received doses of vaccines, a single dose of vaccine they live in very remote areas and I have seen their faces because I have travelled to the field. So, in the morning, if I get up and I think that I’m going to work on, you know, the 0 dose vaccine children. It’s not a data that comes to my mind. It’s not about, you know, 13% children are missed. It’s about those faces and every face has a story connected to it. So, I think about those faces. I think about those people. I think about where they live and how it is so important for us to find ways to reach those people. So, that’s one aspect the faces that I remember and immediately I get inspired to really go out. And start working on something in order to, you know, change, what needs to be changed. The second thing which is very important is that the kind of, as you rightly said, the impact it has made, you know, when we started discussion on the polio eradication or elimination from India, I joined the first batch of WHO surveillance medical officers in 97. You know, I had never seen a case of acute flaccid paralysis, which presents as a polio. I was very nervous. Will I ever see a case? Will I, you know, ever this disease go away. Do vaccines really work so well that you know that the disease will one day be wiped away? Just two years before the disease was wiped away from India, we had so many cases in India, everybody was nervous, but miracles. It’s almost like a miracle that the vaccine worked and till date. We have so strong surveillance, but we haven’t found the case. So just to know that I’m working with something. That works so well is an inspiration that, you know, we really need to make this work so well. that we get the impact. So that’s the second aspect that I know that I’m working with something which is going to give me the rewards and the results. The third thing is that it’s a little bit about, you know that nationalistic feeling that India is today, one of the leaders in terms of vaccine. We call it about vaccine production, vaccine delivery. We conduct the largest campaigns when I talk to people outside of India. When I talk to on social media, LinkedIn, Facebook, about India’s programs there’s so much excitement amongst, you know, global audience. There’s so much of, you know, there are so many questions about, you know about how we do. So, we have set a standard and I really feel very blessed that in some tiny way, in some miniscule way, I’m a part of that ecosystem which works on vaccines and infectious diseases. And I think I have a commitment towards this nation, towards the population, in order to really do this program well and contribute. These are the. Three prime drivers that I have every morning. I get up good well.

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You’ve tuned in to the first episode of Badlav for Better, an Indian healthcare story.

Jesal Doshi

 It’s very humbling to hear this. You know, after spending so much time the your passion, your vision for the future and most importantly, the human emotion that you spoke about. I think  that’s very real and just cannot be replaced. So just taking this forward, you mentioned three different areas. One was emotions, the other one was, let’s say, new technologies and things that make that actually work and eliminate and help elimination of various diseases. I think the COVID vaccination was another astounding success for India and I think the third one, which is the nationalistic element maybe taking off from the third element was a nationalistic element. I think India has done an incredible job. You know, I remember many, many naysayers,talking about COVID, especially saying India would never be able to vaccinate so many people, especially during the second wave, you would remember the kind of images that were portrayed around, especially in the foreign media. But I think the government has done a fantastic job and it’s also done a job with the vision. You know, it’s not about just vaccines, but it’s also about how do you get vaccines to the remotest locations? And again, in a country of India size and the kind of terrains that India has, it’s a huge challenge. So maybe to and  to kind of talk a little bit about that, you know, because I’m sure our audience is interested not in understanding how a vaccine reached somebody in Mumbai. But how did it reach, for example, somebody in Jalpaiguri or in a very remote location and and you’ve  travelled far and wide, so would be great to hear a little bit about your experience on this specific topic, right?

Dr. Raj Shankar Ghosh

So, one of the things that we will have to understand, you know if you are talking in the COVID context is that India had 1-2 unique advantages. One was experience. India had conducted some of the world’s most complicated, complex and largest vaccination drives mission Indradhanush, the pulse polio program, the measles rubella drive. So, India had experience of how to conduct large campaigns. The second advantage that India had was the power of, you know, vaccine supply, which means that India had its own Serum Institutes and the Bharat Biotics and the Bioease and all the vaccine manufacturers who provided it, who provided the vaccine. So India knew that, you know, I will at some point of time. have uninterrupted supply of vaccine and the 2nd is ,I have the experience of how to reach people. What was challenging were three things. One,the population was unique. We were no more dealing with infants and children. We were dealing with adults who were able to make their own decisions. So therefore, in that case, you know, we really had to convince the adult about the value of COVID vaccines because there was a lot of negative, as you rightly said, there was a lot of and not only said negative, but there were a lot of controversies that were coming up across the, you know, global media about, you know, vaccines about COVID. There was so much of lack of knowledge about the disease. So that was a very complex environment in which the right information had to be disseminated so that was one challenge. The second challenge that we had, as you rightly said that it had to reach the remotest corner, we did have good micro planning the polio program covered throughout India. We knew where to go, how to go. The alternate vaccine delivery mechanism, but what was important in this case was the speed. That we would have to deliver with such speed that you know we can wipe out the virus by kind of vaccinating all the target population. So, speed became a very important element for us, and the third most important thing that was there was that ,there were these various waves that were happening parallel to the vaccination drive, so it was not just that, you know, the vaccines had a free flow, there was, there was so much other complexities happening , there were, you know, these waves happening, there was a fatigue amongst the health workers there were, you know, concerns among people about the vaccines, so all of these different types of elements which were disrupting the vaccination program. Every time we had to actually challenge them. How did we do it? We did it by doing again three things. One we were truthful in a sense that we let data and science be the commander of all our activities. So much criticism that vaccines have been, you know, developed in such short period, how did the regulatory mechanism go well? Now we knew that we cannot please everyone. The Government of India knew very well that they cannot please everyone. What they needed to do is that whatever evidence they had, they had to work on that evidence, truthfully.The second was dissemination. Every evening there was a public kind of declaration of, you know, how many were vaccinated, what was the status, you know, what was the policy and all of that. So dissemination happened very well and the third thing that happened very well was the global collaboration. Every day there was a very good, you know, conversation between the Indian scientists and the global scientists around what was happening in terms of the virus. I will end, you know this particular conversation with a very interesting anecdote. So way back it I think it was around 2002 or three, one district of Jharkhand, Bokaro district, there was a you know the program, the Pulse Polio program was not happening well. So, you know, we were frustrated that that the program coverage is going low. There was a lot of chaos and everything and therefore we from the Who and UNICEF, we went and talked to the Health Minister and the Secretary and then, you know, there was a change in the district. The district magistrate was changed and All of that happened. A new person came, and then what happened is that within three months, everything changed. Suddenly, you know, the program became very well. The coverage became very well. The supply became very coordinated and all of that. So, we decided that, you know, we will go and see as to what is actually happening. This is data. So, we went and met the district magistrate and we had all this conversation. So, we congratulated him, thanked him and all of. That so when you know we were coming out. So, I asked him that, you know, how did you suddenly meet the all the gaps that were there? There were so many. Gaps and how did you suddenly meet it? So, he smiled and told me that you know, Dr Gosh, I have met the gaps by addressing the gap. And so, I asked him, what is that gap? So, he said Gap stands for governance, accountability and partnerships. So,we set up a good governance mechanism and every time in COVID ,I remember that such a wonderful governance mechanism, accountability at the highest level, the Prime Minister’s office was accountable and they made everyone below that accountable for the job which they were supposed to do. And the partnership that they built with the industry, with the global partners, with the domestic partners,with the Community through this CoWIN and everything, the governance, accountability and partnership became the driver of the COVID vaccination program.

Jesal Doshi

That’s probably the most succinct, but the most articulate explanation of how we went about our COVID vaccination program. So, thank you very much Doctor Ghosh for that. And climate change is intricately linked to almost every aspect of our lives, including these diseases, whether they are infectious diseases like malaria and tuberculosis. Or non-communicable ones. So, what is your perspective about climate change and public healthcare?

Dr. Raj Shankar Ghosh

Wonderful question and and that is the question that I think is being asked at every corner of the globe today. So, the concept of health has now moved to something,what we call one health.One health is basically the coordination between animal health, human health and the environmental factors now we have understood very clearly that we will not be able to address animal health separately. We will not be able to address human health separately, and both of these we cannot solve the problems unless we, you know, you know, address the environment issues. So almost, you know, I think I was reading somewhere that 50% of diseases that happen in animals are actually transmissible to humans. And all of these are dependent on the environment. If we do not address the climate change issues at this point of time and the various factors that are leading to the climate health change, then we will not be able to change the kind of threats that we have to our human lives, we will not be able to address the threats that we have to be, you know, lives of our animals and the and the and the poultry and livestocks and all of that. So therefore, India is a signatory to the global. Kind of commitment to progressing one health India. You know, I would have loved India to have done much more on it, but obviously there were disruptions in between. We have a right start that we have made a commitment. We are working on the policy, the implementation part still needs to happen in a much more robust way, but there are institutes which are designated like the Indian Council of Medical Research, the Department of Biotechnology. Where we have a gap is that,this is not just the job of the Ministry of Health and Family Welfare. This is the job of the minimal Ministry of Animal Husbandry and you know, livestocks, this is. the job of the Ministry of Environment, so all of these really need to come together and have a blueprint joint plan and the joint not only a plan, but an action plan about how they’re going to move together so that I think you know needs to happen. I hope you know these authorities under the leadership of the Prime Minister`s. office because that is where the trust is, the Prime Minister has spoken about one health being one of the top priorities of the country. We need to make good progress in that, but it needs to happen and it needs to happen as soon as.

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Aap Sun rahe hai Badlav for better. A podcast by B Medical Systems Saving lives through reliable and innovative technology ,Jesal Doshi dwara hosted.

Jesal Doshi

It’s actually a fascinating topic, one health. And just recently I read about, I think it was a person in Maharashtra who is apparently the first person in the world to have contracted disease from a chicken.

Dr. Raj Shankar Ghosh

Yes, yes, yes.

Jesal Doshi

And again, these are the kind of things that would have been unheard of even a few years, let’s say even five years ago. But I do believe and  just to give you 1 anecdotal example, I was talking to a friend of mine who said his daughter suffered from a respiratory illness, which is a version of influenza that I had never heard of. But I guess as a result of the investments in diagnostics made primarily for COVID, yes, you can now multi-purpose that equipment for also diagnosing a wide variety of ailments.

Dr. Raj Shankar Ghosh

Right.

Jesal Doshi

So, the question is, when you speak about climate change and the importance of one health and the fact that zoonotic illnesses will play a very, very big. The fact that countries have invested a lot in diagnostics, especially let let’s just take India. I think at one point India had the maximum capacity in terms of diagnosis tests per day. How do you think, or do you think countries could do well to reposition some of that diagnostic capacity for one health?

Dr. Raj Shankar Ghosh

So, in fact yesterday, I think I was reading an article by, you know, the former secretary of the Department of Biotechnology, Dr.Renu Swaroop,where she talked about one health actually being very closely linked to one world, which means that, you know, it’s not about India doing it or it’s not about some African nation doing it. It’s about collective approach to the R&D of diagnostics in order to ensure that diagnostics. You know are available at the , you know, last mile  for the diseases to be diagnosed. But we have miles to go in that direction. See if you see. The most frustrating element about COVID was that. Some of the population across the world, which probably needed the vaccine the most, who probably needed the, you know, COVID care the most were the ones who were neglected. Whereas you know there were affluent nations, there were, you know, countries which had surplus amount of their resources. So, in all of these, when you talk about diagnostics, when we talk about, you know, drugs. Three things have to be kept in mind. One, obviously, you know, we need to have very sophisticated R&D in order to not only develop the diagnostic, but also in order to ensure that we can kind of adapt to the newer, you know strains and the variants and all of those that come up and this need not necessarily be a primarily a countries job, this is something that there needs to be a very good exchange of global knowledge between different countries so that one country can benefit from the other. The 2nd is about the access part because it’s good to develop diagnostics. But if it does not reach the population for whom it is intended, the entire mission fails. And the third, I think that there is a lot of things work that we have to do. Around some of the behavioral change that we need to bring in the population because people are still. You know, not very kind of well accepting in terms of getting themselves diagnosed in time, the importance of diagnosis, the importance, the importance of early diagnosis, timely diagnosis in order to address a, you know, disease is a very, very important aspect. So I think from these three. Aspects of R&D around access and around some of the behavior change communications to ensure that people become proactive in terms of getting themselves exposed to the diagnosis is going to be very important.

Jesal Doshi

And I think the issue of inequity that you raised is a really important one, not just in India but across the world, not just in poor countries, but also in rich countries. Yes, it’s  I think COVID brought that to the forefront. With that said, and you know we’ve spoken a lot about the global South versus the global north and so on. But with that said, today as we as things stand, do you see the world has moved towards the better towards addressing inequity in public healthcare?

Dr. Raj Shankar Ghosh

So I’ll say. You know, three things. One is that. At least you know with COVID we have acknowledged that this was a major problem that you and I are talking of today, that the whole world is talking about today, that Seth Berkeley from GAVI says that, you know, that is an area probably where we could have done better. WHO says that, yeah, we fail to really provide equitable access to vaccines and the other you know solutions. So that part is very important that we have acknowledged and we have understood. The 2nd is that. If you asked me that, have you moved on in terms of better collaborations that only time will tell that when a crisis happens, we don’t know how countries will behave. But given that ultimately it is about humans, it is about leaders who are humans who will make decisions, not robots. Therefore, we will have to keep in the back of our mind. All the fallacies of you know equitable distribution will continue to remain. That is, countries will try to protect their own population. Countries will first ensure that country first the world next. It’s not going to be that the world first and my country next. It’s never going to be that. So, for that we have to prepare. Every country to build some kind of an infrastructure or not only one country may be a regional. At a regional level, some kind of capacity to ensure that the interest of those populations of those countries and those regions are maintained. For example, South Asia, where India is already a leader in case of vaccines, when countries like Bangladesh and Nepal and other friendly nations they fall fell short of vaccines. India stepped up vaccine my 3:00 we supplied. So therefore in Africa we need to do that now. There are, you know, some countries which do have some capacity but. Again, that needs to be many, many times, you know, scaled up. And  the third thing that really needs to happen is that there needs to be some kind of a commitment in terms of investment. I still think and not only its proven by data, it’s not about my thinking is that the investment is still much suboptimal. We have to raise our investments in order to prepare for the diseases that come in order to address the diseases that exist, and that investment must be made in the health systems.

Jesal Doshi

Absolutely True! . And I think there is, as you said, a great realization. But really on the ground in terms of commitments, in terms of dollars being invested, we don’t see that yet across the world, not just in India but globally. I would love to carry on with this fascinating conversation with you, Doctor Ghosh, but unfortunately, we’ve run out of time for our first podcast. We will continue with this extremely insightful conversation in our second podcast, so listeners stay tuned in and thank you very much for joining in for our first podcast, Badlav for Better

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You were listening to,Badlav for better. An Indian healthcare story, a podcast by B Medical Systems, Saving lives through reliable and innovative technology, hosted by Jesal Doshi.