All roads in New Delhi led to Shangri-La’s Eros Hotel last weekend, where the best of South Asian healthcare gathered to honour the winners of the BMJ Awards South Asia 2017. The two day event, which culminated in a glitzy award ceremony, was packed with action for the finalists, jury members, and other invitees.

The awards honoured two icons of South Asian healthcare — Zulfiqar Bhutta, from Aga Khan University in Karachi, and Samiran Nundy, from the Ganga Ram Postgraduate Institute for Medical Education and Research in NewDelhi—who were joint winners of the Outstanding Contribution to Health in South Asia award.
Fiona Godlee, editor in chief of The BMJ, said, “We had the hard task of shortlisting 30 finalists and eventually selecting 13 winners in 10 different categories. The work done by all of them is of the highest standard, innovative in approach, and will make a positive impact on the lives of many people.”

Eight South Asian countries

The finalists were drawn from 2015 nominations submitted from eight South Asian countries—Bangladesh, Bhutan, India, the Maldives, Myanmar, Nepal, Pakistan, and Sri Lanka. 1 The day before the ceremony, the finalists presented their work to a jury representing the who’s who of the medical profession in the region and senior editors of The BMJ.

“The BMJ Awards provided a great opportunity to interact with this diverse group of people, all of whom are making a big difference in their fields,” said Sonal Asthana, senior consultant at the Aster CMI Hospital in Bangalore, and winner of the Excellence in Medical Education award.

Ashwini Kumar Choubey, minister of state at the Ministry of Health and Family Welfare of the government of India was a special guest. He said that investment in health was paramount for progress.
The awards show that despite the paradox that healthcare in South Asia faces—that is, dealing with large numbers of patients with meagre resources and budget constraints—healthcare teams in the region are not easily daunted. On the contrary, they continue to rise to the challenge, pushing the boundaries of ingenuity and innovation.

Treating avoidable blindness

The ophthalmology team at Ramakrishna Mission Hospital in Itanagar, Arunachal Pradesh, which won the award for Surgical Team of the Year, is one example. Arunachal Pradesh, a state in northeast India bordering China and Bhutan, is one of the remotest regions, with the lowest population density, in the country. Because of the mountainous terrain, the people in the state’s rural areas have poor access to healthcare. To cater to their needs, the ophthalmology team conducts surgical camps in various locations across the state. Through these camps, the team has been able to treat avoidable blindness.

Lobsang Tsetim, the senior eye surgeon at Ramakrishna Mission Hospital, told The BMJ that the team started running these camps in 2007 and has since scaled up the project. “We now conduct four to five camps a year, during which we screen the patients, conduct surgeries, and also follow up on cases that we have already completed,” he said. Between January 2014 and December 2016, 12 outreach surgical camps were held, which screened 2720 patients. Around 504 cataract operations and 63 other surgeries were performed. Almost all cases (99.4%)involved intraocular implantation, and 99% had good visual outcome after cataract surgery.

The other recipient of the Surgical Team of the Year award was the Living Donor Liver Transplantation Team at the Shifa International Hospital in Islamabad, Pakistan. This team set up the first liver transplantation unit in Pakistan and has been responsible for bringing high-quality transplantation procedures to the country at a fraction of the cost that patients would have to bear if they were to travel to the UK or the US for treatment.

This year, three award categories out of 10 had joint winners. Apart from Surgical Team of the Year, the Infectious Disease Initiative of the Year category and the Quality Improvement Team of the Year category had two winners each.

“The fact that we had joint winners in three categories is an indication of the quality of nominations that we received,” said Prashant Jha, The BMJ’s senior editor in South Asia. “The finalists might have had a tough time preparing for the awards, but in the end, it was the finalists who gave the jury a tough time in picking the winners,” Jha said.
Kiran Patel, medical director of NHS England (West Midlands), who was one of the members of the jury, told The BMJ that they assessed each of the finalists on the scope, impact, and sustainability of their project.

Ventilator-associated pneumonia

Shrijana Shrestha, from Patan Hospital at the Patan Academy of Health Sciences in Nepal, won the Infectious Disease Initiative of the Year award for her work on vaccine-preventable childhood diseases. The other award winner in this category was Ritesh Aggarwal, of the Max Smart Super Specialty Hospital in New Delhi in India, for his work in minimising ventilator-associated pneumonia, one of the most common hospital-acquired infections in intensive care units.

The Quality Improvement Team of the Year was jointly awarded to Lallu Joseph, from Christian Medical College in Vellore, India, for the hub and spoke model for quality improvement,and to Mohammod Jobayer Chisti, from the International Centre for Diarrhoeal Disease Research, Bangladesh, for his work in improving clinical care and management style, infection control,and low cost innovative clinical research at the hospital.

In her presentation to the jury, Lallu Joseph said that the quality management system at the hospital involves the stakeholders of the departments and the central quality team as facilitators.“The benefits of this model in terms of trust, ownership, culture of openness, and cost-effectiveness have helped the hospital establish a strong quality culture, sustainability, and improvement. The involvement of the clinical teams in the day-to-day quality management initiative is the major success of this model,” she said.

Mohammod Jobayer Chisti told the jury that implementation of quality systems has improved outcomes. “This is achieved by a monthly internal audit, reducing triage waiting time between arrival and being seen by a doctor, increased patient satisfaction through behaviour and attitude of service providers, as well as improved cleanliness and hospital environment.”

Training in transplantation

The Excellence in Medical Education award was given to an initiative that trains surgeons in safe organ removal. This course is conducted by Aster CMI Hospital, Bangalore, in partnership with the not for profit Mohan Foundation; the National Organ and Tissue Transplant Organisation; and surgeons from Oxford University.

Sonal Asthana, the senior consultant in hepatobiliary surgery and multiorgan transplant at the hospital, said, “Safe organ retrieval is the cornerstone of successful transplantation.” Because organ recovery is not part of the surgical curriculum in India, the country faces an acute lack of surgeons who can safely recover organs. Hence the number of organ transplantation procedures is low, especially in smaller cities. Through targeted training of surgeons, specific skill sets can be achieved with short and intense training courses. The programme was designed to provide training to experienced surgeons in order to save lives among those who might die of organ failure while on the transplant wait list. So far, the project has trained 115 surgeons, and three participants have performed heart transplantations after completion of the course. While just 50% of participants were involved in transplantation activity before the course, this number increased to 79% after completion.

BJ Government Medical College and Sassoon General Hospital in Pune, India, won the Maternal and Child Health Team of the Year award for its human milk banking and milk collection van project. The project has benefited 13 500 babies, with 1700 Lof human milk collected from 15 000 donors in the past three years.

Children with autism spectrum disorders

The Mental Health Team of the Year award was won by Kamrun Nahar Koly, from the International Centre for Diarrhoeal DiseaseResearch, Bangladesh, for her work in promoting the mental health of mothers of children with autism spectrum disorders(ASD). In her presentation to the jury, Koly said that mothers of children with ASD have reported higher rates of depression than mothers of children with other neurodevelopmental disorders. Through the project, Koly’s team has introduced mental health support services in two special schools, combined with a training programme to improve mothers’ child care skills.

The Non-communicable Disease Initiative of the Year award went to Rajendra Prasad from Indraprastha Apollo Hospitals, Delhi, India, for efforts to improve road safety for children. Prasad said that a substantial proportion of the 150 000 road traffic deaths every year were those of children. He pointed out that 15 633 children were killed on India’s roads in 2015, and five times as many were left with severe neurological deficit requiring rehabilitation facilities that are severely lacking in the country. “Because of strict laws, the driver wears a helmet but is not aware of, or ignores, the danger to the child who rides without a helmet. Most of these deaths could be prevented if these children were wearing helmets,” Prasad said, in his presentation to the jury.

Prasad and the not for profit Indian Head Injury Foundation have been vocal on the issue. In the past three years, 20000 children and their parents have been inducted in the Ride with Safety programme. Over a three year period, 10 000 high-quality helmets for children aged 9 to 14 years have been distributed during these workshops.

Combining polio vaccines

Swati Mahendru, from Manipal University in Manipal, India, was awarded Post Graduate Thesis of the Year for developing a questionnaire to support assessment, management, and research in audiology. Research Paper of the Year was awarded to Saeed Anwar from Peshawar Medical College, Peshawar, Pakistan, for assessing the impact of combining the injectable polio vaccine and oral polio vaccine in at-risk children.

The winner of the Healthcare Innovation of the Year award was Ramya de Silva of the Lady Ridgeway Hospital for Children in Colombo, Sri Lanka. De Silva’s project focused on the development of a special neonatal transport unit. Results showed that neonates transferred under this project arrived in better condition. This led to the development of the National Neonatal Transport Service in Sri Lanka. The project is now being scaled up with 15 new neonatal ambulances being commissioned.Speaking to The BMJ, de Silva said that the award was a big win for her team. “The award will help us to improve the visibility of our work and we hope that we will be able to reach out to other countries in the region and help them establish their own neonatal transport projects,” de Silva said.

Prashant Jha said that the subcontinent has the finest medical minds, and the common factor is the drive to make a change.“All of the winners went beyond the call of duty,” he said, “Asa group, we are humbled.”