Who would believe a ‘first in the world’ advanced radiology project would occur in India? I am writing this in Chandigarh, India, home of one of India’s most prominent hospitals, PGIMER (Post Graduate Institute of Medical Education and Research) after a visit to the project site of Asha Jyoti (Hindi for ‘Light of Hope’), an impressive mobile outreach to screen women for breast cancer, cervical cancer and osteoporosis.
“It began with a dream.” said Professor Khandelwal, head of the Department of Radiodiagnosis, explaining that he and his colleagues had a vision to bring advanced disease screening to poor communities. This vision remained a few sheets of paper detailing the challenges women in rural India faced in seeking access to healthcare and especially preventive healthcare, the incredible burden of disease faced by these women, and what PGIMER as a premier hospital could offer, until a chance meeting with a visiting delegation from Philips Healthcare. Khandelwal recalled, “I was called at very short notice and asked if I could spend 5 minutes with them. We talked about education, we talked about research and we talked about this.”
‘This’ was initially offered as a scaled-down, basic screening mammography bus but “Nothing to it” was the good doctor’s response. “We are PGI!” His insistence on being pioneering and maintaining the highest standards led to a world-first, a unique combination of breast cancer screening mammography, cervical cancer screening via digital colposcopy and osteoporosis screening via bone mineral density assessment. It was hard work putting everything together as India law disallowed mobile facilities from having more than one imaging device, but Khandelwal obtained special permission. Philips Healthcare only produced mammographic equipment but not bone densitometers; a supplier was found and roped in. The colposcopy set-up came out of Philips Innovation Campus in Bangalore, a novel construct putting together common digital equipment such as cameras and lighting into a powerful diagnostic tool. The bumpy roads of India may have damaged the delicate medical equipment on board, but a military grade suspension system was sourced from Germany.
The partners, RAD-AID an American NGO, Philips Healthcare and PGIMER launched an initial 6-month pilot screening 615 women and detecting 11 women with suspicious findings. Asha Jyoti has won international praise and was recognized at last year’s Clinton Global Initiative “Champions of Action” plenary session.
The program is today scaling up aggressively. “On a really busy day, we can screen 80 women in an 8-hour day” described Meenakshi, one of two nurses in the team. At full implementation, Asha Jyoti hopes to reach out to 2-3,000 women each year but more importantly serve as a model for other communities. In this last regard, Prof Khandelwal and his team have hosted numerous visits and shared generously of their experiences and learning.
What did I find impressive? A couple of things. Firstly, the incredible passion and commitment to serving the under-served. I met with the team and could not help but notice the energy and excitement. Second, Prof Khandelwal’s humility and modesty, constantly referring to the ‘team’ and his role as merely that of ‘coordinating radiologist’. The quote “It is amazing what you can accomplish if you do not care who gets the credit.” (attributed to US President Harry S Truman) comes to mind. The third observation was the involvement of multiple specialties within PGIMER including the surgeons, gynecologists, radiologists and community medicine physicians. I have worked in academic health settings and know the challenges in bringing super-star professors together.
What next then? I see growth for Asha Jyoti in three areas- improving the operational efficiencies within the set-up, e.g. use of wireless technology to quicken reporting, utilizing the Asha Jyoti platform to expand into other health screenings, e.g. diabetes and hepatitis, and increasing the number of vehicles to deepen the outreach. Most importantly however, is the physical realization of healthcare reaching communities where they are, increasing accessibility and reaching the often-unreachable. Asha Jyoti is what works for north India and well-documented accounts of its experience can (and I suspect will) ignite the imagination of like-minded individuals around the world and seed similar efforts. Light of hope!