Was soon as an ambulance arrived with a critically ill patient, Dr R Mubarak’s heart would sink. Its small rural hospital in Bagepalli, like most rural government hospitals Indiahad no intensive care unit. Families had to take the patient, who may have been on the brink of death, on a two-hour drive to the general hospital in Bengaluru.
“Often the patient came back dead in the same ambulance. They never made it,” says Mubarak. “I knew I could sign their death warrant by sending them, but I had no choice.”
His hospital sits on flat farmland in eastern Karnataka, a dry belt, where farmers make a living from groundnuts and millets. However, it is connected to Bengaluru by a good highway.
On a hot, muggy morning, Mubarak and a colleague, Dr GB Sudarshan, beam like fathers boasting a newborn baby as they offer a tour of a brand new 10-bed intensive care unit at Bagepalli Hospital.
“I never thought in my dreams that we would get an ICU equipped with the latest equipment,” says Mubarak.
Today, the intensive care unit has five cases of dengue fever; two feverish and dehydrated babies, one of whom, Mahesh Babu, lies listlessly in his mother’s lap; a third baby with pneumonia; and Ansh Hegde, an elderly man suffering from seizures, who spits his food down his windpipe.
Any one of these cases could have been fatal without the patients’ prompt admission to an ICU. The new unit is the result of a project called 10 Bed ICU, which was designed by Srikanth Nadhamuni, a technology entrepreneur, to fill a critical care gap in India’s healthcare system.
The idea came to Nadhamuni during the Covid pandemic. Like the second wave scorched a trail across India in 2021he received frantic calls from friends asking if he knew of any hospitals with ICU beds because people were dying for lack of available spaces.
It was in the cities, but in the countryside no one had ever seen an ICU.
“I realized with a shock that rural hospitals do not have an ICU. All they can manage is deliveries and minor operations. Critically ill Indians in rural areas have to travel very far from home to the nearest city hospital to receive intensive care treatment,” says Nadhamuni.
In India’s hilly north-east, it can take more than a day on potholed roads to reach an ICU in the city – too late for patients suffering from strokes, heart attacks, aneurysms, head injuries and a host of other conditions.
Thanks to donations from philanthropists like Vinod Khosla, with whom he founded the startup innovator Khosla LabsNadhamuni has raised enough money to create more than 200 10-bed units since 2022.
Each unit costs approx $53,000 (£40,000) and the installations, which come with the necessary electrical and oxygen supply, comply with the World Health Organization’s standards.
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The scheme is run in collaboration with state governments, which provide the space at hospitals, doctors and nursing staff, as well as medical supplies.
However, as the equipment began to be installed, a problem arose as the lack of trained ICU doctors and nurses, increasingly known as “intensivists,” became apparent.
It takes 11 years to qualify as an intensivist and, once qualified, few want to work in remote, rural hospitals.
Nadhamuni’s solution was to deploy a tele-ICU system that connects the rural hospitals with intensivists at a hub medical college or tertiary hospital via the cloud. The ICU specialists can manage staff in the ICU remotely from a command center in the hub hospital.
In Bagepalli, Mubarak and Sudarshan make their rounds, stopping at each bed and consulting experienced intensivists, Dr Aravind B Guleda and Dr Sathyanarayanan Karunanidhi, who sit 60 miles (100 km) away in the command center at Victoria Hospital in Bengaluru.
Guleda and Karunanidhi can view the Bagepalli patients from various angles through computer screens equipped with high-resolution cameras and direct access to their medical details, lab tests and imaging. They provide live streamed treatment advice for the nine patients.
For the dengue patients, they recommend constant monitoring of oxygen, platelets and hematocrit [red blood cell] levels to prevent dengue hemorrhagic fever, which can be fatal.
Once Guleda and Karunanidhi finish at Bagepalli, they turn their attention to another unit, further away at Nanjungud, where a couple suffered burns after their clothes caught fire while dry leaves were burning.
The medics guide the local staff on treating an infection with high-grade antibiotics and monitoring the woman’s falling blood pressure.
Karunanidhi says: “In rural India, people cannot afford the cost of an ambulance or taxi to bring a sick person to the city, nor can they afford to lose their daily wages. It is mental pain for them. In this model, the ICU bed is closer to home and the family can continue to work.”
He and Guleda now supervise 55 patients in 10 hospitals. Guleda says: “If the patient has severe burns, head injuries or trauma, then of course they have to be brought here to us. The local staff cannot handle such cases, but they can at least stabilize the patient.”
The project has relieved pressure on overcrowded metropolitan hospitals, with a 70% reduction in transfers from hospitals with the new units. Dr NN Siri, Karnataka State Program Manager, says, “In the past, some rural patients ended up rushing city hospitals just for oxygen or for minor infections.”
Local doctors have also benefited, thanks to the daily consultations with specialists.
Mubarak says: “Under their guidance, I inserted a catheter into the chest cavity of a patient to remove more than three liters of fluid. I’ve never done this before. If I had delayed the procedure by half an hour, the patient would have died.”
Sudarshan recalls a case in Bagepalli, which he was sure was viral fever. However, the team in Bengaluru suggested further investigations. It revealed a gallbladder.
“I am proud of what I learn from them,” says Sudarshan.
To date, around 65,000 patients have been treated in the units, and Nadhamuni says the aim is to set up one in every part of the country.
At the Bengaluru command centre, Karunanidhi ends his consultation with the Bagepalli doctors before leaving to attend to his own ICU patients in the hospital.
“When you sit here, you feel omnipresent. Here I am, far away, pulling someone back from death, someone who never dreamed of getting specialist care,” he says.
