March 2007 | Back to Table of Contents

Pulse

Passage to India

The University of Minnesota's physician group forms its first international partnership.

Every few weeks, Daniel Weisdorf, M.D., arrives at work by 7 a.m. to discuss with colleagues whether a patient is a suitable candidate for a blood or marrow transplant or how to care for transplant patients who are experiencing complications. Although this sounds like business as usual for the director of the adult blood and marrow transplant (BMT) program at the University of Minnesota, it’s not. What sets these meetings apart is that the physicians he’s consulting with are in Bangalore (recently renamed Bengaluru), India, half a world and 11-plus time zones from Minneapolis.

Videoconferences with physicians at Manipal Hospital in Bengaluru have become part of Weisdorf’s job description now that he directs that hospital’s BMT program as well. Last fall, the University of Minnesota Physicians, the university’s physician practice plan, formed a partnership with the hospital that provides expertise to physicians in India and research opportunities for faculty from Minnesota. The partnership is the first of its kind for the university and is likely a prototype for future ones between it and other overseas hospitals.

“The reality is, there are a lot of transplant programs in the United States,” Jonathan Ravdin, M.D., chair of the department of medicine, told a gathering of international journalists last November, just weeks after he returned from the formal opening of the Manipal program. “So we won’t grow much without diversification. In India, the largest hospital does about 40 transplants a year [the University of Minnesota does nearly 300 a year and is one of the largest centers in the United States]. We want to be leaders in blood and marrow transplantation in India.”

Building a BMT Program
India has long been on the radar screen of physicians and educators at the university for a number of reasons: The country has a growing middle class who can afford to pay for care, it’s relatively safe and politically stable, and its academic community speaks English. In addition, a number of physicians who now work for the University of Minnesota have ties to India. It was through one of those physicians, anesthesiology professor Kumar Belani, M.D., that Weisdorf, Ravdin, and Phillip Peterson, M.D., learned of Manipal Hospital.

Peterson, a professor of medicine who co-directs the International Medical Education and Research Program, was looking for places where medical students, fellows, and faculty could learn about health care in other countries and conduct research. During a trip to India with Belani, he discovered that Johns Hopkins, Harvard, and other medical schools already had a presence in Delhi and Mumbai, two of India’s largest cities. “They missed Bangalore, which happens to be the Silicon Valley of India,” Peterson says. Belani, who had trained at St. John’s Medical College there, introduced Peterson and his group to faculty at St. John’s and at the Manipal Education and Health Group, which operates five medical schools and the hospital.

After discovering that Manipal Hospital had a fledgling BMT program, Ravdin and Weisdorf began looking for a way for the two institutions to work together. (The University of Minnesota did the world’s first such successful allogeneic [donor] transplant in 1968 and is considered a leader in the field.) “The goal was to offer them expanded experience by consultation, protocols, and collaboration to make their program stronger,” Weisdorf says. “And it establishes the beginning of what we can do with collaborative research.”

Blood and marrow transplantation is still in its infancy in India, according to Amit Rauthan, M.D., one of two physicians who is running Manipal Hospital’s BMT program. Rauthan has been with the program since 2004. “There are only 12 centers doing regular transplants in India and about 400 patients undergo transplants each year. These numbers are very low in comparison to the number of patients who require transplants in the large Indian population,” he said in an e-mail interview.

Last year, Rauthan and his colleague, Ashish Dixit, M.D., each spent four weeks in Minneapolis observing physicians working in the university hospital’s inpatient and outpatient departments.

Rauthan and Dixit have worked with University of Minnesota physicians to develop disease-specific protocols that define which patients with conditions such as leukemia, lymphoma, and myeloma may be eligible for transplants, establish criteria for selecting transplant patients, develop guidelines for patient care during and after transplantation, and collect follow-up information on patients that can be used in collaborative research with physicians at the university. In addition, the university has sent faculty to Bengaluru to train nurses to work in the BMT program.

Thus far, the BMT center at Manipal Hospital has performed 11 blood and marrow transplants, nine autologous and two allogeneic. The hospital eventually plans to expand the BMT center from two to 50 rooms as the physicians gain skill and treat more patients.

Slow Growth Expected
Weisdorf expects to see a “slow but steady” increase in the number of transplants done at Manipal Hospital. “They’re trying to be deliberately cautious as they learn and expand the diseases that they’re treating and the number of patients they can handle at once,” he says.

However, what those numbers will eventually be is a good question. No doubt, some patients will come from other countries for care, as India promotes its growing “medical tourism” industry. According to Ravdin, because of India’s lower salaries, the cost of having a procedure done in India is about one-fifteenth of what it is in the United States.

But the challenge that remains is finding a way to provide needed treatment to the vast number of poor people. “India is not like the U.K., where they have government support [for health care], and they have a very small insurance industry. So people have to pay, and they have a number of people who cannot afford anything,” Peterson says. “It’s a developing country, and it’s developing like gangbusters. It’s a place of tremendous opportunity, but it’s also a place of tremendous need.”—Kim Kiser