IEvery time an ambulance arrived with a critically ill patient, Dr. R. Mubarak’s heart sank. His small rural hospital in Bagepalli, like most rural government hospitals in India, did not have an intensive care unit. Families had to take the patient, who might be on the verge of death, on a two-hour journey to the general hospital in Bengaluru.
“Often the patient would come back dead in the same ambulance. They never survived,” says Mubarak. “I knew I could be signing their own death warrant by sending them away, but I had no other choice.”
His hospital is situated on an agricultural plain in eastern Karnataka, a dry area where farmers make a living by growing groundnuts and millets. However, it is connected to Bengaluru by a good highway.
On a hot, humid morning, Mubarak and a colleague, Dr. G.B. Sudarshan, beam like parents showing off a newborn as they give a tour of a new 10-bed intensive care unit at Bagepalli hospital.
“I never imagined in my dreams that we would have an ICU equipped with the most modern equipment,” says Mubarak.
The intensive care unit currently has five cases of dengue fever; two febrile and dehydrated babies, one of whom, Mahesh Babu, lies limply on his mother’s lap; a third baby with pneumonia; and Ansh Hegde, an elderly man who suffers from convulsions, causing his food to go down his windpipe.
Any of these cases could have turned fatal had the patients not been quickly admitted to an ICU. The new unit is the result of a project called the 10-bed ICU, conceived by Srikanth Nadhamuni, a tech entrepreneur, to fill a gaping gap in critical care in India’s healthcare system.
The idea came to Nadhamuni during the COVID-19 pandemic. When the second wave hit India in 2021, she received frantic calls from friends asking if she knew of any hospitals with ICU beds, as people were dying due to lack of available beds.
This happened in the cities, but in the countryside no one had ever seen an ICU.
“I was shocked to find that rural hospitals do not have ICUs. All they can do is deliveries and minor surgeries. Seriously ill Indians in rural areas have to travel far from home to the nearest city hospital for intensive care treatment,” says Nadhamuni.
In India’s mountainous northeast, it can take more than a day on bumpy roads to reach a city ICU — too late for patients suffering from strokes, heart attacks, aneurysms, head injuries and a host of other ailments.
Thanks to donations from philanthropists like Vinod Khosla, with whom he co-founded the innovative startup Khosla LaboratoriesNadhamuni has raised enough money since 2022 to create more than 200 10-bed units.
Each unit costs approximately $53,000 (£40,000) and the facilities, which have the necessary electricity and oxygen supply, meet the standards of the World Health Organization.
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The plan is implemented in collaboration with state governments, which provide hospital space, doctors and nursing staff, as well as medical supplies.
But as the equipment began to be installed, a problem emerged: a shortage of ICU-trained 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 rural and remote hospitals.
Nadhamuni’s solution was to implement a remote ICU system, which connects rural hospitals with intensive care physicians at a medical college or tertiary hospital via the cloud. ICU specialists can remotely guide ICU staff from a command center at the central hospital.
In Bagepalli, Mubarak and Sudarshan are making their rounds, stopping at each bed and consulting with senior intensivists, Dr. Aravind B Guleda and Dr. Sathyanarayanan Karunanidhi, who are sitting 60 miles (100 kilometers) away at the command center at Victoria Hospital in Bengaluru.
Guleda and Karunanidhi are able to see Bagepalli patients from multiple angles through computer screens equipped with high-resolution cameras and live access to their medical details, lab tests and diagnostic imaging. They offer live-streamed advice on treatment for all nine patients.
For dengue patients, constant monitoring of oxygen, platelet and hematocrit (red blood cell) levels is recommended to prevent hemorrhagic dengue, which can be fatal.
Once Guleda and Karunanidhi finish in Bagepalli, they turn their attention to another unit, further away in Nanjungud, where a couple suffered burns after their clothes caught fire while burning dry leaves.
Doctors advise local staff on treating a high-grade infection with antibiotics and monitoring the wife’s falling blood pressure.
Karunanidhi says: “In rural India, people cannot afford to pay for an ambulance or taxi to take a sick person to the city, nor can they afford to lose their daily wages. For them, it is a mental agony. In this model, the ICU bed is closer to home and the family can continue working.”
He and Guleda are currently treating 55 patients in 10 hospitals. Guleda says: “If the patient has severe burns, head injuries or trauma, of course they have to be brought here. Local staff cannot deal with such cases, but they can at least stabilise the patient.”
The project has eased the pressure on hospitals in big cities, which are overcrowded with patients, and has led to a 70% reduction in transfers from hospitals with the new units. Dr NN Siri, director of the Karnataka state programme, says: “Earlier, some rural patients would end up crowding city hospitals just to get oxygen or for minor infections.”
Local doctors have also benefited from daily consultations with specialists.
Mubarak says: “Under his supervision, I inserted a catheter into a patient’s chest cavity to remove more than three liters of fluid. I had 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 a viral fever. However, the Bengaluru team suggested further investigations, which revealed a cyst in the gallbladder.
“I’m proud of what I’m learning from them,” says Sudarshan.
To date, some 65,000 patients have been treated in these units and Nadhamuni says the aim is to create one in every part of the country.
At the Bengaluru command centre, Karunanidhi is finalising his consultation with doctors in Bagepalli before heading off to attend to his own ICU patients at the hospital.
“Sitting here, you feel omnipresent. Here I am, far away, rescuing someone from the brink of death, someone who never dreamed of receiving specialized care,” he says.
