HAILING FROM a small village in the Nellore district of Andhra Pradesh, Dr Ramesh Kancharla stands tall among the greatest achievers in the medical profession. Having immersed himself in the paediatric care, he had worked at one of the biggest children’s hospitals in the world like Great Ormond Street Hospital for Children in London. He let go off lucrative opportunities in the western world early in his career to return to his roots and start his dream project: a 50-bed children's hospital in Hyderabad in the year 1999. Today, Rainbow Children’s Hospital has not only grown to be a reputed paediatric multi-speciality hospital with 15 centres and 3 clinics across the country but is also the first children’s hospital to list on the stock exchange.
With a child-centric atmosphere and state-of-the-art infrastructure aided by a 24/7 consultant-led service, Rainbow has further branched out in maternity care with the vertical, “BirthRight by Rainbow Hospitals”, a perinatal centre within children’s hospital, which is equipped to deal with high-risk pregnancies. Dr Ramesh Kancharla, Chairman and Managing Director of Rainbow Children’s Hospital talks about their inclusive model, IPO and the pediatric healthcare in the country. Excerpts:
Q/ What is the philosophy driving the Rainbow Children’s Hospital?
A/ An important thing in children’s health care I learnt and that has stood the time is that children’s hospitals are not about building a few doctors or working together, it is all about a multi-disciplinary approach. Conceptually, we built a very strong platform with our intensive care services and children centric infrastructure.
Essentially, what I was able to bring to the country is the NHS model, which is a British Canadian model. I practised and established it. It is more of an institutional model. It is not a nursing home or private hospital model or an Indian corporate hospital model. In our hospital, the doctors manage the great internal democracy and diplomacy. This ecosystem is important for a credible health care model.
As we began saving the babies, we became the choice of hospital for Hyderabad city. Also, people have seen us working very hard. Even when the families were facing turbulent times, we were there with them.
Most of the Rainbow hospitals have become referral centres, now. Peripheral hospitals, standalone clinics, nursinghomes understand their capabilities to an extent, anything beyond them, they send to us as one centre cannot do everything. We maintain great relations with other hospitals. The ecosystem we created is very inclusive of the community. That's what we envisaged and built strongly over time.. One of our greatest strengths is that we don’t work like a typical multi-speciality hospital. We all work very closely together. The finances are distributed evenly, thereby weeding out any unhealthy competition among the doctors. So, when
the finance is not there in the picture the doctor wants to give the best to the child.
I also want to stress that most of our doctors are trained outside the country. Our doctors participate in national and International conferences and also involve in research activities. Also, there is rigorous/tremendous focus on training and academic activities to train future doctors. Today Rainbow runs the largest residential DNB and Fellowship program for pediatrics and pediatric super specialities in private healthcare in the country.
Also, ESG (Environmental Social Governance) compliance is very important. We believe in running the company cleanly and we are strong in green building concepts. We have 3 ESG certificates, now.
Q/ How did Rainbow Children’s Hospital raise the bar in innovations and breakthroughs?
A/ With technology, skill, hard work and efforts of a strong multi-disciplinary team, we started saving babies. Initially, we saved babies weighing upto 1 kg. Before that 1.2 and 1.3 kg babies were also not surviving. As we progressed to 2006- 07, we started getting better. We were saving babies, which were 28 weeks and weighed 800 grams. Then it was babies at 26 weeks and 600 grams. Today, we can save 25 weeks old babies with 550 grams of weight. We also attained a place in the Limca book of records for saving Southeast Asia’s youngest baby weighing just 375gms at birth.
I still remember an incident in 2000, wherein I picked up a 900 grams baby from Warangal and shifted it to Hyderabad. A maiden attempt for us, to save a newborn by transporting it a distance in ambulance with ventilator support. We fixed the baby with ropes as there were no latches in those days. The boy was very sick. We put the tube down, ventilated and brought the baby to our ICU. The baby survived and went home. In Bidar, a newborn weighed 700 grams and this was in 2002. We hadn’t gone so far till then. We took all the precautions and went there. The baby wouldn’t have survived even ten minutes without assisted ventilation after coming out of the womb. Luckily, the baby got delivered just when we reached the spot. Straightaway, we took over the baby’s respiratory control and saved the baby. The boy is now pursuing higher studies. Incidents like these motivated us to further develop our clinical skills. Now, we have advanced transport systems for neonates and children.
Rainbow pioneered many innovations over last 2 decades. Now we have started quaternary care services including paediatric organ transplants for liver, renal and Bone Marrow transplants. We also were recognised by the Guinness book of world records for gathering the largest number of premature babies under one roof.
We also started doing transports with high-frequency oscillation. Normal breathing is about 15-20 breaths/minute but this will be 300 breaths. This is given by a specialised nitric oxide to the lungs. We are probably the first in the country or Asia to provide this kind of highly specialized transport service.
Recently, there was an unborn who was carrying 600 grams neck mass and experts told the mother to abort but we saved the baby with a rare procedure called Exutero Intrapartum Treatment (EXIT).
One of our doctors has invented a device named KONAR-MF-Occluder. This is used to close ventricular septal defects and other holes in the heart and abnormal ventricles.
We do a lot of these things because we have the expertise. Nothing that we can't do here that is done elsewhere. Rainbow has reached such a level of maturity that the results at par with the western countries.
Q/ How has Rainbow expanded using the Hub and spoke model to be accessible to a wider population?
A/ With Hyderabad becoming bigger and denser, people started asking us to open up clinics/hospitals in different areas of the city due to distance and traffic issues. Whenever these calls came, we started hospitals and they were super successful. Eventually, it became a classic hub and spoke model. It is one of the business cases, which we were able to orchestrate to the best of the standards and provided right clinical care to the wider part of the city. In terms of business, we are in Chennai, Bengaluru, NCR, and in AP, we are in Vijayawada and Visakhapatnam. In Bengaluru, we have 3 hospitals with 350 beds. The plan is to strengthen the existing hub with the capability to provide quaternary care including cardiac services. Keeping in mind the horizontal spread across the city, we want to go for wider coverage and become the specialized hospital for children. We have 2 hospitals in Delhi and I am working on starting a big hospital in Gurgaon and a 100-bed hospital in Noida. In the North- be it Patna, Punjab or Lucknow - all of them have to come to Delhi. So, much of it is Delhi-centric and it is just one place. So, Delhi is a big opportunity for us to build a large hub and spoke model. For the next 5 years, we have a clear path. We don’t just run hospitals for profit, we have a structure on how to go about in each city.
Q/ How is Rainbow Children’s Heart Institute performing?
A/ It was a long-term dream of Rainbow to have cardiac care services in Hyderabad. In 2019, an opportunity came to us to build a standalone pediatric cardiac hospital. It is 110 bed hospital that provides the most comprehensive treatment for children with congenital and other cardiac issues. We have got one the most reputed team of cardiologists and cardiac surgeons. We are doing a very big number of heart surgeries including the most complex ones.. Rainbow repairs about 1,200 hearts in a year, by performing about 700 cardiac surgeries and the rest, 500 cardiology procedures.
Q/ How is Rainbow faring in the stock market having debuted in May this year?
A/ When we were faced with the option of bringing in another private equity person, we rather went to public markets because Rainbow has always been strong on the governance and the environmental side. Once we listed, I have run into a different set of problems. In the financial world, the analysts have no one to compare and track us. There is no children’s hospital which is publicly listed across the world.
I have to travel and tell people about our story and guide them how can they track us based on the financial and operational
matrix etc. Otherwise, how will they differentiate and appreciate our story? I have been doing this evangelism for the last 5 months. Now people are excited and have understood that a children’s hospital can also be financially viable. Rainbow is the first children’s hospital which demonstrated financial viability, stability and also success in the stock market.
Q/ How significant is medical tourism for Rainbow and also the country’s healthcare industry?
A/ Around 2 % of our business comes from international patients. But it has scope to go to 6-7% in the next 3-5 years. In Hyderabad, earlier, 250-300 bed hospitals were being built but now the number of beds has increased to 500, 600 and 1000, keeping differential areas in mind like affordability, insurance segment, and international patients. Indian healthcare has a huge responsibility to take care of its patients and also to take care of Indian neighbourhood countries and Africa as these people cannot go anywhere but have to come to India for better treatment. If we compare the adult hospitals these countries are 15-20 years behind, and in the paediatric care they’re way behind. Indian healthcare can cater for a much larger population than any other country and Rainbow has the scope to address a very large population of the world. The whole of the middle east comes here only. Our neighbourhood, Afghanistan, Iraq, Iran, middle east come to us. Look at GCC countries like Uzbekistan, and Tajikistan, all these people come to us. We can cover half of the world. We have a big responsibility. That is where India can play an important role to provide world class pediatric service.