 Good afternoon ladies and gentlemen. My name is Asher Hassan. I'm going to be your moderator for this afternoon. We have an illustrious panel of health experts with us today. So I think this is going to be a swashbuckling session. I encourage all of you and I'm going to actually pick on people. So I hope you'll be paying attention. Those of you in the audience, not just in terms of the panelists, to both answer as well as ask questions. So I'm going to start from my left and we'll go clockwise. I'll just briefly introduce the participants and then we'll frame why we're here, etc., etc. So first to my left is Dr. Naresh Trehan. I hope I pronounced that correctly. He is the founder and managing director of Medanta, MediCity, right here in Gurgaon and has trained from NYU. So we have a common connection there as well as practice. I believe you were intending at New York University. Next to him is Jahangir Khan Thireen, a very prominent industrialist in Pakistan and certainly representative of the private sector here. So thanks for being here. Next to him is Vikram Kumar. I hope I got that right. He is the co-founder and chief medical officer of Dimari with a r and I've been told that the reason why it was was named that is because both of the co-founders consider themselves to be brainy. Is that right? I believe so. Okay. We'll find out more about that later. To his left is Preeta Reddy, Dr. Preeta Reddy, who is the executive director of the Apollo Hospital System, one of the foremost hospital systems in the region. On her left is Dr. Sanya Nishther, who is one of Pakistan's most prominent public health experts and a global authority on health systems. And to her left is K. Srinath Reddy, who is the president of the Public Health Foundation of India and I hope I got your pronunciation correct as well. Excellent. So the reason why we're here to frame this discussion and to frame this conversation is to explore the idea or the question which is can health be a bridge or can collaboration in health be a bridge towards peace, especially in the context of Indo Park relations. And to put this question in context, I want to go back or go back in time about six or seven years. There are three panels here who played a very active role in kind of laying the groundwork or laying the foundation of an initiative that we will explore in greater detail called Aman Ki Asha, which means desire or hope for peace. Aman peace in Urdu Asha means hope or yearning in Hindi. So a very apropos phrase. And so why don't we, since I like to be chivalrous, at least I try to be, we'll start off with the lady first. So Dr. Sanya Nishther, can you tell us perhaps give us some historical background to the initiative and to some of the collaborations that you've had with your Indian colleagues dating back to 2005-2006? Thank you Asha. Well the peace initiative that you referred to is an initiative, the civil society initiative. And Aman Ki Asha for those of you who would not understand Hindi or Urdu means a voice of peace. The initiative is backed by governments on both sides but it is largely civil society led and the secretariat is at the media houses, the largest media houses on both sides. The purpose is to foster collaboration between people on either sides with a view to promoting trust, building primarily. And the initiative has six channels of communication and conversation and health is one of them. So Naresh and I co-chair the health side of the track and our purpose under the rubric of that initiative is to promote convenings, to promote collaboration, to provide a convening space annually for physicians and people involved in the health sector on either side. And of course over the last two years we've hosted two meetings, one in Delhi, the other in Lahore and this next year round they're plans for a much larger meeting to bring stakeholders from both sides together. Prior to Aman Ki Asha also I had the privilege of working with Srinath and I think if you recall I think was it 2004 and 2005 when I brought two delegations from Pakistan, one to Bombay, the other to Delhi and Srinath hosted us here. And the flavour of those convenings was more academic in nature so the point of convergence was research and collaboration but with Naresh and in the civil society initiative the objective is more people to people contact, the softer sides of health, bringing the private sector together, bringing of course research and academia together again but bringing a wider constituency of actors interested in health and development in general. So we will take this momentum forward and very much thank the World Economic Forum for giving this particular issue space in their program. Dr. Trehan if you could just to elaborate on that what are your from an Indian perspective what are your aspirations for this initiative? It originates from the belief long-held belief that building bridges of peace on the back of science is much easier than it would be in commerce or any other areas where there are many hurdles, there are many economic interests, other interests which may override it. When you come to science and this is why I think that we are getting more traction than we ever expected is the fact that we are committed to not only our own populations but we are committed to science at a larger level to provide therapies, treatments, prevention and everything which are common to both sides or multilateral or many countries you can take Sark, you can take it on a longer canvas or a broader canvas. The point basically what we are looking at is to say that on both sides we have commonalities, on both sides we have challenges which are to a large degree originating from our geographical and demographic conditions not to say our economic conditions. So it is of paramount interest if you will look at it as a humanity to say what can we do and we must take charge ourselves and can we do it better along with each other or can we do it separately. So here is the convergence which has happened and like Sanya said Aman Ki Asha was a good platform because it has a continuum. Many exchanges have taken place, we've held conferences but then there are like nine day fairs they don't get long-term traction. So when you have a platform like Aman Ki Asha which is on a broad base but we in our sector at health are finding the least resistance to our progress forward. The first two years like Sanya said have actually been to converge our thought process, our challenges, our commitment, more importantly the commitment. So I think that this year's upcoming meeting which we are all preparing for will then bring out the specific programs which we have concretized and are now saying we let us move forward on a broader front rather than just dialogue. So I think it's a great thing that has happened the only it's up to all of us to give it life as we move forward. Dr. K. Srinath as a somebody who's been involved in this kind of dialogue are there any areas that you feel where there needs to be more progress or areas of further discussion and dialogue which could result in some concrete tangible interaction? Let me pick up from where Naresh left. Naresh emphasized the importance of science as a very useful bridge to bring people together but even within the overall realm of science health is particularly well positioned to build bridges because that is an area where there is a tremendous opportunity for empathy compassion and a feeling of common brotherhood where we can actually work a system of fraternity to work together. Essentially I believe that in the area of health there are a number of priority areas where we can actually jointly advance our health systems and our health services by learning from each other and learning with each other. For example in the area of health care there are a number of areas in which we can actually talk about the innovations that are being developed which are low cost high impact and are helpful at various levels of health care whether it's primary health care secondary health care or specialized tertiary care and share those experiences to enrich each other's services. Can you give us a specific example of such an innovation? For example the lady health visitor program in Pakistan has been an excellent program remarkably successful in advancing primary health care has even had an impact on mental health by reducing postpartum depression and in some senses it has been the inspiration for the ASHA program in India. Similarly now we are looking at a variety of innovations in primary health care whether it is conditional cash transfers or IT enabled delivery of services which again we can actually test and share so there is a lot of experiential wisdom that can be easily shared across but in addition there is a great need for joint learning opportunities and joint training opportunities even in education. We have severe shortages at various levels of health workforce right from specialist doctors to frontline health workers and allied health professionals. Now we can actually have joint academic programs in which we can pool our faculty resources together and then train a much larger number of people and now particularly with a variety of distance learning modalities being available geographical distance is no barrier so we ought to be able to take advantage of that. Then in the area of collaborative research there are several opportunities because there's so many health problems which are so common to us whether you're talking about a disease related issue like why are Indians and Pakistanis and other South Asians much more prone to develop diabetes or cardiovascular disease early on and suffer from it in much larger numbers than other populations. Could I have something to do with sugar mills? Well we don't know I mean I call it the South Asians sweetheart syndrome because of the diabetes and cardiovascular connection but what are the reasons is it to do with diet or is it to do with some other areas of propensity. So this is where we can actually conduct collaborative research which is very useful and will help us answer some problems in our countries. Same thing with health systems research. Sanya I know for example has been doing excellent work on how to use primary health care workers for detecting and treating high blood pressure in the primary health care. Now we are beginning to commence that process so again we can do collaborative research. So there are multiple areas just to conclude I would say in the broader framework global health is becoming very important in the 21st century. In fact the ennobling character attribute of human civilization in the 21st century is going to be global solidarity and in global solidarity there cannot be anything better than health to forge solidarity. The cleanses of past prejudices and to help health professionals and civil society partners to become the flag bearers of future friendship. Well said I'm going to pick up on a comment I made earlier so Jahangir Sahib if you can comment on this. So you're one of the most prominent industrialists in Pakistan you run a number of sugar mills. Your family has a lot of interests in the food and beverage industry so potentially you and your family can have a highly positive impact certainly from a nutrition perspective which obviously has an impact on health in the country and perhaps so the question I have is is do you see a role for you as a pioneer or potential pioneer in the private sector a role that could obviously be embraced and replicated by your colleagues in India perhaps as well who are in the sugar industry or in the food and beverage industry. Let me just sort of explain a little bit about myself I am basically primarily a businessman and in these sectors as you have mentioned but for the last 10 years I've been a politician and I have had access to being in government and trying to make public to adapt public policy for change but just to get to your specific question yes there are great potential for people in industries like the sugar industry which is primarily an agro-based industry and is rural in nature. We have about 10,000 people working for us in our various different operations and we have a serious issue with health related problems because there is very little health care available and the productivity of each worker suffers dramatically even more so in the rural areas other than in urban areas. So we have taken a lot of initiative as a part of our corporate social responsibility in trying to bring rural primary health care to two areas where we are operating and the results are in fact quite dramatic in ways because the change in the people's health is so dramatic that productivity increases so it's good for our business as well. But going on from there when I was moving around in the rural areas and doing what I do and I'm also into farming I saw the huge issue of these rural health centers and basic health units that were created by government and not operating no doctors available no medicines available so we took an initiative there and we contracted out from government originally to begin with three basic health units and try to run them in a sustainable system so that it would create a pilot for the for reform and they turned out that was very successful this is now 12 years in the making and now there are about more than two and a half thousand of the or almost 3000 BHU spread all over Pakistan that are being run in this contracting out model same the budget is the same that the that the district governments have and within the same budget just because that they are contracted out and they're taken out of the system the system for the better management the same amount of money results in hugely more health care so there are many lessons to be learned and speaking about Pakistan India collaboration this is just one population in the subcontinent we all have the same villages and the same issues with getting health care to the villages getting education to the villages it said both are large countries India much more so and how do you how do you get health care to the rural population and to the poor population of both countries I'm sure there are many models in India there are many models in Pakistan some work some have not worked so the collaboration between the two countries is of immense interest and of profit to the population of both countries Dr. Prithar Reddy you represent the the private sector in India especially from a health systems perspective one comment that the other Dr. Reddy mentioned was regarding the potential the success of the lady health worker program in Pakistan and this kind of touches upon a theme or a broad-based theme here at the World Economic Forum which is the role the main streaming and the inclusion of women in the workforce which is in most most people would agree is desperately needed in both countries in the health system arena what what initiatives have you taken or Apollo has taken to to gender mainstream women I don't know if you plan this but you know just asked it off the cuff but in the Apollo system there they're four women who've you know taken on from Dr. Reddy simply because there were no sons I don't know if there was a boy here you know the son might have been answering all your questions but having said that I think there isn't too much of a difference between the women as a workforce or the men you know the gender bias has slowly dissipated in our country and I'm sure in the neighboring countries it's happening all the time one of the points I wanted to make is that I think you know between Dr. Treyhan Sanya and Dr. Reddy they've kind of said it all about collaborative efforts between both countries but to me I think you know just as a citizen and as somebody who really loves the humanity in both the countries I'd like to say that the end result are we looking at peace or are we looking at improving you know health outcomes in the region and a group of healthcare professionals should actually look at you know the region as a whole and say that if we can do one to ten things to really improve healthcare outcomes in this region peace might just be you know a natural corollary you know that might be a problem for others to handle but I think that if you look at health and if you look at the the problem of the non-communicable diseases you know cardiac diabetes that's going to become a larger epidemic than terrorism of any sort and you know we need to realize that we have to be aware of that so I think that to me seems like a bigger and a clear and eminent danger than the fact that you know we have to worry about we have to worry but you know that's that's a responsibility a certain group of people have and I'm sure they'll handle it fine but we as responsible human beings responsible healthcare professionals maybe we should look at improving healthcare outcomes and then say that you know as a result of this that actually has been you know with a cross-border exchange knowledge idea data research professionals going across training each other because there's so much to learn from you know from both healthcare systems but to answer your question I think women are a very strong workforce as far as health is concerned you know you look at the nursing staff you look at students and medical colleges more than 50% today seem to be women women enjoy working in the in the healthcare space they'll just come there may be some things you may not find a great woman cardiac surgeon I don't know if I'll go to a lady cardiac surgeon but having said that I think you know they they are a strong very strong support system very good um I'd like to um Vikram I'd like to touch up uh follow up on a comment that Changi sub made earlier which is about the constraints of um healthcare access to healthcare in rural areas remote areas a major issue in southern benjab but certainly a major issue throughout the subcontinent um and you represent if you will the the future generation of tech pioneers and individuals who are really innovating in the e-health or m-health mobile health arena how do you see um uh the two countries collaborating in a way where we can transcend infrastructural constraints or leapfrog those constraints uh and work across borders so I mean first of all I think to answer that question I don't know if we have the right people in the audience to answer that question I mean I think that's a technology can do anything I mean so that's not really to me what's more interesting is um if if the question is how do you collaborate through through countries using technology it's it's not the technology it's really are the systems open so what I can talk about is what technology do we write we write open source software so I think there's a lot that governance can learn from open source software and and and the biggest piece you can learn is communication I think what open source as a movement and why it's really it has no boundaries it has no language nobody owns it is the fact that the community has identified with problems that they care about and I think that's critical and they've found a platform which is email a very simple platform where three through people can communicate so I think in this case the discussion we're having here this room isn't going to change anything the the the discussion has to be a layer lower to how will people what we're talking about is bringing people to doctors in in in both countries but how can you have people to people and health as a medium I'm not convinced that health is going to really do it because if you think about it you know we've all been patients or we're practitioners when you're sick you think of your health and you you care nothing more but your health but you forget very quickly once you're better the last thing you're thinking about is your doctor your medicine you're supposed to take so if we're building a sustainable peace model on health I don't think it's gonna long last long I think health is of course excellent we all need health but I'm I'm not convinced that this is really and I'd love for the what to hear what the panelists say I don't think this is where I put my money show please respond just in response I don't think we are building a sustainable model for peace with health as a sole entry point I mean we all understand and we know from historical experiences that peace is promoted in environments where there are economic interdependencies so you read the you know the history of the unification of Germany and you'll see how the Treaty of Zolverian preceded unification and the promotion of peace in that place we understand what the underlying dynamics are which is why trade is being promoted between the two countries as a vehicle for creating the economic interdependencies which will lead the business communities on either side to prevail upon their governments to exercise restraint and make the right policy choices you're completely right in saying that health is not just the only only foundation on which peace is being built but health is a very important entry point and I want to reflect a little bit upon what what what our what Prita has as well said your sister someone more closely known to me health and peace have a double-edged relationship if you look at the history of these two countries we we know what the cost of confrontation has been it has eaten into the fiscal space at least on our side of the border the relentless insurgency is an impediment to investment which can propel growth and create jobs I mean Srinath will tell you that one of the strongest determinants of health status achievement are per capita income and as opposed to that there's very little independent association with with of any health outcome with the number of doctors or hospital beds so that is one people in the health and development community strongly promote peace as one of the key cornerstones of development without peace development is just not happening and secondly as Srinath very rightly pointed out in this new construct of social solidarity in an in an emerging world where collusion and conflict have to be done away with health is a very good entry point now if I can have your your permission to have the floor for two more minutes I think health a a bilateral focus on health is not just a nice thing to have it's an imperative and I think we must understand the gravity of this imperative let's look at the geographic proximity I mean emerging and reemerging infections avian flu pretty much stalls economies buckles them to their knee I mean the threat of polio is just not over I mean Pakistan in Pakistan we are just not able to eradicate that every every summer and Jahangir will tell you when there's a dengue outbreak this complete havoc in our country and infectious diseases do not need passports to travel across borders we have to converge on this basis alone on the issue of geographic proximities look at the issue of counterfeit medicines I mean if there's a if their price differentials of two diseases there's complete dumping of medicines on either side of the border as it as is as is for agriculture commodities as you would know so for these geographic reasons alone we need to talk to each other we need to talk the policy sides of health need to speak to each other then this is not alone I mean we belong to a common gene pool and what is relevant to us in terms of the threat of non-communicable diseases what's relevant in the space of epidemiological trials and all does not have to be duplicated we have to facilitate comparative advantage and exploit synergy I mean I can continue to go on and on both the countries have a postcolonial imprint in terms of how their health systems are orientated we are both federations and we have similar set of issues and I think it's complete wastage of money for us to be doing building on what you said an evaluation of contracting out reform and for the Indians to be doing that on other side when we know perfectly well that our health systems are so deeply rooted and grounded in the same similarities so I think that we should not think of the conversation around health and development as something nice to have it's an imperative and of course other than that it we are going to capitalize on a huge dividend and for any government not to capitalize on this opportunity on either side would be an opportunity missed well health ministers are not going to be signing peace treaties and no war packs that is certain however if you want to people to people conversation and confidence building measures health is an excellent area to begin with and to consolidate and I think that's what we are really urging and even in terms of technology there is no reason why technology can foster conversation we cannot foster conversation and a better understanding of each other and sharing of information and health is an area where IPR is not a usually a barrier and you can actually share a lot of experience a lot of I mean the accumulated wisdom of all the work that's gone on in each of those countries and secondly remember globally health care costs are escalating budgets are now being busted across the world because of unaffordable health care costs including in the United States people are looking to countries like south a regions like south Asia to become innovation crucibles of low-cost high-impact health care so we can jointly together actually become that crucible and there is no reason why our work together you're not foster both economic prosperity as well as better understanding of people the technology to is a tool that can be utilized appropriately in the health sector you mentioned something which I which was very important which I'd like to get your comments on which is the importance of people-to-people interaction we know or we've we've observed in the past that especially in the that the importance of patient support groups for example patients who have cancer being able to share information with one another is this something that is part of your part of the medical city that you're creating or is it something that what's what are your views on this if you look at the larger picture you must layer it first the basic thing what we are talking about is right now that we if by not proceeding on this platform that opportunity that we have we are going to lose out all of us so that is given and very well articulated by everybody around the table also it's well established as a great entry point and a great vehicle to promote what has not been able to be accomplished in the last 60 years so we don't have to theorize about that the point really is that at our level of our own needs we need to collaborate to set an example of how trust can be built between the two populations we have a great opportunity I'm a dreamer that's the nature of the animal I would not say it is far off to say within the next five years we have an agreement where we recognize each other's medical degrees where the curricula are quite similar we respect each other's education system and contribute to each other and build two hospitals across the border run jointly by Indian and Pakistani physicians on both sides these are visual visible examples of what sharing can do you have to come up with these small little ideas which will then promote that trust what is our problem we know we are destroying each other we know we are depriving ourselves but that trust deficit is what is the core of this problem so I think that there is no doubt in my mind that if we dedicated ourselves diligently civil society private sector government everybody and said look yes this is an opportunity maybe we can do what we can do nothing may happen but doesn't mean that we should not do and that reminds me of the story that that lady who unfortunately passed away who won the peace price from it was in Nigeria or Bengali I don't know the right price so she gave that story who said that there was a raging fire in a forest all the big animals giraffes rhinos lions everybody's running like mad trying to run away from the from the fire and they look up and they see this little humming bird up there flying to the river picking up a drop of water and putting it on the fire again two and so two and so on they all laughed naturally they did so they said what the hell are you doing so she said I don't know what I'm doing but I'm doing the best I can so I think that to to be cynical about something that whether this will get the traction possible we can sit here and give up on it or we can say let's go down with all the commitment that we can put together recognizing the fact that the fundamentals are very strong if we do that then I come to then there is success the chances of success are huge second I come to what Srinath touched upon was technology if you look at it don't only look at South Asia where we are almost 1.5 billion people look at 5 billion people around the world who are deprived of healthcare okay so what does it do for us it's all we it's an attempt to solve our own problems create new innovations for for high impact low cost models and then be the actual leader for the rest of the 5 billion people to access health what are we doing today we are we are master copycats and I'm one of them is like I trained in America I learned everything there is to do I can do it better than Americans of course but that's different but then I'm still a copycat I did I transported that medicine here which we say is very effective it is effective most of the time it is very invasive because all three things we know is either we cut it out or we poison it or we shoot it with an x-ray beam but it's very expensive so we are saying if America is not affording what they are inventing and we are copying it then we are on a suicidal track so we need to reinvent medicine we need to look at while we are plugging in all these gaps we need to rewrite the blueprint of healthcare delivery in our own continent first and then maybe transport it to beyond our borders so I think there's a great opportunity here much more so than any economic discussion will take place so we also know that healthcare is the second largest industry after agriculture so it's not a small little effort of of trying to do cottage industry it is a huge opportunity for us and we may be the leaders of the world eventually because we have so much traditional medicine in our in our genes you look at Ayurveda I want to just get in about so let me be clear I'm not cynical I'm just practical and everybody of course you will say we need healthcare you run a hospital you run a hospital of course but no absolutely my point is we need to break it down a level and I never knew actually I've heard of Aman Kiasha I work in health care work in health IT I never knew Aman Kiasha had any health component what is it affecting the people is what I'm saying and for that absolutely health is a great place to start but there's got to be a lot of work to bring it lower so how do communities care maybe disseminating it through your no so mobile phone platform so let's think further so I thought hard I said you know what could health do so a donor marrow program for example to your point absolutely we have genetic similarity between the countries we have difficulties if it's already there it should be talked about it should be that's a to me an example of a very concrete practical example of how yes you can get a community to say look somebody from this village has saved my life it's not that a hospital has served them it's business to people I'm saying people to people and it can happen but I think we need to bring this this conversation one level lower to to people to people so Jahangir and what would it take for an Apollo and a shock at Hanum or a University to come together and create a joint venture cross-border where where exactly this type of interaction and collaboration can happen you know we kind of said it in many different ways but the people to people connect is there because you know between all the health systems in India or the fact that you know we're working with some of the friend the really good cancer facilities in Pakistan the connectors there it's there between the clinicians it's there between the staff it's not institutionalized you know it's it's like a single initiated between two people our patients come to India they go back and then the families connect with each other I think all that has been happening over the few over the past few years I try to say that you know if we can really do like a pilot or a model and say that for this community we would work together you know Dr Dr. Trehan kind of said the same thing that there would be one hospital in India one hospital in Pakistan and it would be managed same way same SOP same benchmark same outcomes that that would be a model of we just took two communities you know if we took like let's say a rural community in both countries we used all the learnings which you know both of them have and put it there and and really seriously monitor clinical outcomes then that would be a model for the rest of the world to emulate if maybe healthcare providers are you know allowed people from India allowed to go and set up hospitals in Pakistan that's fine you know people from Pakistan wanting to come and do hospitals here I think all these models have to work together you know if we can have clinics if we can have rural clinics if we can have telemedicine linked up with technology data which is seamless across the borders data which is used tomorrow for research and why are we constricting ourselves to research just you know with with India and Pakistan maybe we can take the same data and share it with you know Stanford and Johns Hopkins you know maybe they've reached some level and they really want this genetic pool to make a difference so I think we need to just take mentally say that you know the borders are there but from a healthcare point of view point of view from clinical outcomes point of view that you know we won't worry so much about the about the divide and say that let's really do something substantial you know they've done two three years of phenomenal work on this I'm kind of surprised you know it hasn't been everyone doesn't know about it but I think people in the healthcare space are really reading a lot about it and admire the work which is which is being done of course there's never enough in healthcare you know you think you've reached you won some battle and there are ten more things which you which you have to deal with but the baby steps first you know the little drops first maybe the two communities come together and say let's really monitor health outcomes let's let's look at cardiac disease diabetes cancer all these things which are bothering us and see if we can make a difference thank you thank you sir I would like to bring another dimension to the discussion regarding healthcare collaboration and peace ultimate peace you know the generations now in in Pakistan young generation and even up to my age we have grown up in Pakistan without any connection to India and a similar thing has happened in India without any connection to Pakistan when into when cross-border activities take place and especially in the health sector which is the I think the health and education of the two most serious things that affect each population when cross-border amangiasha type of initiatives take over you come into India and realize how many of the problems of India are similar or exactly the same as the problems in Pakistan let me give you a personal example of what happened today I got up in the morning I opened the paper I read about dengue in India and this is what we have been facing over the last three months in Pakistan I had no clue sitting in Pakistan the dengue is such a serious issue in India as well and I leave through the paper and I come across an article of sanitation and sanitation is without good without taking care of sanitation we are not ever going to fix the health problems of both countries but they're exactly the same villages I don't do not have enough access if government if the public sector comes in and puts in sanitation schemes they don't work they get clogged and so there are solutions in Pakistan regarding sanitation the Akhtar Hamid Khan Dr. Akhtar Hamid Khan is a very famous social scientist who set up something called a dengue project in Karachi and you know this little slump population of a million people took took sanitation in their own hands and he helped them technically and they all lived the entire problem was resolved and now we have taken that into into rural areas of Pakistan also and I remember that there was a sanitation meeting on sanitation arranged by probably the World Bank in which we are people from Pakistan came to India exactly the same problem the point is when you realize that we may be different countries and we may have had a very adverse relationship for the last 60 odd years but at the end of the day we have the same people we have the same problems and so therefore similar solutions this is a huge bridge to peace can I just speak further on that and I completely agree with him you know there's something so romantic about Pakistan India because we travel all over the world but when it comes to India you know there's this you know there's what I would like to call the proximity of the distance you know I crossed the bargain border yesterday it took me two minutes to cross and it takes you such a long time to make a journey and you're really yearning to cross over on the other side because you know that the people over there are ethnically similar you come from the same gene pool your grandfather's house was on this side of the soil you speak the same language when Srinath and I meet in international meetings we are on the same wavelength we speak the same language we eat the same food and and unfortunately there's this distance we did at our at my organization we did an an assessment of the nature of collaborations over the last 60 years and I tell you we stopped counting them we looked at we looked at peer reviewed literature we looked at great literature and we did the keen format interviews using the snowball technique and the collaborations fell in three categories one was the one-to-one relationships the other were the more the Sark or the South Asia type relationships then of course there were initiatives where multilateral agencies convened regional groupings or where overseas western agencies and academic organizations brought us together in South Asian convenings but in each one of them and this is what we dug out from the informant interviews in each one of them the the bottleneck and the impediment were three there were visas number two there's a mistrust you know by certain extreme elements from from from either side of the border not by the by the major bulk of the society and then of course the the impediments to the financial transactions so Srinath and I apply for a joint grant there's no way I can send him the money it's going to take me a month to get a visa and of course there will be mistrust distrust from both sides unfortunately for different accounts there's one thing that I have learned from reading history is that there's some societies where the nature of the confrontation actually seeps down to the level of the society and I don't want to name those but there are some societies where confrontation sows the seeds of hatred between people I have never come across a single Indian where I get that vibe of hatred you know this confrontation this confrontation is costing us on both sides of the border it is costing us a lot innocent people are dying in the process and are being deprived of essential facilities and we really have to look at things in a very different way and all we are saying of course people like us come from this little world of health we really do not have leverage over and beyond that and you know this is back to your story of the hummingbird I think whatever we can do is something that we should I was flying from Beijing two days ago and you know the secretary social protection of Pakistan was on the same flight with me coming back from India and you know he told me he said we've got the Benazir income support program where they've done some very transformational work on developing a database you know which is now a national asset it doesn't have to do with one government it will remain a national asset and on the other side of the border is RSBY who've done some very transformative work in in ascertaining entitlements and we immediately got to the drawing board said this is a perfect fit we can learn something from them and they can tap into our expertise and there are thousands of examples like this but we really have to make those connections those connections in terms of geography in terms of visa in terms of fiscal systems in terms of monetary integrations and most importantly in terms of trust so people like us who are humbled with you know with some level of good name that we've created over the years have to stand up and say that we subscribe to moderate views in our in our part of the world that we want to extend a hand of friendship to all the neighbors around and this cost of confrontation really has to come down well said let's start making some connections in this room if you can please ask a question and don't not a comment or a statement but we do encourage you to ask thought provoking questions based on what you've heard today so men as disease let's start off with it does have to be a question one one can put it as a question you know it's it's more of a visa question coming to a level of collaborative question you know I I didn't know about the Aman Kaisa health initiative I knew about because I'm not from the health sector but I know is that that very very poor people when you when we are talking about bringing it down very very poor people bring their children to India for heart surgeries because that's something very specific and it's very cheap in India and you know so so there is this either they get into onto a bus or to the railways and they do get and how I will put this to the forum it's it's something like very tangible that how do you get easy access to visas or there any kind of easy access to visas possible I had to put a question that's a question it's great I can answer that yes please go ahead see one one thing in spite of the process through which one has to go to get a visa that there is a medical channel which the Indian government at least has put forth and each embassy has had the same briefing to say that when they have the appropriate medical background papers and a letter of from the corresponding hospital here to say that yes we have registered this patient visas become very easy so you know the children that you alluded to we have all these programs where we not only try to subsidize the treatment but there are at least few hundred children that we do free from Pakistan and different institutions of our institutions so that has been an ongoing program and it's very encouraging because you do read news reports of families and all that expressing their their view on how this we are helping each other the basic thing from that I would say is that there is no reason and it looks like the the environment is clearing a little bit on both sides it seems like that it's a very encouraging moment and we can be the agent also to encourage that process and I think what what is happening here today is in public that we are actually renewing the vows of of this movement but it also Sanya I would say particularly that it also behooves us to now put a lot more energy now that we have our own vehicle to travel on top of the platform of Aman Ki Asha if we continue with this conviction and try to bring down bring out these models that we are talking about at all levels public health whether it's public private partnership whether it is collaborative effort across the borders or more importantly and I think Srinath would be the right person to carry to the government level is to say what is the impediment of progressively recognizing each other's educational degrees because not only in in health but maybe in in others but we can start with health because it's easily documentable and then we can you know we can move this along which would be a great gesture and I don't think has any danger attached to it I think just to take the discussion along on the visa issue that there is some good news coming the foreign secretaries of both governments have met they've negotiated for a while and the a much easier visa regime has now been I think agreed upon and it is now awaiting permission final approval of cabinet in Pakistan I know that for a fact and believe me that these initiatives like Aman Ki Asha and other collaborative initiatives where the population of both countries have met have gone to each other's country have played a significant part in the fact that we have been able to negotiate visa removal of some visa restrictions and bringing the two countries together. So I'm I'm born in Karachi so every time a new passport guy comes and looks and says how could we born in Karachi and be in India not noticing I was born before the partition so so maybe that's the reason why I'm more on on the other side of the border. Just a footnote to what Naresh elaborated very nicely at any response to Manaz's question there is an Aman Ki Asha track which is funded by Rotary International which is dedicated specifically for bringing children you know with pediatric cardiac problems that cannot be operated upon in Pakistan across the border and I wouldn't know off the cuff of the number of children who've been brought with financing from that side but they have been brought they have been treated with funding from Rotary International with whom we have the privilege of partnering with so of course there are these channels and we hope that they will deepen with time. And just to answer your question a sports interaction is is another platform that has been used so there's this cricket diplomacy which is which has been where there's been a lot of movement on and apparently there is going to be a series between India and Pakistan starting I think the 25th of December I believe well don't talk about peace then that brings out the worst in us but friendly rivalry friendly yeah that's on a lighter friendly note yeah and apparently there will be liberal liberal visas will be issued liberally for Pakistani supporters to come and cheer these matches other questions we haven't heard from this side Ashwin I think what we have seen today even private healthcare both in India and Pakistan is largely upper middle class upper class so is there you know from both sides are there efforts to sort of look at the affordability question right because a significant portion with whatever we do is still out out of reach of of getting into private healthcare or a good good good type of public system I was alluding to that only when I said see we big impediment for us has been that technology innovation has not taken place based on our needs the reason is that there is investment required and if the critical mass is not there for utilizing that technology or buying that technology it never takes off so what I'm saying is that now if we recognize that one we have over 1.5 billion people in on the subcontinent and even if you took 10% 20% of that population it becomes a huge population which can initiate the first innovation process of course then it'll it'll go down now my personal belief is that look we are on the we are on the wrong side of medicine like I alluded to earlier there is such a huge wealth of traditional medical systems health systems available in our country which got sidetracked for lack of scientific validation we've already started the process of taking herbal remedies or extracts and putting them through the same paces that our pharmaceutical industry has to go through to be able to validate the efficacy the bioavailability in all these other stuff and we've had some very good early success in Parkinson's you will not believe I will show you so we can always show you some documentation of these films where the rigidity that is associated with treatment of Parkinson's with al dopa and other drugs with Ayurvedic oral and and oil massages and all that the rigidity goes away dramatically so there are many many remedies that we are my favorite example is that if you have a if you have an infection throat infection you take X amount of antibiotics so augmentin will give you 99% relief from your infection but 30% will have GI symptoms 100% will have a big hole in the pocket okay so if there was a synergy between which you could find and I'll just take one more minute to give you that example is that we in modern medicine believe that is the body it's ailing I got the means from outside and I'll put it inside your body and treat you ignoring completely the strength of the body to heal itself which was the basis on which homopathy and a lot of Ayurveda and other traditional Chinese medicines are based on so I'm saying that if we can fuse the two if we can use the power of the body to stimulate its immune system or boost whatever we have what we can boost and I don't have the full knowledge yet and then use the outside methodology to combine the power of the two maybe we can reduce the half the dose of the antibiotic reduce the side effects to half and also reduce the cost we're about to start a big program where the it and it comes out of a government institution that all the trials on this herbal stuff has been done up to up to preclinical which we call animal trials and all that and it is holding promise that it will increase the efficacy of cisplatin which is commonly used in cancer treatment by improving or enhancing its efficacy by 2x so you can imagine how much cost you and side effects you can you can take out of the same so there are many many things that we need to look at afresh and that is why I think that the future of medicine that we invent for that five billion people will be the new era medicine which I hope will come out of India certainly not in my lifetime but hopefully in serenades firstly I think we have neglected the whole issue of affordability in our health planning though the intent was there in the beginning it fell into neglect because of the way our health services have been structured and financed and now we are now looking at universal health coverage and the framework of universal health coverage is now being developed and debated in India and I'm sure similar movements must be going on in Pakistan as well so I think we ought to be able to really look at how to reconfigure our health systems to enhance affordability at the same time we must also learn not only from each other's strengths but also from each other's mistakes we have neglected primary health care substantially and disconnected it from secondary and tertiary care and thereby increasing the load on secondary and tertiary care of what were eminently preventable and treatable at the primary health care level so that is something that India has paid the penalty for and we ought to repair it similarly in Pakistan in their zeal to decentralize they dispense with some of the federal regulatory agencies and when they dispense with the federal drug regulatory agencies suddenly there was a spurt of counterfeit medicines in Lahore which claimed a number of lives so we have so much to learn from each other both from the strengths as well as from the mistakes so that we can actually build up sturdier health systems which are affordable at the same time and just on that same note you know as Australia rightly said you know there are these big ticket endpoints health systems and points of access you know geographic access and financial access and quality and cost and of course there are these big ticket recipes of reform to address them but one of the things where which creates another imperative for us to learn from each other or at least to join brainstorm together is the issue of the private role of the private sector and health service delivery I mean not all private sector entities operate with the quality standards of Madanta and Apollo I mean you have a range of private sector entities that the state has absolutely no handle on so they work in different systems of medicine they're all kinds of infrastructure they are what we call described quacks there are health providers who are providing services for which they're not qualified and this particular issue what I like to call the mixed health system syndrome you know the syndrome of the publicly financed and government provided services coexist in alongside the privately provided services where out-of-pocket payments are a major means of health financing is something uniquely endemic to South Asia India and Pakistan in particular an area which has been a very poor area of research and as we hopefully chalk you know in our conversations chalk research research agenda forward I certainly look forward to this being one of the core areas but on a slightly different note and picking upon an earlier thread of the conversation I think you ought to be at that Aman Kiasha health forum table you know on those convenings where people listen to each other's presentations see a synergy immediately want to draw on a comparative advantage and run with the run with the collaboration immediately and we hope to showcase some of them when we come to Delhi next year we all look forward to an invitation one last time for one last question yes so we're concerned about the Indo Park divide and the ratio just talked about the expensive allopathic and inexpensive home apathy for example which is the bigger divide so if you were to convert it into that we I think we suffer from the same syndrome and the divide whether it's home apathy or other traditional medicine the divide is huge and we are largely responsible for it because the practitioners of modern medicine hit Ayurveda and other forms of medicine with such a big stick that they actually froze so now when you reach out and first of all I'm one of the few who even wants to think like that because I'm often criticized about how I want to give away our domain but the basic thing is when you reach out to homeopaths and Ayurvedes their first concern is that what is your motive behind trying to engage with them is it to destroy them further or is it to really you believe in the value of it I for one am a believer and I've seen hundreds of examples of how it has worked together and I think that there is this is just my own belief and I have no nothing to say other people should start believing it till we prove it that there is so much synergy between these different forms home apathy becomes a little difficult to scientifically validate because of the fact that it's a nano dosage kind of description that I've found but herbal you must understand has huge and you must understand also that a large part of our pharmaceutical industry also came from that herbal they may have synthesized it but the roots are in those roots so I think that there is a just a will and I'm just waiting for a few solid you know provable examples where we can put it together that I think that with the the mind will change why because human behavior changes maybe for larger good of society but more so for your own good and if the question that was asked about the cost and the fact that we can bring down the cost and treat many many many more people we will not suffer economically we will gain the economically and once that is permeated into people's heads I think it'll get much more traction today we are so used to going at the same time in the morning eight o'clock and doing the same thing repeating writing the same prescriptions the pharmaceutical guy will come and give you the new miracle but it's all destructive as far as I'm concerned because we are on a suicidal path America has shown it Srinath just said many countries have gone bust and they do so what we are saying is we may not we I mean we may be bust already but the basic thing is that 1 billion people who are out of the health net and they are depending on quacks and all these my own servants from my own house think I'm a quack because they think that you want to do blood tests and you want to do chest x-ray before treating them they want to go to the neighborhood crack who gives them one poke and they somehow feel better so I think that there are many many battles to fight on all fronts but again it's a building block 50 percent of the disease burden can today be reduced by just primary sanitary drinking water all this is all the cliche that we talk about every day but we haven't done anything about it second is the point that we there is no education but so we will see patients come in with with totally advanced disease which is incurable but if we had means of early detection we could decrease the disease burden or the cost burden hugely so where do you start that's one point but today just to keep the focus on our engagement that we pick out some of the some of the quick fixes because nothing like if you can show some results then the the belief is renewed regularly and that's what we are working on that we want to announce on the in the March April meeting that we have the following four or five fronts which we have done all the basic work on and we can now collaborate to start working and show some quick results on these things so we look forward to to that evidence of yes the real tangible evidence I want to thank all of the participants of course the panelists who shared their thoughts and views as well as all of you for being for taking part in this discussion I just wanted to make a housekeeping announcement that the buses will be leaving for Dreamworld is it is that the right name of the place Hingdom of Dreams so to your point we're all dreamers and as John Lennon said you're not the only one so we're now going to go from this dream world to a real dream world Kingdom of Dreams very exciting highly recommended excellent look forward to it so thank you once again and just uh uh I'd like all of you to join me in giving the panelist a warm round of applause thank you