Dr. Nakul Raykar, Belagavi-born Harvard Trauma Surgeon Speaks About Trauma and Blood Availability in India and Around the World

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Belagavi born young citizens are remarkably performing in various domains across the globe and have propelled the name & fame of the city to newer heights. These professionals are guiding spirit to many youths who are on their toes to perform & contribute to the wellbeing of mankind. Belagavi Born Dr. Nakul Raykar is a trauma and acute care surgeon at Harvard Medical School’s Brigham & Women’s Hospital in Boston, USA. His team provides complex care to critically injured patients.

Dr. Raykar’s core research interests includes trauma system development and surgical system strengthening across the world with a specific interest in expanding access to safe blood transfusion.  He spoke at length on various issues of trauma and emergency surgical care in India and US hospitals.

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What are the types of Traumas in India & USA?

Dr. Nakul: There is a wide variation of trauma patterns across both India and the United States but, in general, India has a high burden of road traffic accidents, work place accidents, and falls. With an increasing congestion of all types of vehicles on narrow roads shared with pedestrians, bicyclists, and animals, the number of road traffic injuries are only expected to increase in the coming years. While most of these injuries are at low speeds, there is often direct impact with pedestrians and two-wheelers which can lead to devastating injuries. In theUnited States, road traffic injuries are typically at higher speeds and there is also a relatively high prevalence of penetrating injuries from gunshots and stabbings

Is there any study being conducted to find the outcome of trauma in India & USA?

Dr. Nakul: Yes, under the sponsorship of the World Health Organization Collaborating Centre for Research in Surgical Care Delivery in Low and Middle IncomeCountries, a comparative research study is being conducted to understand injuries in India and compare against global outcomes. This work will lead to identification of weak spots in the trauma system and point to interventions that can improve these deficiencies. Dr. Nobhojit Roy, trauma surgeon and public health specialist in Mumbai, leads this collaborative work. In a study from 2013-2016 which included over 16,000 trauma patients in major public hospitals in four cities in India, overall trauma mortality was over 20% in India, compared to approximately 2% in the USA. More work is urgently needed to understand the nature of these differences so that we can address them. Our overarching aim should be to establish trauma training and systems throughout India, with adequate workforce, infrastructure, systems and financing to meet the needs of Indian trauma patients. Solutions that work in the United States may not be appropriate or work in India; these ideas need to be tested in the Indian context, and the low-cost innovation that India is known for may have great impact on trauma care in other parts of the world, too, including the United States.

Why are results of post Trauma encouraging in USA compared to India?

Dr. Nakul: Trauma care is an entire system in the United States that includes a level or organization that has been evolving for decades. Hospitals are designated as trauma centres based on their capabilities; prehospital personnel preferentially transfer critically injured patients to these centres, and once patients arrive at these centres, a very specific protocol for the care of these patients is typically followed. The treatment team consists of a broad range of consultants from trauma surgery to neurosurgery, orthopedics, and emergency medicine. While many Indian medical centers are world-class facilities, the trauma system as-a-whole in India is still in its infancy. For a trauma ‘system’, one requires trauma centres positioned 24×7, ready with a multidisciplinary team including physicians and nurses and prehospital personnel. Bleeding in trauma cases is huge and is a major reason for mortality. The time taken to shift from Primary hospitals to Trauma Centres is large and the golden hours are lost and many patients succumb to injury. One critical area that I am particularly interested and concerned with is the lack of blood available for transfusion across India. Blood transfusion is a critical element of a trauma response when dealing with bleeding patients, which is quite common. Further – very important to the development of a trauma system – is research and a continuous evaluation of every case and, specifically, every death or morbidity. These structures are more developed, at the moment, in the United States.

What are the immediate needs of a trauma centre?

Dr. Nakul: To ensure good outcomes for trauma patients, the following immediate practices should be followed:1. Maintaining airway (intubation)2. Treating lung related complications (ensure breathing) 3. Circulation to all parts of the body; the heart needs to be pumping and supplying blood to all parts of the body.  4. Immediate & safe blood transfusion to the patient 

The status of blood donation in India & USA

Dr. Nakul: We will have unnecessary deaths from trauma if we do not have blood available for transfusion, and India – like many low-and-middle income countries (LMICs) – is in a shortfall.  Globally, there is a 114 million unit blood deficit in LMICs. On average, LMICs have a donation rate of <4 units /1000 population compared to 20-40 in high-income countries.  In some parts of India, blood availability is less than 1 unit per 1000 population.  When there is a dearth of blood supply for want of blood, patients are shifted to other hospitals for trauma, obstetric hemorrhage, pediatric anemias; treatments are deferred and precious time is lost. Blood banks with adequate stock of all groups of blood is the need of the hour.

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What are your Research areas of interest?

Dr. Nakul: How do we make blood transfusion available to all patients who need it, when needed? As a Trauma Surgeon, without a blood supply we can’t cannot treat patients. My research is heavily focused on blood transfusion availability in the lowest resource settings around the world. There is much, excellent work ongoing in optimizing the blood transfusion system in India, led by state and national-level policymakers and experts in transfusion medicine. But we should also be looking at novel and alternative strategies for transfusion in the most remote areas, which are at greatest risk. These strategies include the concepts of civilian walking blood banks, intraoperative autotransfusion, and drone-based blood delivery.

How you compare USA medical training to Indian training?

Dr. Nakul: Indian allopathic medical training, research,and doctors are at par or even better than any doctors in any part of the world. In America, the Indian born, Indian trained doctors are well respected. They enjoy the trust of their patient population as they are, in general, talented, skillful, communicative, and committed to the profession.

How do you wish to connect with Belagavi?

Dr. Nakul: My roots are strongly connected to Belgaum and I make it a point to visit here multiple times a year. Professionally, I love to share my expertise in improving the quality of treatment to trauma patients as well as methodologies for universal blood transfusion, along withcollaborating with hospitals for community medical research – particularly in blood transfusion and trauma. Belgaum is a wonderfully gifted city with a multi-cultural, multi-lingual population. I always cherish the memories of Belgaum and look forward to my visits here.

Dr. Nakul Raykar is married to Reena who works in Deloitte in Boston, USA. Reena is an active volunteer and sitting board member at Chinmaya Mission, and leads youth spiritual classes and camps. Dr. Nakul’s father, Dr. Prakash Raykar is a pharmaceutical research executive and currently resides in Bhagyanagar, Belgaum, along with his wife and Dr. Nakul’s Mother, Surekha Raykar.

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