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Rama: After you started this Specialities Centre in 1991, how many patients would you have cured?

Dr. Mohan: There is no cure for diabetes. We offer treatment for diabetes. When I left my father's centre, I was literally empty handed. We didn't have money. So we had to start everything from scratch. We had a small rented place in Royapettah High road. We started in a humble way. We had no in-patients. Since we came out with experience, we had already learnt from our mistakes. And, we came to the right place at the right time. That was when diabetes was growing in our country. South Madras very badly needed such facilities. We brought in hi-tech to the heart of the city and the growth was phenomenal, much more than what we had initially thought of. We grew so fast in the initial two years itself, so much so that we had to move to Gopalapuram, where we started our Hospital in our own building.

ANNA NAGAR CENTRE

Though we continued acquiring land around our building, that was hardly adequate to match the demand. Then we started a Centre in Anna Nagar. Then we opened one in Hyderabad. Then we started a Centre in Tambaram. We simultaneously established the Madras Diabetes Research Foundation. It started off in one room in our Gopalapuram Centre. It grew so rapidly that we had to sacrifice three or four rooms. We purchased the adjacent land for the Research Foundation. Many were wondering why we were starting a full fledged branch only for research. They felt we were too ambitious. Those skeptics have been proved wrong. The Foundation grew so fast that in two three years, we were looking for more land. It was then that Prof. M S Swaminathan allotted six and a half acres in the Women's Biotech Park to my wife as a woman entrepreneur. We have now built a very big facility there in 25,000 sq. ft area exclusively for research. It is just an year old and it is full and we are looking for more space. We have ten scientists and 28 Ph D students working there.

RURAL CENTRE

We have recently started a Diabetes Educational Academy to run courses in various disciplines of diabetes. Very recently we started a Centre in Chunampet, the southern end of Kanchipuram District, about 120 kms from Chennai. A philanthropist donated some land. We will soon have our own building. Presently we have rented out a building. Its uniqueness is our foray into the field of telemedicine. We have fabricated a big van to our design, with a laboratory, an ECG unit and the retinal camera. A satellite antenna is fitted on top of the van, which goes from village to village. We have covered forty villages and screened over forty thousand people. We ensure that when we find someone affected by diabetes, we have his or her eyes, feet etc examined, ECG taken, all details stored electronically and transmitted to our Centre in Chennai. Doctors are able to communicate with them through telemedicine and provide care. Thus the doctors don't have to go to all the villages. We have found that this model works very well. This is perhaps one of the first of its kind. For those who need further treatment, we have set up a rural centre there. Some of our Doctors go there and stay there too. If they come across very complicated cases, which would be rare, those patients can be brought here for treatment. We hope to further extend this to other districts as well.

Rama:You did a recent survey on diabetes awareness in Chennai. Is there any comparative study on the incidence of diabetes among the cities of the world?

Dr. Mohan: There are some surveys available from cities in and outside India. But these are studies done sporadically. There is no systematic study. For example, If you undertake a survey in 2008, unless you have another one done say in 2011, you will not know if it is increasing or it's coming down. Chennai perhaps is the only city where some system is followed. Right from the times of my father and Dr. Moses some kind of a system is followed. Chennai can be rightly considered the Mecca of diabetes treatment. If you take all the research done in this field in India, almost 40% comes from Chennai. Because of this, we have consistent data from Chennai.

AWARENESS

From the available data, we can say that Chennai has the best awareness level. Of course when we did the PACE survey we found that even the awareness level in Chennai was not that good. It has improved now considerably. If you take the background knowledge in Chennai, it would be much higher than in other cities in India, where such activities are not going on in a sustained way. Since 1998, we have been having a huge annual exhibition, usually in December. Hundreds of thousands of people visit this. We have quiz programmes, lectures and day-long education programmes. Because of such sustained efforts, Chennai stands out from the rest of India. But we cannot rest on our laurels. There is a need to continue these efforts so that the awareness level is increased even further. We have to educate everybody. As the population of Chennai grows, more will have to be educated.

You know, India's literacy rate at the time of independence was about 35 per cent. Today the average is 65 to 70 per cent. But, in absolute number, there are more illiterate people in India now than at the time independence. This shows, whatever you do, you will have to keep on increasing.

Rama: What about the incidence of diabetes?

Dr. Mohan: It is going up. The factors that promote obesity, that promote diabetes are increasing all the time. Take for example obesity. If you take a look at the school group photo of, say your parents, you will find not a single obese student. There could be occasionally one obese student in a class, if at all. In your generation, you might have noticed one or two. Today, thirty or forty percent of the students will be obese. Very few are thin even in school. This is the case right from the LKG. Obesity is a direct fore-runner of diabetes.

Rama: Is it only due to the food habits?

Dr. Mohan: Of course, food habits do play a major role. Some studies have found that if you count calorie to calorie, there is not a huge increase. Not that we eat a lot and that our forefathers never ate so much. They also ate quite well. The difference is in the physical work that they did. They went to the field. They did hard manual labour. They would walk a mile or two, to and from work. Children walked to school. Very often I used to walk back home from school, about five kms. Today can you imagine anybody walking four or five kilometers in Chennai?

DIABESITY

You can see this in every aspect of life. When you go to an airport, you will see an elevator and a staircase. Hundred per cent of people take the elevator. May be one strange person may take the staircase. In hotels in India and abroad, when I am about to use the staircase, some attendant comes rushing to me to show me where the lift is! They would literally prevent you from using the stairs. If you still use it they feel there is something wrong with you. In any new building these days, the elevator comes right in front. Either there is no staircase or if at all, it is tucked away in some corner. Thus society is promoting obesity. This is the cause for the twin epidemic of diabesity ? diabetes and obesity put together! They go hand in hand. The most important reason is physical inactivity.

If you take schools, most of them, if not all had playgrounds. Now, you find buildings there. 'How can you keep an open place like that. We can make more money if you build something there.' This is the new philosophy. Many parents write to the school seeking exemption for their children from PT.

NO PLAY

When I was a student, after I return from school, I would go out some where, play, return, refresh and then sit and study. Now, once they come home, they will switch on the TV and watch it. Or, they will sit at the computer game or videogame. The really studious ones push off to his or her tuition class. Thus the very concept of physical activity has disappeared altogether. Now they say it is not even safe. Unless you have a closed community campus, people don't send their children out at all. Lifestyle has totally changed right from the very young age. Especially when both parents are working, they would ask the child to sit and watch a cartoon or something, with a packet of popcorn or chips in hand. They wouldn't even know the quantity that goes in.

There is another factor to this. Those days we would watch a Tom and Jerry. These days there is an element of violence in the cartoons. Adult themes are brought into cartoon form. The child gets immune to that. This mental disturbance also can cause diabetes and blood pressure even in a young age.

Rama:Do you hope we can correct it even now?

Dr. Mohan: Partly. You see, if I tell people, if you go by car, you will develop diabetes?, how many would respond? What I do is, whenever I go to an Airport, I always use the stairs. Many will be watching me. Some one among them may think, I can also walk up.Where ever you can, be a role-model. Firstly, you have to practice what you preach, you know. This way you can effect at least a slight change. Similarly parents can be role models. They can take the child out for a walk in the park or at the beach or on some not-so-busy road.

Certain things we cannot avoid. For example, the advertisement to promote a soft drink or an ice cream cannot be wished away. What you can tell them is: here are good foods and here are bad foods. Why don?t you take more of these and occasionally the other one? If you must have something sweet after you have your lunch, come on, have a fruit. This is also sweet. If you want to eat out, do that, but not four times a week.'

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