NTSP Special Interviews (India 2026): TMH Head & Neck team

The team were in India in February 2026 and had the privelege to meet patients, families and staff who were working to improve tracheostomy care. This special interview is with Professor Gouri Pantvaidya and Dr Arun Balaji from the Tata Memorial Hospital (TMH) Head & Neck Surgical team. The TMH experts are in conversation with Brendan about their inspiring work, the challenges they face, and their reflections on the highly successful National Tracheostomy Conference held at TMH.

The UK National Tracheostomy Safety Project (NTSP) is committed to providing education, information and resources to improve patient safety and the patient experience for those with tracheostomies and laryngectomies. All of our resources are housed on our website www.tracheostomy.org.uk, accessed by over 30,000 visitors each month from around the world.

This is the only podcast to bring you literature reviews, hot topic discussions and interviews with healthcare staff, patients and families.

Our goal is to improve the safety and quality of care for patients with tracheostomies and laryngectomies through education. We work closely with patients, families and healthcare professionals to develop new resources to improve care. We’ve collaborated with key stakeholders in tracheostomy care since 2009, and developed freely accessible resources, supported by online learning developed with the UK Department of Health. We’ve worked with the Global Tracheostomy Collaborative since 2012 to improve care for patients and their families everywhere.

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Transcript

SPEAKER_02 0:32

So welcome to Cracky Talk. We are in Mumbai at the Tata Memorial Hospital. And I'm joined by uh Dr. Guri and uh Arun. I'm just going to start off by getting these two uh clinical guys to introduce themselves and tell us about their jobs. So Guri, she's up with you.

SPEAKER_03 0:49

Hi, I'm Gauri Pattavaity. I'm a head and neck surgeon and I head the head and surgery services here at the Tata Memorial Hospital. I have been working here for close to 20 years, and my uh specialty is only heading cancer surgery.

SPEAKER_00 1:05

Hi, I'm Arun Balaji. I'm the uh lead speech language therapist at Tata Memorial Hospital. I started working in this hospital in 2015. I my major uh work in head neck oncology rehabilitation, thoracic oncology rehabilitation, and a little bit of uh neurorehabilitation.

SPEAKER_02 1:23

So, Gary, we've been here for a couple of days now. We're really struck by how unique this place feels. So I wonder, would you be able to just give us a little bit of a flavor about the hospital here and what it represents?

SPEAKER_03 1:34

Sure. So uh the Tata Memorial Hospital was um something that was started by the House of Tatars in 1941. And after that, it was handed over to the government of India, and we are run by it's we are a Grand Anade institution of the Department of Atomic Energy, Government of India. So basically, it's a government hospital. We cater to all types of cancer patients. It's a tertiary cancer care center. We cater to all types of cancer care patients across all socioeconomic strata in the country. We have a huge footfall, and large proportion of our patients come from far-flung areas across the country, and most of them are from the poorer socioeconomic strata. So it's a government-funded hospital, and most of our patients come from very far away to away the services that we have given. It's a it's a long history of Data Hospital. Most patients have come here because of their trust and faith uh in the services that this hospital provides.

SPEAKER_02 2:34

Yeah, I mean we've really been able to see that while we've been here. We've spent some time with you in your clinics and on your wards. And I just wondered if you're just able to tell us a little bit about the work you do specifically with head and neck cancer, because I was struck by a lot of the differences in your patients and your sort of caseload that are very different to where I work at.

SPEAKER_03 2:54

So at the Tata Memorial Hospital, um, we do a lot of work with head. Hedenic cancer is a common problem in our country, especially oral cancers, because we have the uh habit of chewing tobacco along with a lot of other additives. Uh, most of our cases are oral cancer patients, and 60 to 70 percent of these cancers are in the advanced stages. Now, in het cancer, for advanced oral cancers especially, the treatment is always to in most cases is surgery. And uh so we have a huge workload of surgical exigence, and most of these are very complex. Also, being a tertiary referral center, we have a lot of patients who come to us after having received treatment elsewhere with recurrent cancers. So it's an even more complicated group of patients that come to the doorstep of Tata Hospital because they have received treatment before, have recurrent cancers, and now we probably have to look at how best we can treat these patients with resurgery, reconstructions, and the rehabilitations. So we do have a very, very unique population of advanced cancers. Actually, we have we also see a lot of varied histologies, and as I was mentioning to you a few days back, you can say you want to see the contracharcoma of the nose, and um, you will find a contracoma of the nose somewhere in the OPD. So we have a lot of variety, a huge number of cases, a lot of histology. Uh, really a unique place and a wonderful place to work in.

SPEAKER_02 4:25

Yeah, oh fantastic. So, Arun, you're part of the team. Uh, your role specifically is a speech and language therapist. Would you mind just telling us a little bit about uh your input into the service?

SPEAKER_00 4:36

My professor Gauri told about the Tatamamula hospital. Actually, it's very uh excellent services in surgical oncology, radiation oncology, and medical oncology. What I felt is the uh I was one of the inclusion in the almost 10 years before in speech language therapy. I think already everything structure is uh built, everything, and uh I think speech language therapy made uh like uh painting actually that made a little bit uh more uh beautiful for our services. And uh since then um it has grown up significantly, and a lot of collaborations with our head and surgical oncology, radiation oncology team, and then uh even medical oncology. Apart from the speech language therapy, we initiated the audiology services and uh it was a combined uh uh like project of uh establishing the free services from the heading surgical oncology and speech language therapy, and then yes, it was a like smaller group of team, and then we initiated a uh fellowship for improving the uh human resource for our uh uh country, and I think the collaboration is increasing with other nursing teams and everyone in the hospital. Okay, fantastic.

SPEAKER_02 5:47

So, what is a typical day for you look like if you have a typical day?

SPEAKER_00 5:51

Oh that that's uh interesting. Uh as uh everyone says it's one of the country's uh most important hospital and a big hospital. The footfalls is uh really uh high. Like when I when you think about only outpatient services, almost uh 60 to 65 patients will come to the uh outpatient services. When I look into the uh FES clinic, there is almost more than like uh 10 to 15 patients, and then we have laryngectomy services, inpatient services, like it's quite a bit of uh more work, but still we enjoy our work. We have uh good uh interactions with our uh uh uh surgical teams for uh better uh improving uh care for complex uh patients. Still, it's a big day, and we will enjoy.

SPEAKER_02 6:35

So, Guri, we had the privilege of spending some time in your outpatient department. Um, would you mind just telling us a little bit about that the sort of ethos behind patients who who turn up at your hospital? They basically turn up at your front door, don't they, and sort of queue up and and wait to be seen by you guys. So just tell us a little bit about that sort of like if you had a day in the clinic, what does that look like?

SPEAKER_03 6:56

So um, yes, as I said earlier, uh we have patients coming from all across the world, uh all across the country, and um, they come with their bags and baggages. Um they have heard from their peers and their friends who from their uh states from where they come that this is a center where uh people will look after you. So they come with their bags and baggages on the first day, and our outpatient clinics often have people who come in with their suitcases. And um we do have a huge footfall. The problem is that we're not able to provide all services to everyone who comes to our doorstep. We have limitations to the number of operating rooms, the number of radiotherapy machines, the number of daycare beds that we have for all of these patients, including rehabilitative services. In the last year, we saw uh 11,000 new uh heter neck cancer cases in one year. So we are not able to provide surgical services. I can talk about surgical services for all of them, but we definitely try to work them up, we definitely try to look at staging them well, uh explaining to them. Often they don't know that they have got cancer. It's something that we often break that news to them that yes, you have cancer, you need multidisciplinary care, you need multiple different types of care, and you probably will require long-term care. Uh the other thing that we try to do, and this is the ethos of the hospital, is to provide, uh really try to provide international standards of care, evidence-based medicine to every patient who walks into the door. And that sometimes uh strains all of us because you may have you can have a lot of workload, but if you want to do everything to the highest quality, uh then it does put a lot of strain on the system, doctors, nurses, residents, um, paramedical staff. Everyone does find it difficult. Nonetheless, um uh it's a constant fight and a constant struggle to give high quality uh care uh to a lot of patients with a lot of complex cancer care, and that's really the ethos of the hospital.

SPEAKER_02 9:15

Yeah, I mean two things really struck me. Firstly, very obvious volume of patients, you know, the the waiting rooms, which is a chocker block, the staircase out of patients that's all the way up waiting to see you guys, but then the dedication to staff who are determined to see everyone and provide that high quality care. So it was it's very striking.

SPEAKER_03 9:33

Yeah. We also have a very strong ethos of research and education. So a lot of the work that we do and the improvements we make uh comes from our own research. This institution has always supported all clinicians, all actually all staff to do their own research. It's something that this uh it's unique in this hospital. We are all uh asked to do our own research, and it may not be um uh randomized trials always, but we all are supposed to audit our work, get our data, and then we move forward, you know, trying to make improvements. So the improvements that we make in patient care in this hospital are often, I may not say always, but very often data based. Uh which is again something that is difficult, it takes your time, but that is almost something that everyone insists on.

SPEAKER_02 10:24

Fantastic. Yeah. Okay. The reason I'm here with some other colleagues is for this conference. So, Aruna, that was your idea, wasn't it? So tell us a little bit about the the concept behind this tracheostomy conference that you've laid on, what you hope to achieve from it.

SPEAKER_00 10:39

Actually, uh we wanted to run a tracheostomy course. I think uh even the uh foundation of Hedneck Oncology, which started which uh happened in Mumbai in 2024. We had a discussion also, but that time uh it was uh like we had a lot of many conferences, a lot of pre-conference, and it's a huge day. I think we felt that it might not work out in this uh uh time. Then uh we were thinking what to do next. Then uh one day, a good day I uh had an email chat with uh Dr. Gowri, and uh it was uh she was welcomed, and uh then uh we decided to have a proposal and we sent to our hospital director and he approved the conference setup. And uh we need to thank our National Cancer Grid, who uh is one of the biggest uh sponsors and uh who is supporting our conference. That that's how it uh formed actually everything, and uh, we must thank the all the international faculties who have uh spent their time and uh coming all the way from different countries. And uh, we had a good number of uh delegates uh and uh good number of delegates who attended this uh conference.

SPEAKER_03 11:48

Over 200, how many of these?

SPEAKER_00 11:49

Yes, 200 delegates. Uh it was a multi- truly multidisciplinary. We had uh speech language therapists, uh nursing practitioners, and uh we even had uh ENT surgeons, Hennex surgeons, and then a few of uh physiotherapy uh colleagues.

SPEAKER_02 12:03

People traveled an awfully long way to get it. Yes, yes, definitely.

SPEAKER_00 12:06

Even we had uh uh few participants from Sri Lanka. Yeah, yeah, it was a good thing, and such kind of a high-quality conference, I think we can conduct uh this hospital. I think uh as our uh uh vision and uh mission is like service research and education on both is one of the major things of Tata Namula Hospital.

SPEAKER_02 12:23

Um what are your goals then? But what do you have to achieve from the conference and bringing all these people together?

SPEAKER_00 12:28

I think uh even I also learned from this conference so much. Uh I think this in terms of uh education, definitely we will uplift our uh uh education as well as our competencies, and then we can apply to our regular uh workplace and we can formulate the protocols as a team member, and then uh Professor Ragauri uh said that is definitely how we can audit our results and we can show our outcomes, and that will become a benchmark of practice, and I'm sure other hospitals also will follow the similar kind of practice.

SPEAKER_02 13:01

Fantastic. And just to sort of wrap up, I mean it's very clear from us sitting in listening to what's happening in this hospital and in other hospitals around India that there's a lot of really good, high-quality work going on, particularly around tracheostomy care, which is what we've been mostly discussing. But like any healthcare system, there are challenges. Yeah, there's challenges in my healthcare system and there are challenges here. I'll perhaps I'll ask both of you in turn um uh any specific challenges around tracheostomy care, do you think, in in the Indian healthcare system that that we really need to get hold of over the next few years? What do you think, uh Gary?

SPEAKER_03 13:36

So I think the main uh thing is about um giving a lot of importance to tracheostomy. First, thinking about the tracheostomy and uh understanding that performing a tracheostomy is easy, but it really uh changes patients' quality of life. And uh it's probably one of the most important things that patients think about uh when you do a tracheostomy. So the concept that the tracheostomy, um you have to think a lot about it and you have to see how you want to manage it correctly, remove it on time. I think that's one thing. The second thing I think that is a challenge is to institute uh I have learned the word interprofessional care, not multidisciplinary care, interprofessional care to look after the tracheostomy. It cannot be just surgeon-led or SLP-led, um, nurse-led or um respiratory physiotherapist-led. Uh, I think this concept that something like a tracheostomy, which often is not very glamorous in the whole scheme of things, especially when you're dealing with cancer patients who need reconstruction, free flaps, radiation, robotic surgery. But that is one thing that also requires people to come together and to work. So I think the greatest challenge is to put that, to put the job description. Everyone works, the nurse works, the surgeon works, but to put everyone's job descriptions and to work together for every tracheostomy in the hospital, according to me, that's that's that's a huge challenge. And I think that's something that's the most difficult to work on. Getting tracheostomy tubes, um getting uh infrastructure, getting a fiber optic scope, getting those things are probably a little easier than uh the other challenges. The also the challenge that we have in oncology setups is uh the long-term use of tracheostomy tubes. And patients cannot be coming here on follow-up uh very often. And how do we then assess them, give them exercises, look at their compliance, and then uh see how we can because if you don't do all of that, you can't get them off the tracheostomy tube. So I think the biggest two challenges are one to institute the interprofessional multidisciplinary team to look after uh a tracheostomy, and the second is how do we continue to follow up our patients for a longer time? That I believe are the two biggest challenges.

SPEAKER_02 16:02

And Arun, then in your specific role as a speech and language pathologist, what do you think are the challenges for your profession?

SPEAKER_00 16:09

I think uh we need to increase the access for the tracheostomy tubes, the various types of tracheostomy tubes, and even uh speaking valves, everything. Maybe uh we need to work with uh clinicians, engineers, and I think we need to have a vision of uh Mecan India tracheostomy tubes so that the availability is uh uh very it will increase the availability as well as the cost we can uh reduce. That is one thing, and next thing is like regular educations, and that will improve the uh service, and then in the then after that, definitely that will improve even research aspects as well. So these are one of the major uh things we need to consider. Make in India trachastomy is one of the visions. I think that is what uh even our Indian Prime Minister keeps on telling about Atmanirbar. Yes.

SPEAKER_02 16:59

Fantastic. Well, I've been I've been really struck by your dedication to your patience to your willingness to put together events like this and to sort of hear what we have to say.

SPEAKER_03 17:10

So can I just uh can I just thank you and your team for what we have learned? And uh um really we had four of you come down here from the Global Tracheostomy Collaborative and the National Tracheostomy Safety Program from the UK. And um I cannot tell you, I have said this before, and I cannot tell you the number of things that we have learned uh across the last two and a half days. You interacted with us, with our patients, uh, with our students, uh, speech language pathology, nursing. Um it really has made a tremendous difference. And we really will we will be collaborating in the future, and we hope that we can have this dialogue for a guidance for us to move forward in our uh practices in tracheostomy.

SPEAKER_02 17:56

Well, it's been a pleasure visiting. Thank you both for your hospitality. Thanks, Bean. Great to be here. And thanks for doing this. Thank you.

SPEAKER_01 18:09

That's it from the special episode in India. Hope you found that interesting. Please, if ever, leave any comments on our social media platforms and feel free to follow us, to get involved, and to check out our resources on the website. The opinions that you've heard are the opinions of the individuals and not necessarily those of the organizations who have too well. Hope you found that useful. Look forward to seeing you next time. Bye for now.