NTSP Special Interviews (India 2026): Brendan & Sarah Part 1

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 a conversation between Prof Brendan McGrath and Prof Sarah Wallace from the NTSP, reflecting on their time in India. The team visited the Tata Memorial Hospital Mumbai, and attended the National Tracheostomy Conference hosted by TMH, the Christian Medical Centre in Vellore, and St John's Hospital in Bengaluru. Brendan & Sarah discuss some of the community work, innovation and patient contact that they were invovled in during their trip.

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_01 0:08

Hello and welcome to this special episode of Tracky Talk. We're here in Bengaluru in the south part of India, and I'm joined by Professor Sarah Wallace, OBE, who's a legendary speech and language pathologist that I'm sure many of you know. We're currently in the Holiday Inn near the race course in Bengaluru, and we're very grateful to the staff for finding us this nice quiet space. We've got a bit of time to kill before we have to head home, so we thought it'd be a really good idea to spend a bit of time just reflecting on what we have observed and learnt and some of the people that we've met and some of the things that we've seen in India. So I hope you find that useful. We've been to quite a few different centres, haven't we?

SPEAKER_00 0:59

Yes, we've done a fair bit of travelling.

SPEAKER_01 1:01

Yeah, so we were hosted initially by the Tata Memorial Hospital in Mumbai. We were working with the speech and language therapists and the head and neck oncology team primarily, and we participated in a two-day conference by the National Cancer Grid, which had 250 delegates from all over India, and some people had travelled days to get there, which was quite amazing and quite humbling. And then we travelled to Chennai and moved from there to Valour, where we spent some time at the Christian Medical Centre or CMC as it's more widely known. And then we moved across to Bengalulu, where we spent some time at St John's Hospital, which is just in the south of the city, and at Art Park, which is the AI and Robotics Institute here in Bengaluru, seeing the sort of innovation pipeline for ideas, particularly focused on healthcare, which was absolutely fascinating. We've seen a lot of things. We've obviously tried to contrast the differences between the way we practice in the UK and what we've seen in India. I mean, from a speech and language therapy perspective, tell us your thoughts on what you've seen in India.

SPEAKER_00 2:13

I mean, it's hard to process, isn't it? How much we've seen, and we've talked to so many wonderful people, and we've been able to visit wards as well as obviously having meetings with people. But I spent the most time, I suppose, with the Tata Memorial Hospital speech language therapy team, who are all wonderful. And I think one of the things that really has struck me is just the volume of patients that all the clinicians across the board have. And I mean it's sort of quite mind-boggling, isn't it? How when we observed this when we were walking around the hospital, it's just the numbers of patients, partly as they explained to us, that just the sheer population of India, but also the fact that their cancer rates are incredibly high. And so they have a lot of oral cancer and head and neck cancer as one of the main you know diseases in India. So, you know, they're talking about seeing 10,000 patients a day in an outpatient clinic. And when I met with the team, we had a really lovely exchange of ideas, and everything that I said, they sort of tripled in terms of numbers of case on their caseload and numbers that they do in fees and video phrascopy, and they have got access to instrumental assessments, but a lot of people that we talk to during the conference don't have access to that. Um, they are very reliant on bedside assessments. They also, because of that, are using things like blue dye testing, which we've been able to sort of move away from in the UK, but because we have instrumental tools, but they they're probably seeing the triple the numbers of patients that we see. Um, and I just can't can't conceive of how they do it and and how little time they have. They work very, very long days, and um they rely a lot on their fellowship students. They have um a lot of close links with the the ENT team and the surgeons, and everybody says, don't they? I wish we had more staff so they could do more, but a lot of the work they're doing is outpatient-based. Yeah, and um it's very difficult for them to find any time to see the inpatients. And a sort of strong theme, I think, across all of the people that we've met in all of the hospitals is this sort of inability to see patients while they're still in ICU. Certainly, nobody's really seeing patients on ICU, they're seeing them either on the ward or just before they go home. Yeah, and you know, they're travelling incredibly long distances, the patients, aren't they, to visit the hospitals. So, especially at a tertiary centre like Tartan Memorial, the same patients would spend three or four days just by train trying to get to the hospital for one outpatient appointment, and then you've got you know just an hour or so to see the patient, and then they're gone. Yeah, so that whole idea of you know having the the luxury of time to follow patients up isn't really there, so you've got to kind of give very kind of rapid input and then cover everything because the patient's going and they're not going to be there anymore.

SPEAKER_01 5:29

I mean, I think you and I have busy days at work and they just another level, isn't it?

SPEAKER_00 5:35

Yeah, it really is another level, and they you know they're lacking things like um you know availability of trache tubes, aren't they? So things like subglottic suction tubes are really difficult to come by. Everybody gets speaking valves, you know, virtually non-existent. There were a couple of people at at the conference who had come from an other parts of India who were saying, Oh, yes, we can get speaking valves, but they're getting the erata valve, which is which can't be used on ventilated patients. So, so speaking valves they're all super interested and really want to use, but the cost for patients is really high, and finding a supplier in India is a problem. And there were some sort of uh I suppose in discussions we found some differences in how people manage cuff inflation and deflation, weren't there? Yeah, what you thought about that, but yeah, no, it was interesting.

SPEAKER_01 6:32

I mean, it's probably worth just going back and just talking about the different hospitals because the the care you got is is slightly dependent on the model of the hospital that you're in, and you know that the guys in every hospital were doing their absolute best. It was stunning that the quality of care that people were giving in such difficult circumstances. But they we were visited when all the hospitals uh had different tiers of um patient care, I guess, and then there was that sort of fully private, semi-private where you made a contribution towards your care, and then in in Tata Memorial Hospital, in particular, that they they basically would see anyone, and they had a unique funding where they were funded partly by the uh Tata Group, which is a big international group, uh but also the government, yeah. Yeah, sort of government funded hospital, and so and and philanthropists, I think. Yeah, and and it was amazing, but so that their philosophy was that if someone turned up on the doorstep, they would see them, and as you said, Sarah, people were travelling, you know. We we were in a clinic, and remember the first guy I saw was a farmer from West Bengal, and that's miles away. I mean it's a huge clinic. Yeah, it's like a three-day trek to get there with nasty established oral cancer, and and just some of those sort of challenges, like you say, about you know, you see you see that person, you can offer them some treatment, and patients were having to then go and find somewhere to live in Mumbai for a couple of days, maybe a couple of weeks, then have major surgery, then have to find somewhere to recuperate.

SPEAKER_00 8:00

They did have hostile accommodation for some of the patients, didn't you? And they subsidise a lot of things for patients who who can't afford to do that. But yeah, yeah, the scale of it was quite um yeah, really impressive. So impressive, and I think we we attended a multidisciplinary team clinic where they I think they tried to arrange for tracheostomised patients to come. And you know, I think the the cancers in these patients were really quite far advanced, so they're having to consider doing you know really large surgery, and I think it must be terrifying, you know. And a lot of when you consider as well that there's 750 languages in India and communicating this information to patients who've traveled from other district, you know, the states in India and and the language barrier is a huge problem, isn't it? And yeah, it it's the the I thought the passion that the clinicians, the surgeons, everybody we met was incredible, the dedication, um, the hours that they work is is so uh I think we're both so impressed, aren't we?

SPEAKER_01 9:08

I mean the the the outpatient clinic that we went to in uh at at Tata in in Mumbai, the the hall was full of football clinics. It was just insane. People sitting on the stairs waiting for their outpatients, people sleeping, people eating there.

SPEAKER_00 9:24

It was just a single space on the floor, was there? And people very patiently taking a ticket.

SPEAKER_01 9:29

Yeah, people were super patient, and and they were, you know, the and the the teams were just working until they'd seen everyone. It was so amazing. Um I guess we started off this segue with with your question about cuffs, and I think we we did realise that it depended a little bit on on sometimes how much money you had. So for the if you could afford it, um, then you could have you know, you could follow up on those recommendations, perhaps moving from a cuff to an uncuffed tube. If it was a sort of philanthropic or a publicly funded patient, then you know, generally what patients needed they got, but it was uh you know, you had to justify everything, and and I think it made me realise how sort of privileged we are in in our NHS that you know, generally by and large, in in critical care, if you need something, you you get it, and you know the guys are working really hard to make sure their patients got the right sort of care.

SPEAKER_00 10:21

And they were sort of using corking or capping, but literally a cork, wasn't it? Because the whole um problem with trying to wean patients without I mean I mean it was just so difficult for them because they didn't have that time where they could consistently go back and review patients today. It was sort of like, right, what are we gonna do? And the idea that we've got an energy to remove and a trackie to remove, and we need to kind of sort these two things out, and and and I think without that again, that time for the uh full sort of multidisciplinary team approach because everybody's running around like headless chickens, is you know, meant that some of those decisions would seem to be taking longer than they they were comfortable with, and patients were very often going home with a tracheostomy, weren't they? And then coming back you know six months later, and then they could you know have another conversation about whether it could be removed. So they were very concerned when we talked to um Dr. Guri and the ENT team and the speech therapist that they wanted to be able to decannulate patients sooner, and they've got all these constraints that make it very hard.

SPEAKER_01 11:32

Yeah. So I mean it was great to be able to share some of the work that we've been able to do in collaboration with other sites in the UK and around the world about some of the strategies that we've worked out over the years that that that might be able to help patients get decannulated more quickly, which you know nearly everyone we spoke to was was really interested in, because as you say, if the the the best way to reduce tracheostomy problems is to try and get the tracheostomy out. And and what struck me about the the care that they were delivering often you know, if patients particularly were paying for it, or there was such pressure on their beds that patients got their care, and as you say, a lot of patients were being discharged of tracheostomy, and maybe in a week or two, if they were under the nose of the teams, they could have got decannulated, but the patients were then travelling back home. And there was often that the TATA group, for example, um, and CMC as well, had a network of hospitals around the country, yeah. And so they were able to try and signpost patients to to other hospitals where they may go if they had either problems or or if they needed a review. But as you said, quite often patients are coming back to Tata.

SPEAKER_00 12:38

And there's a cost burden to that for patients as well, isn't there? So but each yeah, each particularly CMC uh has and Tartan Memorial have this vast network of um hospitals where they have and CMC are training you know thousands of nurses who now work all over India and often also in the UK and USA as well, but who are taking those skills with them, but that community care is incredibly challenging, isn't it?

SPEAKER_01 13:07

Yeah, absolutely. Alright, well, Sarah, it's always a pleasure to talk to you. Thank you so much for your insights. Yeah, cool. So uh that's it for this episode. Uh as ever, the opinion you just heard are our own opinions, they don't necessarily reflect the opinions of the organizations uh which pay our wages. Uh you can find out lots more on our website, uh, you can follow us on our social media channels. Um, thanks for listening and see you next time. Thank you.