Satarupa Biswas, Author at Adamas University

#HealthcareNext: Wearable Biosensors will be the next big thing in healthcare technology

Wearable technologies offer a convenient mode of monitoring many vital statistics of physiological conditions, presenting a horde of medical solutions. A recent report from Research and Markets predicts global sales of wearable devices will exceed $60 billion by 2025. The greatest benefit of these healthcare wearable devices is that they offer individuals with the data they require to gain much better control over their health outcomes. Not only are these devices easy for the consumer to use, but they offer real-time data for physicians to analyse as well. Widely available and often inexpensive, the tools are finding a role among physicians and in many elements of care delivery.

With increasing consumer demand to monitor their own health, a study by Business Insider Intelligence showed more than 80% of the consumers are eager to wear fitness monitoring devices. The use of wearable technology has more than tripled in the last four years and would grow exponentially in post COVID scenario.

The popularity of wearable originated from smartwatches and wristband fitness trackers like Fitbit. Wearable technology relies mostly on different types of miniaturized sensors. The data gathered by the sensors are monitored through different Apps in smartphones. Initially used to count steps and tell time, smartwatches have now transformed into clinically viable healthcare tools. According to Jacek Urbanek, assistant professor of medicine at the Johns Hopkins University School of Medicine “People can overestimate or underestimate on surveys how much and when they move, but wearable devices provide accurate data that cuts through the bias and guesswork.”

Wearables technology in healthcare has moved beyond smartwatches in last two years. From wearable ECG monitors to wearable blood pressure monitors, blood glucose level monitors and various other types of biosensors. Wearable devices can provide a completely new level of monitoring, diagnosis and treatment. Many companies across the world are using this technology because of its benefits and asking app development companies to develop wearable apps. This technology is specifically right for people with chronic conditions requiring continuous monitoring. It becomes easier to gather medical data regularly so that the underlying disease can be seen accurately and necessary action like hospitalization can be done immediately. These devices also reduce recurring medical expenses like visiting the doctor/ hospital/ diagnostic centre regularly. Real time monitoring helps doctors understand the severity and prioritize cases.

Some of the emerging wearables

Current Health’s artificial intelligence (AI) wearable device that measures multiple vital signs has recently received FDA-clearance for patients to use at home.

Smartphone applications, wearable devices such as smartwatches and rings, and other consumer devices offer an accurate and convenient means of monitoring physiological changes associated with Alzheimer’s Disease. Parameters like gait data, fine motor control in terms of finger tapping speed, motor control of eye, sleep pattern and heart rate can be made available which can predict Alzheimer’s Disease.

A research team of Northwestern University, USA has come up with a Wearable Sweat-Sensor that informs athletes of water and electrolyte loss from their body, preventing health deterioration.

Researchers from University of Michigan have recently developed a wearable device precisely detects cancer cells in blood. It can continuously collect and examine circulating tumor cells (CTCs) in the blood. These cancer cells are typically obtained via blood samples to provide a biomarker for treatment.

A Singapore based company, AWAK Technologies, have recently received FDA Breakthrough Device designation for their wearable and portable Peritoneal dialysis device. Once fully commercialized, it would be immensely convenient for renal diseases patients undergoing dialysis.

The future looks promising

The healthcare industry has quickly adopted these connected medical devices for lowering operational costs and improving efficiency. Medical Director’s CEO Matthew Bardsley said that the increased wellness digital usage of individual users will have a wealth of data on their own wellbeing at their fingertips, making them far more empowered and equipped to track and monitor their own health and to some extent, even self-diagnose. There is no stopping for the healthcare wearable market and will continue to evolve in the years to come. Areas of concern that will need addressing are data security, privacy as well as opportunities for advanced data analytics. IoT healthcare wearable devices will enable consumers to remain accessible to the cloud for transmitting data back to appropriate persons, enable healthcare providers to gain the information they require and ensure regulatory compliance by protecting patient data. It will thus reduce human intervention in healthcare, enabling context-based automation. Therefore, when it comes to wearable technology, the sky is the limit, and it will continue to make waves in the healthcare industry.

#PositiveCorona : COVID-19 crisis can make people pragmatic towards health and hygiene

COVID-19 has had irrefutable and despicable consequences on people’s lives and the economy. It seems to have changed our lives forever. Hopelessness is evident with sickness, death and unemployment rates soaring almost everywhere around the world. Social media has been flooding with have “Can we uninstall 2020, this version has a virus in it” memes since April. Community spreading could not be contained even after months of lockdown and life becoming a standstill in India. The Coronavirus has made communities stay away from each other for survival. While the COVID-19 pandemic is still unfolding, a number of changes, both in terms of collateral damage and co-benefits of the fight against the virus, have already started digging their heels in.

For every low, there’s a high. and even in this current scenario we are looking for a silver lining. Covid-19 has brought the vulnerability of human existence back into focus. Behavioural changes were no more a personal choice. It was designed collectively and imposed as a constraint by governments on the general public. Although the national policies meant restriction of some individual and collective freedom, the ethical principle of protecting human life was given priority. Some surprising health benefits were observed during the lockdown as people invest more time and energy looking after themselves. Here are some reasons to be hopeful about the future.

Improved hygiene

Although it’s still a long way to full recovery, the heightened public awareness about communicable disease generated by the pandemic have clearly made the average person realize that personal hygiene and sanitation can play vital roles in preventing disease transmission. Those who have tested positive for COVID-19 are a lot more likely to be washing their hands and sanitizing their workplaces and living environments than they were in the past — we are reaching close to 1.5 million positive COVID-19 cases in India now — and those who were fortunate enough to avoid exposure now feel the pressure to follow suit. While people are wearing masks out of compulsion due to government directives, they would soon realise that masks not only protect from Coronavirus, but also from air pollution, pollen grains (which acts as allergens for many), and other contagious diseases like influenza, common colds, viral and bacterial gastrointestinal disease agents.

Moreover, when good hygiene practice is institutionalized, they become part of the culture. These beneficial behaviours are expected to be passed along to the children and pay dividends in better health and longer life for generations to come. These practices, if sustained, will also help to control the next round of emerging pathogens.

Healthy living

According to World Health Organization, tobacco kills more than 8 million people globally every year. More than 7 million of these deaths are from direct tobacco use and around 1.2 million are due to non-smokers being exposed to passive smoking. Since COVID primarily affects the lungs, researchers found that smokers with a positive Covid-19 test were more than twice as likely as non-smokers with coronavirus to be hospitalised. This finding encouraged 300,000 people to quit smoking and pushed another 550,000 to try and give up the habit, according to research from YouGov and campaign group Action on Smoking and Health. The lungs start repairing themselves almost immediately after quitting smoking, with function increasing up to 10 % within nine months, according to the NHS. After a year, the risk of heart disease halves; after a decade the chance of getting lung cancer is half of that of a smoker.

A research by charity Alcohol Change UK found that with parties, pub trips and long lunches cancelled, many people’s drinking habits have been hugely disturbed. Only one in five is drinking more often instead, while one in three has completely stopped drinking, or reduced how often they drink since lockdown began, according to their research. Although reduced socialising can have different impacts on lives, a break from drinking can lead to reduced blood pressure, fewer headaches, weight loss and improved liver function, according to the Priory Group.

Work from home has become the new normal for many people. During lockdown, when people did not have to commute long distances to get to work or have to get the kids ready for school on time, we can get a little more sleep. Even an extra hour of sleep could mean seven hours instead of six, which makes a big difference to our health. In the evening too, as people don’t have to get home late, it is possible to get to bed a little earlier and get more rest. A lot of companies are offering work from home even now, as they believe productivity can increase with improved resting hours.

The extra time on our hands and the worry of gaining weight has prompted many people to start working out at home. From yoga and meditation to energetic Zumba sessions, people all over the world are getting creative with their home workouts. This is also a fun activity because the whole family can join in and stay healthy together. Others are opting to travel on foot or bike to avoid the infection risk of going on public transport. All of this is adding up to a boom in cycling. According to an estimate by traffic and transport directorate, 15 lakh people have been out on Kolkata’s roads on bicycles since June 1. There is anecdotal evidence from doctors that people are getting more active which when made a habit would benefit in both physical and mental wellbeing.

Many people have become cautious about eating outside food because they don’t want to catch COVID-19. As a result, people are eating home-cooked food. Home cooking usually uses less oil, fresh ingredients, and little to no processed foods, making it a healthier option than eating out. Moreover, cutting out junk from diet improves metabolism, immunity, decreases obesity and obesity related health risks.

Fear, worry, and stress are normal responses to perceived or real threats, and at times when ‘normal’ people being exposed to ‘extraordinary situations’ emotional difficulties like anxiety, depression, biological effects like sleep, appetite disturbances as well as severe mental illness and substance misuse are well anticipated. This has led to awareness about the importance of mental health. People generally tend to look after their physical health, but with the rise of government and NGO’s opening up helplines for attending mental health issues, people are likely to accept psychological needs of their own self and those around them. Even after the crisis is over, people are likely to acknowledge metal illness equally as they do for physical ailments.

Enhanced public health

Health systems around the world are being challenged by increasing demand for care of people with COVID-19 while trying to maintain the delivery of routine health services. As part of the response to the COVID-19 pandemic, the state health departments had to get their health infrastructure, human resources and medical supplies in place to handle the expected surge in cases. The Central, state and district administration engaged in the government and non-government machinery, engaged in partnerships and collaborations, swiftly provided necessary approvals and embraced information and communications technology (ICT) and frugal innovation to accelerate their public health response. Even if a part of the technology and workforce deployed to combat this crisis stays after COVID is over, it would drastically improve the overall public health infrastructure which has been proved to be inadequate before COVID outbreak. Spreading awareness would also become much easier post COVID.

Gaps in patient care of chronic diseases during COVID 19 can be a long-drawn burden on healthcare

Mr. Banerjee, who is now 70, had a pacemaker implanted in the year 2010. The battery of the pacemaker lasts for around 10 years and he was supposed to undergo a minor surgery for replacing the battery sometime in July 2020. His physician suggested to avoid stress and anxiety so that battery lasts longer and the surgery could get postponed to September when doctors are expecting the pandemic would ease out.

Ms. Singh is supposed to deliver her first child in the month of August. When she last saw her gynaecologist before the lockdown, she was detected with gestational diabetes. March onwards her doctor instructed her not to visit diagnostic centre for regular blood tests or USG, neither visit her, for that matter, until any emergency situation.

Ms. Awasthi, a cancer patient, was undergoing last few phases of chemotherapy after surgery when the lockdown was announced. With a feeble immune system as a side effect of the therapy, she had to run between hospitals as the hospitals were shutting down one after another when healthcare workers were getting infected.

The state of mind of these three people and their family members is unimaginable. Mr. Banerjee lives with his wife as his children are settled elsewhere. Unable to bear the stress, he collapsed one day around mid of May 2020. He was shifted to an ICCU and the battery of his pacemaker had to be replaced within few days, way before it was scheduled. Ms. Singh along with her husband are fighting to keep calm and keep her blood pressure and glucose level under control. They can only pray to god so that no complication arises. Ms. Awasthi, a fighter by nature, is now unsure of every tomorrow that comes. And these are just a few examples from my life. There are hundreds and thousands of such patients who needed diagnosis, treatment and care, but are denied or delayed due to obvious reasons. The entire healthcare system is focused on prevention, diagnosis, treatment and containment of COVID-19 infection. Additionally, the doctors also want to safeguard their regular patients from COVID-19 infection. Therefore, many such regular patients are likely to miss opportunities for timely diagnosis and treatment of their diseases.

Patients of chronic disease, being wary of going out, or facing difficulties in movement due to lockdown restriction might miss on treatment, ending up with long-term consequences. Many diseases like cancer and neurodegenerative disorders certainly require an early detection failing which their chances of recovery and survival will drop. Also, postponement of elective surgeries and procedures could have adverse impact on quality of life while the patients wait for the right time to get the treatment they need. There will be increased possibility of complications and worsening of disease, which will raise the overall burden of diseases of the country.

Moreover, the unavailability of several government set-ups that have been earmarked for COVID-19 has also limited the availability of emergency treatment of acute conditions for the less privileged whose only fall back for healthcare needs are public facilities. The inconceivable liability coming up on the healthcare industry of India and many other countries with ailing healthcare system cannot be assigned to the doctors and healthcare workers. The physicists, biologists, chemists and engineers should all come forward and innovate healthcare technologies that can support the doctors in diagnosis and treatment of these patients, thus decreasing the burden to some extent.

Digital Healthcare Awaits Worldwide Transformation Post COVID 19 Pandemic

The exponential spread of COVID-19 across the world has forced us to accept a new convention of leading life that involves distance and discipline. It is our responsibility to not only save ourselves but also to protect lives, safeguard the vulnerable, shield the frontline workers and secure the entire healthcare system through the pandemic. As we understand the necessity of social distancing in today’s context, medical distancing has also been prioritised by the World Health Organization to minimize physical contact between patients and healthcare providers. It is for the benefit of both the patients and the physicians that virtual treatment is now practiced everywhere.

“I’d estimate that the majority of patient consultations in the United States are now happening virtually”, says Ray Dorsey, director of the Center for Health and Technology at the University of Rochester Medical Center (Rochester, NY, USA). With a ten-fold increase in two weeks’ time, the transformation is one of the biggest in the history of US health care. Similar trends were reported from countries like China, Canada, UK and many other European countries [1]. History suggests that measures imposed during emergency often outlasts the emergency period. This is what is expected to happen in case of digitization of the healthcare system. Now, that will be advantageous to many, while there will also be a downside of it.

Why ehealth is going viral?

There are numerous patients, probably more than COVID-19 positive cases, who are suffering from chronic diseases like cancer, diabetes, cardio-thoracic diseases, gastrointestinal diseases, neurological disorders who needs regular check-ups and monitoring by physicians and healthcare professionals. Unfortunately, they would be exposed to a greater threat, the virus, if they try to maintain their routine check-up by visiting the doctors. Therefore, telemedicine comes for their rescue. With the innovations in healthcare technology and communication system, it is now possible to monitor many vital signs at home through wearable/point of care medical devices and present the reports to the doctors through virtual platforms. Imagine the amount of risk that got reduced through this remote care facility. While it prevents the spread of infection during COVID-19 crisis, it can save a lot of valuable time and physical space in post pandemic era. This, in turn, will make the health monitoring cheaper and affordable for many around the world. Remote health monitoring through telemetry and telemedicine will be a boon for India, especially rural India, which is deprived of basic healthcare facility [2]. Moreover, crowdsourced disease monitoring, a part of virtual health monitoring is generating huge amount of data for the researchers for disease detection and prediction. Overall, the transition from a previously slow adoption path of digital healthcare solution to becoming the new normal seems inevitable.

The loopholes

While experts believe that telehealth can significantly slow down the spread of infections and flatten the current epidemic curve, uncertainty regarding payments and insurance coverage distract both patients and healthcare providers from its use. Legal liabilities for damages and malpractices, unreliability regarding privacy and confidentiality, unmet patient and provider expectations are some of the areas that can addressed by policy makers of health systems. Once resolved, telehealth can transform the entire healthcare system in favour of patients and service providers. But the real challenge remains for the elderly or not so tech savvy people. It is upon us, the health care innovators to produce simple, user friendly applications that can be effective and suitable for region specific people of different age groups and educational backgrounds.

Conclusion

Beyond the pandemic, we need well defined and easy-to-understand guidelines and regulations for the use of ehealth technologies. The guidelines should be realistic enough to take care of user expectations. Although virtual treatments cannot completely replace traditional physical care, it can certainly reduce the burden of the health care system and make it accessible to a larger community.

References:

Webster, Paul. “Virtual health care in the era of COVID-19.” The Lancet 395.10231 (2020): 1180-1181.

Babu, Sudheer, et al. “Smart telemetry kit for proactive health monitoring in rural India: The journey so far and the road ahead.” 2018 IEEE 20th International Conference on e-Health Networking, Applications and Services (Healthcom). IEEE, 2018.

How the healthcare industry needs to be reshaped to fight pandemics like COVID-19

“There’s no point dwelling on what might or could have been, you just go forward”. — Jack Nicholson

If we are to believe the numbers given by the state and central government, it seems India has until now managed to tackle the COVID crisis quite well. Despite a few cases of religious mass gatherings and some elite weddings and garden parties, the nationwide lockdown since 24 March 2020 has ensured that India does not become the next USA, Spain or Italy. The disturbing part is the increasing gap between the recovery rate and the number of new cases. We, as common people do not really know where we are heading. Now let’s have a look at countries like South Korea, Taiwan, and Singapore. These are the countries that could successfully flatten the curve before COVID-19 cases could reach the exponential growth rate like most other countries.

South Korea, with the largest initial outbreak outside China, managed to bring down the total number of new cases without even having to impose a national lockdown. Taiwan, another neighbouring country to China could limit the total number of cases to just 395 (till April 17, 2020) in a span of 4 months since its first outbreak in January 2020. Similarly, Singapore, which has already reported over 5,000 cases, has had only 10 deaths until April 17, 2020. Aren’t these numbers intriguing? How have these countries managed to limit the spread of the virus so effectively?

The answer lies in 3 specific steps: preparedness from the very beginning, rigorous random testing, social distancing, and contact tracing. All three countries mentioned above took the coronavirus seriously right from the start, perhaps because the sufferings from the SARS 2003 outbreak are still fresh in public memory. Taiwan started screening passengers at airports since the day they came to know about the outbreak in Wuhan. South Korea, with a population of 51 million, tested 20,000 people daily. Singapore was tracing, detecting, and isolating people at large. Not only immunocompromised patients, but even those who came in with the mildest symptoms were treated with utmost care from the very beginning. These countries were using tracking devices for updates from the suspected and infected patients. Even Canada has reduced the impact of COVID- 19 by taking necessary steps without any delays.

Has India managed to do the same? The answer is both yes and no. Yes, because Kerala, the southernmost state in India is already working towards flattening the curve. Kerala which has a large diasporic population had a higher chance of spreading the contagion as they returned from all over the world. However, the state promptly responded to the crisis with extensive random testing at different locations without violating the lockdown imposed by the central government. Indeed, the Kerala model has worked like a miracle. It has also set a great example for the rest of the country.

As the country reels under the pressure of this recent COVID crisis, how has it affected India’s general health care system? How, for instance, has this affected cancer patients who have to visit the hospital for regular treatments, pregnant women who are going into labor, stroke survivors, heart patients, geriatrics, and patients with mental illnesses? How are they coping in the midst of this pandemic? It has become clear that the healthcare industry in India needs a massive reform in order to fight such contagious diseases. Given that the country’s healthcare system is already overwhelmed with a sudden surge in the number of health related cases, governments have been trying to “flatten the curve” through social distancing and self-isolation so that existing infrastructures can continue to accommodate the number of patients requiring critical care. It’s however too early to call India a success story. To understand where India stands and what the future holds, we need to pay attention to a few things:

Public health vs private healthcare systems

At present India ranks 129 out of 189 countries in Human Development Reports published by United Nations Development Programme. A report by The Financial Express says India spends only 1.15% (as compared to 1.3% for the last three years) of the GDP on healthcare which brings India to rank 184 out of 191 countries. More funds need to be allocated to heathcare in India. The Pradhan Mantri Jan Arogya Abhiyan (PM-JAY) or the Aayushman Bharat was launched in 2018 which was to provide insurance coverage (for hospitalization) of up to Rs 5 lakh to about 50 crore poor people. Although there are no detailed reports of its execution, this year the Niti Aayog was proposed as a public-private partnership (PPP) plan which allowed the takeover of government-run district hospitals by private investors. The Indian Medical Association opposed such model. COVID-19 showed us why. The private hospitals were charging humongous amounts of money for a simple screening test. What would have happened if the government had no control over the hospitals? Poor people wouldn’t get even the bare minimum. Thus PPP model in Indian healthcare is expected to fail miserably.

On the other hand, private healthcare facility in India is doing well and people have started depending on the doctors and hospitals of our country rather than visiting abroad unless absolutely necessary. This indirectly indicates that the private players are striking gold. But can we really grow individually if the country falls behind? Is making money the only motivation for these private enterprises? We all know the answer, but it’s time they should realise the existence of the unprivileged. Both the government and the private healthcare providers need to direct funds towards public health and healthcare in general as we know health is wealth.

Low cost medical equipment

The biomedical industry mostly imports high performance diagnostic and therapeutic equipment. This, in turn, increases the cost of the service provided through those instruments. For few of such facilities provided by the government, too many patients and mismanagement reduces the availability to the ones who needs it the most. Needless to say, the middle class can neither avail these facilities, nor afford the private hospitals. Therefore, access to CT scan, MRI, and many more diagnostic tests and treatments which are commonly prescribed, becomes a financial burden for most. COVID-19 sets a wonderful path to what could be done to improve this scenario. A three-year-old Pune based start-up, Mylab Discovery Solutions, a molecular diagnostic company came up with highly accurate COVID-19 test kits, with faster response time for 1200 INR as compared to 4500 INR charged by the private labs using the imported test kits. They got a funding of Rs 1 crore from Action COVID Team Grants to scale up their production, which could further bring down the price of the test kits. As more kits become available, the whole country will be able to shift to the model of random testing and tracing of COVID-19 positive cases. The healthcare industry in India should welcome more such companies with qualified scientists and large scale manufacturing units to meet the increasing demand of disease diagnosis and treatment in India. Moreover, price control on medical devices and reduction of import duty on raw materials and medical equipment could be done to make healthcare more affordable and equitable.

Role of academic and research institutes

The academic institutes are focusing more and more on teaching interdisciplinary subjects to prepare the students to find some application in the healthcare industry as they envision the huge demand to be created in the healthcare sector. It is not necessary that one becomes a doctor or a scientist to contribute to the healthcare industry. The technologists operating the devices, the biomedical engineers taking care of the medical devices, the medical physicists taking care of radiation safety, and the paramedics are all part of the healthcare industry, who are currently risking their own lives to serve the nation and its people. We need more young, dynamic people to boost up the healthcare system.

Almost all the research institutes in India are already working on innovation in diagnosis and treatment of diseases. They understand that universal healthcare is no less essential than basic necessities like food and hygiene. As researchers, we mostly focus on low cost, easy to use, biodegradable/reusable, diagnostic devices which can be used at home as well as in hospitals and diagnostic centres. The researchers not only develop equipment, they also analyse data. That brings in the other domains like network engineers and AI specialists to collaborate with the biomedical researchers. An article published in a medical journal in England mentioned that situations like corona virus spread would bring in a digital revolution in the healthcare sector. As education is uninterruptedly continued through digital platforms globally, digitized healthcare gadgets could reduce the vulnerability of the healthcare providers and increase tracking of patient condition. India is almost digitized now with internet connectivity reaching the majority. So digitizing health monitoring is possible through telemetry. Moreover, laboratories in India are capable of producing vaccines and medicines better than many other countries as we witnessed that we need not depend/threat other countries for hydroxychloroquine. But what we need is funding for the research. The Department of Science and Technology – Science and Engineering Board announced several special research projects for fighting COVID-19. We still require more funding from the government on healthcare projects.

Technology transfer

IIT Kanpur, IIT Roorkee, IIT Hyderabad developed low-cost ventilators that could be used during COVID-19 outbreak to provide life support. IIT Delhi developed an infection-proof fabric for the healthcare providers to prevent hospital-acquired infections. A team of researchers at IIT Bombay developed nasal gel to prevent spread of the coronavirus. IIT Ropar developed a UV-technology fitted ‘trunk’ for homes to sanitise grocery, currency and other essential products acquired from the market. All of these discoveries happened in such a short time! Undoubtedly, there is potential in India to revolutionize healthcare. But where are the products? How many of the research innovations are actually coming out as products or getting commercialized? The vast gap between innovative protocol discovery and large scale manufacturing (which could make the products affordable) needs immediate attention to reform the present healthcare industry. Strong collaboration of the research and academic institutes with the industry can support the commercialization and actually help reconstruct healthcare system in India.

Rural development – awareness and monitoring

About 70% of India’s population live in the rural areas of the country, which means they are deprived of the best facilities and that most of them are unaware of the services they deserve. We all know education and health do not reach these areas the way they should. Although the government has launched a list of schemes for skill development, employment, basic education and healthcare, we the privileged ones should also take up certain responsibilities. We need to spread more awareness regarding hygiene and healthcare. It can be proposed that involvement in projects related to rural development could be made as a part of the curriculum for higher studies. Monitoring of vital signs by organizing health camps just as we organize blood donation camps will result in early detection of chronic diseases, just like rapid testing would help contain the spread of epidemics like COVID-19. Efforts from the young generation along with their supervisors will not only help in development of the poor but also build strong characters in students who would understand the value of giving back to the society.

To summarize, we need to reboot our healthcare system once we win the fight against corona. The healthcare industry would certainly get exhausted as we are not able to take care of the frontline workers as the way we should have done. We should learn from the situation and bring into action the changes that are required for public health in India. All of us can contribute in our own little way and make India proud and rich.