We constantly adapt to the new challenges posed by major catastrophes: Neeraj Balani

Read this exclusive interview with Neeraj Balani, Managing Director, International SOS, India.


Neeraj Balani, Managing Director, International SOS India. recently spoke to BW Applause and Everything Experiential about the extent of challenge posed by the ongoing pandemic on the healthcare sector and more.


In your view, what is the extent of the challenge that this pandemic has posed to healthcare workers?

COVID-19 pandemic has spread to 198 countries, with approximately 37 million confirmed cases and 1,077,629 deaths globally as of October 12,2020. Frontline healthcare workers face a substantially higher risk of infection and psychological impact due to excessive COVID-19 exposure.

The key challenges faced by the healthcare systems in India are inadequate medical infrastructure (lack of it in many remote parts of the country), medical supplies etc. This combined with a high number of cases has ensured that many healthcare workers are now facing fatigue. 

However, what is unique about this pandemic is also the public reaction which the healthcare workers have to respond to patients and their families. Panic and rushing to the hospital for advice and testing are the first reactions of a suspected patient. It has been observed, Isolation and alienation of COVID-19 patients, leads to aggravated mental state of patients and their families – further worsening the situation. Today, anxiety and depression are a major fallout of the pandemic onslaught in India.

Finally, we have to be cognizant of the fact that the health workers are themselves at risk of contracting the disease in our stretched and inadequate healthcare setting. In India over 1 lakh healthcare workers have been infected by the pandemic.

How have the last six months been for International SOS, when it comes to dealing with surging demands of immediate healthcare?

International SOS has responded to COVID-19 related queries since late 2019. We are working very closely with our customers to ensure that their employees have access to the best medical assistance program in the world during these challenging times. Inline, if an employee or her dependent is not feeling well, they reach out to International SOS under their medical assistance program to get reliable medical information and advice on the next steps by a qualified medical professional. To put the above in context – as on 31st July 2020, International SOS has assisted over 33,000 Covid cases, carried out over 450 medical evacuations and reached over 80 million people globally via our COVID-19 microsite which provides accurate and reliable information and data. These numbers are increasing exponentially every month as the pandemic spreads further across the world today.

International SOS India team is working 24 x 7 to ensure that our records, regarding hospital status, bed availability, isolation centers, testing centers, medical supplies including PPE’s is updated. So, when someone calls for medical, our doctors are not only able to guide employees on the next steps but also can guide on key resources available (hospitals, beds, testing) near them. Managing employee panic, especially in cases where dependents (parents and children) are involved has been a major victory for us. We have also set up dedicated mental wellness helplines and facilities for customers in India which are proving to be helpful for employees. 

We also are a global assistance platform across 100 countries and providing responses in over 100 languages. Many ex-pats and their dependents in India rely on us for medical assistance. We have had several cases wherein we have helped ex-pats/international assignees with medical evacuation from India – which is a complex operation of combining logistics, medical professionals and infrastructure on an airplane and coordination with respective countries and airports for permissions and approvals.  

International SOS is also helping organizations build a wellness engagement platform for their employees. We have an end to end solution complete with a wellness app wherein we customize and execute monthly wellness programs for large organizations. Our wellness program constitutes of key pillars of execution starting with Health and wellness assessment, health and wellness promotion, behavioral change management, chronic disease management. This combined with an analytical reporting platform and governance structure has helped many of our customers increase their employee wellness, build resilience and generate a solid ROI on the employee engagement agenda. 

Since you have a global presence, what kind of insights are emerging around COVID 19 and the spread of this pandemic? In your view how soon can this threat get mitigated? 

International SOS with its operations across 100 countries, our 5600 medical professional are regularly interacting with hospitals, healthcare workers, administrative officials at the ground level. These data are then collated to provide insights and advisories to our 11000 plus clients. 

Today businesses are facing unprecedented challenges on multiple fronts. While trying to ensure the sustainability of their business operations, organizations are looking for ways to protect their employees and guarantee their safety and wellbeing – all while complying with measures and advice from government & public health authorities.

Our Medical Advisory service gives CEO’s access to global medical experts from our consulting platform to help them build the right policies and procedures which are consistent with the organization’s duty of care and also take into consideration country level specifics. We help roll out the right programs for medical assistance for employees globally so that they have a similar level of care which is aligned to the local medical challenges and protocols laid by the government.

As the lockdown is being phased out slowly, we have developed “Return to Office” programs by auditing workplaces and setting the right social distancing and medical exception management protocols. In our experience, organizations where leadership has taken measures to implement change management on behavioral front (social distancing, personal hygiene & personal health and wellness) and enabled the right medical assistance platforms for employees have already mitigated the pandemic threat to a great extent. This change management and enablement will have to continue for the next few quarters to ensure threat mitigation till we have a reliable and accessible vaccine at our disposal. 

Predicting any timeline at this stage would not be advisable, but with the global data available, the latest update suggest there are 36 vaccine in human trails and 145 in the pre-clinical evaluation, out of which nine vaccines have reached phase 3 of human trails. Data also suggest in the last decade, 94% of the Pre –clinical vaccines, did not reach the last stage of human trails. 

With the growing number of cases, the pressure on the healthcare system, Flu vaccine can be an effective tool to avoid unnecessary visits to hospitals, as the symptoms of flu are quite similar to Covid-19, the flu vaccine can be used as a preventive measure to protect the at risk groups (people above 65 years, children, pregnant ladies etc.) as the flu vaccine is about 50-70% effective in reducing the severity.

Through this work, we have identified some key lessons to guide how organizations should operate during moments of crisis. These include:

Contingency planning is essential

With unpredictable events, such as COVID-19, businesses need to do their best to bring some order to the situation. When it comes to evacuations specifically, making sure that an organization has essential information centralised is critical. Organizations need to understand where their assets and people actually are. With many employees now working remotely, a decentralised model means that a business might not have this information ready to hand. It may appear obvious, but the evacuation process becomes a lot simpler when an organization knows where all its dispersed employees are located and where they need to repatriate to from the get-go.

Always be prepared to be flexible

Even if a company spends the correct amount of time updating and evaluating contingency plans, crises are naturally unpredictable. They often cause situations that could only have been partly accounted for at the planning stage, which generates the need for businesses to be prepared to be flexible in their response. We understand this principle at International SOS, as we constantly adapt to the new challenges posed by major catastrophes such as COVID-19.

Hectic situation demonstrates how flexibility is a crucial trait during a crisis. To respond successfully, organizations need to be goal orientated, understanding that there may be multiple routes to achieve objectives. Trying one route and it failing is clearly not an ideal result, but businesses should respond to this failure with adaptation; they should explore different strategies, displaying operational flexibility to produce the best results during a crisis.  

Good communication, both internal and external, is key

During a crisis, it is never more important that employees understand what is going on and what exactly is expected of them – good communication is at the heart of this. Internal messages need to be clear and concise, cutting through the noise and misinformation which is often associated with large catastrophic events. This principle also holds for external communication, as often organizations need to collaborate with each other to mitigate the fallout caused by a crisis.

External communication was particularly important for our evacuations support, as often the evacuations required communication with different international governments and regulatory bodies. This was the case with one evacuation, which involved the first repatriation of a Chinese national with confirmed COVID-19 back to mainland China. The evacuation itself required authorisation from both the Chinese government and Nigerian authorities (the Chinese national was stuck in Nigeria before we were brought in to assist). As such, we had to stay in communication with both governments to ensure the process could go ahead without any hitches – with the successful result that on June 13th the evacuation was completed after over 20 hours of travel.

When it comes to the use of air-ambulances, what are some of the big changes that need to be addressed?

International SOS is highly experienced in evacuating patients with infectious disease, having safely transported numerous infectious patients around the world.In the recent past, our medical and technical capability has helped us provide aeromedical transportation for confirmed COVID-19 infected patients by air ambulance. 

Multinational businesses faced huge challenges at the start of the COVID-19 pandemic, as many of their employees around the world were left stranded, unable to use commercial flights to return home. There was huge demand for repatriations, but questions remained about how these could be carried out safely given the infectiousness of COVID-19.

International SOS supported many organizations with this issue, playing a vital role by carrying out safe evacuations throughout the pandemic. To date, we have arranged evacuations for over 1,500 passengers (and their pets in some cases, including 12 cats and five dogs), supporting governments and commercial entities to repatriate their people.

Some instances were extremely time sensitive with evacuees needing to be flown to a medical facility to receive care. One case involved a suspected COVID-19 positive patient – who was suffering from shortness of breath, fatigue, and a fever – being evacuated from El Salvador. Located outside the capital city of San Salvador, the individual requested evacuation to the United States for urgent medical attention. During this period, many were concerned that local health care systems in less developed regions, like El Salvador, would soon become overwhelmed by mass numbers of COVID-19 cases. This added a heightened sense of urgency to our work with this evacuation, as we coordinated with local authorities and medical teams to transport the individual from El Salvador to Texas. This required the use of an air ambulance, which moved the patient with a Portable Medical Isolation Unit to avoid the risk of the individual spreading coronavirus

Undertaking international evacuation of patients with COVID-19 infection has its own challenges, Aeromedical movement of patients with either a history of travel to a COVID-19 affected location, and/or overlapping symptoms. Some patients experience significant delays in evacuation and have to rely on local healthcare resources for prolonged periods, additional testing are required  and if COVID-19 cannot be excluded, the patient may require the same levels of infection control and permissions as a confirmed case.

Therefore to unable aeromedical movement, it is necessary to revisit the protocols that can reduce the   lead-time to confirm the feasibility of such evacuations

Some key variables that can assist is quick turnaround time for the patients may, but are not necessarily limited to:

  • Acceptance of the patient by Health Authorities and other Governmental bodies in the designated country, in addition to the authorization of Health Authorities in the originating country for discharge of the patient.
  • In some circumstances including patients presenting with fever or other symptoms similar to COVID-19 infection, international evacuation may not be achievable due to local health authority regulations.

Air Ambulance services required for medical evacuation is a complex and has many variables: 

  • Availability of aircraft operators willing to consider the transport of a patient with known or suspected COVID-19.
  • Restrictions as to the choice of country destination for air ambulance flights in addition to the choice of medical facility for receiving care.
  • Implementation of restrictions by some countries on inbound international flights, including Air ambulance aircraft.
  • Granting of overflight and landing permission by countries that the aircraft carrying the patient needs to overfly or land in to refuel en-route to the destination. Strict public health regulations may be enforced, and countries retain the right of refusal for such medical transport flights.
  • Due to limitations on movement of exposed or confirmed patients, consideration of direct repatriation flights to the country of origin of the patient where operationally and medically feasible may be required.

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