Chapter Four — AIG: The Tube That Opened a City

How Dr D. Nageshwar Reddy left government service because India would not take the stomach seriously, built Asia’s great house of gastroenterology from a day-care room in Hyderabad, and then raised a multi-specialty fortress in Gachibowli so that a liver, a pancreas and a heart could share one roof.

The talks and rooms below are written as a book chapter, drawn from his interviews, from the official history of the Asian Institute of Gastroenterology, and from the long argument he made to a country that once thought ulcers did not deserve their own hospital.

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The third doctor in the house

He was born on 18 March 1956 in Visakhapatnam, with Alur and Kurnool in the family map. Grandfather a pathologist. Father a pathologist who would retire as Vice-Chancellor of Kurnool Medical College and Director of Medical Services. In such a house a boy does not discover medicine. Medicine discovers him at breakfast.

“I am not a true entrepreneur,” he would say decades later, smiling at the word people pinned on him. “I am an accidental one. I come from a family of professionals.”

Kurnool Medical College. Then Madras Medical College for his MD — and it was there, not in a boardroom, that the accident began. A new virus had a name: hepatitis B. A vaccine was arriving that could change the fate of millions of livers. At the same time, strange flexible tubes were entering the world. Through those tubes a doctor could walk the intestine without opening the abdomen. Early cancers. Bleeding ulcers. Stones in ducts that had always meant a long knife and a longer scar.

He went to Germany, to Hamburg-Eppendorf, and learned the new grammar of the scope. When he came home he joined Nizam’s Institute of Medical Sciences in Hyderabad, then state government service in 1984, later a professorship at Guntur Medical College.

The work was real. The respect was not.

“Gastroenterology was not given enough importance,” he said, “by institutions or by society. People felt liver and gut did not warrant a separate institution.”

He would quote a number that still sounds like an accusation: nearly thirty percent of a population walking around with ulcers, cancers, chronic liver disease, dying pancreases — and the specialty treated as a cousin of general medicine, given leftover rooms and leftover budgets.

Bureaucratic files. Machines that arrived late or not at all. A young professor who could see, through a scope, what an open theatre would mutilate — and could not buy the scope the year he needed it.

He quit.

Friends asked if he had lost his mind. Government service was the respectable river. A private day-care for the intestine was a puddle.

His wife, Carol Ann, and their daughter were, he has always said, the strength that let him step out of the river.

“We will start small,” he told the first colleagues who did not laugh. “If the tube can do the operation, the patient should go home the same day. That is the whole idea.”

A polyclinic, then a name

The official memory dates the birth of the Asian Institute of Gastroenterology to 1994: India’s first dedicated day-care centre for gastrointestinal disease. Some of the house histories reach back further, to a 1986 day-care seed. He himself speaks of a concept born from a polyclinic — a small step, then a journey.

Somajiguda. The heart of Hyderabad, not yet a glass suburb. A room where major endoscopic work could be done without a week in a ward. Patients from the city, then from the state, then from Sri Lanka, Bangladesh, Nepal, Malaysia, because word travels faster than a referral letter when a stone comes out through the mouth instead of through a scar.

Dr G.V. Rao stood with him — the surgical mind to his medical one. Dr Manu Tandan and others entered the circle. It was never a lone-genius story. It was a small faculty that decided the gut was a country.

Money came, he has said, from friends and from liberal donations. Later, names like Nimmagadda Prasad and G. Pulla Reddy appear in the telling — an industrialist’s mobile van for rural surveys, private capital when the day-care had proved it was not a hobby.

In 2004 the day-care grew a spine: a standalone gastroenterology hospital in Somajiguda. Sources remember it as 130 beds at the first expansion, then 200, 250, 300 — India’s first hospital of its kind devoted to the widest spectrum of GI work under one roof. Theatres for open work when the tube was not enough. Dedicated medical and surgical ICUs. Interventional radiology. The unglamorous backbone that lets a famous endoscopist sleep.

They treated tens of thousands. Only a sliver needed to stay the night. That ratio was the argument he had made in 1984, now written in occupancy registers.

And the volume became a kind of fame the textbooks could not ignore. AIG would be called the largest referral centre in Asia for therapeutic endoscopy, and the place that performed the largest number of ERCP procedures on earth — the difficult dance of scope and X-ray in the bile duct, the procedure that separates a craftsman from a tourist.

The firsts that sound like science fiction

In a reconstructed corridor after a long list, a visiting fellow from Europe once asked why so many “firsts” seemed to carry a Hyderabad address.

G.V. Rao, if one imagines him there, might have shrugged.

“Because we do the case. Then we write the paper. Then we train the next twenty people. That is the order.”

The list is long enough to fatigue a dinner table. NOTES — natural orifice transluminal endoscopic surgery — and the claim of the world’s first transgastric appendectomy: an appendix removed through the stomach, the abdomen never opened from outside. POEM and G-POEM for the gullet and the stomach’s emptying. ESD and EMR for early cancers lifted like stamps. STRETTA and GERD-X for the burning chest. Endoscopic sleeve gastroplasty. Islet-cell transplantation. EUS-guided tricks that measure pressures once reserved for a surgeon’s hand.

He invented a gastric stent that the world calls the Nagi stent. Manufacturing rights went to a Korean firm on a condition that sounds like his whole politics: keep the price inside an ordinary family’s reach.

World Endoscopy Organization named the institute a Centre of Excellence in 2014 — then the first and only such recognition in India. He trained hundreds of doctors from other countries. DNB seats filled. Four hundred and more research papers. Collaborations with ISRO, IITs, IISc, ICMR, CCMB — the gut speaking to satellites and to genomes.

In 2008 the Asian Healthcare Foundation was registered as a scientific body, so that the questions behind the procedures — why this pancreas fails in an Indian body, what this microbiome is doing — would have a room of their own.

Awards arrived like a second pulse. B.C. Roy. Padma Shri in 2002. Padma Bhushan in 2016. The Rudolf V. Schindler Award in 2021, the American society’s highest honour, named for the father of gastroscopy. In 2025, Padma Vibhushan — and with it a quiet historic note: the first Indian doctor to hold all three Padmas.

He received them the way he received patients from twenty countries: without slowing the list.

Ten years to build a second city

Somajiguda could not hold the future. The city was moving west, toward the glass of Gachibowli and Mindspace. Liver transplants, hearts, kidneys, cancers that were not only GI, lungs, obesity — the patient who came for a duct often needed a country of specialties.

The mega project took a decade of planning, raising money, and arguing with drawings. Investment remembered around a thousand crore. Built-up area spoken of in the range of 1.4 to 1.7 million square feet. An 800-bed idea that the market would later count, with expansions, past a thousand across the group.

In 2018 AIG Hospitals opened in Gachibowli: not a larger Somajiguda, but a multi-specialty tertiary campus that still wore the old name like a surname. Medical and surgical gastroenterology. Liver sciences. Transplants. Pulmonary, renal, oncology, cardiac, metabolic therapy. More than twenty endoscopic suites — the first hospital in India, they said, to gather that many in one place. Hybrid theatres, Endo-alpha rooms, where the medical team and the surgical team could work in the same light without wheeling a half-finished body down a corridor.

He wrote a chairman’s note that sounded like a man still surprised by his own building.

The concept was born from a polyclinic. The new facility had been designed after listening to what people actually needed. He prayed that everyone would be blessed with good health — the sentence of a clinician who has seen too many livers arrive too late.

Occupancy at Gachibowli climbed hard. Somajiguda kept drawing more than half its admissions from outside Telangana — a single-specialty magnet in a country of referrals. Private equity arrived; Barings took a large stake in the early 2020s. Eight thousand employees, he would say, require a different economics than thirty specialists and a dream. He had to learn finance the way he had once learned the side-viewing scope.

“I was primarily a gastroenterologist and a researcher,” he told The Hindu after the Vibhushan. “A close-knit team of twenty-five or thirty. Then five hundred consultants. Managing that is another profession.”

Research budgets moved from lakhs to crores. CSR cheques went back to PGI Chandigarh, the place that had trained his hands.

Banjara Hills opened as a further wing of the same will, in 2025. New towers on the Gachibowli campus were drawn for hundreds more beds, trauma, a proton-shaped ambition in oncology. The gut hospital had become a city that happened to remember it began with a tube.

A rural van and a city list

He never fully left the argument of 1984. Mobile vans. Camps. The belief that a specialty born in a German theatre must still answer a farmer with jaundice in a district without a gastroenterologist.

A junior once asked him, in the sort of evening conversation books require, whether he regretted leaving NIMS.

“If I had stayed,” he said, “I would have been a good professor. The patients who come from Bangladesh for an ERCP would have gone somewhere else, or not come at all. The appendix we took out through the stomach would have been a paper in someone else’s journal. Regret is a luxury. The list starts at eight.”

Carol Ann, in the public telling, remains the private ballast. A daughter in the house. A team that became famous in its own subspecialties, which is how he measures succession — not by a surname on the gate, but by whether the next endoscopist can do the case when he is in Shanghai collecting an award.

What AIG changed in the book of Indian hospitals

Apollo proved a hospital could be a company.

Medanta proved it could be a multi-specialty city led by a surgeon-founder.

Narayana proved volume could drag a price down to the edge of mercy.

AIG proved something quieter and, for a vast number of Indians, more intimate: that the organs we do not discuss at dinner — the liver that drinks our mistakes, the pancreas that fails without warning, the colon that hides a cancer behind a year of “gas” — deserved a cathedral of their own. And that the cathedral could begin as a day-care room where the patient went home before night.

Hyderabad, which already had Apollo’s Jubilee Hills and a rising skyline of corporate medicine, gained a different kind of landmark: the place you send the impossible duct, the bleeding that will not stop, the child whose pancreas is eating itself.

He still talks like a teacher from Guntur who cannot believe the specialty is finally fashionable.

“Thirty percent of people,” he repeats, as if the country has not yet heard. “We built a hospital because no one else thought that number was a building.”

The building stands in three pieces now — Somajiguda the original argument, Gachibowli the expansion of the argument, Banjara Hills the latest sentence — and the scopes keep moving through them like a second circulation.

That is how AIG was planned: not as a chain first, but as a refusal to treat the gut as a leftover.

That is how it was executed: day-care, then a specialty hospital, then a decade of drawings and a thousand-crore campus.

That is how it expanded: by letting the tube teach the city that a life can be saved without a scar the size of a story — and then, when the story grew larger than one organ, by building rooms for the rest of the body as well.

If you want the book to go on, the next chapter can be CMC Vellore and the three knocks, or Tata Memorial, or AIIMS as a temple the Republic built for its own students.