Dr Kunal Sarkar, Head – Medica Institute of Cardiac Sciences and Senior Vice Chairman, Medica Superspecialty Hospital, Kolkata, gives an outlook about the advancements in the field of cardiology over the years
Of all the specialities in medicine, cardiology is perhaps the youngest. The year was 1913 when Rabindranath Tagore was awarded the Nobel Prize. During the same time a physician in Chicago made one of the major breakthroughs in clinical medicine.
The physician worked it out that fatal heart attacks were caused by blockages of the blood supplying arteries and the medical world started a tireless journey for finding a cure. It was four years later that a humble Frenchman, Alexis Carrel, born to a poor seamstress defined techniques for suturing blood vessels together. But still there was no way that we could visualise the arteries of the heart. Till one morning in 1958 by sheer accident, Mason Sones in Cleveland Clinic, injected some dye into the arteries of the heart to accidentally obtain a coronary angiogram. It was left to an Argentine post graduate student, Rene Favoloro, to devise the operation of coronary bypass. This led to a paradigm shift in medical science and soon enough people with crippling chest were cured.
As the story goes, a young Swedish cardiologist, Gruntzig, devised on his kitchen table the tools that enabled him to perform the first angioplasty in 1968. Unfortunately, he was denied a much deserved Nobel Prize, but it was a dawn of minimally invasive procedures. In the next four decades, treatment of heart diseases though bypass surgery and angioplasties became common procedures performed in clinical medicine. How in India did we catch up with the therapeutic revolution?
In colonial India, medical treatment was a privilege of the feudal upper classes, the rest of the population has neither access nor any expectation of seeking proper medical care. Medical colleges in major cities were the domain of the elite. Independence brought with it the expectancy of teeming population that was thrust on a rickety infrastructure. Over the past few decades, the government infrastructure has fallen far short in terms of both in quality and quantity. The rising incidence of coronary problems in the city was seized by the private nursing homes and hospitals that were forthcoming in setting up coronary care units. In the 70’s and 80’s mere presence of a coronary care unit was a crowning attribute for a private healthcare set up.
It is believed that the first open heart surgery in India was done in the early 70’s by Dr KM Cherian. Most of the explosive growth of cardiac surgery in the late 80’s and early 90’s was powered by coronary bypass, which was a very effective and a safe procedure. The impact of coronary surgery was not only a matter of technical brilliance but also its dramatic effect of resorting the quality of life. Till date no known treatment in the history of modern medicine has had such an impact on the society.
With less than two per cent complication rate, bypass surgery and angioplasty gifted a productive life to millions who were cursed with the crippling disease. We perform about three and half lakh coronary bypasses and angioplasties in the country. Sounds like a staggering figure, but it is less than a fifth of what needs to be done. Because of the economic constraints, millions still are not able to access the treatment. This has been resolved to a some extent with private and government health schemes, but still that covers less than 20 per cent of the population. Indian surgeons are acknowledged as the world leaders in innovative coronary surgery. We perform most of our operations on the ‘beating heart’, without the use of heart lung machines. This makes the operation less complicated and far less expensive.
This is the point of principal attraction for medical tourism in India.
Over the past decades, facilities for cardiac care have spread into tier-II cities and towns.
Some states, specially in West Bengal, we have one of the most robust cardiology programmes in government hospitals, an attribute to be proud of. We still need deeper penetration of centres in non-urban centres. Perhaps a partnership format will hasten the spread.
Success in coronary surgery is matched by the results of treatment of paediatric and valve disorders.
But the needs of a billion strong population cannot be matched in the operation theatres or cath labs alone. Awareness needs to be generated. It is scary to realise that every third Indian is a potential diabetic and every tenth Indian will probably have heart disease. So the cure of stents and arteries has to be matched by measures like reduction in smoking, detection of diabetes, diet and blood pressure control.
We are in arms in this war it is not our battle it is your war as well. The path ahead is equally challenging. India in its entirety has to conquer this frontier. We will.