Awareness saves

Renowned cardiologist, Dr. Upendra Kaul, is the Executive Director of Fortis group of hospitals and Director of Cardiology, Fortis Escorts Heart Institute. Besides being a visiting faculty of several universities in the West, China and Australia, he has been conferred with Dr B C Roy Award for developing specialties in 1999 and the Padmashri in 2006. He talks about the cardiac healthcare scenario in Kashmir in an interview with Ikhlaq Qadri.

IKHLAQ QADRI: What is the current status of heart ailments in valley?
DR.U.KAUL: The current status of heart ailments in valley is worrisome. The number of patients with heart disease, especially heart diseases which lead to heart attacks, unstable angina which is a very common cause of death in young people is increasing exponentionally. We have been discussing the reasons for it and the reasons are multiple. One of the reasons is that the life style has changed in the last twenty to thirty years adversely. Less and less people are physically active. Smoking has not gone down. The level of stress has gone up because of all the happenings especially in last 10 to 15 years and every year it happens that you are indoors and you are stressed. This fellow might come in, police fellow might come in, militant group might come in, rowdies might come in. It has become a sort of have not’s versus have’s fight which leads to lot of stress. People want to get home as early as possible. Children are totally stressed because schools are closed, homework pressure is there, parents’ pressure is there so all that in a combination is leading to major problem in the state and it has to be dealt effectively.

IQ: What is the magnitude of the problem?
UK: I can only give you some idea of the magnitude of the problem. I think at least 12 percent of the population over the age of thirty years is suffering from heart diseases in Kashmir. One doesn’t have to go on wasting time in calculating the number, it is there. What we need to do is through the help of media (spread awareness).

We had a symposium last night, on “Heart Attacks”. A multi-pronged approach is required. Number one: people are to become aware about the symptoms of the heart disease because if a heart attack occurs and if a patient does not seek medical attention for a day, he is finished. He is not necessarily going to die but can suffer permanent damage. So public at large has to be advised through media, through camps, through audio visual media, information technology that any symptom of chest pain, any sudden shortness of breath, any sudden loss of consciousness in a young person could mean a heart attack and they should immediately seek (medical) attention and get ECG done.

That is to be sort of hammered in the minds of public. Now comes administration, you have to have ECG facilities. Every person should have an access to ECG within 15 minutes. So we have to gear our primary health centres, district centres where I was told yesterday that facilities are poor. There is no ECG machine and ECG machine is not prohibitively expensive, so that facility is to be provided. Continuing medical education programs where the doctors sitting in smaller hospitals can start treating the heart attack. It is not that you refer all the heart attack patients to SKIMS, SMHS or to Khyber because it is delay due to traffic jams that is the hesitancy.

We have got very important medicines these days like injections or giving a tablet of Aspirin. There is no problem in that. Or administering intravenous agents which dissolve the clot and reduce the mortality substantially. The mortality of twenty percent can come to four percent. You gave that and then refer the patient.

IQ: You come to Kashmir very often. Is Dr. Kaul thinking of establishing a heart care centre in valley?
UK: Well, I don’t want to establish a centre of my own but I am ready to be associated with any centre, any number of centres and give my expert advice. I have got so many students here. I can bring students here. I can organise these things provided there is will. They come we talk, when I come next time it is all forgotten.

IQ: Dr. Fayaz Shawl left valley with disappointment. What do you think Valley missed by not having the state of art cardiac centre here?
UK: Well, valley should have not only one but multiple state of art hospitals which are affordable, where people at large can go because very rich people with chronic heart disease can go anywhere. Howsoever big centres you will make they will still go Delhi, Mumbai. What we are concerned is that the state of art facilities should be there for the poor person and there are so many people who are denied medical care because facilities are not there and some of them may have money also as I told you heart attack needs early treatment.

Even if you have all the money to reach to a centre in Delhi, you don’t have the time. You are so sick with heart attack that no plane is ready to take you. We need to have what is called state of art not very sophisticated, glamorous looking hospitals with all those malls which some people think of. What we need of all the basic infrastructure, manpower and in that I have been telling administration also if we want to do it faster we need to have public- private partnership which is easy. There are so many groups who want to have the expertise, there is the need. Classical example is in (Government) Medical College there is a cath lab which is grossly underutilised. There are two or three doctors.

Half a day they are at some place and half a day at other. No infrastructure, nurses not trained. If you can have a public-private partnership. Ask for people who are willing to partner and then give structure to them. Have a understanding and with that you would see that whole facility will change. Like we have from  Escorts some three or four  public-private partnerships in Raipur, Dehradun, Aligarh Muslim University is approaching us that you run the hospital, appoint us staff and the some kind of a  win-win situation for both. They will not be charging exorbitant to you. Put your rules that below poverty lines no charges, between this and this so much charges and  equipments you can get at much lower cost for public because these big groups  buy things in bulk  and if you buy things in bulk it is very cost effective

IQ: Khyber has also started the Cath Lab?
UK:  Yeah, it has a cath lab where angiograms and some procedures are being done. Last time I came on 8th January, we started angioplasty programme there. We did, I think, eight or nine cases and everything went smoothly but after that it has to have a regular programme.

IQ: Do we have expertise within Kashmir that can be organised?
UK: Expertise is there but they have to be made cohesive. It can’t happen that there are two doctors trained and they don’t talk to each other. They come to me separately. Important is they should work together. If you have done an angioplasty and go away to see some other patient at some other hospital, in that case second doctor should take care of patient. Let them train other doctors.  Starting a centre you have to have team spirit.

IQ: Can healthcare sector in Jammu and Kashmir become a success story as it has massive per capita consumption of drugs besides medical proffesion attracts brightest minds in the state and they create names once they cross the range of Pir Panchal?
UK: I think there are all the reasons to have a success story provided we put in concerted efforts such as which have been put in, in other parts of country .If you go down to south, Tamil Nadu, Karnataka, Andhra Pradesh governments have made healthcare especially acute healthcare focussing on acute heart attack so simple that they have started some insurance.

Everybody pays very little, five rupees for every person of the family. They have got a kitty and government has put equal amount of money and any patient with heart attack in these three states when reaches a hospital. Doctor rings up, this patient has come as authentication, documentation has to be done and eighty thousand rupees are given straight to the patient for treatment. Eighty thousand rupees if you are not making profit is good enough for angioplasty. So we don’t have to go and reinvent the wheel. Call them and see how they have done it and do it. Why not? A poor person when asked that you will get all these facilities pay ten rupees per member, large number of them will pay but you have to organise.

IQ: A common man may change life style but can not change situation. What are your suggestions to bring down the stress?
UK: Physical exercise, eating right kind of food.  Avoid smoking. If these things are done there will be 30 percent reduction in the problems.

IQ: How many people go outside the valley for treatment of heart ailments?
UK: I won’t have numbers but I think out of 100 people with heart ailments, 50 go outside for treatment.


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