Heart Break

After years of suspense, Kashmir has lost its chance to have a super speciality cardiac centre headed by internationally renowned top cardiologist Dr Fayaz Shawl, a Kashmir Life report 

In his e-mail on April 5, 2010, when he suggested the chief minister Omar Abdullah “please google search my name – as (Dr) Fayaz Shawl and see what (I) have done in the last 37 years in the United States and rest of the world,” the doctor was not bragging. An authority on interventional cardiology, Dr Shawl’s bio-data runs in 57 pages. He is the director of two interventional cardiology institutes in the US. His patient list is almost the who’s who of world politics and business.

“As you may have heard that I have been trying to build a super-speciality cardiac centre along with a wellness centre in Srinagar, which will treat the underprivileged at no cost, supported by my Foundation,” Shawl wrote to Omar. “Over the last 30 years I have trained most of the leading cardiologists in India, who are now running major institutions in Delhi, Bombay, and in other cities. As you know we have no such facility in Srinagar. I do not need anything from the government, what I need is permission from your government.”

State government, Dr Shawl told reporters later, had asked him to change the date of the groundbreaking ceremony for the project in Zabarwan Hills from June 4 to June 5. It did not happen. Eventually, on this date, he chose to announce the abandoning of the project. People close to the top doctor say it has been his dream project and he was chasing it since 2003 when Omar’s predecessor Mufti Sayeed discussed the idea of a high-speciality cardiac institute at Srinagar with him in the USA. Mufti had stayed at Dr Shawl’s home. The American citizen accused the Omar government of sabotaging the project and termed it ‘Gupkargate’.

A resident of Narparistan, Fateh Kadal, Fayaz is the son of a middle-class handicraft dealer Mohammad Saleem. Fayaz and his elder sister Fareeda burnt the midnight oil to become doctors. Brother Farooq is a businessman and sisters Farhat and Fareeda, are serving SKIMS.

After graduating from the Government Medical College Srinagar in 1972, Shawl was posted in Rajouri’s Shardha Sharief belt. For most of the week, he was a doctor and on Sundays, he would act like a judge to settle their disputes.

Soon after, he went to the UK with barely $50 in his pocket. He actually accompanied one of his friends. There, a plain accidental interaction with a senior professor fetched him residency. In 1977, he flew to the USA and completed his cardiology fellowship at The Walter Reed Army Medical Centre. His profile took such a jump that one fails to understand how he was serving at different places in different capacities at the same time. Currently, he is heading two interventional cardiology institutions in the US. Trained with the angioplasty pioneers, Andreas Gruentzig and Richard Mylar, Dr Shawl is solely responsible for taking the “US military into the balloon age”. Right now, Shawl is being considered as one of the world’s three best interventional cardiologists.

Apart from being a teacher and a top-notch trainer, Dr Shawl is credited for the Shawl Technique, using a heart-lung machine in such a way that the machine takes over heart function as the doctors perform angioplasty without opening the chest. Since 1988 when he put his innovation to practice, there has been only one death in the institute headed by Dr Shawl. Apart from being the world’s best-known intervention cardiologist, he is the only person on earth who can stake claim to around 20,000 interventional procedures – a record in itself. While his patients are all the big shots – Boris Yeltsin, Bill Clinton, Dick Cheney, Nawaz Sharief, most of the Saudi kings and Hollywood celebrities, he has been a teacher to most of the best names who run India’s cardiac care sector.

These include Dr Ashok Seth, Dr Upendra Kaul, Dr Ashwin Mehta, Dr Mathew and many others.

Shawl lives in the US with sons David Salim Shawl and Jonathan Hussain Shawl (from his first wife) and daughter Isabella Banu Shawl, his six-year-old daughter he has with his second wife Jina, a nurse.

A globe trotter, he flies in charted aircraft that his patients send him. After 9/11 he opened Shawl Cardiovascular Institute at Zulekha Hospital, Dubai which is attracting patients from the UK, India, Pakistan, Bangladesh, Saudi Arabia, Oman, Jordan, Syria, Canada and other countries in South and West Asia.

I have earned a lot of fame and money at the international level, Dr Shawl told the Hindustan Times in April, “I want to do something for my people now. I will bill the rich to help the poor.” He wanted to replicate his Dubai experience in his home town. Unlike Dubai, it was envisaged to be a non-profit venture.

Shawl credited Omar for his personal intervention in getting the project through. “Initially (I had) got disheartened by the needless hurdles being created in the initiation of the project at various official levels,” he told the newspaper. “But after I got in touch with the CM Omar Abdullah the other day and sent him the details of the project, I was really overwhelmed by his quick and positive response.”

This was Shawl’s first excitement after the project was revived. He had moved the file as early as April 2008 and had in fact invited his friends including Nawaz Sharief for the groundbreaking ceremony. “He had purchased land and had applied for the change in its use,” said Tariq Hamid Karra, the then Urban Development Department Minister. “We had initiated the process but then the government collapsed and we went into the governor’s rule.” Shawl told the newsmen last week that the Azad government was not supportive.

Doing something at his place of birth was the outcome of his visits to Srinagar that followed Mufti’s request to him to do something in Kashmir. “Mufti Mohammad Sayeed once told me: ‘Before I die, make a heart hospital in Srinagar’ and then I bought land in Srinagar for the hospital,” Shawl said. But Sayeed soon lost power and the Ghulam Nabi Azad government started ‘creating impediments’.

Soon after his first visit, he could feel the state of crisis given the massive load of cardiac morbidity on one side and the lack of infrastructure, expertise and poverty of the patients on the other side. His initial response was to fly with enough equipment and material (like costly stents and balloons) for distribution among the neediest. The initial shock came when the then director SKIMS Jalal-ud-Din refused to accept the material and prevented Dr Shawl from entering the hospital premises. There was no logic for his stubbornness (except that he was feeling dwarfed when he tried to compare himself with Dr Shawl). Though newspapers reported it faithfully but the doctor did not budge.

The situation eased after Jalal’s transfer and paved the way for Shawl interventions. He has been coming year after year with suitcases of costly equipment. He donated and implanted stents worth two crore rupees to deserving patients in 2007 and 2008. “I saw him distributing cheques to the poor patients who had no money for the bypass surgeries,” a senior SKIMS official said. “Even this time he gave SKIMS these costly items worth Rs 1.25 crore for poor patients.”

Restrictions on movement, sedentary lives, food habits, tensions, and smoking are the major agents that trigger heart problems. Kashmir has plenty of all these things given the situation that exists here for over 20 years now. This has helped heart problems compete with cancer, which looks more like an epidemic these days. “I believe sixty per cent cases of interventional cardiology cases go outside along with over ninety per cent of the cardiac surgeries,” a senior official in SKIMS said. “We have a few doctors but there is a massive load and the survival rate is not encouraging as well.”

Dr Shawl intended to set up a world-class facility not far away from the Nishat garden, which does not fall under the green zone. It, however, falls under a restricted category where permission for changing land use is required.

The Kashmir Cardiovascular and Wellness Institute was supposed to have two state-of-the-art CATH labs, a 20-bed trans-care holding unit (for immediate pre-operative and post-operative management), one fully equipped cardiac operating room, a 10-bed intensive care unit, a 10-bed-coronary-care-unit, fully incorporated 50-telemetry beds, an echocardiography laboratory, nuclear cardiology testing centre and non-invasive endovascular laboratory.

It also envisaged having a 100-seat auditorium, a wellness centre with facilities of a gym, a swimming pool and other facilities required for meditation and diet consultation besides 30-50 hotel rooms. The hotel was supposed to cater to the requirements of the families of the patients and attendants besides the visiting faculties and researchers and the staff most of which Dr Shawl had foreseen being flown from the US. He had already an understanding with the SKIMS that its cardiologists would be rotating to this super-speciality centre for knowledge and technology upgrades and cross-training.

“I am hopeful to promote similar (as that of Dubai) tourism (medical) and opportunities in Srinagar,” Shawl wrote in his application of March 29, 2010 (e-mailed to the chief minister). “The income generated from this medical tourism industry will help the valley and create jobs in Srinagar. Additionally, the cardiac centre will generate revenue that can be spent on patients who cannot afford treatment. I like to use the phrase – charge the rich and feed the poor.” Shawl had added in his letter: “This…centre will treat the underprivileged at no cost regardless of the patient’s ethnicity, religious preferences or country of origin. However, there will be charges to those who can afford to pay for these highly specialized quality services.”

After the Azad government fell under the weight of the Amarnath agitation, Dr Shawl had apparently given up the project. But a chance encounter with Dr Farooq Abdullah, his buddy, in February last revived it. “I will take your bullets,” Dr Abdullah told him and assured him all help. From America, Dr Shawl resumed his communication with the government in Srinagar. Apart from e-mail exchanges with the chief minister, he would talk to Nasir Aslam Wani, Omar’s friend and junior minister. Both agreed on a groundbreaking ceremony but on Wani’s request date was changed to June 5 with chief minister Omar Abdullah presiding over the function.

After the cardiologist landed in Srinagar, almost everything was haywire. Initially, sources close to him said; the doctor was told the chief minister may not be able to come because there is no road linking the site with the main road. Later, he was informed the piece of land – 40 kanals which he had procured for the project, falls in a green zone where no constructions can be permitted. Eventually, he tried for a meeting with the chief minister but was initially denied. It matured on June 5 evening only after he threatened to go to the press. But the meeting marked the end of it.

This is the saddest day of my life, Dr Shawl told a hurriedly called news conference. “I am stopping my project which was for the people of Kashmir,” he said. “This is Gupkargate.” In his 55-minute interaction with the media, he gave the details of what transpired between him and the chief minister in the presence of the principal secretary to the chief minister Khursheed A Ganai.

Shawl said though Omar knew every bit of the project, he still briefed him about it. He also showed him the photographs of constructions taking place in the immediate vicinity of the 40-kanal land, which involves the house of the GMC principal and an advocate general.

Details of this most disastrous meeting are being discussed almost everywhere these days. There have been lot many juicy sentences uttered by Shawl that are keeping the discussions hot within and outside the civil secretariat. But what had annoyed Dr Shawl was the lack of attention that the chief minister exhibited by playing with his blackberry during the meeting. There were charges of corruption as well.

After Dr Shawl rejected the alternative options that were offered to him, he said he told the chief minister “I am gonna stop the project, he (Omar) said: ‘so be it’”. At this point, the chief minister left the room in anger. Sensing that his dream was over, Dr Shawl wanted to see him again (and probably apologise) but his aide said: ‘never on earth’. It might have been the ‘big decisions’ of the two big men of Kashmir. In the name of Kashmir, both of them voted against Kashmir.

A dejected Shawl felt lonely on the Gupkar Road. He drove to the Grand Palace had a drink and cooled his heels. He felt insecure and rang up his friend, Mufti Sayeed, and sought security. The security was with him till June 6, the afternoon when he boarded a Delhi-bound aircraft. “He was scared,” one of his acquaintances told Kashmir Life. He did discuss the issue with Mufti but was strongly advised against going to the press. But he did not listen. He spilled the beans and it continues to be a major embarrassment for the government.

Nasir Aslam Wani, whose name figured many times in the meeting between Shawl and Omar, was quick to react to the allegations. Terming the allegations (of corruption) false, concocted, malicious, baseless and bereft of facts, Wani challenged Dr Shawl to expose the smoking gun that he has referred to and substantiate his allegations in this regard.

Wani said the land is a restricted area under the Master Plan and in the absence of a formal proposal; the state government was gracious enough to offer Dr Shawl either to take over the Kashmir Nursing Home at Gupkar Road or exchange his land for Custodian land by paying the differential cost where he could build his Centre. Besides he was asked to submit the (Detailed Project Report) DPR “along with an undertaking to treat poor patients who could otherwise not afford treatment after which the State Cabinet would consider amending the Master Plan”.

Seeking an undertaking from a person who has been spending money year after year, even paying cash to the poor for surgeries was too rude, people who know Dr Shawl assert.

The issue was raised by former Deputy Chief Minister Muzaffar Hussain Baig with the Prime Minister on Monday night. Sources told Kashmir Life that Dr Singh directed his principal secretary T K Nair to get in touch with Dr Shawl and ask him to stay in Delhi till he flies back from Srinagar. By then, however, Dr Shawl had boarded his flight to London.

Plenty of theories are in circulation about why the project’s drop scene was so crude. One theory is that since it was initiated by NC’s arch-rival PDP founder Mufti Sayeed, Omar did not want it for political reasons. Yet another theory is that in the long term, it will create yet another name in the medical science that will run parallel to the Sher-e-Kashmir in whose name Kashmir’s only tertiary care hospital runs. Even a section thinks that some influential people wanted to be its partners and make it a commercial initiative rather than a non-profit organization.

Vested interests, another theory says, played the spoilsport. The presence of such a super-speciality would have prevented a huge rush of patient flow to various medical centres, especially Delhi. A number of India’s top doctors frequently come to Srinagar for identifying the potential patients to be treated in high-end hospitals in Delhi. Some of them having strong political connections are actually working to build a hospital not far away from the spot that Dr Shawl has purchased.

Bureaucracy has all along been negative towards such initiatives in Kashmir. Insiders refer to an earlier initiative in which a group of non-resident Kashmiri doctors purchased land around Bemina and wanted to have a major charity hospital. “I am sure they even greased the palm of some influential person in the last government but at the end of the day they are yet to get the permission,” a middle-rung officer said. “At one stage even the governor intervened seeking its immediate clearance but nothing changed.”

In Shawl’s case, however, officials indirectly involved insisting there was no hanky-panky. “The project had the fundamental problem that it lacked a DPR and there is no application on record anywhere in any department,” said one senior officer. “How can one go to the cabinet without formal details of the project that the law requires? It needs a drawing, a plan and a detailed waste management system.” One officer said he got records of the last four years checked but could not trace an application. Another officer said that when Shawl’s representatives visited him they were told to submit site plan and other project documents. The government even tasked a senior district officer to give advice. All these officers pass the buck to “Shawl’s friends” who, they say, did not guide him in having a formal DPR and Minister Wani conveyed to him that he can go ahead with the groundbreaking ceremony, an invitation he backtracked later.

“We understand there is an e-mail but nowhere in the world can a few-page e-mail be treated as a project report that can be submitted to the cabinet,” fumed an officer. “It does not happen even in the banana republics.” But what happened to the file that he had moved in the Azad era?

Officials, however, are hawking the same theory that they once used to kill the Mughal Road project saying constructions in restricted or forest belts are subject to permission of the courts. This is a norm but courts do permit developmental activities in protected belts as long as the projects are indispensable.

Generally, people here want the project to go ahead. “Why should Dr Shawl contribute Rs 40 crores to SKIMS,” said M Altaf, a state government employee. “Let him keep it with his foundation till the project is revived, pursued and cleared in the larger interests of Kashmir.” Interestingly, Dr Shawl was approached by two senior ministers from Jammu who offered “whatever it needs” if he implements the project there. “He told them he believes in the indivisibility of the state but he wants it to be in Srinagar because he was born here,” a source close to Dr Shawl said.

Note

Dr Shawl did not disclose any name of his patients he has treated. Possible patients named in the report was the information collected from individuals who knew the intervention cardiologist. The names put in the article was an error.