Fine-tuning the YOUNG HEART
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Fine-tuning the YOUNG
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Fine-tuning the
YOUNG
HEART
Every year 2 lakh children are born in India with congenital
heart defects. Only some 5,000 get treatment because awareness
is abysmally low and diagnosis is delayed
By K. SUNIL THOMAS/Delhi, QUAIED NAJMI/
Mumbai, VIJ AYA PUSHKARNA/Ghandigarh,
N. BHANUTEJ/Bangalore
and FARWA IMAM ALI/Chennai
heir worry lines increased
with every new whoosh of
air from the little one's
lungs. No antibiotic,
Madhura and Kiran Chittar realised to
their dismay, seemed capable of
subduing the severe cough that racked
f 1 six-month-old son Mihir's tiny
bAnd their hearts sank when the
paediatrician referred the child to
Mumbai paediatric cardiologist
Bharat Dalvi.
A few days later, the Chittars sat
numbed with pain as Dr Dalvi told
them that Mihir's cough was the
symptom of a congenital heart defect.
The valves of their baby’s aorta, the
main vessel that carries oxygenated
blood from the heart to the rest of the
body, were in bad shape. What was
heartening, though, was the doctor’s
assurance that the defect could be set
right through a non-surgical process
where a balloon is inserted into the
i
i
YOURS WHOLEHEARTEDLY: Dr K.S. Iyer of
Escorts Hospital, Delhi, with Vinayak,
who was operated on for a heart defect
tiny heart to dilate the valve to make it
broad enough to enable normal blood
flow. Today, six years after the
treatment, Mihir is as active as any boy
of his age—he swims, attends karate
classes and is a topper in class.
Pooja is not so lucky. Her
condition—patent ductus arteriosus,
where a passageway through which
blood flows in the foetus, does not
close after birth—went undiagnosed
till recently when the eight-year-old
was brought to the Postgraduate
Institute of Medical Education and
Research in Chandigarh. Though she
had fever soon after birth in Kangra,
Himachal Pradesh, and could not
suckle, neither her doctors nor parents
thought it could be because of a defect
Congenital heart defects
account for 20 per cent of
infant mortality in the
country. In half the cases
parents never even get to
know of the problem.
in her heart. “During a trip to Vaishno
Devi with a three-month-old Pooja, we
returned without having a darshan
because she was gasping for breath,”
recalls her father Subhash Chand.
As Pooja lies in the advance
paediatric centre of the Postgraduate
Institute, awaiting surgery, the skinny
girl’s expression is deadpan when she
is not in pain. “I have spent so much
time and money and still she is ill,”
says Chand. “We wrould have been
better off if she had been operated
upon as a kid.”
Early detection and treatment
would be the ideal scenario for the 2
lakh children born every year in India
with congenital heart defects, though
the reality is just the opposite. Most
Indian children cannot be a Noor
Fatima, who came all the way from
Pakistan to get the multiple holes in
her heart corrected at Narayana
Hrudayalaya in Bangalore this July,
because over 50 per cent of the parents
of children with heart defects never
even get to know of the problem. Only
some 5,000 of those affected get
treatment. Congenital heart problems
account for 20 per cent of infant
mortality in India. Of the 633 patients
given free treatment at Madras
Medical Mission as part of Malayala
(-over Story
What causes
congenital
heart defects?
Common heart defects that appear at birth
Atrial septal defect
A hole in the wall between the upper
chambers—the right and left
atrium—causes blood to flow from
the left chamber to the right.
More blood in
the right
chamber
means more
blood will flow
through the
lungs than
would
normally.
Single
ventricle
cardiac anomaly
A group of different cardiac
defects where only one ventricle
is of adequate functional size.
Ductus
arteriosus
Transposition of the
great arteries
The two m^jor arteries leaving the
heart—aorta carrying oxygen-rich
blood to the rest of the body and
pulmonary artery carrying impure
blood to the
lungs—arise
from the
wrong
chamber.
Aorta
Pulmonary
artery
Manorama's
Hridayapoorvam
programme for heart patients, 30 per
cent were children with congenital
heart defects.
“At least one third of these 2 lakh
children need some form of treatment
in the first year,” says Dr K.S. Iyer,
paediatric cardiac surgeon at Delhi’s
Escorts Heart Institute and vicepresident of the Paediatric Cardiac
Society of India. The experience at the
Postgraduate Institute has not been
different. Dr Rohit Manojkumar,
assistant professor of cardiology, says
that six out of the 40 children visiting
his paediatric cardiology clinic require
cardiac catheterisation, generally
called angiography. An equal number
40 CSE233 Aug 24, 2003
Though scientists have discovered
more than 100 genetic mutations
that cause heart defects, they
have also identified factors in the
environment that could affect the
structure of the baby’s heart.
These are:
Rubella virus infection—German
measles—during the first three
months of pregnancy; certain
medicines; use of alcohol during
pregnancy; diabetes and
phenylketonuria in the mother
Prevention
Patent ductus Arteriosus
In the womb the foetal lungs are not
yet in use. Blood, therefore, flows
through a passageway called ductus
arteriosus, which normally closes
soon after birth. If it does not,
usually in premature babies, blood
does not flow correctly.
requires surgery, though not all kids
undergoing angio will need surgery. Of
six children undergoing angio, two will
definitely require surgery.
The minuscule percentage of kids
lucky enough to get help includes
Manju, an eight-year-old from Jind in
Haryana. Her heart defect, too, went
undiagnosed for long though she had
symptoms such as recurrent infections
and breathlessness. When it became
debilitating, her father Jai Narain, an
Army man, took her to the Research &
Referral Army Hospital in Delhi,
which sent her to Escorts. Post
surgery, Manju is weak, but the worst
is over for her.
Fourteen-month-old Vijay was
A woman should, during pregnancy,
immunise against measles, shun
alcohol and check with the doctor
before taking any drug. Should
consult a doctor before conceiving
if she has chronic illnesses or is
prone to seizures or, if either
parent has a heart defect or the
couple already has a child with a
heart defect. Get a foetal echo
cardiogram (an ultrasound scan of
the baby’s heart) done if the
expectant mother has had
miscarriages or stillbirths.
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ChopperCrash
Damning charges
ONGC accused of neglecting safety norms
By P. SREEVALSAN MENON
& DNYANESH JATHAR
<
\
helicopters were considered. Despite
two bidders offering new Eurocopter
helicopters, it chose an Indian
"X" "T 'T’hen a Russian-made Micompany which could provide only
%/%/ 172 helicopter carrying 29
four out of the six helicopters required.
W
W
pprcnnnol
rirrc Qnrrov
personnel
of ml
oil rigs
Sagar\ Even those four helicopters were old.
Jyoti and Sagar Kiran crashed into the \
The ONGC has 15 helicopters for
Arabian Sea, no one knew that the \western offshore operations and the
biggest casualty will be the reputation
ill-fated one was a stand-by. “For
of India’s largest oil company, Oil and marine logistics, the selection criteria
Natural Gas Corporation. The ONGC
for\operators has been revised to
is now immersed in controversies over
ensure that only firms with required
its callous attitude towards the
safety of its own staff and violation
i
of many norms.
For the umpteenth time, the
Mesco Airlines-ONGC relation
has been questioned. Earlier this
year, there were allegations that
the ONGC had ignored the
disapproval of the Union home
ministry about hiring services of
the company and the directorgeneral of civil aviation’s
comments
about
the
airworthiness of some of its
aircraft. ONGC staff alleged that
it had never been company’s
priority to hire properly maintained
A SEA OF PROBLEMS: Minister Ram Naik
choppers.
surrounded by agitated ONGG employees
The ill-fated helicopter had been
poorly maintained, say some ONGC
competence and capability bid for
engineers. During heavy monsoon, it
contracts,” said Raha.
used to leak. Choppers meant for
Industry sources say Mesco’s
offshore operations normally have
quality of maintenance was suspect.
fewer seats for safety reasons. In this
“Often spare parts available for
Russian-made helicopters are not
case, the norm was flouted.
However Union Minister of original,” said a pilot in Mumbai. But
Petroleum and Natural Gas Ram Naik
a senior Air Force official said there
said, “The helicopter had a certificate was never a shortage of genuine spare
of air worthiness issued by the
parts for Mi-172 choppers.
director-general of civil aviation and it
“Technologically, too, they are
was valid till March, 2004.”
advanced,” he said.
“A special team from the Russian
Helicopters have to be customised
manufacturer had inspected and
for offshore operations with emphasis
certified the helicopter in March,” said
on safety in times of accidents. “The
helicopters are supposed to float safely
Subir Raha, chairman and managing
for a while and send alarm signals,”
director, ONGC.
said
an
expert.
industry
Industry sources said that ONGC’s
lack of concern for security in offshore
“Customisation ensures that extra
operations was evident last month
windows are created to enable the
when tenders for supplying
passengers to get out safely.” It is
\
at
NOSM
anybody’s guess whether Mesco’s Mi172 was customised.
If it was not, it would mean the
ONGC had not been conducting a
proper audit of hired equipment.
Insiders cited a recent Canadian
Helicopters Association report which
apparently said that ONGC takes
virtually no steps to ensure safety of
passengers and the equipment. In
today’s competitive world, operators
have to invest heavily to acquire modem
aircraft and upgrade them. “You have to
spend at least Rs 1.5 crore every three
years on a helicopter for maintenance
and upgradation,” said a Mumbai
based commercial pilot.
If some of the past tenders are am
indication, the ONGC only believes in
cheaper helicopters and
companies which hold the ‘right
contacts’. A Mi-172 costs ONGC
Rs 1.5 lakh per flying hour
whereas a highly efficient
Eurocopter would have cost Rs 2
lakh per flying hour as per the
bids offered recently. Last
month’s tender was one of the
few it floated since 2000.
Incidentally, during this period
Mesco had lost its operator
permit.
Industry experts also say that
the operator had not maintained
AP
any facility for search and rescue
operations. In this case, ONGC seems
to have reacted slowly to initiate such
operations. Deccan Aviation operater
such a rescue mission at Surat, nearly
100 nautical miles from the disaster
site, but it was not activated. Although
ONGC says the Navy began operations
15 minutes after the disaster, one of
the passengers who was rescued told
the media that he was picked up after
nearl\90 minutes.
For the ONGC management and
Union Petroleum Minister Ram Naik,
it is time for introspection. The unions
now want Chairman and Managing
Director Subir Raha’s head for the lapses.
“We will not work in insecure
conditions,” saict Mirchandani,
Mumbai unit president of the
Association of Scientific and Technical
Officers. “Apart from DGCA clearance
we are demanding that even the
logistics department of ONGC should
certify that the helicopters are safe.” ■
Aug 24, 2003
37
Hypoplastic left heart
syndrome
i
Malformation of the left side of the
heart—the side which receives
oxygen-rich blood from the lungs
and pumps it to the body.
Aorta
1
Tetralogy of Fallot
—Blue baby
A combination of four related
defects: pulmonary stenosis;
ventricular septal defect;
enlarged aortic valve; thickening
of the walls of the right
ventricle. Impure blood flows to
the body so that babies with the
problem appear blue.
Interrupted aortic arch
Absence of a portion of the aortic
arch; in normal cases, the aorta,
after it leaves the heart, branches
off into blood vessels to the arms
and head, and arches down towards
the lower half of the body.
Ebstein’s anomaly
Two leaflets of the tricuspid valve
between the right atrium and the
right ventricle are displaced
downward and the third is
elongated and stuck to the
chamber wall. Blood
flows back into the
atrium when the
ventricle
contracts.
Aorta
Truncus arteriosus
Instead of two, there is only one
great blood vessel leaving the heart,
which then branches into vessels
that go to the lungs and the body.
Tricuspid valve
Coarctation of the aorta
Part of the aorta is too narrow.
Affects blood flow.
Graphics/N.V. JOSE
z
luckier. His heart defect—a hole in the
wall that separates the chambers of the
heart—was detected when he was a
few months old. “A hole in the heart
can create a lot of problems for the
child,” says Dalvi, who has performed
corrective surgery on more than 400
such children at his Glenmark Cardiac
Centre in Mumbai. “More blood goes
to the lungs which stiffen as a result,
and this leads to breathlessness. It
causes malnourishment because these
kids cannot eat properly, which leads
to high fever and cough, and stunted
I THE SMILE IS BACK: Manju, with father
g Jai Narain, after heart surgery at
< Escorts in Delhi
growth.” Vijay, who was also found to
have a genetic anomaly called Down’s
Syndrome which is usually associated
with congenital heart defects, is
breathing easy after Dr Rajesh Sharma
of Narayana Hrudayalaya mended the
hole in July.
While surgery, implants and
medication can correct common
defects like holes, defective heart
valves and wrong positioning of the
valves or the main blood vessels,
“complex or multiple defects are still
not treatable with surgery and at least
0.5 per cent of cases are fatal,” says Dr
B.K. Goyal of Mumbai.
Up to 30 per cent of the defects
may have a genetic basis but even that
Aug 24, 2003 E£S2Si3l 41
CoverStory
A MOTHER'S STORY
An alarming murmur
By ROHINI GHOUDHRY
bhiraj came into this world through a caesarean section three years ago.
The delivery was at Madhu Jindal private nursing home in my
hometown Meerut and the ultrasound scan had shown a normal baby.
Trouble started two days after delivery when the paediatrician Dr
Deepak Seth, after a routine check, said that Abhi’s heartbeat was
abnormal. “It could be a murmur in the heart,” he said. “You should get
it checked.”
I was alarmed. My husband, Vivek, who is an advocate at the Allahabad
High Court, consulted many people before taking Abhi to Dr Rajeev
Aggarwal, a cardiac
surgeon in Badauth,
Uttar Pradesh.
The echo-cardiogram
showed a 0.5 mm hole in
his heart. “No need to
operate, it will probably
close with age,” said
Aggarwal. We were
worried, but he reassured
us, “There won’t be any
clinical problem if we
leave it like that.” Since
Abhi was not a blue baby,
the situation was better,
he felt. “Only,” he warned
me, “do not let him play
in water. And ensure
there is no chest THE ORDEAL IS OVER: Rohini with Abhiraj after
congestion and that he the surgery to close a hole in his heart
does not catch a cold.”
Easier said than done. Abhi’s first winter was a nightmare for us, as we
tried to protect him from invisible germs. Quite often, he was put on
nebulisers for instant relief from the spasm of coughs. One night, he woke
up gasping for breath and we had to rush him to hospital. It was harrowing.
Even his sister Kanika, who was then only five years old, would say, “Abhi
ko thand math lagne dena” (Do not let Abhi catch a cold).
The next summer was okay. Meanwhile, he underwent several
treatments and took a lot of medicines.
Early this year Dr Jaiwardhan Rai, paediatrician at Valsalya Hospital
in Allahabad, told us that Abhi’s hole was still open and surgery was the
option. Rai referred him to Escorts Hospital in Delhi.
On Holi this year, Vivek and I finally made up our mind. If it was surgery
Abhi needed, we had to go ahead with it. But we would get that done only
by a specialist.
I was composed when he was wheeled into surgery on July 1. But I
couldn’t control myself when I saw him later, bandaged and connected to
various contraptions in the ICCU. The ordeal was soon over. Abhi was
discharged in five days. I am so happy we took the step, because Abhi can
now lead a normal life.
|s
hi
(As told to K. SUNIL THOMAS)
42 ESiEESSS Au« 24, 2003
has not been precisely identified, says ’
Dr R. Krishna Kumar, chief paediatric
cardiologist at Amrita Institute of
Medical Sciences and Research Centre
in Kochi. “That does not mean that the
next baby will also have a defect,” he
says. “There is only a 5 per cent
chance.” Though genes certainly play
a part, certain drugs and alcohol if
consumed by the pregnant woman in
the first trimester, and certain diseases
can tamper with the foetal heart. The
other miscreant a pregnant woman
should keep a watch out for is the
rubella virus which causes German
measles. There are probably other
factors that we don’t know enor-1about because the heart is a comp
organ and its developmental process
involves millions of steps.
But most of these defects go
unnoticed because a child with
breathlessness or fever is usually taken
to a general physician or a
paediatrician, who may not suspect a
hole in the heart. Many children do
not even have access to a paediatrician,
let alone a cardiologist. The basic
instrument to detect heart problems is
the echo-cardiogram, which costs
around Rs 20 lakh, and therefore, is
available only in big towns.
Pooja’s problem went undetected
for long because doctors in Jammu,
where her father was working, treated
her for pneumonia. Even if doctors
read the ‘murmur’ and detect the
problem, say, a hole in the heart, f
tell parents that the hole would ck^.as the child grows. Says Devi Shetty,
paediatric cardiologist and founder of
Narayana Hrudayalaya in Bangalore:
“That single advice of a compassionate
doctor has killed more children than
the bomb that hit Japan in World War
II. The biggest problem we surgeons
face is that children are brought to us
very late.”
Take the case of Ravi Kiran, a
playful 14-year-old from Bangalore.
“When he was three months old, a
doctor said the hole will close with
time,” said his mother Rajeshwari.
Doctors intervened only at six but an
operation to close the hole did not
succeed because the valve had become
weak. Dr Sharma of Narayana
Hrudayalaya corrected Ravi’s valve
recently. “I play cricket and cycle a lot,”
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TIME FOR SOME IGE-GREAM: Ravi Kiran celebrating his recovery with mother
Rajeshwari post surgery at Narayana Hrudayalaya
DON'T WAIT FOR THE HOLE TO CLOSE:
Dr Devi Shetty of Bangalore
says Ravi. “But I used to get breathless.
Sometimes, I couldn’t walk a few feet.”
The trend, however, seems to be
changing in favour of early correction,
if possible in the first year of life itself,
says Iyer. But only a handful of centres
in India perform paediatric cardiac
surgery. There are not more than half
a dozen institutions in India that offer
dedicated paediatric cardiac intensive
care facilities. Worse, there are only an
Very few specialists focus on
paediatric cardiology because
operating on children’s hearts is not
lucrative. In adults, most cases are of
coronary artery bypass; the procedure
is generally the same and the heart is
about five times as big as that of a
child. The chances of survival are
much higher.
In small children, congenital
heart defects are of many types,
equal number of surgeons who
exclusively focus on paediatric
cardiology. “Sickest of all are children
with heart diseases, but majority of the
doctors are cardiologists who are
trained to look after adults,” says Dr
Vikas Kohli, paediatric cardiologist at
Delhi’s Sir Gangaram Hospital.
“Ideally children should be looked
after by an MD in paediatrics who has
also done cardiology.”
To open or not to open?
says Kohli, who advocates
interventional treatment instead of
open heart surgery for congenital
By K. SUNIL THOMAS
heart defects. “The trauma, pain and
inflating it at the affected part) and
the large scar can be avoided, while
valvuloplasty, besides inserting stents.
hospital stay is only for a couple of
anwaljit could not bear the
“About 30 per cent of children with
days.” Since blood loss is minimal,
thought of her 7-month-old
heart defects can be saved this way,”
there is no need for blood
baby’s chest being cut open for
heart surgery that his doctor at
transfusion.
Though some doctors argue
AIIMS in Delhi had advised.
So she and husband Prithpal
that the defects recur even after
Singh gave the go-ahead when
multiple angioplasty, Kohli is
planning to take the message of
Dr Vikas Kohli of Delhi’s Sir
z non-surgical intervention to the
Gangaram Hospital suggested a
< villages of north India, where
non-surgical method to plug the
§ awareness on congenital heart
hole in Gurinder’s tiny heart.
intervention
Non-surgical
defects is the lowest. He is also
includes processes like balloon
planning a tele echo-cardiogra
angioplasty (inserting a balloon TINY BUT STURDY: Gurinder being examined by
phy programme in the small
into the heart through a vein and Dr Vikas Kohli of Delhi's Sir Gangaram Hospital
towns of Uttar Pradesh.
Aug 24, 2003
43
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sial
fe
is ’
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CUT, SLICE AND CROP: The Live 3D echo at Indira Gandhi Hospital, Kochi
A surgical view
By P. SRIDEVI
T t is almost like holding the heart in your hands. You can even cut it and
± slice it, on the screen, that is. The image you see is so palpable. Called Live
3D Echo, the ultrasound technology gives three-dimensional images of the
pumping machine as it goes lub-dub in real time. The latest advancement
in echocardiography, which turns 50 this year, Live 3D will arrive in India
next month when the Indira Gandhi Cooperative Hospital in Kochi, Kerala,
acquires the technology.
Developed by Philips Medical Systems, the Netherlands, the machine
uses the same technology that submarines use to navigate. A handheld
scanner sends high-frequency sound waves, which get reflected back as they
strike different organs and tissues in the area being scanned. This soundwave
is sent to a processor, which calculates the distance from the probe to the
structures in the body, converts the data into 3D images and displays them
on the screen. Though a little expensive at Rs 1.2 crore, the technology helps
cardiologists see the heart in totality. “You can visualise all the structures
of the heart in different angles,” said Dr A.K. Abraham, chief cardiologist
at the hospital. “Because it is direct visualisation it is also authentic. It gives
feedback in real time during catheterisation or when implanting devices.”
Live 3D scores over 2D imaging in pinpointing abnormalities of the
heart and enlightening surgeons on what to expect when they open the heart.
Unlike the flat 2D images, Live 3D provides a ‘surgical view’ of the heart.
For instance, in operations involving the mitral valve (shaped like a mitre,
it opens from the left atrium to the left ventricle), surgeons can assess the
problem and decide whether they should replace the valve or repair it. In
procedures such as balloon mitral valvuloplasty, where a balloon at the tip
of a catheter is inflated to dilate the valve, the 3D image of the heart helps
the doctor guide the therapy with accuracy and avoid complications.
Abraham feels that 3D echo, which at Indira Gandhi hospital would cost Rs
1,500, can substantially cut down on the need for paediatric catheterisation.
Calculating the ability of the heart to pump blood is another task Live
3D can help simplify. Until now, doctors had to make certain geometric
assumptions of the left ventricle while using 2D Echo to measure the
capacity of the chamber.
44 EHiEZESI Aug 24, 2003
requiring different types of surgery,
maybe in multiple sittings. And the
heart is really tiny. While it clearly
requires a lot more expertise, surge
ons who opt to operate the tender
hearts are unlikely to find patients in
as large numbers as, say, doctors
doing surgery on adults. “Paediatric
cardiology is forced to ride piggy back
on adult cardiac surgery,” says Dr
K.M. Cherian, director, Madras
Medical Mission. “It has clearly not
progressed at desirable rates so as to
reach out to the majority of the
2,00,000 children.”
Another reason is the cost of
treatment. “Good work is being <
in several corporate hospitals, but „
many rural families can afford the
kind of money involved?” asks
Cherian, who pioneered paediatric
cardiac surgery in 1975 when he
operated on one-year-old Mariam at
the Railway Hospital in Chennai.
Many parents are put off by the
costs even at government-run
institutes. Some give up, a few beg the
doctors to make arrangements for
funds, some others mobilise resources
and return. "Many parents refuse to
admit that their children have a
problem," says Dr Vasant Khatav,
paediatrician in Mumbai. Most find it
less expensive to have another child,
especially if the ailing child is a girl,
than spend Rs 1.5 lakh on surgery.
Says Dr Manojkumar: “In the lac,t
six months I have done only two (
;
each of arterial septal defect (a detect
in the wall that separates the upper
chambers of the heart) and patent
ductus arteriosus device closers, and
they were government beneficiaries.
The remaining just could not afford it.
Many are sent for surgery which is a lot
cheaper than implants.”
At the Postgraduate Institute, for
instance, ballooning costs Rs 25,000.
Manojkumar does it free for every
second child—the needy and poor—by
resterilising the balloon with ethylene
oxide gas. A device-closer for atrial
septal defect costs Rs 1.5 lakh, while
surgery for the same condition costs
only Rs 40,000. A device-closer for
patent ductus arteriosus costs Rs 1
lakh, while surgery costs Rs 5,000.
Though angiography is done for Rs
5,000, a poor patient need pay only Rs
News You Can Use
How parents can help
T ook out for symptoms of
J—i congenital heart defects:
At birth
♦ Blueness at birth or immediately
after birth
♦ Murmur of the heart
♦ Accelerated breathing
♦ High pressure in the lungs
♦ Low blood pressure
At two to six months
Difficulty in feeding—baby is
.liable to suck properly, sweats or
starts breathing fast while
feeding
♦ Blue nails and toes.
Fainting spells
♦ Inadequate weight gain
♦
Recurrent chest
infection
First three years
♦ Fainting spells (which may
sometimes be fatal)
♦ Abnormal heartbeats
Avoid rigorous activity for the child.
Ensure the child does not get dental
infection; the heart could get infected,
too. Maintain the salt balance in the
child’s body
Drugs to avoid during pregnancy
♦ A strict no to isoretinoin,
estrogens,
oral
thalidomide,
contraceptives,
angiotensinconverting-enzyme inhibitors,
chloramphenicol, chlorpropamide,
erythromycin, tetracycline and
haloperidol.
♦ Anti-cancer drugs and phenytoin
are harmful but the benefits of these
drugs outweigh the side-effects.
♦ Epinephrine, ephedrine, bblockers and promethazine do not
pose any significant risk, though
research is inadequate.
♦ Research studies on the effects of
penicillins, nitrofurantoin, insulin
and cephalosporins have not shown
significant risk to foetus.
♦ Multivitamins can be safely
taken.
Source: Dr B.K. Goyal,
cardiologist and director,
interventional cardiology
and hon. dean ofBombay
Hospital & Medical
Research Centre
1,000; hospital admission is
The absence of a national
policy for congenital heart
free, and resterilised
material are used to bring
defects, as Dr Krishna
down costs.
g Kumar says, perhaps reflects
| g the prevailing attitudes that
Centres like Narayana
Hrudayalaya, though, have
11 the defects are uncommon,
mostly fatal and therefore
programmes.
charity
not worth the effort.
“Fortunately there are
While expenses for
people and organisations HOME'S WHERE THE HEART IS: Mihir Chittar with parents
Manju’s surgery will be borne by the
lik*1 the Sarojini Damodaran Trust
older—there were many others before
Army, Pooja’s father has taken salary
tl
;ive money for operations on
him. The wait extends as many of the
advances, and tapped other resources
kids, ’ says Shetty. Amrita Institute has
specialists are lured by lucrative posts
for the Rs 1 lakh estimate her doctor
had some 60 children with heart
or fellowships abroad. Hemant
has given him. For every child who
defects from Mumbai because “we are
Kumar Sahu of Raipur brought his
recovers with support from family and
inexpensive”, says Dr Krishna Kumar.
son Ayush back from a hospital in
doctors, there are a hundred others
“Amma [Mata Amritanandamayi, the
Puttaparthi, in Andhra Pradesh,
who perish for want of timely help.
head of the mutt that runs the
because of the long waiting list there.
The situation is alarming. Even big
hospital] said she wants the best care
“Money was a problem,” says
centres like the Postgraduate Institute
to be available to the average Indian
Hemant. Ayush’s surgery could be
do not perform open heart surgeries
and not make it out of reach. For a
done at a Delhi hospital only
on neonates and babies under 10 kg
simple condition like arterial septal
because Rs 1 lakh was granted from
because it needs excellent post
defect it could be Rs 60,000 and an
the Chattisgarh chief minister’s
operative care, besides expertise. “We
arterial switch may cost Rs 1 lakh.”
relief fund.
need more centres for children with
Hospitals like Delhi’s All-India
“There are more patients in India
heart diseases,” says Dr Manojkumar.
Institute of Medical Sciences (AIIMS)
with congenital heart diseases than
“The centres in Delhi, Chennai,
charge only for the consumables and
polio, but the government spends
Bangalore, Kochi and Mumbai are not
while this itself is a big sum, the longmore money on polio,” says Dr Kohli.
capable of handling the huge load.
waiting list in such hospitals is a
Adds Iyer, “There is a lot more
problem. When seven-month-old
emphasis on diseases like leukaemia Another problem is money. People
Gurinder was diagnosed with a
should contribute in their own small
and thalassemia, which are not even
'murmur', the AIIMS doctor told his
fully curable, while a vast majority of way because the children of the poor,
father Prithpal Singh to wait till he got
too, deserve to live.”
■
heart defects are with one operation.”
Aug 24, 2003 ECS5S53 45
Travel
Joy in the ruins
CAMBODIA: This once war-ravaged country is getting better every day
By ROSHIN VARGHESE
o most people Cambodia
conjures up images of Angkor
Wat and Hollywood star
Angelina Jolie swinging on vines
inside crumbling temples as Lara
Croft in Tomb Raider. With her
adopted Cambodian son, Maddox, a
semi-permanent fixture in the crook of
her arm, she has reopened the eyes of
the world to another dimension of life
in Cambodia, far removed from lofty
Buddhist ideals, ruins overrun by the
jungle, wats, and Mount Merus
soaring skywards.
Most ofthe world has forgotten the
horrendous rule of Pol Pot and his
Khmer Rouge of the 1970s and the
gory images of mountains of skulls and
skeletons have been pushed into
distant memory. But for the
Cambodians, rebuilding their lives and
war-shattered economy has been an
uphill task.
Phnom Penh with its teeming
masses, spacious boulevards and
colonial French buildings is far
removed from the visible destruction.
Every day things change, mobile
phones get better connectivity,
domestic flights get fuller, roads get
built and adoption rules get tighter.
While we were wandering through
the stunning, Khmer-style, red
sandstone Phnom Penh National
Museum designed by a French
architect in the 1920s my guide bolted
out midway through her animated
lecture on bronzes. Moments later she
was back, explaining the reason for her
panic: the last time she ignored the fire
brigade’s ring she found her flat had
been burned to cinders in an accident.
Composure back, she was once again
tracing the Indian influences and later
Buddhist touches in the exquisite
. ..-f
bronze collection in the museum.
Behind the museum is a French
SPECTACUUlM^m^^
colonial building which houses the
temple
near Siem Reap
Friends restaurant. To a casual <
46 ESS52S3 Aug 24, 2003
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