Accent on preventive care

Print edition : June 06, 2003

The Dr. V. Seshiah Diabetic Care and Research Institute. -

Diabetes, hypertension, heart ailments, renal disease... a growing list of medical problems have their roots in the way people live their lives. On what is on offer in Chennai to help cope with the situation.

THE state of a person's health is often directly related to that person's lifestyle. With more and more people aping the Western food culture, which involves stuff high in saturated salt, fat and calories but low on fibre, vitamins and proteins, obesity is on the rise. This, in turn, is leading to a higher incidence of hypertension and diabetes than before.

While a third of the population of India is obese, over half the people suffer from hypertension, often leading to ailments of the heart, the kidney and the eye. Diabetes and hypertension are the primary causes of kidney disease and blindness. The World Health Organisation (WHO) has predicted that going by the current trend India will become the "diabetes capital of the world" by 2025. It has also declared the country to be one with a fast-growing rate of heart disease. If in the 1950s 1 to 3 per cent of the population had hypertension, recent studies show that the figure has risen to 25-40 per cent, particularly in the urban areas. It is the most serious risk factor behind cardiovascular diseases.

While in 1980 coronary artery bypass grafting accounted for less than 10 per cent of all cardiac surgical procedures in India, today the figure is over 60 per cent. Every year, some 25,000 coronary bypass surgeries and 12,000 percutaneous transluminal coronary angioplasty procedures are carried out. In 1999-2000, valve replacements were done in 6,607 cases and surgical procedures to correct congenital heart defects were carried out in 6,750 cases. As many as 42,000 open heart surgeries were performed in 1999-2000.

For all these ailments Chennai offers some of the best diagnostic treatment facilities. Patients come here even from Western countries. It offers facilities of international standards at an affordable cost. The 87-year-old American, Brennan Benard Emerson, who was recently operated upon (to replace the mitral valve with a bio-prosthetic valve) at a city hospital, says: "As against $40,000 in the U.S., the cost of surgery, along with four weeks' stay in the hospital, including medical expenses, was less than $8,000 in Chennai." Apart from open heart surgery, angioplasty and valve replacement procedures, hospitals in Chennai perform atherectomy and coil embolisation to treat AV malformation to interrupt anomalous vascular channels and collateral vessels in the case of acquired and congenital heart diseases. Balloon valvuloplasty and angioplasty are procedures routinely done in cases involving rheumatic mitral stenosis, pulmonary stenosis, congenital and degenerative aortic stenosis, peripheral pulmonary stenosis and coartation of the aorta.

Arterial switch operations, pulmonary atresia and single stage correction of intracardiac anomalies along with repair of arch obstructions, beating heart surgery, complex multi-valvular surgery, repair of cardiac aneurysms, redo surgeries and the Ross Procedure are all routinely performed here. Certain hospitals specialise in non-invasive cardiology.

Among the doyens of cardiology in the country is Dr. T.J. Cherian, who now offers consultations at Devaki Hospital. Among the surgeons who specialise in the treatment of cardio-thoracic diseases in Chennai are Dr. K.M. Cherian at the Madras Medical Mission, Dr. V.V. Bashi at the MIOT Hospitals, Dr. K.R. Balakrishnan at the Sri Ramachandra Medical College and Research Institute, Dr. Solomon Victor at the Heart Institute in the Vijaya Health Centre complex, Dr. M.R. Girinath at the Apollo Hospitals and Dr. K.N. Reddy at the Heart Foundation at the Vijaya Hospital.

The Madras Medical Mission (MMM) that set up the Institute of Cardio Vascular Diseases in June 1987 and does over 2,000 diagnostic and 3,000 interventional procedures every year, performed the country's first successful heart transplant in the private sector in 1995. It was the first in Asia to do TMR (transmyocardial revascularisation) laser surgery; it has performed over 200 such procedures. MMM specialises in the arterial switch operation; this procedure was done on a four-year-old, the youngest to undergo it in India.

The Vijaya Heart Foundation, that charges nominally for surgery, is well-equipped and offers comprehensive rehabilitation and preventive cardiology services.

ANOTHER disease is on the rise, owing mainly to the changing lifestyle and eating habits - diabetes. A diabetic is two to four times more prone to heart disease and 30 times more prone to kidney disease than others. Seventy per cent of diabetics suffer mild to severe nerve damage and vision impairment. According to the International Diabetes Federation, India has over 33 million diabetics, the largest number for any one country. The figure is expected to double in the next 10 years.

Chennai has a number of diabetes management centres. The M.V. Hospital for Diabetes and Diabetes Research Centre (MVHR), the M.V. Diabetes Speciality Centre (MVSC) and the Dr. V. Seshiah Diabetic Care and Research Institute are major facilities. The MVHR is one of the oldest such hospitals in the country. Started in 1954 by Dr. M. Viswanathan as a general hospital, it became a specialised centre in 1972. Over one lakh diabetics have been treated here. One of its features is that it focusses on diagnosing early those foot, eye and kidney diseases that are rooted in diabetes. It has a well-structured diabetes education programme. It was the first in Asia to start an exclusive department for the primary prevention of diabetes. After Dr. Viswanathan's passing in 1996, Dr. Vijay Viswanathan and Dr. A. Ramachandran are the directors of the Centre.

Dr. V. Mohan, who was initially with the MVHR, started the M.V. Diabetes Speciality Centre in 1991. More than 45,000 patients from within and outside the country are treated at the MVSC every year. The hospital has a full-fledged eye unit to treat diabetic retinopathy, a heart clinic, a foot unit and an impotency clinic.

The Sri Ramachandra Medical College and Research Institute.-

According to Dr. S. Balaji of Apollo Hospitals and Dr. Madhuri S. Balaji of the Dr. V. Seshiah Diabetes Care and Research Institute, the alarming rate of increase in the incidence of diabetes can be halted only by primary prevention methods; lifestyle changes will not prevent the disease, they will only postpone its onset. Maternal hyperglycemia, they say, has a direct effect on the insulin secretion function in the foetus. Thus, it is important to control gestation diabetes (diabetes during pregnancy), the risk of which for Indian women is 11.3 times higher compared to women in the West. Thus, they conclude that taking care of pregnant women with abnormal glucose tolerance is the only way to prevent India from becoming "the diabetes capital of the world".

A serious fallout of diabetes is end stage renal disease (ESRD) or kidney failure. Every year, over a lakh of people in India are diagnosed to have ESRD, necessitating a kidney transplant or continual dialysis. With hardly 650 dialysis units - equipment that performs the work of the kidney - in the country, ESRD patients often turn to Chennai for kidney transplants. The city has a thriving trade in kidneys. Of course the city has an excellent set of doctors who specialise in the management of renal problems and perform kidney transplants. The nephrologists in Chennai include Dr. M.K. Mani (Apollo) Dr. Sunil Shroff (SRMCRI), Dr. Amalorpavanathan (Government General Hospital), Dr. R. Ravichandran (Vijaya Hospital), Dr. K.C. Reddy (Devaki Hospital) and Dr. Georgi Abraham (SRMCRI).

But with hardly 2,500 kidney transplant procedures being performed each year, managing the condition of renal failure patients, supporting them and ensuring preventive care, have become important tasks. In Chennai, there are institutions such as the Mohan Foundation and the Tamil Nadu Kidney Research Foundation that work on this. The former has created a support group for patients, physicians and the public and promotes a multi-organ cadaver programme set up by Dr. Sunil Shroff. The latter foundation set up by Dr. Georgi Abraham, provides financial assistance to the poor for dialysis, transplants, investigations and life-supporting medicines. Dr. M.K. Mani focusses on preventive care. His group at Apollo has adopted the Chennai suburb of Sunkuvarchathiram, and has been screening the over 25,000 people there for diabetes and hypertension since 1996. With both these diseases under control at Sunkuvarchathiram, nobody has had a kidney problem there in the last seven years. Such preventive measures, says Dr. Mani, is what India needs as it cannot afford to provide dialysis or transplant facilities to all those who will otherwise need them.

Diabetes affects the eyes also. Over 60 per cent of diabetics end up with retinopathy and lose their sight.

Among the well known eye care centres are Sankara Nethralaya (under Dr. S.S. Badrinath, offers consultations and treatment to over 1,000 patients a day; 30 per cent of them free of cost); Agarwal's Eye Clinic (headed by Dr. R.S. Agarwal, it has a vision analyser for mentally challenged persons and for children who cannot express themselves); Rajan's Eye Clinic (under Dr. N. Rajan, specialises in squint and glaucoma); and the Eye Research Foundation in Vijaya Hospital (Dr. Babu Rajendran here pioneered the use of lasers to treat eye diseases).

Some of the modern procedures and facilities available at these centres are sutureless cataract surgery, automatic visual field analyser, excimer and lasik laser, fundus flourescein angiography, laser photocoagulation, paediatric ophthalmology and eye bank.

While Chennai has excellent facilities and professionals to treat diseases caused by lifestyle changes, the importance of preventive healthcare cannot be over-stated. For this, there is a need to map the population, conduct epidemiological studies and concentrate on preventive measures.

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