Social, psycholgical state crucial for recovery for cardiac patients | Dr Dhananjay Malankar

In today’s age many young adults and children are at a higher risk of cardiac ailments and it has become crucial to keep up with the latest methods in cardiac surgeries to prevent patients’ from further risks. Dr Dhananjay Malankar, Pediatric Cardiac Surgeon, Fortis Hospital Mulund discusses the factors for increase in CVDs, why holistic treatment can’t be ignored and the possible initiatives the government can undertake towards healthier hearts in India. By Tanuvi Joe 

Why are factors like pollution and work stress responsible for increase in CVDs and heart ailments?
CVDs have multi-factorial etiology, meaning that it is very difficult to pin-point one single cause for CVD. In the end of the 20^th century we used to see CVDs in older age groups like 60s and 70s, but now even young people in their 40s and 30s are suffering from CVDs. Stress certainly plays a role in the causality of CVDs, and there are many studies which prove that people with Type-A personality (those who take more stress) have more Cardio-Vascular events than those with Type-B personality (those who are relaxed), underlining the importance of relaxation techniques like meditation and Yoga, which can help in decreasing the incidence of CVDs.

Primarily, pollution affects the body by decreasing the functioning of the lungs, and as the heart and lungs work in synchronisation, more stress is exerted on the heart leading to early CVD. Other causes of CVDs include, high blood pressure, high cholesterol, Diabetes, sedentary lifestyle, lack of regular exercise and genetic predisposition.

You have worked very closely with young children. How can one detect heart ailments in them at an early stage?
There are many signs and symptoms leading to Congenital Heart Disease (CHD). Some of these are; failure to gain weight, feeding difficulty, fast breathing, bluish discoloration of lips and fingers, profuse sweating on the forehead while feeding, repeated respiratory tract infections, etc. Easy fatigability i.e. when kids get tired easily after playing, is also one of the symptons of Congenital Heart Defect.

In recent years, what are the various trends you have observed while performing cardiac surgeries?
With respect to technology and equipment concerning to open heart surgery, I have observed that we have all the latest technology and the instruments; and also as compared to the West we can conduct the most complex cardiac surgeries, with equally good and positive results. When it comes to managing these patients in the ICU, we have state of the art machines and other supportive devices available, including excellent manpower.

As a result, the age group of the paediatric cardiac patients is going down and we are now content in operating on more neonatal patients; even those who need surgery on day four or five of life, resulting in effective outcomes. The only deficit which we face is in the part of funding. In the West everything gets covered through insurance, the patient doesn’t have to pay anything from his pocket, but unfortunately that is not the case here. Most of the parents whose kids we operate upon, are financially weak and unable to fund the treatment of their ailing children

Can you tell me more about the project where you and fellow doctors performed cardiac corrective cardiac procedures and surgeries (NABADAT)?
NABADAT is an initiative of the Dubai Health Authority, they sponsor paediatric cardiac surgeries in many parts of the world. This time they decided to sponsor about 130 children suffering from Congenital Heart Disease (CHD), and as a result we held camps in many parts of Maharashtra and were able to diagnose patients with CHD in a short span of time and provide them with surgical and interventional help. Over 130 children from underprivileged and disempowered families across Maharashtra benefitted from this initiative.

Can India take a cue from cardiac healthcare models in other developing countries?
There are many developing countries in the world where all the medical care is sponsored by the Ministry of Health. Most of the paediatric patients coming to us are financially weak and cannot afford open heart surgery. The government, which has made headway already, should find more ways to fund these particular surgeries at least partly, if not fully.

What are the necessary factors that come under holistic treatment for the patient’s full recovery?
Holistic treatment is very important in a paediatric cardiac surgery. Many of these conditions in children require Palliative Operations, wherein they need surgeries in the future as well. For this reason, it is important to know their social and as well as psychological state. Once all these factors are taken care of, only then we can ensure that proper care and treatment will be delivered to the kids at home and regular follow-up will be ensured.

What initiatives can the government take up with respect to making cardiac treatment more advanced and accessible for the masses?
The government needs to spread awareness amongst the public on a large scale. We see many such cases of children who come to us with a simple defect which could have been corrected in infancy with negligible risk, now presenting with a bigger problem which is either inoperable or needs surgery but has become very high risk procedure now. The General Practitioners and Paediatricians also need to refer these cases of Congenital Heart Defects (CHD) in the higher care centres as facilities for these types of surgeries are not available everywhere.