Dr. A.P.J. Abdul Kalam: Former President of India
  Dr. A.P.J. Abdul Kalam    
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18-12-2005 : Parumala
Quality Health Care in Rural Areas

I am delighted to visit and interact with the Doctors, Reserchers, Paramedical Staff and other members of the International Centre for Cardio Thoracic and Vascular Diseases at Parumala. My greetings to all the participants of this Unit for your health and happiness.

Cardiac care is a vital health care area for Indian community. I am happy to find that a high technology Cardio Thoracic and Vascular Diseases Centre has been created in a remote Panchayat in Kerala which is a dream for every rural Indian. This will be one of the models which can serve many NGOs who are going to contribute to healthcare in rural areas. It is also heartening to note that the Centre is sending medical teams to remote villages located in this region for screening the patients in the village itself. This is definitely a noble societal mission.

Kerala with its tourism potential is an important destination for medical tourism. This Centre here should cater to the needs of medical tourists and also provide quality healthcare to the people living in the rural area at an affordable cost. In this gathering I would like to discuss on the ?quality healthcare in rural areas?. Since this hospital is located in a rural area, I would like to suggest commissioning an insurance model followed successfully in certain hospitals in Karnataka.


Health Insurance

For providing comprehensive quality health care, we suggest citizen?s make a contribution of about Rs. 5/- per month and a matching Government contribution of about Rs. 5/-, which will lead to a Consolidated Health Fund of Rs.One crore per month for a population of ten lakh in certain rural clusters. The International Centre for Cardio Thoracic and Vascular Diseases may consider promoting such a scheme in the villages located around this area which will enable provision of quality healthcare at an affordable cost for each of the villagers who become partners in this scheme. The scheme can subsequently be made applicable to all the districts of Kerala by the Government. This in my opinion is an extremely cost effective method of providing quality healthcare to our rural population. This unique Health Insurance Model will include an Information Communications Technology assisted Medical Advisory System and Health Awareness Education over and above quality medical and surgical treatment and services to all the people.


Management of Cardiac Diseases

Multi-dimensional solutions are available for management of the diseases based on my discussion with experts. The solutions include medicinal treatment using Statins, which lowers the cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver responsible for making excess cholesterol.

However one has to be careful about the side effects and take adequate precautions while treating the patients. The second is through angiography and angioplasty using stents. Advancements in stents have resulted in the introduction of drug quoted stents which hold a tremendous promise in the near perfect of coronary artery disease. I understand that very soon we may have bio-degradable stents. The next generation stents may be nano-stents. If the heart blockage is severe, valve defect and death of cells in the heart due to less blood supply etc. surgical intervention will be necessary.


Progress in Treatment of Coronary Artery Disease

We have all witnessed the treatment of cardiovascular disease moving from very invasive to less invasive methods. In the seventies bypass surgery was the big news, in the eighties it was balloon angioplasty and in the nineties it was the stent.

Now, moving a step further is a totally non-invasive treatment - EXTERNAL COUNTER PULSATION (ECP), a truly non-operative, non-pharmaceutical, safe and effective treatment which has made big news in the west. ECP is FDA (USA) approved and finds reference in medical and cardiology textbooks. Many favorable articles have been published in a number of reputed journals. The success of ECP can be judged from the fact that in USA the insurance sector reported that the reimbursement for ECP has gone up by 6 % whereas that of other procedure like angioplasty, bypass surgery, etc. has come down by 7%. Now the treatment is available in most of the leading hospitals of the world. In India, ECP is available at Sibia Medical Centre, Ludhiana besides Escort Heart Institute and Research Centre, New Delhi, Peoples General Hospital, Bhopal, Jamnagar etc.

It is well known that following bypass surgery - only 75% patients are symptom free for 5 years or more and only 50% after 10 years or more. The number of patients having recurrence after bypass, ballooning and stenting is increasing and for them ECP is the only FDA approved treatment available which is documented to increase the blood supply to the heart by 20-42%, to the brain by 22-26% and to the kidneys by 19%. ECP also increases heart's output. More patients now prefer non-invasive treatments. With improved cerebral circulation, patients may notice improved memory, etc. I am happy that EXTERNAL COUNTER PULSATION facility has been established in the Kottayam Unit of this Centre and you have already treated four patients with success.


Medical Tourism

Ministry of Tourism has taken various steps to promote medical tourism in India with a view to making India a prime medical tourism destination by 2010. These efforts include accreditation of hospitals for international standards, offering Medical Visa from six months to one year stay, improvement of medical personnel expertise and even developing brochures and CD ROMs for marketing efforts to advertise these services to overseas markets. Currently India is receiving medical patients from 55 countries to have various surgeries such as Cardiac operations, multi-organ transplants for Liver, Heart and Bone Marrow. I am sure the International Centre for Cardio Thoracic and Vascular Diseases at Parumala will be an important medicare centre in this mission


Research Area

One of the observation by medical scientists is that the occurrence of coronary artery diseases in India is taking place between the age group of 35 and 55, whereas in the western world, it generally occurs after 55 or 60. It is also found that the occurrence of Cardiovascular cases is 4% in rural area as against the 10% found in big cities in India. Whereas the world statistics says that the incidence is only 3 to 4%. A research is essential for establishing the reasons for occurrence of heart ailments among Indians at a young age and also the reduced occurrence of the disease in rural areas. The International Centre for Cardio-Thoracic and Vascular Diseases should participate in this research programme. Now I would like to talk about life style intervention needed for preventing cardiac diseases.


Life style intervention

There is a need to propagate the importance of appropriate food habit and life style among the urban population to combat the situation of increased occurrence of heart ailment. Hospitals in the country should take proactive steps to counsel their clients in a family atmosphere for ensuring reduction in this number in the years to come.

It has been reported that the repeated occurrence of heart ailments is caused by diet, smoking, and lack of exercise and uncontrolled diabetes. All these factors can be controlled by an appropriate life style intervention. I have seen the change of life style pattern practically taking place in Global Hospital and Research Center, Mount Abu. There was a joint project of Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO and the Global Hospital and Research Center for studying the effect of "holistic lifestyle intervention" on the patients suffering from Coronary Artery Diseases during the year 1997-98. The project involved both Control Group and the Experimental Group. The Control Group was subjected to conventional treatment whereas the Experimental Group was supported by an intervention involving low fat, high fiber vegetarian diet, aerobic exercises and meditation. This three-dimensional psycho-physiological mind-body approach in treating heart patients of the Experimental Group resulted in dissolution of angiographic plaque and improvement in microcirculation of blood in heart muscles of the patients. The treatment was also supported by participation of spouses and other family members of the patients, leading to a unique family system approach to Medicare.


Stem cell research

During my visit to various laboratories in India, I happened to see the beginning of stem cell research for different purposes including brain research. I would like to share with you an important stem cell research application in the field of cardiology. When I met Dr.P. Venugopal, Director, All India Institute of Medical Sciences (AIIMS) a famous cardiovascular and thoracic surgeon, he told me about his experiences. He said in one of the cardiac diseases, where conventional medical and surgical treatment were ineffective because of the affliction of the heart muscle, use of autologous bone marrow stem cells implantation into the diseased heart muscles had been applied in order to improve the function of heart muscle. This kind of application of this procedure is the latest and very few cases have been done in the world, the first time in India. This is expected to open new frontiers in the treatment of patients for regeneration of heart muscles, thereby giving new hope for the patients suffering from end stage heart disease. I would request participation of many medical institutions in such a promising area of research.



Cardiac Researchers have to recognize another potential area of research of nano-science which has already entered into diagnosis and treatment of diseases, particularly relating to brain cancer and heart. It is predicted that nano-robots will carry diagnostic probe and treatment solutions. Finally the robots will get digested in the human system after curing the disease. Sometimes I feel that the world may declare the early phase of twenty-first century, as a century of nano-science research and technology leading to revolution in human life enrichment. I would recommend the Centre to take up research on the application of drug delivery system using nano-technology.

My best wishes to you all.




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