Advanced Pediatric and Adult Complex Cardiology and Cardiac Surgery at the SSSHIMS Free Hospital, Bangalore, India. December 14th-23rd, 2014
CardioStart conducted its first mission to The Sri Sathya Sai Institute of Higher Medical Sciences, (SSSIHMS) at Prasanthigram, Bangalore, India.
India is a mosaic of contrasting wealth, with more billionaires than most advanced nations but with statistically confirmed evidence of massive social and health deprivation in which large sections of the population have a grossly inadequate level of healthcare. Throughout the population costs of consultation, treatment, surgical procedures and medication procurement are increasingly unaffordable. The doctor population in India is 1:1,500 when compared to an estimated 1:1,000 in China and 1:350 in the United States (USA). In urban cities, the ratio is estimated at around 1:500 while rural India it is at around 1:2,500.
The SSSIHMS foundation was inspired by the late Bhagawan Sri Sathya Sai Baba, an Indian spiritual leader. The Foundation created free hospitals, free schools and colleges, multiple medical camps and mobile clinics in more remote areas throughout India and elsewhere, safe drinking water for millions and spiritual ashrams as well as sustainable environmentally sound solutions for diverse villages. The hospital complexes function under the Sri Sathya Sai public charitable Central Trust (since 1972). An ever growing core of Sai volunteers take part in all medical support, including help to the needy in natural calamities such as floods and earthquakes, to support his legacy since his death in 2011.
During its evolution, the main hospital location and building projects were financed and supported by the owner of the Hard Rock Cafe chain, USA, and a number of other donors, including those from corporate medical industry within India.
SSSIHMS offers free advanced tertiary care in four specialties: Anaesthesiology, Cardiology, Cardiac Surgery, Neurology and Neurosurgery. The hospital attracts patients seeking treatment from all over India, Bangladesh, Nepal, Sri Lanka and Pakistan. The main hospital has seen over 2.8 million outpatients and performed well over 206,724 surgeries and procedures.
OUR MISSION: ADULT & PEDIATRIC CARDIAC SURGERY
CardioStart’s role in this location conducted the following activities in support of the local program:
- Dr. Krishna Rao (Rochester, NY, USA) provided the vital link between the local team and CardioStart, and in his role as co-Mission Director, represented both parties very well. CS volunteers were active in the following areas:
- Enhancing the quantity and quality of the (already well established) cardiac surgery program at the SSSRIHMS.
- Working with the local cardiology team, helping to identify the enormous burden of cases awaiting intervention.
- Identifying where the need for additional nursing staff is best applied and the potential need for introducing mid level medical/nursing support i.e. Physician Assistants and Nurse Practitioners.
- Intensive Care nursing education and development of existing protocols and algorithms of care and benchmark improvements where needed, were introduced.
- Surgeries: Many complex surgical procedures (both pediatric and adult operative techniques were shared by the two visiting surgeons) in collaboration with local team were accomplished. The nursing staff were given daily support lectures on number of topics ranging from post op care, IABP, hemodynamics to pacemaker management. Some fine surgical instrumentation was donated.
- Review of perfusion techniques. CardioStart’s student perfusionist supported by AMSECT’s international training program made some helpful suggestions on the perfusion techniques that are used in the USA and gave protocols and procedural guidelines to the local team.
Future potential opportunities
CardioStart volunteers were disadvantaged by the short (one week) duration of the mission, having less than ideal time to develop a strong working relationship; in future, a two week mission period would be preferable. This first mission was helpful in identifying the current status and how future volunteer program assistance can be best designed. As an established unit with several features of excellence, SSSRIHMS should now acquire innovative and new procedural skills such as ECMO and higher risk operations not currently available to local team. It does need refinement of its unique and impressive compassionate care model in order to keep mortality levels at a minimum. Future visiting CS teams could be reduced to one volunteer drawn from each relevant medical category collaborating with the local team to help increase the volume of patient management during the visit.
The list of patients successfully undergoing surgery with the local team leading the surgeries are:
|INDR001||38||Mitral Valve Replacement||Satisfactory|
|INDR002||2||Closure of PDA & VSD||Satisfactory|
|INDR003||46||Mitral Valve Replacement||Satisfactory|
|INDR004||12||Sub-aortic membrane resection||Satisfactory|
|INDR005||53||Aortic & Mitral valve replacement& repair of Tricuspid valve||Satisfactory|
|INDR007||42||Mitral Valve replacement||Satisfactory|
|INDR008||50||CABG x 3||Satisfactory|
|INDR009||35||Aortic Valve replacement CABG x 1||Satisfactory|
|INDR010||4||Supra-cardiac TAPVC correction||Satisfactory|
|INDR011||9||Fontan full correction||Satisfactory|
|INDR012||39||Sinus Venosus ASD repair||Satisfactory|
|INDR013||13||TOF correction with PV replacement||Satisfactory|
|INDR015||39||Mitral Valve repair||Satisfactory|
Surgeons: Aubyn Marath (UK/USA) & Paul Perch (USA)
Cardiologist: Krishna Rao (India/USA)
Perfusion: Nick Starkey (USA)
Nursing: Tiana Dowty (USA/Australia), Emilee Froiland (USA), Debbie Siameh (Ghana/USA), Steven Singley (USA), Melanie Sudofsky
Education Coordination: Matt Plourde (USA) Database: Heidi Hill (USA) & Jill Plourde (USA)
Mission Coordination: Ajay Krishnamoorthi (India)
A number of individuals and corporations made generous in kind and financial donations. CardioStart gratefully acknowledges the specified support of the following:
- Accuware Consultants, (Mr. Bahram Hashemi,), Columbus Ohio, perfusion and ICU related equipment.
- Amy Lauth Foundation, Roanoke, Virginia: Funds supporting logistic activity (internal transport within USA).
- Edward Lifesciences Inc., Irvine, California, USA, R bio-prosthetic valves.
- Scanlan Inc., St. Paul, MN, USA R donation of fine procedure surgical instrumentation.
- Synovis-Baxter, Minneapolis, MN, USA.
- Administrative and Medical staff of SSSRIHMS, Putthuparthi: Dr. C. Voletti,, Dr .Desai and Sai Shankar.