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Shifting the focus of the Healthcare Sector to AP

Where in the world is VIJAYAWADA, and how it is doing with Healthcare?

The present capital of the new state of Andhra Pradesh, it had a visionary chief minister who has been replaced by the young and dynamic Mr. Jagan Mohan Reddy this year. There has been an emphasis on infrastructure development with transparency here and with the support we have from the government the health care sector of AP has grown very fast with over 10 new cardiac surgery centers coming up in the past 3 years. The widespread availability of social media has helped us reach more people, both local and international.

This same media, which millions use on a daily basis, is creating awareness of health and wellness at unprecedented speeds in hitherto uncharted regions in the region and internationally. Modern medicine has thereby penetrated deep into this state like in several under-developed countries in Asia and Africa. Through increased awareness has come increased the chances of diagnosis and evaluation of heart disease in adults and children. Like in AP, many of these countries have been unable to meet this increased need for detailed evaluation and surgical treatment of new patients so identified. You can read more about this in our next article on the burden of congenital heart disease in the world.
Non-availability of many such treatments has led to the need for people to travel the nearest affordable city for treatment. And this is called medical tourism, or by one of the many synonyms. Coming to one of the many metros in India, people from within India, Bangladesh, Africa and the Middle East find similar socioeconomic, ethno cultural and linguistic regions and are comfortable to visit India for healthcare services and treatment.

Vijayawada, which is centrally located in India, is well connected by road, rail and air within the country and has shot to fame because of its rapid development in many sectors, healthcare being one of them, this is because we have the unique combination of high quality and low costs. Many patients who have taken health insurance, when they cannot find good care in their own country are also looking east to avoid waiting lists and get quality care. Both Indian and foreign insurance companies are also looking at India as an affordable and prospective healthcare destination and are tying up with corporate hospitals which can treat to global standards.

Air travel to and from Vijayawada, is now just a hop away with airlines connecting over 101 destinations. The airport has seen a rapid growth in international traffic that is very efficiently handled by the modern systems in place. Most major currencies are freely traded in the many Nationalized banks and registered currency exchange centers in the Airport and the city.

AP has many top-notch centers for open-heart surgery and especially pediatric heart surgery at Dr. Benedict’s centre at Ramesh Hospitals Vijayawada. The many achievements are very often in the news, from complex heart diseases treatment to latest innovations. All of India’s top clinics are equipped with the latest electronic and medical diagnostic equipment. The cost of all tests and investigations are cheaper here because of the sheer (large ) number of treated patients and efficiency that comes out of necessity. The most frequent travelers to Bangalore come from the region known as MENA: Malta, Djibouti, Egypt, Ethiopia, Iraq, Jordan, Israel, Kuwait, Lebanon, Libya, Yemen, Bahrain, Algeria, Qatar, Morocco, Sudan, Saudi Arabia, Syria, United Arab Emirates, Tunisia, West Bank and Gaza, Iran and Oman.

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New Capital of India in the Healthcare Sector

Bangalore is the not only the Capital of digital media in India, but also health care. Its rapid development in the field of back office management is behind the fancied term “Bangalored” entering the English Dictionary.

This same media, which millions use on a daily basis, is creating awareness of health and wellness at unprecedented speeds in hitherto unchartered regions in the region and internationally. Modern medicine has thereby penetrated deep into several under-developed countries in Asia and Africa. Increased awareness has increased the chances of diagnosis and evaluation of heart disease in adults and children. Many of these countries have been unable to meet this increased need for detailed evaluation and surgical treatment of new patients so identified. You can read more about this in the next article.

Non-availability of many such treatments has lead to the need for people to travel the nearest affordable country for treatment. And this is called medical tourism, or by one of the many synonyms. Coming to one of the many metros in India, people from Africa and the Middle East find similar socioeconomic, ethno cultural and linguistic regions and are comfortable to visit India for healthcare services and treatment.

Bangalore, which is centrally located in India, is well connected by road, rail and air within the country and has shot to fame because of its rapid development in many sectors, healthcare being one of them, This is because we have the unique combination of high quality and low costs. Many patients who have taken health insurance, when they cannot find good care in their own country are also looking east to avoid waiting lists and get quality care. Both Indian and foreign insurance companies are also looking at India as an affordable and prospective healthcare destination and are tying up with corporate hospitals which can treat to global standards.

Air travel to and from Bangalore is now just a hop away with airlines connecting over 101 destinations to Bangalore. The airport has rapidly growing international traffic that is very efficiently handled by the automated systems in place. Most major currencies are freely traded in the many Nationalized banks and registered currency exchange centers in the Airport and the city.

Bangalore has top-notch centers for open-heart surgery and especially pediatric heart surgery. Virtually all of India’s top clinics are equipped with the latest electronic and medical diagnostic equipment. The cost of all tests and investigations are cheaper here because of the sheer ( large ) number of treated patients and efficiency that comes out of necessity. The most frequent travelers to Bangalore come from the region known as MENA: Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Malta, Morocco, Oman, Qatar, Saudi Arabia, Syria, Tunisia, United Arab Emirates, West Bank and Gaza, Yemen, Ethiopia and Sudan.

ADVANTAGE – MEDICAL TOURISM IN INDIA (Bangalore)

What makes Bangalore what it is?

Blend of medical and leisure tourism: –

When somebody comes to India for health revitalization, there are many options to spend leisure time with family who are accompanying the patient. People treasure the freedom to travel without fear in India, the increased value of their money, the infinite choice of shopping experiences with the unique combination of metropolitan buzz and multicultural Indian cuisine at Bangalore. Being centrally located in the country, this Capital of Karnataka displays the multiplicity of the Indian cultural fabric and it is best experienced by easily travelling to and from here.

World class medical services: –

Bangalore is considered as the hub of highly educated specialized doctors in India and the treatment facilities are at par with the world’s best medical services. Indian doctors, nurses and paramedical staff are also among the best trained in the world.

Low cost advantage: –

The treatment costs are far less in India is a well known fact, with no compromise on quality, some of the doctors are even better than the rest of the world considering their huge experience. Many have international experience and they are up to date with the latest developments.

Smaller waiting lists: –

In most of the developed countries the patients usually need to wait for long time till they get the doctor’s appointment, investigations done and even the actual treatment. But in India, the waiting time is minimal due to the vast choice of hospitals and therefore we are able to help you return sooner to health and reduce the duration the family spends time away from home.

Advancement in IT: –

India is also among the world’s fastest growing Information Technology (IT) hubs. All your health related data is safe and HIPPA compliant. You will be provided all necessary documents to follow up with your regular doctors at home. If necessary our doctors will come on video call to help your health provider understand what has been achieved during your visit here. And Bangalore being the IT Capital of India has a cosmopolitan flavour that many find as a great experience.

Shopping: –

All leading brands of most products are available in the many shopping malls and online stores, accessed through the low cost mobile call and Internet DATA with excellent mobile phone reach. Digital transactions can be done using international credit cards and paid for in your own currency.

Low Language Barriers: –

The doctors, nurses and other medical staff, as well as Bangaloreans in general, can not only understand but also converse fluently in English which removes the language barriers for many overseas patients and make them comfortable as soon as they land. Translators are also available for most other foreign languages on request, especially French, Arabic and even Spanish.

Affordable Personalized Care: –

With a little planning, it is relatively easy to hire a concierge or a trained carer, through one of the many home care solution companies, for taking care of an unaccompanied patient, both during and after treatment and thus healthcare in Bangalore suits these situations also.

Easy access: –

The initiatives taken by both the Government and private sector gives easier access to medical visas, with very short time needed for approvals, provided Passports are valid for 6 months from the date of arrival. The presence of several international airlines, domestic transportation systems and concierge services make it easy to travel to, within and out of the country. Most Bookings can be done online for travel and accommodation. Food is never a problem with most major fast-food chains around the corner or delivered to your doorstep. Major Foreign currencies are easily exchangeable with most banks with nil or minimal restrictions.

Some of the areas seeing improvement, to make Bangalore the future of global healthcare are:

An image revolution: –

The government, the healthcare industry and the travel industry have started to work together to change the predominant image in the minds of the average medical tourist and their countries to show India in its deservingly brighter light, contrary to what mainstream media has projected.

Raised quality standards: –

hospitals in India have now benchmarked themselves to National and international quality accreditation standards as part of the quality assurance direction given by the government. Most doctors have been trained in modern medicine to international standards and have many publications in the international journals in their specialties and are up-to-date with the latest developments in the field.

Improved infrastructure:

The growing middle class affordability of India has increased patient inflow, and this has enabled hospitals to steadily build up their infrastructure and facilities that has vastly improved the overall quality of all investigating and treatment facilities. These systems are the ones attracting international patients in big numbers.

Simplification of procedures: –

Technological advancements in India enable electronic transferability of data, medical records, invitation letters, visa approvals, funds, etc efficiently.

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Preparations for the Heart Surgery?

One individual’s experience before surgery can be altogether different from another’s yet we follow similar planning for most regular procedures.
This is because there are many varieties of heart surgery.
Most people start their journey by contacting specialist doctors and get examined (by a cardiologist) who after a precise diagnosis guides them to the cardiac surgeon. The surgeon plans the operation according to his understanding of the disease and in discussion with the cardiologist.
The patient and their relatives are counselled about the plan of treatment so that they have understood both the disease and the plan of treatment. Most people start preparing themselves very well mentally for the procedure. Then they start to plan their Hospital admission, travel and finances.
On arrival at the hospital, they will be guided to the care of the consultant in charge of the treatment by coordinators. After the consultant re-examines the patient, he/she will be admitted the previous evening for the proposed operation.

Doctors and nurses will re-examine you, take blood and urine samples and other investigations as advised by the consultant. Your consent for all procedures is once more taken and documented. The anesthesiologist will also examine your fitness for the procedure. You may need to have body hair removed by some means to help to operate unhindered. You will be given a special scrubbing solution to have a bath with, so as to reduce the chances of infection.

An intravenous (IV) line will be put into a vein in your arm to give you liquids and medicines. Just before the surgery, you’ll be moved to the operating room. You’ll be given medicines so you are relaxed and stress-free when going to the operation theatre.

The operation will be done after you have been made to go into a deep sleep so that you do not feel any pain. After the planned procedure has been completed you will be brought into the ICU where you will recover from the operation. On waking up you will find many tubes and wires attached to you, there will be sounds of computers and other machines beeping, doctors and nurses talking. This is normal. You may not be able to move or speak for some time, because of the medicines. We will wait for your complete recovery before allowing you to move and then removing the ventilator machine. Now you will be able to speak. 3 to 6 hours after removing the ventilator, you will not be given anything to eat or drink. Only when your recovery is complete will you be transferred to the wards.

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What are the Types of Cardiac Surgery?

There is more to heart surgery than only open-heart surgery.

Open-Heart Surgery:

Open-heart surgery is one in which a specialist surgeon opens the chest to reach the heart. In order to To keep the patient alive during the time we are working on the heart, the blood circulation to the body is taken care of by a heart-lung machine. The heart-lung machine oxygenates and pumps the blood back to the body. It is only when we open the heart, that we can see and correct abnormalities in the structure of the heart. In general abnormalities are like holes, blocks, valve malfunction and abnormal interconnections.

Closed Heart surgery:

Closed-heart surgery is surgery in which a specialist surgeon opens the chest to reach the heart or great vessels and then operates on these structures from outside,  without stopping or opening the heart. Examples are PDA ligation, Coarctation repair and BT shunt.

Heart Valve Repair or Replacement:

Some people are born with heart valves that do not open adequately and some that do not close well. Some develop disease that damages the valve leaflets later in life. In the past these valves were being replaced even in the USA. Now techniques to repair most of these valves are available in India also. There are advantages of repair over replacement and vice versa.

CABG:

Coronary artery bypass grafting surgery is done for patients who have blocks in the blood vessels (coronary artery) supplying blood to the heart muscle. To do this, the chest of these patients is opened and the block is identified. Then a suitable artery from inside the chest wall or a vein from the leg is taken to carry blood from the Aorta to the heart muscle, beyond the block. This bypasses the block and brings required blood to the muscle. This prevents heart muscle dying from the lack of oxygen, which is commonly known as a heart attack.

Heart Transplant:

When a person has a severe form of heart disease that cannot be treated either with medicines or surgery, he may need to have the entire heart replaced with a new one. The donor for heart transplant is a person who has had a severe illness or accident and whose brain is damaged irreversibly, also known as brain-death. This healthy heart is harvested (with consent from the close relatives) and surgically transplanted into the recipient in place of (after removing) the diseased heart. This heart functions normally and helps the recipient recover. Yet to protect the transplanted heart we need to keep the patient on medicines for life.

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What are the Risks of Heart Surgery?

Open heart surgery in children and what to expect.

Despite the fact that its outcomes are frequently amazing, heart surgery has its risks. The events that can affect the patient include:

The causes for concern when we take a person for open heart surgery are because untoward events can happen, even when we are very careful. What are these situations we need to be aware of?

  1. Reaction to medicines used in Anesthesia.
  2. Bleeding after the operation.
  3. Infection, of the surgical sites.
  4. Reactions to the any of the medicines used during surgery.
  5. Arrhythmias (abnormal rhythm of the beating heart).
  6. Affections to the brain, kidney or liver function.
  7. Damage to blood vessels and
  8. Damage to the lungs.

With growing expertise in our specialty of pediatric cardiac surgery, we are seeing more safety. The better long term results and lower costs than ever before are also because of expertise and establishment of safe principles.

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Ventricular septal defect ( VSD )

The  VSD is a defect in the septum that separates left and right ventricles. Blood from the left ventricle, which is at high pressure flows across the VSD, Right ventricle and then into the pulmonary artery. This results in blood reaching the lungs at high pressure. Over a period of time, the blood vessels of the lungs undergo changes and this is called pulmonary hypertension. It is to avoid this that we close the VSD.

How does it look when a surgeon opens the chest?

We see the heart situated between the diaphragm and the collar bones, and between the lungs on either side. The right border of the heart is formed by the right Atrium. The right ventricle forms the front of the heart. The left ventricle lies under the left half of the chest and the left atrium lies behind all these chambers.

To do open-heart surgery, we connect the major veins and arteries, and thereby the patient to the heart-lung machine which takes blood out of the venous system and give it back to the aorta. This is CPB, it ensures a supply of oxygenated blood to the whole body and hence keeps the patient alive, therefore, once we know that heart-lung machine is able to maintain the patient’s cardiac output, we stop the heart by giving potassium-rich solution into the blood vessels supplying the heart muscles. This is known as cardioplegia.

Open Heart Surgery

To close this VSD, we enter through the right Atrium surgically and place a patch on this defect and attach it using stitches. When we look through the oval orifice of the Tricuspid valve we are able to locate the defect in the interventricular septum, the VSD. Through which we can see the inside of the left ventricle. This is the ventricular septal defect that has got to be closed. It is closed by placing a patch and stitching along the edges with suture material, working in the motionless heart. This is VSD closure.

The heart is then closed, all the inside air is taken out and blood is returned to the heart. It is allowed to start beating and once the heart and lung function comes back to normal, we wean the patient off the heart-lung machine and remove the tubes inserted earlier. When the child is safe, we close the chest and shift them to the ICU for care under trained doctors and nurses.

During this entire time, the patient is under anaesthesia and is not aware of any of this activity.

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Atrial Septal Defect ( ASD)

There are multiple defects that can happen in of the heart of the child while developing inside its mother’s womb. The most common is the atrial septal defect. It is A Hole In The Wall that separates the two Atria, viz. the right and left upper Chambers of the heart.

Blood from the left atrium thereby flows across the ASD, into the right heart and goes to the lungs. When this condition persists, the increased flow of blood to the lungs causes changes to the blood vessels in the lungs. This can result in permanent damage to the lungs known as Pulmonary hypertension. This is one of the commonest reasons for closing the ASD.

What do we do?

To close the ASD, we enter through the right Atrium surgically (Open Heart Surgery) Under vision we place a patch on this defect and fix it using stitches. And this is called atrial septal defect closure.

So, How does it look when a surgeon opens the chest? Surgery being very clean, there is nothing here that surprises us, because our cardiologists can actually see using modern technology how the inside anatomy of the heart looks. We see the heart between the diaphragm and the collar bones. The right atrium forms the right border of the heart. the right ventricle is the front of the heart. the left ventricle lies under the left  half of the chest and the left atrium lies behind all these chambers.

To do surgery, we connect the major veins and arteries, (and thereby the patient) to the heart lung machine which takes blood out of venous system (now the heart is empty) and give it back to the aorta which supplies the whole body and keeps the patient alive. Once we know that heart lung machine is able to maintain the patient’s cardiac output and keeps the patient alive, we stop the heart by giving potassium rich solution,known as cardioplegia, into the blood vessels supplying the heart muscles. Then we open the right Atrium and see within it the atrial septal defect. Once visualized, we can close the ASD in the motionless heart.

The heart is then closed, all the air inside is taken out and replaced by blood that is returned to the heart. The heart starts to beat once the muscles get normal blood,  and once the heart and lung function comes back to normal, we wean the patient off the heart lung machine and remove the tubes inserted earlier. During this entire time the patient is under anesthesia and is not aware of any of this activity.

Recent advances

Almost every country in the world has the facility to do this kind of open-heart operation. Whether in the USA, Europe, India, or anywhere else, it is associated with minimum risk to life of the patient. Many centers are now able to close ASDs using devices without surgery in all but the smallest children.

In some hospitals we are able to do this operation through small cuts, or the side of the chest using advanced instruments and techniques.

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