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A NEW ERA IN THE TREATMENT OF CORONARY ARTERY DISEASE IN BANGLADESH |
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Since
the beginning of nineteen ninety, patients from Bangladesh had been
going to their neighboring countries, especially India for treatment of
their Heart. Kidney, Liver and Brain problems. India, which was in the
same boat 15 yrs. ago, has now geared themselves up and in this 21st
century no specialty in India in modern medicine is inferior to that of
the rest of the world. To alleviate this situation, the present Prime
Minister of Bangladesh, Sheikh Hasina had promulgated that these four
super specialties could be improved in this country, by bringing in
specialists from abroad for training the Doctors in Bangladesh, and
thereby transferring technology to this country. This
was the backdrop on which Mr. Z H Sikder, the Chairman and the Founder
of Z H Sikder Women’s Medical College & Hospital Pvt. LTD, took
the initiative and brought Doctors and equipment from abroad to set up
the present Z H Sikder Cardiac Care & Research Center. Early days,
when Doctors, came and stayed for a few days as Local Consultants, not
much could be achieved as there was no continuity in the patient care,
which frustrated them and again people continued to go to India for
their treatment. Hence to restore this faith and confidence of these
people towards the Doctors Mr. Z H Sikder invited mc to develop this
Department of Cardiac Surgery and Cardiology in this Hospital. We had
been here for the past fifteen months and have been trying hard to help
these Cardiac patients by offering them a 24hr service. Though
we started functioning since the beginning of last year, we performed
the first Open-heart surgery- Coronary artery bypass surgery - on the
21st of February 1999. This probably had been one of the first CABG’s
done in the private sector in this country. There was no looking back
from then on. We have now gone on to perform six to eight open heart
surgeries, and fifteen to twenty angiograms a week, and routine
angioplasties and Pacemaker implantations. Coronary
artery surgery has always been successful in the private sector,
anywhere in the world. And it has always been the corporate sector that
had been in the forefront of the same. But here in this country, we have
a lone Philanthropist and a Visionary Mr. Z H Sikder, who had sown the
seed for this high tech Cardiac centre, by bringing in foreign
specialists to come and set up this, State -of-art Super Specialty
centre in his already existing 500 bedded Multi specialty hospital. Dr.
Ajit Kumar, MD, DM, Chief Cardiologist, who was from CTIMS, Trivandrurn,
India and Dr. Prasandan, MBBS, MD, Chief Anesthesiologist, had helped to
setup this centre from scratch. Now Dr. Ravikurnar, MD, DM, Dr.
Shams Munwar, MRCP, D. Card, and Dr. Matiur Rahman, Ph.D., D. Card, with
their able colleagues. Dr. Nazmul, Dr. Sharnimul Haque and Dr. Kazi Abu
Noman, maintain the standards of the cardiology department. As
postoperative nursing care has been the most important entity in the
success of any cardiac centre, we had brought in more than fifty
dedicated Cardiac nurses, mostly from India to support us to achieve
these results. As of now, we have performed more than 160 open-heart
procedures with 95% of them being Coronary artery bypass surgery
with excellent results. With less than 1% mortality in the CABG’s
performed here, we are in par with any reputed cardiac centre in the
world. We
now perform mostly Total arterial coronary revascularisation with
warm heart surgery and we have performed Beating heart surgery in
a number of patients. We were the first private centre in this country,
to perform beating heart surgery , using the Octopus 11, stabilization
device. We now routinely use Radial arteries and bilateral
mammary arteries for most of our young patients. In
our first phase, of our Centre we had focused on Adult Cardiac surgery,
and have established the very same with excellent results. At present we
have a 6- bedded Cardiac surgical 1CU, a 6 bedded Coronary care unit,
and a 30 bedded cardiac ward , which has now reached its full occupancy
rate. Hence we are now starting our new 12-bedded Coronary care unit,
and another thirty-bedded cardiac ward to accommodate the increasing
number of patient load. To supplement this we are now commissioning our
second theatre and another Cath lab, to start our second phase of
expansion. In
this second phase we are going to start Pediatric Cardiac surgery, and
other Thoracic and vascular surgeries. We had already started training
the local Doctors in Cardiac surgery. Dr. Ramakanth Jadhav, MS, MCh,
Associate Prof. in Cardiac Surgery, from Nair Hospital, Bombay, and Dr.
Kuldeep, MS, MCh, Cardiac surgeon, trained at Madras Medical Mission,
who had been with me all though, had stood up as a glaring examples to
the local Doctors. Dr. Abul Kalam, Dr. Amran and Dr. Qureshi. who have
also been with us, have already reached different stages of expertise in
Cardiac surgery, and their skills and acumen in this field is
commendable, leave alone their dedication and perseverance. Our medical
officers, Dr. Shoukath, Dr. Fredouse, Dr. Harun, Dr. Bidyut, Dr. Hassan
Sheriff and Dr. Rabiyul had been working hard through out these days
with us and by now, have successfully managed several acute cardiac
emergencies and had helped maintain the standards. This proves that the
local Doctors are no way inferior to the rest of the world. Just a
little bit of caring, training and encouragement, would make them great
surgeons in the future. Though we were skeptical in the beginning, they
have proved us wrong with their hard work and eagerness to learn and
develop this specialty, which does not come easy. Though in the
beginning the long hours and no rest put them off a bit, but when they
found that the results we produce was gratifying to the soul , they
themselves came forward, and now this 24 hours which we spend in the
centre has been a routine to them too. In
Cardiac Anesthesiology, Dr. Prasandan, has been the guiding light to a
couple of the local Anesthesiologists, Dr. Shahidul Islam and Dr. (Maj)
Mujibur Rahman. With his constant guidance and training, he has nearly
transferred the technology to these already smart Anesthesiologists.
Fate had not been very good to us; we lost Dr. Shahid on Easter day, due
to Cardiac arrest at his residence. He was only forty-two. His loss has
devastated his family and us. Though this has set us back a bit, Dr.
Mujib has been working hard to compensate this loss. Now he has reached
a stage, where he can independently conduct open-heart surgery for us.
His achievement has been commendable. With
ever increasing number of young patients, in this centre and with the
increasing number of younger patients ending up in our CCU we have now
started our Executive Cardiac Check up for all, over 35 years of age.
This is actually to stratify the risk of having Coronary artery
disease and to modify the risk factors in these young individuals who
are going to be the breadwinners in this society. This part of
preventive cardiology is important for any country and especially for a
country like Bangladesh where the oily food, increased red meat
consumption, smoking and Diabetes has increased their risk of having
Coronary artery disease, even at a younger age. The
future of any specialty depends on the commitment to research and
development, which has been lacking in this country, especially in this
specialty of Cardiac surgery and Cardiology. We have already started in
a small way, and have already earmarked our animal lab and would be
going full swing in research by the end of this year. The animal lab
would also help in training with hand on experience for the trainee
surgeons in this centre. In
a couple of months we would be setting up our Dialysis unit and our
Urology and transplant services, along with Neurology and Neurosurgery
departments to fully support the Centre. The support, which we received
from the following Departments like Transfusion Medicine, Microbiology,
Pathology and Biochemistry, Radiology, Physiotherapy, Nutrition and
Biomedical engineering, had been commendable and without their continued
support this work would not have been possible. We
have also commissioned the new Cardiology Ambulance, both land and Air
(by Helicopter) which would definitely benefit the acute patients from
any part of this country to get immediate attention in their place
itself and be flown to our centre for subsequent management. This
ambulance would take a Cardiologist, anesthesiologist and a paramedic
with the Monitor, ECG machine, Defibrillator, Portable ventilator and
medicines to start the treatment at zero hours if necessary. This would
be the first of its kind in this country. This would also help our
Accident and Trauma centre that would also be starting in a couple of
months. We have a newly constructed helipad for this purpose. This
year all Bangladeshis should look forward to a sea change in patient
management in this country. We hope the Government would continue to
extend all support to this new venture the way Mr. Sikder has been
extending to us to make his dream a reality. We wish this dream of
providing treatment for all ailments under one roof would materialize
soon in this township he is developing. Dr.
Murali P. Vettath Clinical Director & Chief Cardiac Surgeon Z. H. Sikder Cardiac Care & Research Centre
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