Heart disease at an alarming stage

Many are still unaware that a simple Arterial Septal Deflect operation of the congenital heart disease which cost IC Rs 300,000 in India is conducted here for a mere Rs 40,000, writes Tashi Dolma Thinley

The heart is a muscular bag that pumps blood, receiving oxygenated blood and passing it through the arteries all over  the body. These coronary arteries supply oxygenated blood to the heart. They run along superficial surface of the heart. The left artery is the main arteries which branches into two channels supplying blood to the front, left and back chamber of the heart. The right artery supplies blood to the bottom and right chamber of the heart.

When the lumen of these arteries is partially blocked by cholesterol rich material the heart receives less blood than normal and chest pain (angina) occurs. If this is not attended promptly a heart attack (myocardial infraction) may follow.

Smoking, diabetes, high BP, hypertension, obesity, a sedentary lifestyle, faulty diet, tobacco addiction, hyperlipidimia (increased fat in the blood) stressful work profile, lack of exercise and family history of coronary artery disease many contribute to Coronary Artery Disease (CAD).

In Nepal, with the increasing number of heart patients, the major cause of heart disease is known to be diabetes. Tribhuvan University Teaching Hospital (TUTH), capital’s leading public hospital’s records show that over 23 per cent of the people visiting the hospital suffer from heart ailments.

In terms of absolute figure also the number of heart patients have grown alarmingly. Till 1996, only 5000 cases of heart disease were registered in TUTH while figures have surpassed over 20,000 thousand during the last five years alone. At NORVIC, to date there have been 25,000 patients out patients and 5000 in patients.

Experts’ say, compared to the world average, Nepali males are more vulnerable to heart disease than female. In Nepal 80 percent of the heart patients are male while 20 percent are females. The incidence in women also starts rising after menopause, albeit at a slow pace. Doctors suggest Comprehensive Cardiac Checkup (CCC) for men and women above 35 years of age, which costs Rs 6,000.

Growing level of pollution, smoking, improper diet, lack of exercise, stress and strain are greatly increasing the risk of Ischemic heart disease among the valley people. (A disorder caused by lack of oxygen to the tissues of the heart, in which the muscles of the heart are affected and the heart cannot pump properly)

The next common case growing in Nepal is the Rheumatic heart disease a kind that thrives in poverty affects people who live in congested unhygienic houses. The symptoms are fever, pain in the joints, swelling and throat pain. Another such common one is the congenital (inherent) heart disease, which is found generally in Nepalese children. In this, the child looks pale and grows weak.

Your cardiologist can assess whether you are suffering from CAD, by considering the primary symptoms. To confirm the CAD, a stress test is taken, suspicion of which, coronary angiography is offered to determine the number and severity of blockages and the extent of CAD.

Coronary angiography is done in a Cathlab machine under local anesthesia. On evaluation of the location of blockages and extend of the disease, the cardiologist will recommend one of the three modalities in the management of the disease.

On a minor case, cardiologists will suggest the first modality that is medications that can help to decrease the oxygen demand of the heart by slowing the heart rate, dilating the blood vessels or lowering the blood pressure.

The second modality is the coronary angioplasty, a procedure under which the blockages in the arteries are opened through the administration of catheter inserted through a small nick in the right groin. This is done under a local anesthesia in a similar way to angiography and does not require surgery. It is safe, quick and effective.

The third modality that is conducted under the most serious case called the Coronary Artery Bypass Surgery which is a procedure to restore blood supply to the heart musculature by grafting a blood vessel from the leg or chest beyond the stenosis. This way blood can flow past the narrowing to reach the heart muscles.

With the increasing number of heart patients in Nepal, the number of country’s hospitals and nursing homes have doubled, each coming up with competitive facilities and better service. There are in the capital a number of heart centers like the NORVIC in Thapathali and Shahid Gangalal National Heart Center in Bansbari which are especially meant for the heart diseases but then one can get similar treatment for consultation and medication in TUTH and other private clinics too.

Hospitals like NORVIC have made a huge stride in heart treatment facilities. Doctors at Norvic recently performed Nepal’s first "beating heart" coronary artery bypass surgery (CABG) in the capital. The surgery was performed by a team led by chief cardiac surgeon Dr Naresh Trehan of Escorts New Delhi and Cardiovascular surgeon Dr Damodar Pokhrel of NORVIC Nepal. Dr Damodar Pokhrel said, "The beating heart surgery is a shorter, surer and a less painful surgery and the recovery is faster compared to other bypass surgeries."

Amrit Lal Thapa, 78 of Balaju was the first person on whom the doctors performed the CABG successfully on January 6, 2002. The same day also witnessed the second such surgery on Ghanshyam Makaju Shrestha, 58.

Thapa, talking to The Kathmandu Post after the surgery said, "I have been lucky that they did the surgery here in my country. It has been cheaper and easier for my family to share my pain. I feel now I can live for decades. "

According to experts at the NORVIC, the CABG, which costs Rs IC 4- 5 hundred thousand in Delhi (includes only hospital expenses), has been done in the country for half that amount. Also, today, with equipment like the intra-aortic balloon pump, heart-lung machine, cardio-pulmonary bypass machine, cardiac color doppler monitor and cathlab all here in Nepal, they are serviced at a much cheaper rate compared to private hospitals in India.

Many are still unaware that a simple Arterial Septal Deflect operation of the congenital heart disease which cost IC Rs 300,000 in India is conducted here for a mere Rs 40,000. And an operation to change the valve that cost approximately 150,000 in Nepal, in India, it might cost approximately Rs IC 400,000. A coronary angiography with a complete package in NORVIC cost Rs 28,000.

But many of the patients still prefer to go to the neighboring Delhi and Mumbai for treatment while few go to Bangkok too. Many are ignorant of the facts that while under going treatment away from Nepal, there are a lot of hurdles one can expect, financially, mentally and otherwise. Firstly, the patient has to be accompanied by two or three persons. That means the cost of airfares, lodging, food expense, communication and local transportation has to be borne.

Most importantly, doctors say that for an open-heart surgery, one will need 8-10 point blood of the same group which at that time will be very difficult to manage outside one’s home country. While the fact remains that treatment facility and technology is equally competitive here, it is often suggested that one should consult and take advice from the doctors here so as to make sure you are doing the right thing by taking the patient away.

Mission Born in Mumbai

The real life drama in Bombay gave birth to a mission in the mind of a young Nepalese, writes Sudha Shrestha

Mumbai is not just a city of glamour and riches but also a city of miseries and agonies. Everyday, when he passed by the main city, he saw different scenes ranging from breathtaking lifestyles of rich people to hand -to- mouth daily life of poor people. Some people there travel in air conditioned cars and their houses too are air- conditioned while others spend their lives under trees and still others pick up grains from the floor to quench their hunger.The most heart-rending picture for him was the cries of the abandoned new-born babies coming from the dustbin containers in the early morning. This dark side of life in the mega city gave birth to a mission in the mind of a young Nepali, Uttam Sanjel. After finishing his graduation course in political science, Sanjel had just started his career in film directing. But the real life drama drew him more than the life on the screen.He came to Nepal some years back and started doing social works by taking part in Bal Sikchhya programme for educating little street kids.This did not satisfy his urge for social service much. Early this year, he established a school at the corner of Jorpati for kids of people at the lower rung of society including kids of carpet labourers, Tibetan refugees, the Dalit castes and also kids of those who cannot afford education at expensive boarding schools in Kathmandu. As people belonging to this low-income bracket cannot afford good education for their children , the majority of their kids tend to go to nearby streets where they play with dust and pebbles instead of going to schools, fight with each other and learn anti-social behaviour like teasing ladies and hitting stones at the passers-by.

The school, Samta Sikchhya Niketan , which covers an area of four ropanies of land was built at the cost of Rs. 6 million. On entering its premises, an outsider gets the feeling of the Vedic Age. Built with only mud and bamboos, the architecture of the school resembles that of Ashrams of the Vedic period. And inside the one-storey class ( Tahara) you meet with innocent and naughty faces waiting to greet you with natural smiles .Girls clad in Gunyu Cholo and Sari and boys in Daura Surwal and Nepali Topi in seven different colours of rainbow look like budding flowers in the garden.Uttam is the architect behind the unique setting of the school which he says aims to preserve the human values of Eastern culture. For him, the so-called modernity is widening the gap between the haves and have-nots than ever before.

This trend has affected the people of the so-called lower caste the most.

"I believe, humanity is the only caste of mankind. That’s why this school imparts education to people from all social backgrounds. The caste is man-made thing," he says.

With the motto of global togetherness and fraternity, education in the school primarily focuses on cultivating moral values in students and thereby building up their characters, according to Uttam. The pictures of well-known national literary figures like Parijat, Dharanidhar Koirala, Laxmi Prasad Devkota hung at the entrance of each class room testifies to that fact.

Despite ancient setting , the curriculum of the school includes the standard text-books of the boarding schools in Kathmandu. The medium of education is more English than Nepali.

"We want to show the so-called modern people here that one can learn English even in Daura Surwal and Gunyo Cholo and no matter even if they study in huts like this school.Many people here tend to judge a person by the clothes he wears instead of his inherent abilities. They look down upon their own national dresses with much desdain. So I wanted to preserve culture and nationality by introducing them to these small kids," says Uttam who himself prefers to wear Nepali topi with a sense of pride.

There are 35 staffs including teachers who are devoting their time and energy for the school. Besides, Laxmi Ram Dangal, Dhurba Humagai, Sahadev Pudasani,Dorje Lama are making special contributions to the school. It took teachers a lot of effort at first in socializing kids when they first came to school.

"As their parents are illiterate, these kids did not know how to behave at first. They often used vulgar languages in class when they first came to school. Now they have learnt to greet visitors and parents at home and say ‘thank you’ and ‘sorry’, " says Uttam with an air of satisfaction.

When he first opened the school, it was like an emergency ward of the hospital - a big rush of complaints of parents and kids. Uttam remembers a kid who had came to school with nothing on his body and bare foot. He bought him books and clothes. These days, Uttam is on his toes catering to the every smallest needs of kids.

The school, which teaches from nursary to grade three, has attracted a large number of kids in the periphery of Jorpati.The first batch contains 900 students out of whom 200 study free of charge, 100 are orphans and only 400 students pay tuition fees. the tution fees upto UKG is just hundred and they have to pay five rupees more when they reach class one. " Although the fee is too low, still some of the parents grumble saying that the fee is expensive", complains Uttam. " Those parents do this as they spend their money in unneccessary liquior."

He is attached to these kids so much that he feels that they are his future and he wants to concentrate on them instead of directing films which he had thought earlier."The innocent faces crowd around me . I have grown so much attached to them now that I feel that social work will be my prime profession instead of directing films. Just the reverse has happened in my life , " says Uttam who had already directed Nepali teleserial, ‘Trikon’. He is set to co-direct films also for Zee TV so that he could pour moneyinto kids as the school is facing financial crunch due to excessively lower tuition fees.Uttam is looking for different sources and organizations for charities to sustain the school "If I close the school, the kids will go back to streets again. And when they are deprived of education, they will be criminals one day" says Sanjel.

Australian day celebrations at Radisson

Spost

The Australian Embasy along with the three hundred Australian residents in Kathmandu observed Australia’s national day celebrations at the Radisson Hotel on Saturday, the 26 of January. Australian Day is a celebration of Australia’s character and culture and Australians hold events on this day all around the world.

Three hundred Nepalese and international dignitaries and friends of Australia were invited to the celebrations at the Radisson Hotel. It was like no other national day celebration Kathmandu has ever seen.This celebration reflected both the dignity of the occasion and the warmth and friendliness of Australia. The event was held in the Nepa Dhuka Hall ballroom and out into the Radisson Waterfall Garden. The ballroom was decorated with artworks from Australia’s indigenous aboriginal culture and images of Australia’s natural beauty, rural and urban life. In the garden, the theme "the bush" which the countryside of Australia is known, was presented. The general manager of the Radisson, Mr Kent Davidson let slip that some native Australian animals had flown in especially for the event.

Similarly guests were able to sample Australian Foster beer straight from the can and they could have the imported Australian "tucker" on the Barbeque. For each can, a donation of one hundred rupees went to the malnutrition ward at Kanti Children’s Hospital and for the purchase of dental equipment for the Shanti Sewa Leprosy Clinic.

The Australia Day elebrations for 2002 in Kathmandu was dignified as Australia in style.

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