February 27, 2020
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A Miracle In Operation

Cardiac tele-medicine becomes a reality as telecom and surgery come together at the Escorts Heart Institute

A Miracle In Operation

LIKE every year, Dr Ravi Kasliwal, senior cardiac surgeon at the Escorts Heart Institute in Delhi, should've been with his wife on their marriage anniversary on June 11 this year. But the doctor had bigger things on his mind. And as Mrs Kasliwal waited outside the operation theatre at the Institute on the all-important day, a team of doctors led by Dr Naresh Trehan and including Kasliwal, were making history in India.

The pictures of a group of patients being operated upon for cardiac ailments were being beamed live to the best-known cardiac surgeons and other medical professionals halfway round the globe in San Francisco. Something that had never happened before in India and made possible because of the opportunities provided by the changing face of medical science and telecom.

To the delight of all those associated with this little piece of history, the feat was repeated the next day again. And what had originally been planned to get over in only 15 minutes, went on for over 40 minutes. As the video cameras kept pace with the hectic activity in the operation theatre, the joy on the faces on the doctors was palpable. Rightly so. Declares a beaming Suvendra Das, a senior executive with the Medical Products Group at Hewlett-Packard (HP) in Delhi which provided the back-end support: "Such a thing is not a very regular occurrence even in the US and we made it possible for the first time in India." Naturally, Das and his team members had to burn the proverbial midnight oil to ensure that the surgeries carried out on the six patients on June 11 and 12 went off without a single technical hitch. Says Dr Kasliwal: "This may help diagnose heart diseases at the OPD level in a definitive manner."

Dr Trehan, director of the Escorts Heart Research Institute, and his team members played their surgical roles effortlessly. But to ensure that they had an answer to all the queries posed by the 200 cardiac specialists and over 1,000 other delegates, who had gathered under the aegis of the American Society of Echocardiography, was no mean task.

Says Dr Kasliwal: "The specialists at San Francisco were watching the entire surgery on a giant screen that had been specially put up for this purpose and were also quizzing us about the way we were carrying out the operation. It was a lot of learning for them since the heart ailments found in India are not the same as those which occur in the Western countries." With the experience under his belt, he is convinced that the fibre-piped global surgery will be replicated shortly. In fact, Escorts was the only medical institute selected from Asia amongst seven centres in the world which would similarly interact with the American Institute of Echocardiography.

"Through this technology now, people all over the world can benefit from the expertise of one person," says Dr Trehan, who feels that it is exciting that the telecom link could remain reliable for such a long period.

The institute is already thinking ahead. The thought of a similar exercise with the affiliates of the institute in Nepal, Sri Lanka and Bangladesh has already been mooted. If these hospitals are linked up with Escorts, when the surgeons there need some expertise or second opinion from the top surgeons at Escorts, all they need to do is hook up. Expert advice will be just a phone call away.

On an Integrated Services Data Network (ISDN) line, to be precise. The reason why one needs this particular kind of telephone line is because video images can't be transmitted over a normal telephone line. Video images have to be converted into digital data—bits and bytes—to be transmitted, but the result is too much digital data for a normal telephone line to handle smoothly. The situation is similar to large trucks trying to negotiate a narrow alley. Hence, the ISDN lines, which are only being offered in India by Mahanagar Telephone Nigam Limited ( MTNL) in Delhi and Mumbai at present. A service which will multiply with the introduction of private basic telephone networks across the country.

To ensure that the pictures being transmitted were of diagnostic quality, three ISDN lines of 128 kbps (kilobytes per second) were leased from MTNL. "This was necessary because one frame of the video was one megabyte (MB) and hence the 384 kbps connection was absolutely necessary," recalls Das of HP. Not willing to take any chances, the testing for the entire hardware had begun one week before the actual 'event'. And when the real thing did happen, everything went very smoothly.

"I was very excited," admits Dr Kasliwal, certain that the impact of the experiment will be felt soon. "A person, say in Sikar in Rajasthan, can hook up and ask 'What do I do? Where should we take the patient? Or not take him anywhere at all?' All of which shall help remote corners of the country benefit from the experience of few such centres." At a price that won't burn any holes in the pocket.

THE cost that will be associated with such an exercise is far cheaper than actually travelling to Delhi or Mumbai. The leasing of an ISDN line from MTNL costs Rs 15,000 apart from a security deposit of Rs 5,000 only. In addition, those who hook up will have to pay normal STD rates. All of which will reduce the burden of travelling to Delhi or some other metro and finding a roof over the head till the treatment is over.

 "Since there are other centres of excellence in India, this (the technology) could be a very, very important tool," confirms Dr Trehan, adding that "the patient should not be shortchanged just because he is sitting in Agra or Meerut". "If we can multiply this within the length and breadth of our own country several times, we may have done the people a lot of good," says Kasliwal.

The applications of tele-diagnosis open up vast new frontiers. For instance, the patient's entire records can be transmitted digitally—which also implies instantaneously—to the consultant. The quality of care accorded to heart patients can be improved manifold as can the knowledge that can be disseminated to those who do not have the good fortune of having access to the latest medical journals or books. Or for upgrada-tion of professional skills, "professional development" as Dr Kasliwal would like to put it. "We can become the referral centre for several satellite centres," says Dr Trehan.

And sure enough, the ISDN lines are now becoming a permanent feature at the institute. And perhaps unknown to a majority of its patients, the quality of healthcare for them will be further enhanced because of, to put it simply, a telephone line. In fact, the institute is all set to become a telecom engineer's delight. HP is now helping the hospital get wired on a fibre optic network so that the June event can be repeated over and over again. The network is being planned in such a manner that a doctor in one room can monitor patients in any other room. In addition, data storage space of over 500 hard disks of two gigabytes each has also been planned (a normal home computer being sold today has a hard disk capacity of two gigabytes).

All this because the World Health Organisation (WHO) figures, which are believed to be conservative, say that India has over four million cardiac patients. Besides, the incidence of heart attacks in India is the highest in the world. "The least, then, you can expect is quality of service," says Dr Kasliwal.

Surely, missing one marriage anniversary to let the partner make history is something no spouse can have a complaint against.

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