Chennai Corner

Bugged Beyond Belief

It may have been named after Delhi, but the outrage in Chennai is no less. And all of it is concerned only about medical tourism, it would seem, with hardly a thought about the possibilities of any serious health-hazards.  

The reasons are not too difficult to fathom. Of the 1.5 lakh medical tourists who come from 55 countries to India every year, 50% or so head to Tamil Nadu (mostly the Christian Medical College in Vellore) and a majority of them to Chennai. 

“The infection control system in hospitals in India is as good as in hospitals overseas,” says TN’s health secretary V K Subburaj. And besides, he points out, “there is always a way of inventing new antibiotics.”

Dr K M Cherian of Frontier Lifeline Hospitals says the Lancet report is “baseless and meant to deter foreign patients from coming here.” He points out that the hospitals that treat foreign patients are NABL-accredited and ISO-certified. “Why would they violate the infection norms?” Why indeed.

Also discounting that the Superbug is believed to be lurking in our hospitals is Chennai-based author of the report, Karthikeyan Kumaraswamy. In fact, he has dissociated himself from parts of the report saying he had not written many of the interpretations of the report. 

He has been quoted as saying, “I do not agree with the last paragraph which advises people to avoid elective surgeries in India. While I did the scientific work, correspondence author Timothy R Walsh of Cardiff University was assigned to edit the report.” He says: “It was too small a sample to extrapolate. My intention was to find out whether such multi-resistant bacteria existed in India. We see several such strains of multi-drug resistant bacteria across the world.”

But Walsh has countered that Karthikeyan was sent the draft of the report, published in the prestigious Lancet medical journal, in July and had all of two weeks to record his objections. Go figure.

Karthikeyan’s guide at the University of Madras, Padma Krishnan, said the report would “create boundaries” between scientists. “The research was taken up in the interests of patient care, but the report has projected a negative image of India.” 

It seems the report has already done that. At least about how we react to any such news.

Mecca of Medical Tourism

Much is written about how Chennai is the Mecca of medical tourism and that was proved recently. Last month, Chennai - and India - got its first medical tourist from the South Pacific island nation of Nauru when Mathew Fritz (52) who had coronary disease, got endoscopic harvesting and grafting of his vessels done at the Frontier Lifeline Hospital. “I have the obligation to tell other people in my country that Chennai is the best place for treatment,” said this security officer who got sent here by his government under its medical referral scheme. 

It must be said that he came before the Lancet report had stirred up controversy here. But even so, there are those who are nervous (“Should we get a superbug test done?” Dr S.M. Balaji, director, Balaji Dental and Cranofacial hospital, was asked by an anxious patient), those that are sanguine that they’ve come to the right place and those that have not even heard of the whole hullabaloo. “India (and Chennai) is the best hope for cost-effective and quality treatment,” says Ansar who brought his brother from Japan for a liver transplant. Then there’s Zablon Mwangitau from Kenya who came here to get a kidney transplant. “We are afraid (of the Superbug) particularly because once you get treated here, you come back here for follow-ups. But I am satisfied with the services. Hospitals in India are clean.”

Hear it from Norman Powell, Adviser to the Department of Health, Nauru, who accompanied Mathew Fritz here. “We found that Chennai had world class medical facilities which offer value for money. The reputation of the city was the main reason for opting for Chennai.”

Reverse Gear

For years, Indians headed to the US for medical treatment but recently you had an American coming to this city for a new heart. Not because it is cheaper – that it is, definitely – but because doctors in the US told Ronald Lemmer, 65, that he had only one year to live and that if he went to India, he would return in a coffin. Instead Lemmer got the heart of a 36-year-old accident victim and after an eight-hour surgery on July 21. Lemmer has gone back, ready to start life afresh.

“Doctors in the US told me that I would have to wait a year to get a donor. I decided to come to India for the transplant after some research on the Internet,” said Lemmer, who owns a glass business back home. After a bypass surgery, an angioplasty, and a pacemaker, Lemmer found himself being given a death warrant – that chances of him dying in the next one year were 80 per cent.

After his operation here, his wife Shelly says, “He looks 15 years younger and his heart which was only working at 20 per cent capacity is now working at 60 per cent.”

I am willing to bet that Superbug or not, if Lemmer would do it all over again because the option doctors in the US gave him was “die here or return in a box.” After Chennai, he has gone back with a new lease of life.

Donate Organs, Save a Life

Dr Prathap C Reddy, chairman of Apollo Hospitals, who introduced Lemmer to the media, said, “On one hand there are people waiting for heart, liver and kidneys, while on the other hand, organs are getting burnt”. In other words, there’s a dire need for cadaver organ donations despite the upsurge in donations in the state following the awareness created after the doctor-parents of a teenager, Hithendran, donated his organs when he died in a tragic road accident in September 2008. With a record 12 cadaver transplants last month, TN’s transplant programme is truly impressive. “With 615 organs donated so far, our performance in cadaver transplant is as good as any developed country's,” says Dr J. Amalorpavanathan, state transplant co-ordinator.

But What About the Poor?

Among the spats that CM Karunanidhi and AIADMK chief Jayalaitha had was over the Kalaignar Kapitu Thitam (Kalaignar Insurance Scheme for Life Saving treatments) that is supposed to benefit the poorest of the poor. The scheme that was rolled out on June 23, 2009 after an MoU was signed with Star Health Insurance, has benefited 1.45 lakh families of 1.33 crore families who were issued smart cards.

The CM, while hotly denying Jayalalitha’s charge that he had received Rs 400 crore as a commission from the insurance company, said that Star Health had settled insurance claims to the tune of Rs 394.72 crore. The state had earmarked Rs 517.307 crores in the first year to families whose annual income is less than Rs 72,000 and also to members of the unorganised labour welfare boards. Those covered are entitled to undergo treatment at more than 500 hospitals, both private and government, across the state for up to Rs 1 lakh. But despite all these vote-catching schemes, it is clear that the poor don’t get the medical help they need. 

Open-heart surgeries were on hold for almost a month at the government-run Institute of Child Health (ICH) in Egmore, because the Oxygenator, a part of the heart-lung machine that takes over the functions of these organs while surgery is on, was kaput  Dr P. Ramachandran, director in-charge of ICH said, “The problem cropped up because of issues in allocating the budget funds.” But following a report in the media, magically Rs 10 lakh was made available to fix the machine.

Nearly 20 little patients, with holes in their hearts, ended up waiting. Their parents did not want to take them home lest they get pushed down further on the waiting list, despite a substantial emotional and financial cost. A lady from Vellore district was among the parents who ended up waiting several weeks with her eight-year-old daughter. She was forced to leave her one-year-old son to be cared for by relatives. She may have gone to another hospital closer home, but she had not received her insurance smart card, so her only resort was the ICH.