AHF reaches out to remote areas through telecardiology

EHM News Bureau Kolkata

The Asia Heart Foundation (AHF) was set up with a mission to deliver quality and affordable healthcare to the people at their doorsteps. The objective was to especially reach out to those deprived people who lived in remote areas with a deficiency in cardiac care, create coronary care units and treat them from specialist ends at Kolkata and Bangalore, in case of any kind of heart ailments.

With this mission in mind, Dr Devi Shetty, chairman, AHF, took up the cause of telemedicine, in which lay the answer to these problems. He was ably supported by Dr Alok Roy, vice-chairman, AHF who was instrumental in planning and implementing the entire project.

Technology made it possible to connect two distant centres to each other, either through ISDN lines or via satellite. For ISDN connectivity, both centres applied to the local telephone exchange, which provided the required cabling to enable videoconferencing with a bandwidth of 128 kbps. However, the image quality and resolutions largely improved with higher bandwidth.

This was made possible through V-SAT, which provided bandwidth of 384 kbps, making it easy to transfer images in real-time and of superior quality. With the active support of ISRO and the personal initiative of its former chairman Dr K Kasturirangan, satellite connectivity was provided at the Bangalore Hospital at Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), and Udaipur in Tripura.

Large satellite dishes were installed at strategic locations at these centres, enhancing the entire process of sending and receiving medical data, images and providing crystal-clear videoconferencing.

Specialised hardware and software was installed at all the telemedicine centres, e.g. scanner, online ECG machine, computer, videoconferencing camera and television et cetera. All kinds of images could be transferred through these equipment. Even angiogram films which are moving images, could be transferred in a matter of a few minutes.

A positive outcome of so many telemedicine players coming into the field has been the lowering of the costs of these equipment, because the entire project has to be self-sustainable. Even the connectivity providers are working at solutions to make the facility more affordable.

AHF embarked on the telemedicine journey in April 2001. What began as a slow trickle of patients who wanted to seek Dr Devi Shetty’s opinion soon turned into a virtual OPD with him seeing 20 patients on certain days, sitting thousands of miles away in Narayana Hrudayalaya, Bangalore.

AHF’s tryst with inpatient treatment began on the June 24, 2001, with a coronary care unit being set up within SD Hospital, Siliguri. The state watched as Buddhadeb Bhattacharjee, the chief minister of West Bengal, alongwith Dr Shetty at the Kolkata end went online and spoke to Dr Roy at Siliguri, thus inaugurating the telecardiology project. This was the first time in India that telemedicine was being utilised not merely to advise OPD patients, but also to treat emergency cardiac life-threatening situations.

This unit is tele-linked to Kolkata round the clock. Cardiologists at RTIICS treat any patient admitted in the CCU, with the aid of MBBS doctors and nurses, who are intensively trained in CCU management at its center at RTIICS.

Technicians are responsible for maintaining communication with RTIICS specialists as and when required, for assisting and treatment of emergency cardiac patients. The unit has all the emergency medicines and necessary equipment and is manned round the clock by the CCU staff. The videoconferencing facility is provided for better patient care.

A similar facility was set up in Bankura in the Bankura Sammilani Medical College and Hospital, which was inaugurated on July 21, 2001 followed by a CCU in the Tripura Sundari District Hospital, Udaipur, which is a small town about 55 kms. From Agartala, capital of the northeastern state of Tripura. The Udaipur CCU began functioning on August 22, 2001. The latest cardiac hospital with all modern equipment and facilities has been set up in Tinsukia (upper Assam) on August 1, 2002.

So far, AHF has set up 20 telemedicine sites, including the ones in the south. These are connected to each other either through satellite or through ISDN, and some locations have both the facilities. More than 3000 cardiac emergencies have been treated in various remote centres and more than 500 patients have been successfully thrombolysed.

More than 8,000 OPD patients have been advised through this facility. With the advent of telemedicine, patients living miles away from the doctor can be successfully treated. Distance has become immaterial. Patients are able to save on precious time and unnecessary expenditure on travel.

To cite an example, a 40-year-old policeman posted in Udaipur developed severe chest pain on a cold December night in 2002. He was rushed to the CCU, where his ECG showed a massive heart attack. His case history and ECG were transferred within minutes to the Kolkata telemedicine room, where cardiologist Dr Sanjeev Garg immediately advised thrombolysing him. Within an hour his condition stabilised. The next morning, when his family joined him, they were thankful for the presence of such a facility, which had helped saved the sole bread-winner’s life.

The remote monitoring of these units, medically and administratively, is done regularly, to make certain that all medical equipment is in working condition, medicine safety stock is maintained, manpower attendance is regular and most important, patients are being treated as per directions of the specialist doctor.

AHF stands by its commitment of providing free treatment through telemedicine and even supplies the life-saving drug, streptokinase, free-of- cost to the patients.

The medical fraternity has woken up to the fact and has accepted that telemedicine can provide solutions to most of the problems faced by people living in rural and distant areas that arise mainly due to the physical barrier between the sufferer and the healer. And the biggest satisfaction has been the ability to give a new lease of life to an ailing person, even from a remote distance, only by leveraging the benefits of technology.