DNA
17 April 2010
By Deepa Suryanarayan
Mumbai, India

Dr Ramakant Panda, cardiovascular thoracic surgeon and vice–chairman, Asian Heart Institute, is the man who set right prime minister Manmohan Singh’s faltering heart last year. He was recently awarded the Padma Bhushan. Last Tuesday, he was also nominated by the union health ministry to the Institute Body (IB), the highest governing body of the All India Institute of Medical Sciences (AIIMS). Panda is credited for being among the first surgeons in the country to introduce the concept of ‘total arterial revascularisation’, as well as being one of the pioneers of ‘off–pump’ (beating heart) bypass surgery and redo bypass surgery. Under his leadership, his surgical team has successfully performed over 11,000 bypass surgeries, more than 1,000 repeat (redo) bypass surgeries, as well as more than 2,000 high–risk surgeries. Dr Panda spoke to DNA on matters of the ‘heart.’

India is the heart–disease capital of the world. What are we doing wrong? And what advice would you give to the common man?
In the last decade, the US had seen a 17% decline in the incidence of heart problems. We have a lot to learn from them. They have stopped smoking and even changed their food habits, banning trans–fats in their restaurants. In India, unfortunately, we are going through the opposite phase. Change in lifestyle, lack of exercise, coupled with bad food habits, smoking and stress, have resulted in coronary disease. Obesity and diabetes have worsened the problem. Twenty years back, starvation was a problem, but today there is a problem of plenty. And that ‘plenty’ is not the right type of food. My advise is exercise, quit smoking, and be aware of your health.

Former PM Vajpayee’s knee surgery raised huge awareness about knee replacement surgery in general. Has the PM’s heart surgery resulted in such a change?
Yes, people are not scared of heart surgery anymore. More importantly, they are not afraid of leading a normal life post–cardiac surgery. Earlier, a lot of patients used to lead a ‘cardiac crippled’ life – they thought surgery was the end of life. But now, I see a lot of people looking at the PM as a role model and gaining the confidence to lead a normal life from the success of his surgery.

You’ve worked in Cleveland Clinic, USA, and have seen the way healthcare is dealt with abroad. Do you think the US health reforms model or British National Health Scheme (NHS) model can be replicated in India?
The US has completely privatised healthcare. Public hospitals contribute hardly 5%, while 95% is handled by private hospitals, non–profit, trust–run or community–run hospitals. The richest country in the world is able to handle just 30% of its patient–population.

In the UK, the entire population is covered under the NHS – the number one expenditure in their budget is health. However, people have to wait for a year or even two years to get heart surgery or knee surgery done. The government gives a hospital some amount of money for a year during which the hospital has to handle a certain number of patients. When I was in the UK, the Royal Brompton Hospital ran out of funds in 10 months, and for two months, they could not perform any surgery.

I would say the best model for us would be a combination of both private and public hospitals as well as public–private partnership, which is efficient.

Since the setting up of hospitals and running them smoothly involves crores of rupees, do you think hospitals are now turning into a profit–making industry?
I disagree. There are several private hospitals which do a lot of charitable work. Besides, there is a huge need for public as well as private hospitals in the country. The number of beds, nurses, and doctors per 1,000 people in India, is the lowest in the world. We are not even at par with sub–Saharan countries.

We have 0.8 beds per 1,000 people, in sub–Saharan countries it is 1 per 1,000, in China it is 3 per 1,000, and in the US it is 7 to 8 per 1,000. The hospital infrastructure, equipment, doctors and nurses that we have in this country is much less than what we need. There is a huge demand–supply gap and we need to fill this gap.

India needs bullock carts, aeroplanes and spacecraft… While there is a need for the government to put up public hospitals, we also need NGOs and trust–run hospitals to provide subsidised treatment. At the same time we need private hospitals to bring in technology and advanced treatment.

How is technology helping the poor man on the street, with heart surgery and the cost of stents, running into lakhs of rupees?
One good thing is that the incidence of coronary artery disease is a little less in that stratum of the society, mainly because they do a lot of physical work. But the best thing for the common man to do is to get health insurance. There are some state governments like Karnataka and Tamil Nadu which even cover patients living below the poverty line. The only long–term solution I see is universal health, but that’s a distant dream.

You have been nominated to the AIIMS governing body. What will your role involve?
The health ministry on Tuesday reconstituted AIIMS’s highest decision–making group, the Institute Body (IB). Health minister Ghulam Nabi Azad, in his capacity as president of the AIIMS, is the chairperson. As a former student of AIIMS, this is a great honour for me. The Institute Body is constituted for a span of five years. It is a statute body in charge of making various administrative decisions about the country’s premier hospital.

You’ve recently been awarded the Padma Bhushan. This year, the Padma awards were a subject of controversy. Your comment?
I am very honoured to receive the third highest civilian honour in the country. Every award is associated with some sort of controversy. Even the Nobel prize is not free of controversy – it has been awarded to people 15 to 20 years after their work has been established. Recognition is never instantaneous.

In India, with a population of over one billion, there are plenty of deserving people. And when you select a handful of awardees from this large pool, there is bound to be controversy.