A short conversation with Dr. Neelam Desai
The Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) in Puttaparthi, completed 21 years of its existence on November 19, 2012. Commemorating this occasion Radio Sai team spoke to some of the distinguished doctors of this mansion of healing located 150 kms away from Bangalore.
Presented below is the edited transcript of the conversation with Dr. Neelam Desai, Senior Consultant and Head of Department, Cardio Thoracic and Vascular Surgery (CTVS) of this Hospital. She has performed more than 3600 surgeries till date and has over 40 publications in various National and International journals.
In this short conversation with Radio Sai's Bishu Prusty, Dr. Neelam shares about her fulfilling moments of working in this Hospital besides how this Department of Cardiac Surgery has progressed in these two decades and also the road ahead.
RS: Sai Ram Madam, this year (2012) we are celebrating the 87th Birthday of Bhagawan and it is also the occasion when we commemorate the 21st anniversary of this Hospital, which Bhagawan inaugurated in 1991.
On the inauguration day, the first operation performed by the doctors was a heart surgery. And you have been part of the Cardiac Surgery Department for more than 20 years now. So tell us how has this department developed from the time of its inception.
Dr. Neelam: 21 years sounds a very long time. Swami inaugurated this Hospital on November 22, 1991 and today (Nov 19, 2012) we are just two days away from its 21st anniversary. From the time I joined, which was February 1, 1993, until now, I can say very proudly, that we have grown immensely, and have helped many thousands of people to get back their health and lead normal lives again.
This beautiful building that you see, has stood tall and resplendent ever since Swami held its inception. And in the last 21 years, there has not been a single day when we ran short of supplies and had to stop carrying out surgeries.
Swami’s directive was that even the most costly surgery must be performed, if it was going to benefit a patient. So this became our motto – whatever was going to benefit a patient had to be done, irrespective of the cost involved. And this has remained our resolute principle throughout.
In the last 21 years we have performed 22,527 cardiac surgeries. And I want to know if there is any other hospital where they treat their patients absolutely free of cost and keep patient care as their topmost priority, and can boast of such a record.
I think the personal and humane touch which patients enjoy in this Hospital, is rarely seen the world over. We see patients entering the Hospital with a smile on their lips – and of course they leave happily smiling as well! That is very noticeable in our Hospital.
Some might suspect that because we treat everyone for free we use cheap drugs and equipment. But that is simply not the case. In fact the opposite is true! We are using the costliest, state-of-the-art equipment, and matching the highest standards of international medical care.
We use the latest technology for our cardiac surgeries and adopt the most up-to-date international surgical skills and methods – all to benefit the patient.
RS: That is certainly impressive. Would you like to say something about the journey of the Cardiac Surgery Department? How has it progressed from the early days and where do you see the road lying ahead?
Dr. Neelam: Well, initially, when the Hospital started there was a visiting team of Doctors from AIIMS, that used to come and perform surgeries at periodic intervals. This stage lasted for less than a year. Within the first year, we had a permanent team of three surgeons. In that initial period the team focussed on simpler cases, but after two to three years, they began to cover the entire spectrum of cardiac problems.
Today we perform all kinds of cardiac surgeries from congenital to semi-adult to adult. Barring heart transplants, we have performed all types of cardiac surgeries. We fully cover the range, from paediatrics (children), to adult, to geriatrics (the elderly). When we have a visiting faculty from abroad, they are amazed to visit our ICU (Intensive Care Unit), because they find a 3 kg baby in one cot, in the next bed they find a 60 year-old patient, and in the following bed a young child. We treat a mix of congenital cases, valve cases and bypass surgeries. Nowadays, the trend is usually to focus either on adult care, or paediatrics; but we are different.
In 1994, we were recognized for Diplomate of National Board (DNB) training in cardiac surgery. We have been having one student every year, but from next year we will be taking two students for this programme.
We have a less than 1.5% mortality rate, which is less than the international standard, and we have a very low infection rate. And we now have around six to eight regular members in our department’s surgical team.
With a stable team, we are focussing on complex congenital cases. We have always aimed to be a centre of excellence and now we can rightly use the appellation ‘Super Specialisation‘. This is because we will soon be able to carry out surgeries on babies weighing less than 3 kg. And for this specialisation, we have already procured two Infant Care Warmers. We also have ventilator facilities and we are developing the neonatal cardiac surgery programme in a major way. So that is one focus for the coming years.
The second focus is on academic research and publication. I am happy to state that last year our department published more than 20 research papers in international cardiac care journals. We have presented very rare cases at conferences and in journals and our work has been widely acclaimed. With our experience over the last 20 years, with so many varieties of cases, we are aiming to make this a centre of excellence for education and training.
For example we have treated cases of ventricular septal defects with pulmonary hypertension. Abroad, they believe that when an operation is performed after the age of two years, the quality of life will not be so great. But we have seen cases of 30 year-old patients doing absolutely fine, even five or ten years after cardiac surgery here.
So we have started a study on this particular type of health problem, where we are going to take a lung biopsy from the patient, study the tissue under the electron microscope, take it to the histopathology level and observe the changes which occur in the lung arteries, to investigate whether what has been told and believed so far, is true or is it different in reality.
We will investigate whether we are seeing a different progression of the disease in the Indian and Asian population than what has been shown to happen abroad.
And we see many coronary artery disease patients with very severe stenosis (narrowing of the heart’s blood vessels). In any other hospital they would have been immediately rushed into theatres and operated upon, but our patients come to us with their reports saying angiography has been done a year or two ago and they are still moving around.
So from our experience, we can say that the conventional practice of immediate surgery for patients with severe stenosis may not be necessary. May be the epidemiology (the study of the causes, distribution and control of disease) of this particular cardiac disease has to be rewritten. But for that we will have to do more analysis and study.
So we would like to apply ourselves more to academic research, and study the case scenarios that present to us different patterns as compared to what is normally observed.
At the moment we have two cardiac theatres and there is a real need to have a third one. Our workload is such that patients with certain complaints must wait up to seven years. A third operation theatre will increase the number of patients we can treat and in turn cut down on our waiting list. This is a plan for the immediate future.
RS: In all these 20 years of working in the Hospital, can you please pick one or two thrilling moments?
Dr. Neelam: Oh yes, I would be delighted to. On one occasion, I had done one complex congenital case on a 3.5 kg baby and everything had gone well. It had been a long day, but by evening we had been able to shift the baby to ICU, and she was doing fine. And then around 3 a.m., she had a cardiac arrest, and I just could not believe it, because everything had been going well. I was devastated. So I prayed to Bhagawan with all my heart to save the little baby.
At that time, Bhagawan was in Bangalore and I managed to find some people who were going to see Him, as it was the weekend. I went to meet them and gave them an urgent letter to be handed over to Baba, detailing this emergency case.
But, if you could believe it, by the time I came back, everything had fallen into place. Of course, Bhagawan knows everything - the contents of our letters and what is in our hearts and about our medical emergencies. The child then made a good recovery and went home shortly afterwards.
In fact, just two months ago she came back to see us; she has grown perfectly normally and has put on weight and is leading a normal life!
So these kinds of things are very gratifying to us. Another situation, involved a child with congenital cyanotic heart disease, which is a very complex case and necessitates the transposition of the great artery. She would normally not have survived beyond one month or so of the diagnosis! But this child went home after the operation and later came back to visit us, hale and hearty. This gives us a wonderful feeling.
Another noteworthy case that comes to mind is that of a five year-old boy with congenital heart problems. He weighed only 8kgs and had to be carried everywhere, as he could not walk. So we operated upon him and everything was fine post-operatively, apart from the fact that a lot of fluid draining from his chest – what we call pleural effusions - and this was not stopping at all.
We had this rare privilege at that time when we went for Darshan, Bhagawan would come and ask us about the welfare of the patients, and if all was going well in the Hospital. I was lucky enough to bring this boy’s case to the notice of Bhagawan, I said, “Swami, everything is fine with this boy but this pleural effusion is not stopping.”
So Swami asked me, “What is the weight of the boy?”
I said, “Swami only 8kgs.”
I can remember that exclamation of surprise from Him “Only 8kgs? In a five year-old boy?”
Then, in all His mercy and compassion, He materializes vibhuthi and gives it to me. As we say, the rest is history. The effusion stopped, the boy became well enough to go home and then on his next visit, he comes running towards us! He had gained weight, and looked like a normal kid!
So when you sit back and reflect on these memories, they fill you with so much joy and happiness, because it has been a matter of life and death for the patient, between slowly dying and going back to a productive life.
We have so many instances like this. There was a young girl, who had undergone surgery in the very prestigious KM hospital in Mumbai. The trouble was she needed one more surgery, but her family were not able to financially afford it. This girl was already married, she wanted to have children. We took up this case. It was a challenge: she had Tetralogy of Fallot, with severe pulmonary hypertension complications. It’s a very bad combination where the operation carries the risk of loss of life, but we took it up, because we knew there was no other option for her as the disease would slowly kill her. So we operated on her, and it was successful! She recovered well, was able to return home and is now the proud mother of two kids!
There are so many instances where surgery in this Hospital makes a difference in a person’s life and sometimes quite literally grants new life to them! And as we reminisce those times, we are filled with so much joy!
RS: How do you feel Swami’s Presence now, after His Mahasamadhi in 2011?
Dr. Neelam: I think Swami has never left us, because we feel His Presence continuously. He’s guiding us all. Personally He is guiding me both professionally and also in all walks of life – I feel His presence in all my ups and downs.
Our Hospital is growing and soon it is going to be well-known in the world. Swami had kept it in a shell, not allowing it to be infiltrated by the outside world. But, I think, very soon this shell is going to be broken, because the level of work, patient care and dedication that goes on here, really has to be seen to be believed.
RS: Wonderful, thank you very much for giving us this special view into this wonderful legacy of healing and love that Bhagawan has bequeathed to the world. We are all so lucky to learn from you a little about the wonders that go on here. Sairam.
Dr. Neelam: Sairam and thank you.