Sunday Times 2 -13 July 2014
A young heart blooms
Kumudini Hettiarachchi
reporting from Jaffna
Thanks to a pioneering project
carried out by a Sri Lankan doctor from Oxford, teenager Archana, a hole in the
heart patient, smiles again
View(s):
Tightly clutching a cushion
with a bright red heart to her chest, no words are needed, as 16-year-old J.
Archana smiles mutely.
Heart Surgeon Dr. Ravi
Perumalpillai opening the chest of Archana to close the hole in her heart
Knowing since 2009 that she
had a hole in the heart, she and her paternal grandmother, Nakapillai
Gnanasoundarie, from Alankerni in Kinniya, Trincomalee, were compelled to do
nothing due to poverty. They just could not afford the heart operation at a
cost of about Rs. 500,000 in Colombo, while accessing a government hospital in
the capital also brought with it heavy burdens on this ‘single’ grandmother who
was eking out a living as a labourer.
Last Sunday (July 6), however,
her life changed in a way they had never imagined. Archana became the
flag-bearer in a quest to introduce open-heart surgery in Jaffna.
The initiation of open-heart
surgery using the heart-lung machine for people living in the northern,
north-central and eastern areas has been the quest of eminent Heart Surgeon Dr.
Ravi Perumalpillai.
Even though open-heart surgery
under hypothermic conditions (not using the heart-lung machine) had been
available in the 1970s and early 1980s for closure of holes in the heart at the
Jaffna Hospital, it had ground to a halt when the then heart surgeon left.
Currently although cardiac
interventions are performed at a handful of major hospitals including in recent
times at the Jaffna Teaching Hospital, open-heart surgeries in the government
sector are limited to the National Hospital, the LRH and the semi-state Sri
Jayewardenepura Hospital and the Kandy and Karapitiya Teaching Hospitals.
Archana: All smiles
While cardiac interventions
(not open-heart surgery) are being carried out at the Jaffna Hospital, in some
cases such as bypasses, a limiting factor is that due to device-shortages, the
patients would have to buy such devices as stents at a cost of about Rs.
200,000 each, the Sunday Times understands.
Northern, north-central and
eastern regions patients who need open-heart surgery, meanwhile, have to come
either to Colombo or Kandy. For some surgeries there would be long waiting
lists and in others they would also be faced by challenges such as language
issues, getting about in Colombo and Kandy and huge costs in finding lodgings
if relatives wish to be with the patients. Back home, too, their families’
routines would go awry and their own livelihoods would be at stake. So, many
decide to live with their heart problems.
Archana orphaned at an early age and being looked after by Gnanasoundarie is
just one such person. Working as a labourer on and off, the grandmother had
been desperate to get Archana cured. It was to Jaffna that they headed to
collect the money, with the grandmother going begging from shop to shop.
“The humiliation was so great
that Archana had lamented, ‘It would be better if I die’,” recalls the
grandmother, shedding silent tears.
Fortunately for them someone directed them to a charity and it was then that
their path crossed that of Dr. Perumalpillai.
By this time, Dr.
Perumalpillai, who had retired from the prestigious John Radcliffe Hospital in
Oxford, England, had already established the Oxonian Heart Foundation (OHF) to
help the numerous Archanas who are languishing without open-heart surgery.
Having served as an intern at the Jaffna Hospital back in 1974-75 and visiting
Sri Lanka over the years, both on holiday and on work,
View of the surgery from the
head-end of the operating table
bringing teams from Oxford to
strengthen best practices in cardiac surgery at the National Hospital and the
Sri Jayewardenepura Hospital, Dr. Perumalpillai had realised the dire straits
people who required such surgeries were in.
With OHF being set up to support the development and delivery of cardiac care
to the northern, north-central and eastern regions of Sri Lanka, its first
project is the establishment of cardiac surgery at Jaffna’s Northern Central
Hospital (NCH) run by Chairman S.P. Samy.
NCH, which functioned as a
nursing home during conflict-ridden times, has now transmogrified into a
60-bed, Rs. 600 million hospital, under Chairman Samy and Director Dr. S.
Keshavarajah, committed to meeting the health-care needs, over a broad spectrum
of specialties, of the people.
“The NCH has committed its
state-of-the-art operating theatres and also four Intensive
Care Unit (ICU) beds and 10
ward beds to the OHF,” says Dr. Perumalpillai.
And so it was that last
Sunday, Dr. Perumalpillai’s quest saw fruition, with the first needy patient
going under the scalpel. “We closed a large 2.4cm x 2.8cm hole in the heart of
Archana,” he explains.
Pointing out that though more
and more such atrial septal defects (ASDs) can now be closed with a device sans
an operation, he said that after close consultations with cardiologists it was
decided that surgical closure was the better option in this case.
This decision was taken as a team, after Consultant Cardiologists Dr. Poopalan
Lakshman and Dr. Mahesan Guruparan and Consultant Paediatric Cardiologist Dr.
I.R. Ragunathan performed a transesophageal echocardiogram where Dr.
Perumalpillai was also present, the Sunday Times learns.
“The three-hour surgery involved placing Archana on cardiopulmonary bypass or
the heart-lung machine. Following the closure of the ASD, she was easily weaned
off the machine and has made an uneventful recovery. She is expected to be
discharged this weekend,” said Dr. Perumalpillai.
Archana’s is also not just a
one-off open-heart surgery. When the Sunday Times visited the NCH on
Wednesday, preparations were underway for two more surgeries within the week –
one on Thursday (July 10) and the other over this weekend.
Like Archana, but older is
35-year-old S. Nirmala from Kilinochchi. On Thursday she had open-heart
surgery for the closure of a hole in the heart, while the third patient, a
male, will undergo coronary artery bypass graft (CABG) surgery over the
weekend.
When the Sunday Times visited
Archana to say goodbye to her before leaving for Colombo, she is all smiles,
having been moved from the ICU to the ward. Soon it will be back to school for
her with a clear idea of what she hopes to achieve in life. “I want to be a
teacher,” says Archana shyly.
A heart surgeon who was on the
team which operated on her is also in her room, having brought her a small
packet of jujubes that he had saved from his flight up to Jaffna.
Overcome by emotion, as
Archana’s grandmother holds his hands in her own, it is evident that not only
the surgery but also this tiny gesture on the part of the heart surgeon has
gone a long way to prove that OHF cares and cares deeply.
It is a gesture straight from
the heart to the hapless heart patients of the area.
The surgical team which
performed the open-heart surgery in Jaffna this week comprised Dr. Kumaradasan
Gnanakanthan, Dr. Nagaratnam Sriskantharajah, Dr. Ravi Perumalpillai and Dr.
Nihal Kulatilake.
The perfusion team consisted
of Kamal Gunasekera and Pratheesh Maheswaran and the anaesthetic team Dr.
Sundaralingam Premakrishna and Dr. Arulmoli Janaki and Nurses Ramachandran
Neruka and Mayoori Theepan.
The theatre team included
Nurses Vijeyabaskaran Vimalathevi and Ariot Sivasubramaniam and ‘runners’
Karunakaran Mary Powstina and Piraveena Sinnarasa, while the post-op care was
by the ICU team, Niroja Puvanenthiran and Jegatha Sivakumar. The support staff
included Vijaya Kumar, Jaya Theepan, Boniface Maria Jeyarose and Swenthini
Jude.
The team from Oxford which
facilitated the surgery consisted of Consultant Anaesthetist Dr. David Pigott,
Specialist Registrar in Cardiothoracic Surgery, Dr. Sajiram Sarvananthan,
Theatre Sister Angela Grantham, Anaesthetic Sister Louise Wilkins and ICU
Sisters Shirley Janus and Wendy Allen.
Give your mite and
save a life
The OHF is registered as a
charitable trust in Sri Lanka and a charity company in the United Kingdom.
Please show you have a heart and save a life.
In Sri Lanka — donate by direct bank transfer to:
- Hatton National Bank Plc. Head Office Branch, 479, T.B. Jayah Mawatha,
Colombo 10, Sri Lanka.
Account Name: OXONIAN HEART
FOUNDATION
Account No: 003010497806, Swift Code: HBLILKLX
- Amana Bank, 480, Galle Road, Colombo 3, Sri Lanka.
Account Name: OXONIAN HEART
FOUNDATION
Account No: 010-0170533-001, Swift Code: AMNALKLX
Abroad — donate by direct bank transfer to:
- HSBC, UK Bank Account, 65 Cornmarket Street, Oxford, OX1 3HY, UK.
International Bank Account No:
GB05MIDL40353403859908
Branch Identifier Code: MIDLGB2108P
Account Name: OXONIAN HEART
FOUNDATION
Account No: 03859916, Sort Code:
40 35 34
Cheques drawn in favour of the Oxonian Heart Foundation may be sent to:
- Dr. Ravi Perumalpillai (Chairman), 10/1 No. 4, Alfred House Gdns, Colombo 3,
Sri Lanka.
- Mr. Ananda Atukorala (Treasurer), 42/3, Horton Place, Colombo 7, Sri Lanka.
OHF forms
committee to select patients for free surgery
The Oxonian Heart Foundation
(OHF) is setting up a committee of clinicians, social workers and members of
the community such as local teachers who will select the patients for free
heart surgery at the private Northern Central Hospital (NCH).
“The operations for 20% of all
patients who undergo heart surgery at the NCH would be performed free of
charge, after strict evaluation of their economic status,” said Dr. Ravi
Perumalpillai, adding that they are drawing up a pro-forma for the eligibility
criteria.
The operations would be mainly
for adults and some older children with simple congenital heart disease, it is
learnt.
When asked whether the OHF’s
target of US$ 2 million had been achieved, Dr. Perumalpillai said they had
raised some funds but it was a “long way short of our aim”.
However, the OHF Board which
comprises eminent people drawn from all communities — Sinhalese, Tamils and
Muslims — decided in January 2014 that using the funds available currently, a
limited programme would be carried out in the first instance.
“Our numbers in the coming months would reflect the
funds available,” says Dr. Perumalpillai, adding that they hope to carry out
about 70 procedures in the next 12 months.
