Open Heart Surgery in Jaffna

Muttuvelu Maheswaran	11:00 AM (18 hours ago)

Sri Lanka

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

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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.

For more information please access http://www.oxonianhf.com/ or email: chairman@oxonianhf.com or phone: +44-7850730203 (UK) or +94-778573717
(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.