June 2016

Advancements Come With a Cost, But Save Lives

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Vanita-Arora

Dr Vanita Arora, Associate Director & Head Cardiac Electrophysiology lab & Arrhythmia Services, Sr. Consultant Cardiac Electrophysiologist & Interventional Cardiologist, Max Super Speciality Hospital, Saket & Patparganj, New Delhi

I believe future technologies will help us to take our success rate close to 100 per cent and to reduce procedure time to do more in less time, shares Dr Vanita Arora, Associate Director & Head Cardiac Electrophysiology lab & Arrhythmia Services, Sr. Consultant Cardiac Electrophysiologist & Interventional Cardiologist, Max Super Speciality Hospital, Saket & Patparganj, New Delhi to Elets News Network (ENN)

How difficult it was for you to break into the till now believed to be male-dominated field of cardiology? What are your recommendations for women aspiring to enter this segment of healthcare?

In 1985, at the age of 17, I left home for MBBS to stay in a hostel at Dayanand Medical College (DMC), Ludhiana and after that there has been no looking back. I completed Doctor of Medicine (MD) (Internal Medicine) from DMC in an era when females only opted for ‘Gynaecology’ or ‘Eye’ or ‘Skin’. Not many male peers had high hopes on my capabilities, but I surprised them with my hard work and intellect. However, I was discriminated by my male colleagues, just because I was a hard working “Female” doctor with brains.

I became the first lady electrophysiologist of the country and am addressing with passion the heart failure and heat beat problems of the patients for more than 20 years. I joined Max Super Speciality Hospital in 2009 as the head of Department of Cardiac Electrophysiology. Now, I am the director of the same department. However, the “Bias” against me as a headstrong female surviving in a man’s world of cardiology still persists.

I thank to God for giving me both troubles and strength to fight back. This made me what I am today, i.e. independent and tough. I attribute my success to my sheer hard work and ‘never give up’ attitude in this man-dominated world. I have made the mountain from the stones thrown at me and that has made me scale towards the goal. I refuse to be deterred by these stones, instead choose to rise above them. My family and friends have been my backbone in this climb, and they have never let me down.

Young women who are aspiring to become electrophysiologists should adopt my attitude to rise above all to be victorious and achieve a good position in their career. Just remember “No one can make you feel inferior without your consent”.

It is quite interesting to note that you run a blog to spread awareness on the key issues of cardiac diseases. Please describe in detail other platforms, workshops and activities through which you communicate on cardiac issues.

I conduct regular continuing medical education (CME) workshops, teaching courses, health camps and patient advocacy programmes to spread awareness regarding electrocardiogram (ECG) tests, arrhythmias (misbehaving heart beats), sudden cardiac death, heart failure, etc., some of the most dreadful and debilitating aspects of cardiac diseases in which physicians and patients lack awareness. I believe the most challenging aspect is developing awareness amongst physicians and patients about problems of heart beat and their treatment being available with a good success rate.

What kind of technological, both hardware and software, solutions are emerging to help cardiac care providers and negotiate their way through a healthcare environment that’s increasingly competitive, costconscious and challenging?

I am constantly motivated to learn new developments on technology and research which benefit the patients. I believe these future technologies will help us to take our success rate close to 100 per cent and to reduce procedure time to do more in less time.

I laid the inception of treating challenging complex arrhythmias (misbehaving heart beats) in the country by starting the threedimensional (3D) mapping programme at first in Fortis Escorts Heart Institute and then in Max Hospital. There are still very few operators of 3D mapping in our country. As such software advancement keeps happening every year, but 3D mapping system is the latest technological hardware advancement in the management of arrhythmias. Some of the challenging arrhythmias are the major cause of stroke (clot in the brain) in patients, and treating these arrhythmias using 3D mapping can prevent stroke. 3D mapping has given us the confidence to challenge life-threatening arrhythmias and save lives. We create the geometry of upper and lower chambers of the heart in real time and search the site of generations of electrical short circuits in the heart and then ablate them with a good success rate.

The advanced treatment for the heart failure patients in term of Device Therapy (COMBO Device) improves heart function and prevents ‘sudden cardiac death’. These implants are being successfully performed by me at Max Hospital, with hundreds of patients benefiting from it. Newer devices with latest algorithms and magnetic resonance imaging (MRI) compatibility have been the latest technological advancements.

These advancements come with a cost, but then they save lives. What is a cost of Life? This question should be left to the individual patient to decide. What I can insist on is that everyone should take health insurance. Paying for the premium of health insurance should be taken as part of package. It makes life easy in case of any eventuality or urgent requirement.

Good work never goes unnoticed. If you do your work well and give good outcomes to the patient, then the results travel by word of mouth and good will is spread by patients amongst the public. Competition doesn’t matter if your patient confidence is with you.

What are the key challenges in incorporating these new technologies in the Indian healthcare system? What kind of changes need to be undertaken by both cardiologists and medical facilities to adopt such technological innovations?

These new technologies are costly and require specific training. A corporate set-up is required to make these technologies available to the patients, but more than this proper training of the cardiologists is required prior to trying new technologies on the patients.

There is a lack of proper training institute in our country for ‘cardiac electrophysiology’, and there is a time period of at least 2 years required to get trained in this field. The young generation tends to take short cuts for this training and wants to start practicing these procedures without getting properly trained. These compromised skills result in poor outcome of the patients.

Top Advancements

  • 3D mapping has given us the confidence to challenge lifethreatening arrhythmias and save lives
  • Newer devices with latest algorithms and MRI compatibility

I insist on proper training of cardiologists in cardiac electrophysiology, so that there is growth of technology in our country. From past 3 years, I am running a Fellowship in Cardiac Electrophysiology programme, where we take one fellow every year to train them in electrophysiology for a period of 1 year. I know it is just the beginning, but then we have to start somewhere. I insist on initiation of more such programmes.

As a cardiac surgeon what kind of infrastructural and manpower challenges you witness in both urban and rural areas? Are enough training programmes being designed to upgrade the skills of the nursing staff and physician assistants?

If you need good outcome, you need good working hands. Infection is a big challenge in my field, as I implant expensive devices which play havoc with our patients in case there is even 1 per cent chance of infection. Rural areas are compromised in this aspect of maintenance of sterility.

Availability of trained nurses is a big challenge nowadays. It is a known fact that our good nursing skills are being drained to other countries, such as the United States (US), United Kingdom (UK), Saudi Arabia and South Africa, only because of the huge difference in the pay package. More depressing is the thought that we are not doing anything to stop this.

Same stands true for the trained assistants of physicians.

We should do good reforms in the pay package to stop India from losing the trained staff that forms the backbone of a good department.

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