(TRAINING & RESEARCH)INTERNATIONAL CENTER FOR CARDIO THORACIC & VASCULAR DISEASES

ST. GREGORIOS CARDIO-VASCULAR CENTER

Functioning from St. Gregorios Mission Hospital, Parumala Sponsored by Frontier Lifeline Pvt. Ltd., Chennai Promoted by Dr. K. M. Cherian

+ 91 479 2310664, 2310665 - Fax + 91 479 2311008

Email: sgcvc@rediffmail.com Website: www.frontierlifeline.com

“I am happy to find that a high technology Cardio Thoracic and Vascular Diseases Centre has been created in a remote Panchayat (Parumala) in Kerala which is a dream for every rural Indian.” His Excellency, President Dr. A. P. J. Abdul Kalam December 18th, 2005

“The state-of-the-art hospital at Parumala under the leadership of Dr. Cherian, is carrying out valuable research in tissue culture for heart valves and is also performing heart operations. It is a hi-tech hospital in a rural setting. It is indeed noteworthy.”

His Excellency, President Dr. A. P. J. Abdul Kalam December 20th, 2006

Our vision Chairman’s Message

A Tertiary cardiac care unit, such as St. Gregorios Cardio – Vascular Centre, attached to the St. Gregorios Mission Hospital has been a bold step in our endeavor to deliver Health Care in a village atmosphere for the needy and poor.

This unit was inaugurated on 15.2.2004 by Shri A.K. Antony, Hon’ble Chief Minister of Kerala. We had the unique privilege of having His Excellency, President of India, to inaugurate our rural Telemedicine connectivity as well as the International Children’s Heart Camp Scheme. It has been a most satisfying experience for us that the President had acknowledged and appreciated this fact in his speech delivered during his Republic Day message to the nation.

We had the distinction of treating patients from Iraq, Pakistan and Kenya in this small village ushering in the concept of Medical Tourism.

Her Excellency Varshine Jagdeo, the First Lady of Guyana visited this unit and has shown keen interest in sending children from Guyana for treatment here.

The number of diagnostic and interventional procedures in cardiology has been increasing day by day. We also have the distinction of giving surgical treatment both for pediatric and adult population, where the results have been comparable to the best results in any other international unit.

We also have initiated many innovative procedures such as Tissue Engineered valves and training programs in cardio vascular technology, EECP, etc.

To help and serve the needy and poor rural population, the charges for all the procedures here have been subsidized to an extent where it is affordable to all and is one of the cheapest available in any private hospital in this country.

We are sure that with all our commitments to serve the poor and needy, this private venture will be totally different in a world where “Healthcare has become an Industry, but care of the sick is not an Industry”.

INTRODUCTION Parumala is a small village with a population of 8,300 in Pathanamthitta district of Kerala State, situated on the banks of river Pampa, which originates from the abode of Lord Ayyappa. This river is the Ganges of South India.

St. Gregorios is the first canonized Saint for Syrian Christians in India.

St. Gregorios Mission Hospital which is about 35 years old was started in his memory, mainly to serve the poor rural population.

In 2004, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation started a tertiary cardiac care unit by leasing out a portion of this mission hospital.

The population of Parumala village mainly comprises of farmers, fishermen, coir workers and artisans, who are experts in brass work and are famous especially for temple and church bells. The population here comprises of an equal number of Hindus, Christians and Muslims who are living in perfect communal harmony, which is an example for everybody to emulate. The importance of this tertiary cardiac care unit in this village can be assessed in the background of a recent WHO report released on 7th April 2006, which says that India has only 3 primary healthcare workers for a population of 10,000 people. This tertiary cardiac care unit is unique and probably is the only one of its kind in India anywhere around the world.

Majestic elephants

Ducks and their brood on the banks of River Pampa

FACILITIES We have all the modern facilities available for treatment of Cardio Vascular diseases manned by highly skilled dedicated professionals, medical and paramedical staff. Department of Cardiology Adult Cardiology

1 Echocardiography Lab with Doppler facilities, TMT (Treadmill Test) and Holter Monitoring

2 Modern Cath Lab with most recent Electrophysiology Lab (for arrhythmia study)

3 Facilities for Balloon Angioplasty with stenting. Balloon Valvotomy and valvoplasty and Device Closure for Congenital defects (ASD, VSD & PDA)

4 Fully equipped CCU with facilities of temporary and permanent pace makers, Ventilators, IABP, etc.

5 Enhanced External Counter Pulsation ( EECP)

Cardiac Catheterization Laboratory with Electrophysiology Facilities Pediatric Cardiology This unit contains all the facilities to diagnose, investigate and manage the pediatric patients of any age with various complications are available at our center. Department of Cardio Thoracic Surgery & Anaesthesia

Well equipped Cardiac Surgery operation theatre and Post operative ICU

Adult Cardiac Surgery – Coronary Artery Bypass Surgery, Beating Heart Surgery, Valve Repair and Replacement Surgery, Thoracic Surgery, Aortic Aneurysm Surgery

Pediatric Cardiac Surgery – Acyanotic Congenital Heart Diseases (ASD, VSD & PDA), Cyanotic Congenital Heart Diseases (TOF, TGA, DORV, TAPVC, etc.) and other complex congenital diseases.

Vascular Surgery – Thoracic Aorta Aneurysm Surgery, Aortoiliac, Iliofemoral, Femorofemoral Bypass Surgery, Embolectomy etc We have the latest in anesthesia ventilators, heart lung machine and advanced haemodynamic monitoring systems, with state-of-the-art intensive care management facilities including IABP are available.

Cardiac Surgery in progress

Intensive Care Unit Department Of Cardiac Rehabilitation Patients in the Cardiology or Cardiac Surgery, Intensive Care Units or wards, are usually very sick and need not only medicine but a lot of care so as to make them ambulatory and also keep their lungs free from infection. Our department of rehabilitation takes care of all these aspects. They are also advised on how to start their activities at home and also prescribed an exercise program to keep them fit.

Research and Training Program Epidemiological research in the fields of prevalence of rheumatic heart disease in school going children, hypercholestremia in relation to food habits especially coconut oil, incidence of congenital heart disease and other birth defects in relation to the female literacy in the state, especially in a village which is an island, are being undertaken. It is our attempt to train all the able-bodied men and women of this village in the technique of CPR. We envisage the whole population to be trained in this, starting with the auto and taxi drivers, etc. Primary and secondary care delivery will be given to all the students who are undergoing two-year cardiovascular training program so that it will be possible for us to have a different stream of trained personnel to deliver health care in the villages. This is a unique venture like ASHA (Accredited Social Health Activist to supplement healthcare) at different levels, with basic scientific knowledge of the human body and diseases. MILESTONES Inauguration – Our center was formally inaugurated on 15th February 2004, by the Honourable Chief Minister of Kerala, Shri A. K. Antony.

Clinical milestones First Bypass Surgery 27.12.03 First Pediatric Cardiac Surgery 23.12.03 First Angiography 24.01.04 First Pacemaker Implantation 05.05.04

International Pediatric Cardiac Surgery Services and Rural Telemedicine connectivity was inaugurated by His Excellency Dr. A. P. J. Abdul Kalam on December 18, 2005.

Honorable President Dr. A. P. J. Abdul Kalam inaugurating the rural Telemedicine Facility and International Paediatric Cardiac Services

Graphical representation of Admissions - Dec 03 - Mar 06

717

3626

60 6370

6370

101 97103 99

116

80

109

129

115

134136 133

161

111

155

98

363535

020406080

100120140160180

Dec-03Jan-04Feb-04Mar-04Apr-04May-04 Jun-04Jul-04Aug-04Sep-04Oct-04Nov-04Dec-04Jan-05Feb-05Mar-05Apr-05May-05Jun-05Jul-05Aug-05Sep-05Oct-05Nov-05Dec-05Jan-06Feb-06Mar-06

GRAPHICAL REPRESENTATION OF SURGERY - JAN 04 - MAR 06

CABG, 256

ASD, 31

VSD, 11

OPCAB, 1

AVR, 11

MVR, 15ICR, 8

CABGASDVSDOPCABAVRMVRICR

GRAPHICAL REPRESENTATION OF CATH PROCEDURES90

8480 79

70NO. OF CATH PROCEDURES 69656463 63

60 585553 52 52 525050 49

4240 Oc363433 333230

2725 24 242320

1010

0JAN.-

04MAR.-

04MAY.-

04JULY.-

04SEPT.-

04NOV.-

04JAN.-

05MAR.-

05MAY.-

05JULY.-

05SEPT.-

05NOV.-

05Jan-06 Mar-06

MONTH

GRAPHICAL REPRESENTATION OF CATH PROCEDURES -JAN 04 - MAR 06

PTCA, 84

BMV, 5PPI, 43

TPI, 35

Peri Angio, 20

Angio Plasty, 3

BPV, 1

Ceri Angio, 9

Embolectomy, 3

Cath Study, 14

PDA Closure, 1PTCABMVPPITPIPeri AngioAngio PlastyBPVCeri AngioEmbolectomyCath StudyPDA Closure

Visiting Dignitaries

• His Excellency President A. P. J. Abdul Kalam • The First Lady of Guyana • Chief Minister of Kerala

First lady of Guyana paying tribute to Mahatma Gandhi at Parumala Hospital VISITING FOREIGN FACULTY MEMBERS

Cardiac Surgeons & Cardiologists Dr. Rimantas Benetis, Head of the Cardiac Surgery Department, Kaunas Medical

University Clinic, Lithuania

Dr. Eric Hjelms, Sweden

Dr. Robert Karp, Retd Prof of Cardiac Surgery, University of Alabama and Chicago,

USA

Dr. Christina Koch - Paediatric Cardiac Surgeon, Charite University Hospital, Berlin

Dr. Ashok Sharma – Cardiac Surgeon, Wellington, New Zealand

Dr. Simon V Abraham, Indiana Polis, USA

Dr. Natesa Pandian - Tufts University School of Medicine, Boston, USA.

Dr. Rimantas Benetis, Head of the Cardiac Surgery Department, Kaunas Medical

University Clinic, Lithuania at the Inauguration of the Parumala Centre

Dr. Ashok Sharma–Cardiac Surgeon, Wellington, New Zealand with the Parumala

Team

Dr. Natesa G. Pandian, Tufts University School of Medicine, Boston conducting a

workshop “Echo made Easy” on 26th January 2006.

Other Visitors

Dr. Muneer, Honourable PWD Minister of Kerala

Mr. Suresh Gopi, Film Actor

Mr. Jean-Michel Delage, French Photographer who visited for Medical Tourism

ACHIEVEMENTS Total number of patients seen in OPD – 6202

Total number of admissions – 2395

Total number of angiographic & catheterization procedures – 1252

Total number of permanent pacemakers implanted – 40

Total number of device closures – 01

Total number of cardiac surgical procedures – 408

Adult cardiac surgeries - 356

Pediatric cardiac surgeries – 52

Total number of foreign patients operated – Iraq 6 Kenya 2 Pakistan 1

Three Iraqi kids after open heart surgeries with Dr. K. M. Cherian & his team

Mr. Suresh Gopi with Ali Nawaz (Patient from Pakistan) after the heart operation CAMPS We have organized free cardiac camps in nearby villages so as to create awareness

regarding heart disease and to diagnose and treat the patients.

No. of Patients

• Parumala Hospital 22-04-2005 95

• Kurathikadu 30-04-2005 99

• Ochira 14-05-2005 112

• Ambalapuzha 15.06.2005 131

• Edathuva. 15-10-2005 42

• Kottayam, 14-11-2005 59

• Anandapally 19-11-2005 101

• Parakkunnad (near Pathinamthitta) 22-11-2006 73

• Pavukara 06-01-2006 53

• Poovanpara (near Konni) 04-03-2006 92

• Kanyakumari 02-04-2006 193

ACADEMIC ACTIVITIES CME Programmes Interventional Cardiology basic steps – Dr. Tadas, Kaunas Medical University Clinic,

Lithuania – March, 2004

Writing and presenting a scientific paper - Dr Robert Karp, Retd. Prof. of Cardiac

Surgery, University of Alabama and Chicago, USA – October, 2004

Newer Trends in Angioplasty – Dr. Ali Faizal, MIMS - February, 2005 Heart Transplantations – Dr. Madhu Shankar, FLL, Chennai - February, 2005 Off-pump vs. Conventional CABG – Dr. Murali Vittaya, MIMS - February, 2005 A live workshop on off pump CABG was conducted by Dr. B. R. Jegannath and Angioplasty through Radial approach by Dr. Pramod K. Jaiswal, February ,2005. Dr. Natesa G. Pandian, Tufts University School of Medicine, Boston conducted a

workshop “Echo made easy” January, 2006.

International and National Paper Presentations Dr. Saji Philip presented a paper on “Immunological Complications of Vasculitis in swine model – San Diego”, Sep 2005. The following papers were presented at CTCON – 2005 – 51st Annual Conference of the Indian Association of Cardiovascular Thoracic Surgeons, Cochin: Dr. Saji Radhakrishnan presented a paper on “Anamalous origin of the left coronary artery from pulmonary artery in adults”.

Dr. Sumithran presented a paper on “Cardiac surgery in a rural setup: Surgical results in first 100 cases”. Sister Gloria presented a paper on “Management of ICU in rural setup for open heart post operative patients”. Ms. Vilma Fernandez presented a paper on “Organization of open heart theatre in rural set-up”. Dr. Saji Philip presented a paper on “Re-appraisal of LV tendon - True or False?” – Indian Academy of Echocardiography, Bangalore February 2006. Roadmap for Future “A recent study conducted by the Indian Institute of Public Opinion found that 89% of rural Indian patients have to travel about 8 kilometers to access basic medical treatment and the rest have to travel even farther.”

We at St. Gregorios cardiovascular centre, Parumala, are dedicated to provide tertiary level of cardiac care besides basic primary health care at the very doorstep of rural patients. The inspiration stems from the vision of PURA outlined by our beloved Honorable President Dr. A. P. J. Abdul Kalam. PURA as everybody understands is to provide urban amenities in rural areas and we as a medical fraternity under the able leadership of Dr. K. M. Cherian, are playing our role to fulfill it with dedication & diligence. We are also working on the guidelines provided in the National Rural Health Mission, which is the dream project of our Honorable Prime Minister Dr. Manmohan Singh. In future our emphasis will be in following areas –

1) Health education to the local rural population. 2) Preventive cardiology – so as to minimize the incidence of heart diseases and

their subsequent complications. 3) Integration of Ayurveda, Yoga and other local traditional medicines in our

treatment methods utilizing experts in these areas. 4) Health insurance to the farmers, fisherman and other poor people in the area. 5) Organizing camps in nearby villages for creating awareness, diagnosis and

treatment of heart diseases. 6) To reach out to rural population of other states as well as other countries in

providing our expertise in the area of healthcare. 7) To provide our services of health education and consultation to the population

that is not easily approachable through telemedicine facilities. 8) To provide tertiary level of cardiac care at local level so that no villager

suffers due to non availability of it. 9) Research and training programs in tertiary care with rural emphasis and

creation of job opportunities in these fields for youth in villages.

FUTURE PROJECTS

Nation al Medica l B iosc ie n ce P ark

Medica l In formation Tech n ology

Medica l In n ovationUn it e tc .

PROPOSED

Faculty Adult Cardiology Dr. Madhu Paulose MD., DM Dr. Saji Jose, MD., DM Dr. George Kurian MD., DM Pediatric Cardiology Dr. Saji Philip, MBBS. D.Ch, Ph.D (Card), F. Card. Cardiothoracic Surgery Dr. K. M. Cherian, MS, FRACS, DSc (Hon) Dr. Sunil Agarwal, MS, MCh, DNB Dr. Pankaj Kumar Srivastava, MS, MCh Dr. G. Sumithran, MS, MCh Dr. Saji R. MS., MCh Cardiac Anaesthesiology Dr. Thomas Varghese, MD, DA, PDCC. Dr. R. Mahadevan, MD.,

Medical officers Dr. K. G. Suresh, MBBS Dr. Jiji Thomas Varghese, MBBS Nursing

Ms. Kalyani Kumar Sr. Gloria Cardiac Rehabilitation Ms. Feba John Ms. Ashwathy S. Nutrition & Dietetics Ms. Bindu Sebastin Training & Research associate Ms. P. J. Ruth Pastoral Care Rev. Alexander Koodarathil – Executive Director, St. Gregorios Mission Hospital Public Relation officer Ms. Nivy Abraham

Dr. K. M. Cherian along with his team of doctors