There’s a different mindset in Mumbai. “I have never seen so much philanthropy anywhere else in India. No doubt it’s a rich city but it’s also a city with a heart to do something significant, provided the cause is the right one.”
It is a grateful Dr Suresh Rao, Paediatric Heart Surgeon and chief of the Children’s Heart Centre at the plush multispecialty Kokilaben Dhirubhai Ambani Hospital (KDAH) in Mumbai, and a veteran of at least 12,000 paediatric heart surgeries, who articulates his views on India’s commercial capital. He has been operating on children with heart diseases for almost 25 years, having worked in Chennai, Kochi earlier.
It is easy to do a coronary bypass surgery; you can make tons of money if you are good, but this is a different ball game.
– Dr Suresh Rao
For a service-minded medical specialist who can save lives irrespective of the class of the patient, what better boon than a partnership with Rotary, “an international organisation with tremendous credibility”, that enables him to save the lives of children who otherwise lack the means to get quality medical care at such a hospital.
When Dr Rao calls Mumbai “a city with a heart” he is not exaggerating. “What is really heartening is that you have two children next to each other, one is from a wealthy family and the other one is poor. All of them get the same treatment; the same ICU, the same ward and the same medical expertise. And sometimes, at the time of discharge, the grateful parents want to sponsor another poor child,” he says. So he now has a dozen families who have told him that when a needy child comes along “give us a call and we will organise the funds.”
A District project
District 3141 DG Gopal Rai Mandhania explains that till now different clubs in Mumbai were helping children with congenital heart projects undergo surgery. But now it has become a District project. “This being the Centennial year of The Rotary Foundation we have taken up many mega projects, but the biggest one is paediatric heart surgery, where even a few days old children are operated.”
For the Centennial year of TRF, we’ve taken up many mega projects, but the biggest one is paediatric heart surgery, where even a few days old children are operated.
– DG Gopal Rai Mandhania
Since this project concerns mending of little hearts, appeal for funds invariably hit home. “For instance, the other day, at a meet of RC Bombay Seaface, along with PP Pankaj Parikh, I made an emotional appeal for Paediatric heart surgery and we instantly received an initial commitment for 20 surgeries at Rs 25,000 for every child.”
He says every day a couple of kids receiving treatment at KDAH are sponsored by Rotary. “But the day I visit it, there are as many as 13 “Rotary” children there; at the OT, ICU and the ward,” points out Natasha Sejpal, wife of Parth Sejpal, charter president of RC Mumbai Lakers, who is passionately involved with D 3141’s Little Hearts project.
Natasha’s story is as interesting as inspiring. She is not a Rotarian, but passionate about social work. When Dr Rao was working at the Amrita Institute of Medical Sciences in Kochi, “we’d get many paediatric surgery cases from Maharashtra and Gujarat. Instead of making them come to us for follow up, we held two camps every year in Mumbai to examine the children.”
Natasha volunteered at such camps to guide the mothers. “One day Dr Rao said Rotary has taken up this project, why don’t you join?” With her husband Parth being an ardent Rotarian, she took the plunge.
The KDAH was started in 2009 and within six months Dr Rao joined its centre for heart care, and since then “I have been coming here every alternate day from 11 am to 5.30 pm,” says Natasha. She talks to the parents, and arranges funds through her Rotarian and other friends. Natasha admits that “money was a bit of a problem till last year, but now that Rotarians of the District are wholeheartedly involved and DG Mandhania has taken up this cause, money is coming in. He says his thrust area was diabetes but nobody wants to give money for diabetes now; you’re taking away all the money for the children,” she grins.
Two children sponsored by Rotary have stayed for three months, but the hospital hasn’t asked us for any more money.
– Natasha Sejpal
Mandhania adds that the District’s target is to help the healing of at least 300 little hearts through surgery, “but looking at the momentum it appears as though we may even go up to 500. Each surgery costs between Rs 1.75 to 2.25 lakh which we are meeting from various sources.” Thanks to an MoU with the Hospital, Rotarians get a discounted package between Rs 1.75 lakh and Rs 2.25 lakh. Funds are available through one or two global grants, the DG allotting District funds, the CM’s fund and temples such as the Siddhi Vinayak and Mahalakshmi temples, and organisations such as the Agarwal Samaj. Lalit Grover from RC Bombay Hanging Garden, who is the Managing Trustee of Manav Seva Sanstha has agreed to give Rs 5 lakh for these surgeries.
The patients are identified through camps in smaller towns. “We are extremely lucky in having Natasha and Rtn Khuzem Sakarwala from RC Mumbai Green City, both dedicated to this project. They have a personal rapport with the parents and our success rate is about 98 per cent. We also organise paediatric surgeries for poor children in the Wockhardt and Holy Family Hospitals. RC Bombay alone has promised 100 operations,” says the DG.
Sakarwala adds that a single Rotarian, Shamim Botawala from RC Mumbai Green City, who runs an orphanage in Mahim with 80 children and a school in Surat, has also given Rs 27.5 lakh for the Little Hearts project.
Paediatric heart surgery is a little different; compared to any other branch of surgery, we reconstruct, we do not take out anything such as a growth or tumour.
– Dr Suresh Rao
Paediatric surgery in India
Both Dr Rao and children’s heart surgery specialty have had a “long, arduous but joyful journey in India”. Working with Dr K M Cherian in Chennai for 11 years, he moved to Kochi to set up the heart centre at the Amrita Institute. In 2009, six months after the KDAH was started, he returned to Mumbai, where he did his medical schooling. “Children from Mumbai and Gujarat came to Kochi for heart surgery and the KDAH management gave me and my team an opportunity to save lives. But this specialty requires full time care and management, so we are not visiting but whole time doctors here.”
What Dr Rao enjoys the most here is helping the poorest of poor children. “When we started there was no comprehensive paediatric programme in Mumbai, and our Chairperson Tina Ambani has made it clear that no child should be turned away for want of money,” explains Dr Santosh Shetty, Executive Director. Heart operations on children are done here on a package basis, the highest is Rs 4 lakh but the average is between Rs 1.75 lakh to Rs 2.35 lakh, with Rotary getting the Rs 1.75 lakh package at a subsidised rate of Rs 1.3 lakh.
Being a non-profit hospital and a CSR venture of the Reliance ADA Group, it is able to offer affordable specialised care. “The package includes everything from admission to discharge. The average stay of a patient is 10 days, but if there is a complication, and the child has to stay for three weeks or even more, no questions are asked. And, of those three weeks, if two are spent in the ICU, it’s okay. “Congenital heart surgery can overrun prescribed costs like crazy, not only here but the world over. But once the parents have organised the package money, either themselves or through NGOs such as Rotary, not a single extra rupee is charged. That makes a lot of difference in the quality of care and gives confidence to the parents about best treatment irrespective of complications or length of stay,” says Dr Rao.
Our Chairperson Tina Ambani has made it clear that no child should be turned away for want of money.
– Dr Santosh Shetty
He adds that if a child has to stay for a month, the bill can go up to Rs 20 lakh, but the cost is absorbed by the management. Natasha adds quietly, “We’ve had two Rotary kids staying for three months. But I didn’t get any phone calls for more money. Today a father called me and said: ‘I hope they won’t ask me for more money.’”
Later, when I walk around the ward, Bhavika Patel, an anxious mother from Surat, whose family owns a textile mill, says her baby had completed one month’s stay, but her package of Rs 3 lakh held good. No more money was demanded.
Dr Rao says that unlike other private hospitals where a deposit has to be paid first, “here there is a blanket mandate from the management that even if the child needs ICU care, administer that, stabilise it, and then think about the money. If surgery is needed, we approach Natasha and she helps. If I can’t reach Natasha, our social work department steps in. The most painful thing for a doctor is his inability to give his expertise because of financial considerations.”
The ratio of poor to rich children getting specialised cardiac care here is 60:40, but sometimes it goes up to 70:30 in favour of poor children. “For me, as a doctor, it gives a sense of fulfilment. It is easy to do a coronary bypass surgery; you can make tons of money if you are good, but this is a different ball game. The challenge here is to make a difference in an entire family’s life and to develop this specialty for which there is a huge need in this country. Dr Cherian planted the seeds and we have today come to a level where we more or less match the European and American centres of excellence.”
Congenital heart surgery can overrun prescribed costs like crazy, not only here but the world over.
– Dr Suresh Rao
When it comes to hardware, the poorest of children admitted here by Rotary, or others, get the best treatment, along with medical and surgical care. “We’ve had visitors from Boston Children’s Hospital and UK and other places; they are envious of our facilities… particiulary those from UK hospitals,” adds Dr Rao.
On the main challenges this specialty has faced as it developed in India, Dr Rao says, “When we started, when the specialty was crystallising in India, we saw the bigger children who had survived congenital heart problems.” As the surgeons got more expertise and parents and paediatricians more awareness, and ultra sound imaging came in, cardiology matured. “We now operate on newborns; the youngest I have done here is a 12-hour baby.” The problem was a wrong connection, the child, an extremely blue baby, born in another hospital had crashed. It was rushed to KDAH; “we tried to stabilise the baby, did not succeed and did the surgery to fix the problem. The child is now doing well,” smiles the cardiac surgeon.
We showed the film on Little Hearts at our PETS conference, and in 30 minutes we got a commitment for 250–300 surgeries.
– Gopal Rai Mandhania
The other problem in India is that many of the children coming to him are malnourished and low birth weight babies… with the average weight of the child his team operates on being a mere 3.9 kg. “Paediatric heart surgery is a little different for the simple reason that compared to any other branch of surgery, we reconstruct using tissues, we do not take out anything such as a tumour.”
The Rotary experience
Dr Rao has been associated with Rotarians from his Kochi days; “I am aware of the enthusiasm and passion with which Rotarians work. Once they take up something, they see it through. Even earlier some Rotary clubs in Mumbai were providing monetary assistance to children from poor families, but once the seed was sown by Natasha, the entire District has now taken up this project, and now I think it is going to be an explosion.”
Thanks to Sakarwala, who got his filmmaker friend Adi Pocha to make a moving short film on this project, where several parents spoke, Little Hearts has got a shot in the arm. “We showed it at our PETS conference, where RI Director Manoj Desai was present, and in 30 minutes we got a commitment for 250–300 surgeries,” says Mandhania.
Going around the ward with the Rotarians and Dr Rao, I see children hooked on all kinds of tubes and monitors, battling for life. There is a 12-day-old baby who is really tiny, there is a three-month-old, a child from Kyrgyzstan, 8-year-old Shrutika Kamble, other children from Surat, Mumbai etc. The worry on the mothers’ faces is palpable, but the gratitude for Dr Rao and the Rotarians cannot be expressed in words.
But once the child is fine, gratitude is profuse. Anmol Sharma, who works as peon with a Rotarian and whose daughter Ananya underwent a surgery wrote: “It is because of people like you that families like mine are able to survive in this world. I don’t know how to thank you.”
Pictures by Rasheeda Bhagat
When a girl baby’s heart is undervalued
The most common congenital heart problems are babies born with wrong connections for which an arterial switch operation has to be done. The other common emergency is when blood flowing from the lungs back to the heart is obstructed; hole in the heart and defective valves are other problems. “These children we’ve taken up Saturday or Sunday, day or night. Of late we get kids with dengue fever who have to be put on life support systems.”
On an average each procedure takes about 5–6 hours, and most of them are open heart surgeries.
It is heart-breaking to hear Dr Rao describe how many families with limited means are reluctant to get a girl child with a heart problem operated. “Often the husband’s family doesn’t support treatment for the girl child, but the parents, specially the mother, move heaven and earth to find the resources,” he says.
Once the surgery is successful, the mother breaks down and confides in the doctor while thanking him how the entire family was against the operation. “I’ve had instances where the mother has given consent and the father has walked off, only returning when the child does well. It is such gratitude that keeps us going,” adds Dr Rao.
Virendra Widge, Special Aide to the DG, says recently, the Rotarians who had helped surgery for a 22-day-old baby were overwhelmed “when the parents asked us to name the child. It was so touching. In another case, sponsored by our club for a girl child called Tanu, the father wept after the surgery and said but for you people my child would have died.”