A 50-year old Afghan citizen Shadaab, with limited means, was diagnosed with a defective heart when a tertiary centre in India conducted a cardiac screening camp in Kabul. He needed a pacemaker and Shadaab, who owned a small farm in Kabul and was the sole earning member of his family, managed to reach Delhi, after he had tried for treatment but in vain in both Kabul and Lahore. In Delhi he was shunted from one medical facility to another but he found the cost of treatment prohibitive and no benefactor to help him. Soon he ran out of money.
“The desperate man was told by some kabuliwallas in Delhi to go to Kolkata as they had heard that patients with limited means were getting free heart procedures done in that region. In Kolkata, he heard that there was a doctor in Jamshedpur who was helping heart patients, and one fine day he landed up in my home,” recalls Dr Vijaya Bharat, a cardiologist and member of RC Jamshedpur, RID 3250. She has been helping fix pacemakers, for 17 years, at a very nominal cost associated with only hospitalisation and medicines at the Tata Main Hospital in Jamshedpur.
She examined him and found that he had a heart problem with a lower heart beat and required a pacemaker. She told him that he could be cured by placing a pacemaker for his heart to beat at the required rate. “Jab maine kaha ki pacemaker laga degey, toh usne kaha Madam paise aur visa dono khatam honewale hei (Both my money and visa are running out). So I told him don’t worry about the money, just get your visa extended and return here.”
With a low heartbeat, a person cannot do any normal activity and will feel very tired. So in order to keep such a person’s heart beating at a normal pace, we need to put in a pacemaker.
At this point, Shadaab went on his knees on the ground under the open sky, and looking up started screaming in an Afghan language that she couldn’t understand. Thinking he was worried about the pain the intervention would cause, she tried to comfort him by saying there would be no pain as anaesthesia would be used, etc. Imagine her astonishment when he said: “I am not scared, I am praying for you as you are the first person who has said you’ll help me and I can get cured.”
He returned after extending his visa, the pacemaker was placed and he went home a happy and healthy man.
Shadaab was the 99th man to receive a Rotary pacemaker; till date RC Jamshedpur has helped in the placement of 222 pacemakers. The story of the Rotary pacemaker begins in 2004 when Dr Vijaya was not even a Rotarian and only a Rotary Ann, with her husband Ramachandra Bharat being a past governor and member of RC Jamshedpur. Working as a cardiologist at the Tata Main Hospital in Tatanagar, Jamshedpur, she came across Anjali Das, a 65-year-old woman, the wife of a retired school teacher, who used to lose consciousness often. She had a problem in the electrical circuit within her heart known as Complete Heart Block (CHB). The solution lay in implanting a pacemaker in her chest. But the poor school teacher could not afford the cost and he helplessly watched his wife getting fainting episodes. “Das would come to my hospital every other day and say desperately ‘Madam meri patni ko bachaney ke liye aap kuch karo’ (Do something to save my wife). She needed a pacemaker, for which her husband had no money.
So one December evening in 2004, Dr Vijaya did a google search on “pacemakers for poor patients”, and literally struck a jackpot. Co-incidentally, around that time, after returning from the incoming district governors’ training in the US, Ronald D’Costa from RID 3250, and also a member of RC Jamshedpur, was excited about doing a project to give pacemakers to needy patients. One of the answers that google threw up was about Heart Beat International (HBI), US, which supplies pacemakers all over the world through Rotary club initiated pacemaker banks.
She now remembered that at one of her husband’s club’s board meetings, DG Ronald D’Costa “had said that during his governors’ training in US he had learnt about a project which gives pacemakers to poor patients. I didn’t know much about it then, but when google threw up HBI, the two pieces of information clicked,” says Dr Vijaya.
Das would come to my hospital every other day and say desperately ‘Madam meri patni ko bachaney ke liye aap kuch karo’. She needed a pacemaker, for which her husband had no money.
When good is destined to happen, everything falls into place. She immediately wrote to HBI, a Florida-based organisation, that had developed a system of routing new pacemakers donated by the best-in-class manufacturers to Pacemaker Banks established by Rotary clubs across the world. RC Jamshedpur swung into action and fulfilled the formalities for accrediting Dr Vijaya as the implant physician and Tata Main Hospital as the implantation centre. Thus the 42nd Pacemaker Bank in the world and the fifth in India was established in December 2004.
Club member K N Venkat came forward to pay the first annual membership fee of $4,200 to HBI on the occasion of his son’s 40th birthday. Soon a carton of new pacemakers was shipped from the US to Jamshedpur, “and the first beneficiary was Anjali Das,” beams the cardiologist, adding, “since then, no poor patient in need of a life-saving pacemaker has been turned away from the Tata hospital.” Initially a spouse, she later became a Rotarian and joined RC Jamshedpur.
Giving details for the lay person on when a pacemaker is needed, the doctor says “there are people with a very low heartbeat, such as 40 beats a minute, (against a normal of 60–90 heartbeats a minute), and even that can stop suddenly. With such a low heartbeat, the person cannot do any normal activity and will feel very tired. So in order to keep such a person’s heart beating at a normal pace, we need to put in a pacemaker.”
The procedure to implant a pacemaker takes around 30 minutes and it is placed after making a two-inch incision below the collar bone on the right or left side of the chest as required. “From there we pass a small wire into the heart chamber and connect that wire to the pacemaker which is a small lithium battery-operated electronic device,” she explains. With continuous improvement in technology, the current single chamber pacemaker weighs just 15gm and dual chamber one, 19gm. The cost ranges between ₹55,000 (single chamber) to ₹1.2 lakh (for double chamber).
The cardiologist says that once a pacemaker has been implanted the improvement in the condition of the patient is dramatic. Apart from the pacemaker charges, the hospitalisation and medicines can cost between ₹5,000 to 10,000. “In 2018, I retired as the HoD from the Cardiology department of the Tata Main Hospital but I know that in cases where very poor patients can’t afford even ₹5,000 or so, Tata Steel waives off the operation or hospital charges.” She is now a consultant and works for this cause through her club’s pacemaker committee.
She has convinced her successor at the Tata Main Hospital, Dr Mandar Shah, to join Rotary as a member of her club; he is now the chairperson of the club’s pacemaker committee and continues the work of placing Rotary pacemakers in needy patients at the Tata hospital in Jamshedpur.
Actress Vidya Balan, while presenting an award to Dr Vijaya Bharat, said that if ever a movie was made of the project, she would love to act in it!
From 2004 to 2014, HBI used to send big cartons with the pacemakers and the customs duty was negligible, but after 2014, “due to changes in government policies, the import of donated devices became cumbersome and incurred additional duty. The pacemaker committee of our club worked upon an alternative. A corpus was made with the annual donations from Rtn N L Rungta, a member of RC Chaibasa, which was used to buy pacemakers for needy patients. Thus the project to keep diseased hearts ticking continued without any interruption,” says Dr Vijaya.
She adds that only the previous day she got a letter from Rungta saying that since a new Rotary year has started, he will soon be sending the annual fund of ₹6 lakh for the coming year. That will enable the pacemaker committee to help another nine patients.
She adds that for Rungta’s annual contribu-tion PRID Kamal Sanghvi is responsible. “He visited Jamshedpur several years ago and after interacting with a few of our beneficiaries, promised to keep the project alive. He impressed upon a benevolent Rotarian in Chaibasa to donate the annual fee on a permanent basis. That Rotarian is Rungta!”
She adds that PRIP Shekhar Mehta was so impressed by this project that he has referred several patients requiring pacemakers to the Jamshedpur club. The beneficiaries come not only from all corners of District 3250 (Bihar and Jharkhand) but also from the neighbouring states of Odisha and West Bengal.
Each of the 222 beneficiaries from March 2005 till June 2022 has an interesting story to tell of which two, including that of Shadaab, are exceptional. The youngest recipient of the Rotary pacemaker was a poor 22-year-old tribal woman, Dosma Liyangi, who was detected with a heart deficiency during her first pregnancy, requiring a pacemaker. Though that pregnancy ended in a miscarriage, after getting a dual chamber pacemaker implanted, she is now leading a normal life and has two healthy children through subsequent pregnancies.
Though she has retired from the Tata hospital, she works closely with the new cardiologist Dr Mandar Shah. In her private practice she gets a lot of poor heart patients from Bihar and Jharkhand and those requiring a pacemaker are referred to Dr Shah at the Tata hospital.
When a needy person who had received our pacemaker required a new one, I got goosebumps when he turned down a free pacemaker saying that he could now afford to pay for the second device.
In the normal course pacemaker batteries last for 10 years, so some of the earlier patients’ batteries are now getting ineffective, and they need a second pacemaker, and 12 earlier recipients have already had their devices replaced through Rotary.
What is most heartening is that some of the patients, whose financial status has improved over the last 10 years, have turned down a free pacemaker and are paying for it. Dr Vijaya recalls, “When a needy person who had received our pacemaker required a new one, I got goosebumps when he turned down a free pacemaker saying that his children had now grown up and in good jobs and he could afford to pay for the second device. Madam, he told me, with this money please help someone else.” She adds that poor people requiring a pacemaker can be referred to her club which can be reached at email@example.com.
Who knows if this project might at some point turn into a Bollywood film? Dr Vijaya recalls that in 2018 when she was given an award for the pacemaker project (Advantage Woman Award) by ICICI Bank, while presenting her the award, actress Vidya Balan said that the recipients’ stories were remarkable as was the project, and if ever a movie was made of it, she would love to act in it!