By Naomi Gunasekara
Since his posting as Kurunegala's first car-
diologist, life has been a continuous battle
for Dr. K. Rajakanthan, Consultant Cardiologist at the Teaching Hospital Kurunegala. Trained in Angioplasty and Stenting, Dr. Rajakanthan has been forced to forget his expertise as a heart surgeon and treat his patients with general medicine due to lack of facilities at the hospital.
During his four-years at Kurunegala, Dr. Rajakanthan has witnessed thousands of deaths occurring due to inadequate medical facilities.
"There was no cardiology unit when I got here and the patients were treated in the medical wards. Fortunately the director at that time was very cooperative and gave me a small unit," said Dr. Rajakanthan entering his packed cardiology unit, which was once part of the hospital's Bhikku Ward. "We had to fight for this ward and even now when the Bhikku Ward is full they ask for this ward."
The Teaching Hospital Kurunegala is a referral centre for 27 district hospitals including Dambadeniya, Polgahawela, Rideegama, Polpithigama, Hettipola, Wariyapola, Galgamuwa, Alawwa, Mawathagama, Kobeiganae, Narammala, Gokaralla and Katupotha and two base hospitals, Kuliyapitiya and Nikawaratiya. It also serves as a referral centre for super-specialties including complicated cardiac conditions to the adjacent North- Central Province. Patients are transferred to Kurunegala from Anuradhapura, Polonnaruwa, Dambulla, Tricomalee and Vavuniya.
Heart diseases have become the No. 1 killer in the North Western Province, according to Dr. Rajakanthan, who says 40% of the deaths occur due to heart ailments. "Earlier we thought that heart diseases affected only Western countries. That is not true. With urbanisation and industrialisation, heart diseases are becoming more common and severe," he says, advising heart patients to treat heart attacks aggressively and properly in order to save the affected heart muscle. "If you don't treat it properly the muscle will get neglected. Then you will have a big heart attack making your heart weaker and the chances of survival lower."
Aggressive treatment reduces the death rate while reducing other complications as well. "Most heart patients die due to lack of facilities in hospitals and delayed surgery. If they are properly treated in a well equipped cardiology unit the death rate can be reduced remarkably." (Please refer mortality rate box)
The second largest province in Sri Lanka with a population of approximately 2.2 million, Dr. Rajakanthan, says the NWP has over 42,000 patients suffering from coronary heart disease in the Kurunegala district while 350,000 suffer from hypertension. A further 19,000 and 14,000 in Kurunegala suffer from rheumatic valvular disease and heart failure.
Says Dr. Rajakanthan, "Eighty per cent of the patients come from rural areas and cannot afford to seek treatment in Kandy or Colombo. Kandy does not offer surgery; only Colombo has the facilities. The waiting list in Colombo extends to 2013."
"When we send patients with complicated heart diseases to Colombo they are sent back after being given a date in 2010 or 2013. We don't refer patients for surgery unless it is imperative. When they are sent back they die before the date of surgery."
"Although we managed to establish a small unit with 10 beds, two thirds of the patients who seek treatment are refused admission due to lack of space. Of the patients who sought treatment last year, we treated 1,939 and refused admission to 2,669. This is a major problem for us; we have to refuse more often than accept. Even if a patient is admitted we do not keep the patient for more than 48 hours in the cardiac unit.
Realising the gravity of the problem, Dr. Rajakanthan has written to ministers, the President's Fund and other government officials, seeking help. "As far as some officials are concerned a cardiac unit is not a priority. The government has agreed to provide all the equipment but refused to construct the hospital due to lack of funds.
"We realised that we would have to start at some point and selected a site with the help of Save the Heart Society-Wayamba."
The project has been approved by the Ministry of Health and the relevant local authority and will be a six-storey building covering an area of 40,000 square feet. The first three stories will be used for the cardiac unit while the others will be left to accommodate patients. The estimated cost for the construction of the building is over Rs.110 million and the Society has collected nearly 3 million by selling raffle tickets and certificates priced at Rs.1, 000, 500, 200 and 100in areas like Dambulla, Narammala and Polgahawela.
A product of Jaffna University, Dr. Rajakanthan has worked tirelessly to see a well-equipped cardiac unit at the Teaching Hospital Kurunegala.
He hopes to see the ground floor of the proposed hospital constructed by July before he is transferred elsewhere. "This costs about Rs.10 million. I sent about 25 e-mails to Sri Lankans living abroad, yet I still haven't got any response. But we will keep trying." Details about project are available on the worldwide web at http://www.lk/health/kuru/INDEX.htm and http://www.lk/health/ministry.htm.
Dr. Rajakanthan can be contacted at kantraj@sltnet.lk. Those interested may make donations to AC No. 90803565 at the Super-grade Branch of BOC in Kurunegala. Donations made will be tax exempted.
How a Cardiology Unit can help:
*Bring down deaths occurring due to Acute Myocardial Infarction from 30% to 6%
*Reduce deaths occurring due to unstable angina from 25% to 3%
*Attend to other cardiac emergencies
*Treat acute exacerbation of other cardiac diseases like hypertension (prevalent among 25% of the population), heart failure (1% of the population) and Arrhythmia.
*Conduct specific cardiac clinics
*Offer special cardiac investigations: ECHO, EX ECG, HOLTER
Cardiac Catheterisations and Angiograms, Angioplasty and Stentings
Heart surgery
How common is heart disease?
Total population 3%
Population over 30 years 8%
Population over 65 years 30%
Kurunegala district 43,000 patients
North-Western province 60,000 patients
Mortality rate
Mortality before new treatment methods introduced and after:
Before reaching hospital 25%
During hospital stay 13%
Next one year of treatment 6-10%
Annually 2-10%
Next 10 years 50%
Acute myocardial infarction (heart attack): 50% of all deaths occur during first hour, 75% of all deaths during the first 24 hours.
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