Friday, 6 October 2006

Andhra Pradesh government new initiative: Screening for children with heart ailments

2006
By Syed Akbar
Andhra Pradesh is going to add yet another feather in its cap. This time for taking up the gigantic task of providing medicare and conducting heart surgeries free of cost to around 5000 children, mostly from the lower strata of society.
The second phase screening of heart diseases in children, under an innovative scheme launched by the State government in August 2004, is currently on in the State. Already 3,200 children have been identified for surgery in medical camps held in September. Another round of medical camps is scheduled for October 8 at 44 centres across the State. Once the screening process is completed, heart surgeries will be performed on these children in about 50 corporate, private and government hospitals.
In the first phase screening held in 2004, over 5500 children were identified for surgeries and of them 4700 underwent heart operations. The remaining 700 children could not make their way to the operation theatre for want of infrastructure. These children will now be included in the list of fresh beneficiaries in the second phase.
Andhra Pradesh is the first and so far the only State in the country where children under 12 years of age are provided free heart treatment in the state-of-the-art corporate hospitals. They are also provided with free follow up treatment. Only the neighbouring Karnataka State has a health insurance scheme for children belonging to below the poverty families. Unlike the cardiac programme in Andhra Pradesh, the scheme in Karnataka provides for general health problems. A CM’s Children Relief Fund was exclusively set up for the purpose.

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How the Scheme Began:
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It was August 7, 2004. The new Congress government was just settling down. Hundreds of children suffering from heart diseases gathered in Hyderabad to press for their demand for free medical treatment. The Mahajana Sangarshna Samithi had organised the demonstration by mobilising poor children and their parents from all most all the rural areas of the State.
Tragedy struck the demonstration. One of the children, T Sobhan (12), of Shanigaram of Karimnagar district, collapsed on the Lower Tank Bund road apparently unable to bear the stress of walking and standing for long under the hot sun. A couple of days later, two more children, Rajasekhar from Prakasam district and Konda Saidulu from Nalgonda district succumbed to heart ailments. Incidentally, these two children too had participated in the demonstration.
This moved the new Congress government and Chief Minister YS Rajasekhar Reddy announced a special package for children suffering from cardiac ailments which includes free heart surgery. Andhra Pradesh thus became the first State in the country to introduce free heart treatment for children below 12 years of age.
In the first year the government conducted screening tests for 5500 children and of them about 2000 children underwent surgeries. Another 2700 children were operated upon in 2005. The government has initially allocated Rs 8 crore for the project and announced that it would be a continuous programme. Keeping its assurance, the government has now called for the second phase of screening tests in all the 23 districts to identify new patients.
The government has also taken up an ambitious programme to strengthen facilities in government hospitals so that state-of-the-art medicare is provided to poor children. The government has also roped in children specialists to perform surgeries.
Now buoyed by the success of the cardiac programme, the government has decided to introduce a universal health insurance scheme to take care of the health needs of children suffering from various ailments. Children below 12 years and belonging to below poverty line families will be covered under the proposed scheme. According to a rough estimate, two lakh children under 12 years are suffering from heart problems in the State and about 20,000 children add to this number every year.

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How It Works:
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Unlike in other States where free treatment is provided to the poor only in government hospitals, the Andhra Pradesh government has made a provision for treatment of poor children even in corporate and top class hospitals. The provides financial aid to corporate hospitals towards these surgeries and other follow up treatment if any.
These private hospitals charge 20 per cent less than the rates fixed by the State-controlled Nizam’s Institute of Medical Sciences. The payment is made by the Director of Medical Education to the hospital concerned after getting scrutiny of bills by a committee constituted for the purpose.
The State government has divided heart diseases into various categories for purpose of treatment. The category I covers PDA interruption pericardiectomy, closed mitral valvotomy and PA banding, while category II covers BT shunt coarctaion of aorta repair. Under category II, surgeries like ASD closure, VSD closure and AP window repair.
The other categories are: category IV: Intracardiac repair of TOF, intracardiac repair of TAPVC; Category V: Intracardiac repair of TGA, DORV, tricuspid atresia, trunkus arteriosus etc., and other surgeries needing special conduits like pulmonary atresia; Category VI: Valve repair, mitrial valve repair, tricuspid valve repair; Category VII: Mitral valve replacements,
aortic valve replacements, tricuspid valve replacements; Category VIII: double valve replacements (mitral valve replacement and aotric valve replacement); Category IX: Interventional procedures like percutaneous
balloon valvuloplasties, balloon septostomy including cardiac catheterization and cine angiograms.
Initially there was no provision for permanent pacemaker implantation (PPI) but now the government has included this category also. A new category - Category X - has been included to provide for permanent pacemaker implantation. Other cardiac problems not included in the above categories, whenever they come up would be examined and put in appropriate category on a case to case basis by the central cell at Gandhi Hospital in consultation with the Director of Medical Education.

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Special Cardiac Cells
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Moreover, special cardiac cells have been created in seven government teaching hospitals, which will treat, operate or refer patients to other hospitals. These cells are located at Osmania General Hospital, Hyderabad, King George Hospital, Visakhapatnam, Mahatma Gandhi Memorial Hospital, Warangal, Gandhi Hospital, Secunderabad, Government General Hospital, Kurnool, Government General Hospital, Guntur and Government General Hospital, Kakinada.
On being approached by a child cardiac patient, the cardiac cell in the Teaching Hospital will conduct necessary screening and render advice to the child patients and his/her parents/attendants. The cardiac cell will undertake treatment of the paediatric cardiac ailments at the same teaching hospital including surgeries.
If the surgeries for which facilities are not available or the required expert cardiac surgeon personnel are not available in the teaching hospital, then the cardiac cell of the teaching hospital will first enquire with the other government teaching hospitals as to whether they can handle the required type of surgeries.
If any of the other teaching hospitals in the State have such spare capacity, the case will be referred to there. If not, it will be referred to the nearest private hospital that can perform such surgery. An identification card is issued to the patient for this purpose, by the government cardiac cell of the teaching hospital.
In case, the patient comes back to the hospital concerned at a later date, where surgery is performed, the hospital should have to take proper care of the patient. It should not insist reference from the cardiac cell.
Congress MP V Hanumantha Rao demands that the Central government bear the cost of operations. "Thousands of children are in a critical condition for lack of medical facilities. The State government does not have the resources to fund the critical heart operations of children who are waiting for months for heart operations. Many children are also dying while they wait for heart operations in Andhra Pradesh. The Central government should pay attention to this critical problem," he pointed out.

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