A Life Saving Innovator

-- Hana Shams Ahmed

A Life Saving Innovator

A heart surgery is one of the most complicated procedures that requires both expertise and intensive postoperative care. Stressful lifestyles, bad diets and lack of exercise have increased the risk of heart disease of many Bangladeshis, especially those living in the city. Besides birth defects and valve replacements, the most common heart problem is caused by arterial blockages, which, if left untreated leads to a heart attack. A blockage occurs when the coronary artery (the artery that supplies blood to the heart) gets constricted, usually because of cholesterol deposits. The heart gets deprived of blood supply and there is an intense pain in the chest. A bypass surgery is usually the only way to clear these blockages. Conventional bypass surgery requires the heart to be stopped and kept in ice. This is done using toxic medicines and stopping the heart and it carries a high amount of risk, especially for older patients and those with a weak heart, lung or kidney problems. A heart-lung machine is used to artificially pump blood during surgery. Once surgery is completed the heart is restarted. This procedure, for obvious reasons, carries a huge amount of risk. Also veins, which have different characteristics from arteries, are taken from the legs (known as Venus Grafting) to replace the arteries. These veins stop working after some time and it takes a painfully long time for the leg or hand to heal. A new method is set to revolutionise the way bypass surgeries are carried out. It is called the off-pump beating heart arterial bypass surgery. It is a method that involves far less risk and has a high rate of success. What's more this method is already at work in our country.

Dr Lutfur Rahman, a pioneer of bringing this revolutionary method of surgery into this country, has so far successfully operated on almost 1500 (1000 others in the conventional method) patients using this latest technology. With this method it is possible to carry out this operation by keeping the heart beating. A device called an OCTOPUS, developed by a company in the USA, is used to keep the heart beating while the patient is operated on. It virtually eliminates all the complications involved in an open-heart surgery. The most amazing thing is that Rahman has no formal training in this procedure. "I collected information and data from seminars and symposiums, watched slide shows and films and read thoroughly from the Internet and many journals", says Rahman, "and I have perfected this procedure using my own experience and knowledge." Currently only about 20% of heart surgeons around the world are capable of carrying out this procedure. Rahman's remarkable achievement is being recognised not only at home but abroad as well.

The off-pump beating heart was invented in the USA. The OCTOPUS machine has a set of small suction ports. Using these ports only the parts that need to be operated on are kept still. An artificial artery is used for temporary blood movement. A bypass surgery is carried out outside the heart; so, theoretically it is not necessary to stop the heart to clear the blockages. In the conventional open-heart surgery the heart is stopped and may lead to many complications. When the blood goes into the machine the cells get damaged plus air might get into it and there is possibility of a blood clot. It is also not possible to do an open-heart surgery on a weak heart. Another trauma that blockage patients and their relatives have to go through is looking for blood donors, especially if the patient has a negative blood group. In beating heart surgery it is unnecessary for extra blood save for some exceptions.

Rahman also uses the arterial method for bypass surgeries, which is an innovation in itself. The mammary artery that is available in the heart as a spare artery is used to replace the coronary artery. When this artery is used a second bypass is usually not needed. "It works like a vaccine", says Rahman, "and prevents further cholesterol from developing". Most operations involve taking a vein from the leg, which can cause problems for diabetic patients; it takes time for the wounds (in the leg) to heal. The leg also remains bloated for a long time. Veins work under low pressure but arteries are used to high pressure so they match perfectly with the flow. It also matches in thickness and diameter. A long incision, around 3 to 4 inches long, is needed in the leg. This type of surgery is done in the US and Japan and some centres in Europe. And only about 1 or 2 surgeons in Bombay are capable of carrying out this procedure. Bangkok and Singapore, which are the top destinations for well-off families for heart surgery still use the conventional method of using veins from different parts of the body to replace the coronary artery.

Rahman has successfully done beating heart surgeries on patients from 26-year-olds to 86-year-olds. The emphasis is on keeping the heart going which makes it equivalent to any other general surgery. As such the recovery process is very quick and has very few complications. "Patients start having tea and biscuits four to five hours after surgery," says Dr. Rahman, "I have done surgery on patients who got turned away from other centres in the country. When asked about how heart patients always complain about postoperative recovery he said, "If postoperative care is substandard, that means the surgeon is also not competent.

It costs around two lakh taka to do a bypass surgery in Labaid (which includes medicine, food and hospital stay). "I do not compromise on the instruments. I always demand for the best in quality." For poorer patients he discounts to as much as 1lakh 75thousand sometimes. Dr Rahman identifies completely with the woes of patients of the country with the private doctors. "Doctors should be more caring towards patients. The habit of just seeing patients in the evening should be stopped. These doctors hardly spend any time with the patients because of their tight schedule," says Rahman, "If someone falls ill in the morning he has to be seen right away. Making him wait till the evening is inhuman." says Rahman who works a demanding twelve-hour shift at the hospital.

Born in Pabna in 1962 Dr Lutfur Rahman spent most of his childhood in the village of Atghoria in Pabna. He completed his SSC exams from Pabna Salim Najir School in 1979 and two years later gave his HSCs from Pabna BL College. He got admitted to Dhaka Medical College and completed his MBBS in 1988. Later he did an MS in Cardiac Surgery from the National Heart Foundation in 1997 and later joined there as the Assistant Professor. After 10 years of government service he joined Shikder Medical Hospital as Chief Surgeon. After three years in July 2004 he joined Labaid Cardiac Hospital as the Chief Cardiac Surgeon.

Bangladesh is a high-risk country for diabetes and heart diseases. "It's because of the extremely unhealthy lifestyle we lead," says Dr. Rahman, "People start having high cholesterol from a very young age. Children have nowhere to play. We make them eat all kinds of fatty food like eggs, milk and butter but where will they shed it off? Schools are built in houses. Children are treated like broiler chickens and moved from one room to the other. Even after school they don't have anywhere to run around, although fried chicken shops and other eateries are popping up everywhere. All this rich food and stressful lifestyle combined with lack of exercise are major contributing factors to high cholesterol. Smoking and red meat should also be avoided. People with diabetes and a family history of heart disease should be extra careful."

"In terms of technology we are very advanced and if we dedicate ourselves to this work we can do much better. An example of this advancement is in cardiac surgery," says Dr Rahman, "All we need is dedication. Unfortunately, many of us don't have that. Even teachers these days concentrate more on politics and private teaching to make money instead of really educating." A large part of Rahman's success stems from patriotism and a commitment to his profession. "I felt really bad when I saw people going to India, Singapore and Bangkok for heart surgery and spending so much money when it was possible to do them at home. I left government service when I saw that many of my senior doctors did not have a very clear conception about bypass surgery."

On July 3, this year, Dr Rahman is set to receive a big honour for himself and his country. He will be presented the Dr Bidhan Chandra Rai Award for contributing to and modernising cardiac surgery in Bangladesh and bringing back confidence in the profession. He has trained doctors and nurses in both Shikder Medical College and Labaid and they are doing well in their respective places. Dr Rahman also places great emphasis on hygiene, which, he sadly expresses, is completely overlooked in government hospitals and even many private hospitals too. "The first thing a patient must be provided with when he gets admitted is a fresh hospital gown. People still don't realise that all kinds of illnesses can be brought inside the hospital through a patient's garments," says Dr Rahman, "A doctor also has to make sure that the nurses who look after the patients are clean. It's not enough to have a clean toilet for patients, the nurses toilets must also be clean and must always have sufficient supplies. Most postoperative infections are spread because those attending the patients are not particular about maintaining good hygiene."

60-year-old Professor Mohammad Ali Asgar has been living with diabetes for the last 20 years. His self-discipline has kept it under control for this long and it's difficult to tell from his tall, lean appearance that he might be a heart patient. But diabetes itself is a major contributory factor towards arterial blockages. "My husband has been suffering unnecessarily for the last four months ever since he started having chest pains," says Asgar's wife Even when he had repeatedly complained about getting weak and having chest pains his doctor at BIRDEM never referred him to a cardiologist. They carried out numerous tests at BIRDEM but his doctor never informed him about the link between diabetes and heart disease. Later when his family charged him about his negligence he apologised, but the damage had already been done. Following that he was taken to Suhrawardy Hospital where a doctor there referred him to Dr. Lutfur Rahman. Asgar's family members praised the efforts of his team for successfully completing the operation. " Doctors like him (Dr. Lutfur Rahman) make us proud and it is because of him that my husband is getting better", says Asgar's wife.

Muhammad Wahid Murad is nearly 40 years old and started having chest pains about six months ago. A politician by profession he comes from Bogura and is strongly involved with the cultural sector of that area. "I was in a procession when I felt pain shooting through my heart. I tried to ignore it but after going for another 20yards I just could not move any further," says Murad, "the family doctor laughed it off telling me not to worry too much and prescribed drugs for acidity." Later he came to Dhaka and did an ETT (Exercise Tolerance Test) and an Angiogram. "When I found out about the blockages I was completely decided on leaving for Bangkok to do the bypass," he says, "when my sister, who lives in Dhaka, showed me a report on Dr. Lutfor Rahman's method. I instantly made up my mind to abandon my plans for going abroad and do the surgery here. And look at me now," says a smiling Murad, just a week after his surgery, "if I wasn't wearing this hospital gown you would never know I had undergone a bypass surgery."

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