Cardiology in India 2011

JACC 2011;57:377-9

Tiny Nair, Trivandrum.

It was an intense academic debate. That is what the American College of Cardiology (ACC) wanted it to be. How to reduce door-to-balloon time in ST-segment elevation myocardial infarction (STEMI), the goal being 90 min, beyond which time myocardial salvage deteriorates. An active emergency medical service, in-ambulance electrocardiogram (ECG) and triage, and direct catheterization laboratory transfers are critical to achieving this. The National Cardiovascular Data Registry (NCDR) data showed that it is possible to achieve this, and it was so in 88% cases in the U.S. (1).

"Kapi ready, get up!" shouted my wife. Kapi, the local name of coffee in Kerala, has been an addiction here for generations. This southern-most state of India, "God's own country," is also the most literate state in India. Kerala has one of the best educational and health care standards in India, with 100% literacy and an infant mortality rate of 12 per 1,000 live births (Indian average of 53) (2). My wife's stern voice and the aroma of south Indian coffee woke me up, still groggy from the multiple phone calls that I had received last night about that heart failure patient in the intensive cardiac care unit (ICCU). As I grabbed the coffee, I lifted the telephone to call up to learn how the patient was. "He is better, sir," the resident told me, "but his relatives want him to be shifted home because they can't afford to keep him in the ICCU any more, now that it is 3 days... ." In this country, including this medically advanced, literate state, medical insurance is still just a vague new concept. With more than 90% of the patients without any health insurance, the patient's family has to bear the entire cost of the treatment, and to make payments now. I could understand the unusual request of the relatives.

"Are you not going to the hospital today? I am ready for school," screamed my 12-year-old son, whose...