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'Paediatric cardiology in Bangladesh suffering from lack of expert paediatric cardiologists'

  • Published at 08:55 am September 29th, 2021
Dr. Tahera Nazrin, Consultant & Coordinator, Pediatric Cardiology Department
Dr Tahera Nazrin, consultant and coordinator, Pediatric Cardiology Department of Evercare Hospital Dhaka Courtesy

In an interview with Dhaka Tribune, Dr Tahera Nazrin, consultant and coordinator, Pediatric Cardiology Department at Evercare Hospital Dhaka, discusses at great length about the condition of pediatric cardiology in Bangladesh, medical tourism prospects and more.

How do you evaluate the condition of pediatric cardiology in Bangladesh at the present time? What, according to you, are the prospects and setbacks of this sector?

Bangladesh has a large number of children in various hospitals who have been diagnosed with heart diseases and been treated by paediatric cardiologists and cardiac surgeons.

Unfortunately, the currently available services are inadequate in matching up to the requirements of these patients. 

Paediatric cardiology in Bangladesh is predominantly suffering from a lack of expert paediatric cardiologists, intensivists, paediatric cardiac surgeons, training programs, and inadequate equipment and infrastructure to allow for the development of this super specialty.

Not to mention, the general lack of public awareness about heart diseases that affect children is an important determinant of this unfavorable state.

Some parents might be unaware of the warning signs of a need to schedule a visit with a pediatric cardiologist for their child. What are some of the risk factors and symptoms they should keep in mind to prevent any surprises?

Symptoms

There are numerous symptoms of cardiac diseases that may present at different stages of the life of a child. At birth, a bluish discoloration of skin, lips, or tongue, rapid breathing/chest indrawing at rest or during feeding, hypoxia (an insufficient concentration of blood oxygen), and a sweating forehead while sleeping or suckling, are all signs of a weak heart or one suffering from congenital heart diseases. Furthermore, if you notice that your child eats little despite being hungry and quickly grows fatigued after feeding, that should also be taken as a warning sign.

You must watch out for symptoms of a weak heart during the crucial time when your child is growing up. Stunted growth is one of the first signs, or if your child suffers from repeated attacks of infection in the lower respiratory tract for which they have to be hospitalized. 

If the child is a little older, heart problems may present primarily with frequent chest pain and palpitation in the chest, along with increased blood pressure. Rheumatic fever, which is fever with joint pain or with heart disease, is another symptom. 

Other than these, symptoms of heart conditions in children of any age include abdominal pain, reddened eyes, a swollen tongue, rapid breathing and chest pain. If your child presents these symptoms, they may be diagnosed with Kawasaki Disease or Multisystem Inflammatory Syndrome.

Risk Factors

There are a number of preexisting conditions you can identify which might point to a heart condition in your child before and after birth. During pregnancy, if the mother has a congenital heart disease, afflicted with viral infections such as the Rubella virus, develops diabetes, is afflicted by maternal connective tissue disorder (SLE), smokes and/or consumes alcohol, or suffers from hypertension, their fetus is at risk of developing cardiac diseases. Taking certain medications before and after pregnancy also poses risks for the child’s heart, such as antihypertensive medicine (ACE inhibitors), anticonvulsants (Phenytoin), contraceptive pills, or high dose aspirin.

There are signs you can look for when the baby is in the womb, as well. 

If your OB-GYN or pediatrician diagnoses your baby with intrauterine growth retardation, Down syndrome, Turner’s syndrome, or Di George syndrome, your baby is likely to be born with a cardiac problem. Your baby is also at risk if they are delivered pre-term, or is born of a consanguineous (incestuous) union. 

As someone who has worked in the healthcare sector in India and Singapore, what would you say are the key differences and similarities with Bangladesh?

As a developed country, it’s undeniable that Singapore has made significant strides in pediatric cardiology and holds the highest standards in the practice. India is also highly advanced in this sector, surpassing Bangladesh by at least 15-20 years. 

Their dedicated paediatric cardiology centers in each state with expert personnel, supporting equipment and infrastructure are proof of this.

Compared to India and Singapore, the pediatric cardiology sector in Bangladesh is lagging behind, especially in terms of the number of skilled medical professionals who have the resources to adequately manage the increasingly large number of patients. 

When in 1998 the first practice in pediatric cardiology was set up by Brig.Gen Prof Dr Nurun Nahar Fatema, there were significant scarcities in paediatric cardiology and cardiac surgery. Unfortunately, the condition has not improved very much since then.

Bangladeshi patients rely heavily upon medical tourism. Now that there are Covid-related restrictions, they have resorted to local healthcare options. What are the results of this action?

Since the onset of the Covid-19 pandemic in Bangladesh, Evercare Hospital Dhaka has adopted vast, integrated measures to protect against transmission of the virus during the hospital’s scheduled operating hours. Our measures include an intellectual taskforce committee, various triage systems, and color-coded zones (red, green and grey) for the facilitation of systematic service. 

In the Paediatric Cardiology department, we have been providing cardiac patients first diagnosis of MISC with zero mortality.

Most required services are being provided by EHC not only in Paediatric Cardiology but Cardiac Surgery as well.

Evercare is known to provide world class healthcare so people can experience globally acclaimed medical services on their home turf. What are some of these services and advanced technologies, especially in the cardiology sector?

Evercare Hospital Dhaka (EHD) is currently providing some of the most updated paediatric cardiac services in the country. We provide our services for emergency patients, outpatients, and inpatients, as well as in dedicated intensive care units (ICUs) and surgical support.

In terms of diagnostics, EHD provides outdoor diagnosis of baby’s heart disease during pregnancy via foetal echocardiogram, after birth via trans thoracic echocardiogram, transesophageal echocardiogram, and catheterisation. Besides this, our facilities for chest X-Ray, ECG, Holter monitor, Cardiac-thoracic CT can all be classified as being at the international standard. For treatment, we make use of interventions such as device closure of congenital holes in the heart (ASD, VSD, PDA), balloon dilation of narrow valves and blood vessels, Rashkind procedure, etc. We also provide highly specialized multidisciplinary services in tandem with the Paediatrics, Neonatology and Gynaecology departments.

Besides, EHD’s Paediatric Cardiology department has an ongoing project for underprivileged children with special packages including free devices and balloons, as well as a subsidized tariff of echocardiogram. Our projects for Kawasaki disease and Multisystem Inflammatory Syndrome in children caused by Covid-19 are also ongoing.

How does Evercare maintain a global standard and what is the organization doing to retain existing patients?

I pursued my fellowship in paediatric cardiology for a long time in different centres in India and NUH Singapore. 

After I returned to Bangladesh, I worked at two cardiac centres. 

All throughout, I struggled constantly to raise awareness in people about the importance of pediatric cardiology, before finally establishing Evercare Hospital Dhaka’s paediatric cardiology department. 

EHD has provided me, and other cardiologists, state-of-the-art equipment and, more importantly, an international environment where we can practice our specialty the way it was meant to be practiced.

What are some of the recent accomplishments of and achievements by Evercare?

Evercare has made undeniable strides since the establishment of the paediatric cardiology Department in 2016 with the support of the hospital’s higher-level management. I am particularly proud of our involvement in the Interventional Paediatric Cardiology, where we are providing a special package containing a free device and balloon, which are highly expensive. 

We have also begun services for foetal echocardiogram.

The academic performance of Evercare's Paediatric Cardiology Department, in terms of our international publications and awareness programs, are widely appreciated throughout Bangladesh. We have been recognized by the Bangladesh Association of Software and Information Services (BASIS), the Bangladesh Paediatric Association (BPA), the Singapore Journal of Cardiology, cardiac healthcare centers such as the NaryanaHrudayalaya Hospital in Bangalore, the Madras Medical Mission Hospital in Chennai, NH – Kolkata India and different Government Medical Colleges of Bangladesh.

In terms of Covid-19 services, Evercare has been the first to diagnose and treat more than 70 children with MISC (Multisystem Inflammatory Syndrome in Children), with a mortality rate of zero.

What kind of health-tech integration does Evercare operate with?

Evercare Hospital is at the forefront of healthcare technology in Bangladesh. In the Paediatric Cardiology department, we are providing integrated services in OPD through our super expert cardiology team. 

We provide services such as foetal echocardiogram, transthoracic and transesophageal echocardiogram with the help of the Phillips Epic 7C echocardiography machine. 

We provide high-standard services in international Paediatric Cardiology fields such as device closure of unusual holes in heart, balloon dilation of critically stenosed valves of great vessels and formation of hole in the heart for survival of neonates with cyanotic heart disease.

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