ROTARY CLUB OF MADRAS SOUTH ROTARY - HEART TO HEART PROJECT

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2 CONGENITAL HEART DISEASE- OVERVIEW Congenital Heart Disease (CHD) is one of the major causes of mortality and morbidity in the paediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of subcontinent and rest of the world could be because of genetic, cultural and environmental factors. The incidence of congenital heart defect is 10 per 1000 live birth worldwide and so there are so many children born with heart defects that require surgery. The incidence is more in poor socio economical status of the population. According to the recent statistics in India for every hour about 20 kids are born with heart defects and about 5% of children die at first month of age due to lack of treatment. Recent data suggest that nearly 12,000 children with heart defects are waiting for surgery in Tamilnadu (DHS Data2016) and similar data are present in other state too. SPECTRUM OF DISEASE Heart is a complex structure with four chambers, four valves and two great arteries (pipe supplying blood) one for lung and one for body. Defect can be either be simple like one hole in the heart or narrowing of valve or complex like defects in Transposition of great vessels i.e. reversal of great artery origin which requires surgery immediate after birth. SYMPTOMS OF A CHILD WITH HEART DEFECTS Careful examination of child can detect almost all defects at birth. Different kids present with different symptoms according to defects in heart. A child with a hole in heart will have symptoms such as poor feeding, recurrent cough and cold and poor weight gain. A child with complex defects will have symptoms such as blue coloured skin and lips and difficulty in breathing. WHAT IF A CHILD DOES NOT GET TREATMENT If child does not get treatment at the right time then either the child will die due to heart failure and lung failure or they become untreatable due to irreversible changes in to lung and other organs. This results in the child suffering from stroke or immobility. WHAT IF A CHILD IS GIVEN TREATMENT AT THE RIGHT TIME These children lead a normal life. About 80% of children even can take participation into sports activity also and contribute to society positively.

3 WHY SPECIALISED TREATMENT IS REQUIRED To diagnose and treat these patients requires special skill and infrastructure. Paediatric cardiology and Paediatric cardiac surgery with specially trained intensivist and Anaesthesiologist requires performing surgery. Well equipped Operation theatre, Special monitors and ventilators and Cardiac cath lab. Trained nurses with hands on knowledge in ICU and paramedical staff. In summary, to establish unit for paediatric cardiac surgery requires more investment and return on investment is not that great as congenital disease is more common in poor socio economical group. Government hospitals in Tamil Nadu, India get a lot of patients but are not able to provide treatment due to non availability of trained Doctors and Paramedical staff. They perform simple surgery, 1 or 2in a day which is a negligible portion when compared to the demand. Private Hospitals gets patients referred from Government Hospitals. Also Private Insurance doesn t cover congenital heart defects. Very few centres in Chennai, India have established congenital cardiac centres with complete facilities. There exists a huge demand and supply gap, due to which large number of patients are waiting for surgery. COST OF SURGERY AND SOURCE OF FUNDS Tentative details of costs and means of funds for performing Paediatric cardiac surgery at Kauvery Hospitals, Chennai is as under: Diagnosis Simple surgery ASD, closure VSD Complex surgery- TOF,TAPVC etc Total cost of surgery Tamilnadu Govt s Contribution (A) Partial sponsor Contribution (Rotary Club of Madras South Contribution) (B) Partial sponsor Contribution (Intl. Club, DDF from 3230 and Intl. District) (C) Shine- Trust Kauvery (D) A+B+C+D ,50,

4 Non Tamilnadu residents, refugee, Slum residents without ration cards are not eligible for Tamilnadu Govt funds. These patients require full funding to cover the cost of surgery. Kauvery Hospitals charge on a regular package for affordable patients is as under: Simple Defects Rs. 1,75,000/- (US$ 2612) which include 1day stay in ICU and 6 days stay in Ward and 1unit of blood. If the stay extends for more than a day in ICU the charges will be Rs. 7000/- (US$ 105) per day. Complex defects Rs. 2,50,000/- (US$ 3732) for 3 days stay in ICU and 6 days stay in ward and 2units of blood. All the above are packages for stay in general ward. The cost of surgery given for the Rotary Heart to Heart project as in the above table includes admission to discharge cost (admission, surgery, stay in ICU, stay in ward, blood units (as per the nature of the defect) and finally discharge). No additional cost will be charged for extra stay. TAMILNADU CHIEF MINISTER HEALTH INSURANCE SCHEME The Tamilnadu Government through its Tamilnadu Chief Minister Health Insurance Scheme provides fixed amount for heart surgeriesto affiliated hospital. The Government through this scheme reimburse the hospital Rs /- (US$ 1120) for simple defects hospital and Rs. 1,00,000/- (US$ 1493) for complex defects. Below poverty line families have been issued health card with Number and affiliated hospital use this number for insurance approval on admission. This process is computerised and hence it is very quick and effective. Hospitals get the necessary approval within 24 hrs of admission. SHINE TRUST@KAUVERY Towards supporting the cause, the hospital during the year 2014 launched 'SHINE@Kauvery' - a save heart initiative for children. This is a sincere effort to instill hopes in the hearts of little ones who would grow up and shape the country`s future. The project`s primary objective is to provide partial financial assistance to children from underprivileged sections of the society, irrespective of their place of origin in the world. The Corpus fund, gained through donations from kind hearted donors and charitable organizations, will be used for partial relief of financial needs for in-hospital procedures in deserving children and adults with birth defects of the heart.

5 ROTARY CLUB S CONTRIBUTION Rotary Club of Madras South along with the International Partner intends to sponsor around 200 surgeries during the Rotary year and Detailed plan is as under. DETAILS OF FUNDING REQUIREMENTS Club Contribution World Fund Match from The Rotary Foundation Total RC of Madras South $19,000 $9,500 $28,500 International Club $19,000 $9,500 $28,500 Subtotal: $38,000 $19,000 $57,000 District Contributions DDF from 3230 $7,500 $7,500 $15,000 International District $7,500 $7,500 $15,000 Total $53,000 $34,000 $87,000 Conversion Rate applied per 67 Amount in Rs Amount to be sponsored per surgery Rs Add : 10% for Contingencies and Exchange rate fluctuations Rs.2500 Total Amount considering Contingencies per surgery Rs No of Patients to be covered 212 The Project is in alignment with the mission of The Rotary Foundation, which is to enable Rotarians to advance world understanding, goodwill, and peace through the improvement of health, the support of education and the alleviation of poverty. The Project also travels within the six areas of focus that are sustainable, measurable and host community driven.

6 KAUVERY PAEDIATRIC CARDIOLOGY AND CARDIAC SURGERY TEAM Kauvery Paediatric cardiac services was established in January 2013 at Kauvery Hospitals, Chennai which is an affiliated hospital under the Tamilnadu Chief Minister Health Insurance scheme. The team comprises of specialist doctors as under: Paediatric Cardiac Surgeon Dr. Prashant Shah. Paediatric Cardiologist Dr. Premsekhar and Dr Karthick Surya. Paediatric cardiac Anesthesiologist, Paediatric Intensivist and trained paramedical staff. Kauvery Hospital so far, has performed over 700 paediatric cardiac surgeries using the financial assistance from Tamilnadu Chief Minister Scheme on children s from different part of Tamilnadu. The hospital has been approaching various sponsors for the cost which is now sought from Rotary Clubs. WHY KAUVERY HOSPITALS WANTS TO BE A PART OF THE PROJECT Paediatric cardiology and cardiac surgery is considered highest speciality in term of complexity and so the hospital that performs these procedure is always considered in top line for technology and expertise and changes the category of hospital. Despite high investment for technology and manpower the hospitals want to develop this speciality as it is a diamond in crown. There are very few centres in Chennai, India, and there are no centres in the neighbouring countries and so International patient prefer India for Paediatric heart surgery. The hospital after establishing this unique department wanted to give the benefit to the local and unaffordable patient. This in turn will enable Kauvery Hospital to utilise their facility to the fullest capacity. Kauvery Hospital has also started a Charity Wing called Shine@Kauvery to help these patients which shows the intention of the management to reach out theunaffordable groups. TRIPATRIATE AGREEMENT A Tripatriate agreement will be entered between Rotary Club of Madras South, Kauvery Hospitals and Shine Trust@Kauvery once the project is approved.

7 HOW THE PROJECT WORKS Identifying patient Kauvery paediatric cardiac team conducts camps every 15 days in areas of Tamilnadu where the underprivileged, slums, poor economic strata and people who cannot afford quality medical treatment in high cost hospitals. The team with doctors does necessary tests like echo in camp and identify the patient to be treated. Shifting to Centre Child with heart defect will be registered and shifted with all necessary documents to Chennai. Public relation officer from Kauvery team will help them to shift to Chennai. Diagnosis and Insurance approval At Chennai centre, child undergoes detailed evaluation with blood investigation, X-Ray, Echo and confirms diagnosis. Team of doctors decide appropriate treatment plan and explain to relatives and obtain their consent. Document and treatment plan will be submitted to insurance department through a special e-portal available for this purpose. The Sponsors will be informed with complete detail of the patient with photograph at this stage. After obtaining approval which normally takes 24 hrs, Patient undergoes surgery and discharged from the hospital at 6-7 days. At discharge complete discharge summary will be given to patient and insurance firm and Rotary Club/clubs will be intimated for progress and discharge of the patient. At the end of every month detailed report with patient details and donor contribution will be prepared and sent to Donor.

8 International Partner Rotary Club of Madras South invites international partners to join us in sponsoring around 200 heart surgeries during the Rotary year and The total cost of the project is (please see the next page for details). The international partner and our Club will contribute US$ each. For more information, please contact: Rtn. Magdoom Mohamed Rtn. K Saravanan President Elect Chairman - Fund Raising& President Nominee Rotary Club of Madras South Rotary Club of Madras South Chennai, India Chennai, India Mobile: Mobile; Magdoom_m@yahoo.com rtn.ksaravanan@gmail.com