Comparing the “jewel” with the “crown”

With the Gauri Kaul foundation going to Manipur for a Health check camp with “No More Heart Attacks” its mission, it is time to look at some similarities of the two places, once upon a time two countries, now a state and a union territory, respectively. The “Jewel of India” and “Crown of India” separated by 3250 Kms.

Both the states came under the Indian dominion after independence of India from the British empire. Both Jammu Kashmir and Manipur were being ruled by monarchs. Maharaja Hari Singh, a Dogra ruler and Maharaja Bodh Chandra, a Meitei, respectively. Both kings wanted to remain independent as countries.   Maharaja of Kashmir signed the accession paper on 26th October 1947 in Delhi and the Maharaja of Manipur in October 1949 in Shillong, against their wishes. Both places have antelopes as their national animals. The Sangai which is the apple of the eye for the people, other than polo, its classical dance, sports and films for Manipuris and the Hangul the beautiful Kashmir stag along with the natural beauty of our valley. Both these national animals are protected species since they were about to get extinct in around 1950’s.  Both Manipur and Jammu and Kashmir have had turbulent past with Japanese and British forces at war on their land, while the occupation of Jammu and Kashmir by successive invaders from Central Asia, Afghanistan and other neighbouring countries including Pakistan.

   

Our group reached for a one-day camp in the district headquarters of Kakching, the cleanest districts of the state from the capital city Imphal on 16th March. Mr Yengkhom Surchandra, an ex-IAS officer turned politician, was our local host for the camp. The residents of this district with a population of around 35,000 had been informed about this “healthy Heart camp” in advance. Registrations were done in advance accordingly. We ended up seeing 110 subjects. The literacy rate of this district at 90 % is the highest in the North East. It has a very fertile land and climate. It is called the granary of Manipur and its population is into farming and related industry. It has also produced a large number of IAS officers and technical people employed in various parts of India. It boasts of a wonderful garden on a hill overlooking the town.  All the 106 subjects who came for the camp, were subjected to calculation of body mass index (BMI) as an index of overweight and obesity, blood pressure measurement and a random blood sugar measurement. An Electrocardiogram was done for all before a clinical evaluation done as per a pre-set proforma.

Findings of the Camp:

Females outnumbered males, 54%. One third subjects were more than 60 years of age. Three quarters of the subjects seen were overweight or obese. High blood pressure detected by history or diagnosed first time was documented in 25% and un controlled BP despite being on drugs was common and seen in half of them ( BP> 140/90 mms Hg despite checking several times by a calibrated instrument. The treatment was modified using cost effective drug combinations with single tablets as far as possible. Additionally, all of them were counselled by our coordinators in their local Meitei language.

Diabetes was seen in only 2 % of the attendees of the camp. Despite being seen in only small numbers, it was out of control in most of them with values more than 300 mgs in random sugar levels. Three subjects who were not aware of their being diabetics, both had very high sugar levels.  All of them were counselled regarding preventive measures and prescribed new drugs which prevent heart failure and protect kidneys. These drugs which have been available for more than five years now and have also become generic recently were not being used by local doctors. A starter kit was given to them and through drug companies and local doctors, local chemists were made aware of these developments.

Established heart disease was seen in 18% subjects, with disease secondary to blocked arteries seen in one third of them. We also saw cases with birth defects which had been operated at several key centres like AIIMS, New Delhi and Post graduate Institute of Chandigarh. Relatively large percentage of patients with established heart disease, seems to be because of selection bias due to the announcement of the Heart Camp.

The common feature with our previous 5 camps under the same banner has been poorly controlled high BP and diabetes. These are responsible for heart attacks, strokes and kidney diseases. It is therefore essential to spread the awareness of early recognition and effective long-term management of these common public health problems. Treatment should be by using cost effective drugs with as few tablets as possible. General heart healthy measures like: regular exercise, intake of plenty of fruits and vegetables, cessation of tobacco use, periodic measurement of blood pressure, sugar and cholesterol is the way to go.

Heart healthy camps by voluntary, non-profit making bodies should be encouraged to disseminate this information. We found that both Kashmir and Manipur have lot to share not only in history, the beautiful landscape, water bodies, flora and fauna but also their medical problems. The remote and poorly accessible areas need to have tele-cardiology facilities as our foundation is starting in various needy parts of Jammu and Kashmir. Roping in corporate social responsibility funds for these activities is a good way to begin. Regular supply of medicines for these units by way of contributions by NGOs and pharmaceutical industries needs well-orchestrated efforts by the chosen representatives of the public in these areas.

We could see for ourselves, the unity in diversity not only in terms of the landscape but also in the occurrence of common public health problems. The people of both these territories are looking forward for better times to come their way, so that they forget the bad memories of the invasions and warfare’s of the past, the uncertainties post accession and political turmoil’s.  A healthy heart with “No more Heart attacks “is an important message to disseminate for a healthy community and the nation.

Dr Upendra Kaul is a renowned cardiologist, recipient of Padma Shri and Dr B C Roy Award. He is the Founder Director Gauri Kaul Foundation

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