Medical Mission to India

In this interview, EP Lab Digest speaks with Kelly Jane Airey, MD, FHRS, FACC about recent medical mission work at Sri Sathya Sai Institute of Higher Medical Sciences (SSSIHMS) in Bangalore, India. Dr. Airey practices EP with the CVM group in Davenport, Iowa.

How did this humanitarian mission come about?

In 2017, I enjoyed a dinner at an Indian restaurant with my fellow EP physicians, Drs. Roger Freedman, Scott Wall, Kim Selzman, and Moeen Abedin during the annual HRS meeting in Chicago. These great folks were my mentors and co-fellows that I trained with at the University of Utah during my EP fellowship. During the dinner, we discussed making the trip to provide EP services at SSSIHMS in 2019. Dr. Abedin had organized trips with Dr. Freedman to SSSIHMS in 2007 and 2010 to implant devices and perform ablations, so we put the plan in motion to return. Humanitarian work has been of great interest to me and the opportunity seemed perfect, as all care is provided to the patients free of charge. We were able to take this plan to fruition in February 2019. Dr. Freedman and Dr. Abedin made arrangements for device and lead donations from Medtronic and Boston Scientific. Dr. Abedin also made arrangements to spend time at the SSSIHMS. We each arranged and sponsored our own travel.

How long were you there? How many and what types of cases were performed?

Our medical mission lasted 5 days. We performed 18 device procedures, including cardiac resynchronization therapy (CRT-D and CRT-P), ICD, and pacemaker implants. We also performed one extraction. We performed multiple ablations, including 5 accessory pathways, one of which was a Mahaim pathway, as well as typical and atypical atrial flutter, SVT, and idiopathic VTs.

What kind of equipment was available at the Sri Sathya Sai Institute of Higher Medical Sciences?

There are two rooms, one was used for ablations and the other for devices. There is an EnSite Velocity Cardiac Mapping System and EP-WorkMate Recording System (Abbott). There are also fluoroscopy systems from Siemens and Philips. The rooms are equipped with biphasic defibrillators, hemodynamic monitors, ventilators, and other interventional systems such as a Rotablator system (Boston Scientific), intravascular ultrasound, intra-aortic balloon pump, etc. It is mind-boggling that the hospital functions fully on donations, but still has all of the required equipment to perform advanced cardiovascular procedures.

What was a typical day like?

Every morning at 8:00 AM, there would be teaching rounds with the residents, cardiology fellows, and cardiology staff. We would then start procedures around 9:30 and usually go to about 7:00 at night.

Who was involved with cases?

We were working with the local cardiologists (Drs. Varyani, Shah, Dash and Keeni), cardiology fellows, and nursing/technical staff. It is all teamwork, and we integrated ourselves with the local team supporting each other depending on the situation. Each member performed at their highest capacity.

Who accompanied you on this medical mission?

Our group included Dr. Freedman and Dr. Scott Wall, both staff electrophysiologists with the University of Utah, Dr. Moeen Abedin, who practices EP in El Paso, Texas, and Dr. Nischala Nannapaneni, who practices EP at St. Mark’s Hospital in Salt Lake City, Utah. We all completed our EP fellowship at the University of Utah at different times. Danielle Rondelez, a Medtronic sales representative from El Paso, accompanied us as well.

Why did you personally want to get involved?

I’ve always felt that a big part of practicing medicine is doing mission work and helping those that are in need. It's also important for personal development and self-fulfillment, to share the knowledge and advanced skills that I have obtained over the last number of years with physicians who are eager to learn and the patients in need of the procedures.

What would you say were some of the biggest challenges during this mission?

We had a huge variety of clinical manifestations and anatomical variations. We treated patients with various arrhythmias, syncope, and heart failure due to various types of cardiomyopathies with and without coronary disease. We treated patients with congenital disease such as ARVC and other genetic conditions. The patients have to be matched with the materials and devices we had on hand. We worked closely with the local team to understand the local practices and provide the best possible care to the needy. The other big challenge is time, as there are so many patients. The local and visiting staff put in a lot of time to get as many cases done as possible. These decisions are all very difficult, but really make you reflect and consider what is really necessary. It was truly an exercise in optimization of resources and time.

What was the age range of patients treated during this trip?

There was tremendous diversity in both age and gender. The youngest patient we treated was a 14-year-old for ventricular tachycardia ablation. Typically, the patient population is much younger than what we see in the United States. For CRT cases, I would estimate that the majority of patients were in their 40s or 50s, with the oldest in the 60-year-old range. In the U.S., our patients are much older.

Do patients receive follow-up care for their device?

Yes, they receive their follow-up care at the Sri Sathya Sai Institute of Higher Medical Sciences as per clinical guidelines. The institution was built in 2001, and they see about 150 patients a day in their cardiology clinic. They provide all of the care to the patients free of cost.

What were some of your more memorable patients?

I was impressed by all of the patients and their families. Each patient is remembered because of severity of disease, age, distance they traveled to receive their arrhythmia diagnosis, care, etc. While the hospital has expertise to handle the patients, it was heartbreaking that we could not treat all of the patients, mostly due to time constraints. We saw diseases that you only read about when studying for board exams, and typically, multiple in one day.

Was this your first time to India? What did you learn about the people and the culture?

This was my first time to India. The Indian people are very kind, giving, and grateful. The physicians and lab staff work very long hours treating a seemingly endless number of patients. Dr. Swapna Kanuri (not a staff member at the hospital), a cardiologist who I trained at Creighton when I was on staff and is now living in Bangalore, took a two-hour Uber ride to visit me while I was there after reading my Facebook post about the impending trip. She brought gifts and shared her appreciation of the service we were providing. The hospital staff also shared their appreciation of our volunteering activity and gifted us with an image of the founder. The appreciation was unexpected and a little overwhelming. I found the entire experience humbling and memorable. It provided an opportunity for personal growth on multiple levels. I hope to go back in the next few years. I see that there is a movement within the Heart Rhythm Society for EP physicians to provide humanitarian work in countries that are in need. Hopefully, this movement will grow and thrive.