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December 19, 1998


The stent man

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Ch Sushil Rao in Hyderabad

What have missiles got to do with medicine? Everything, if you are a heart patient.

The developing of the Kalam-Raju stent has meant life to nearly 1,000 cardiac patients in India who have had India's first intra-coronary stent implanted.

The foundation for the strange fusion of missile technology and medicine was laid when the defence minister's scientific advisor Dr A P J Abdul Kalam asked why the technology could not be used to benefit the medical world.

So what began as a question when Abdul Kalam was working at the Defence Research and Development Laboratory in Hyderabad took shape subsequently as an answer to cardiac health-care in India with cardiologist Dr Soma Raju joining hands with the missile scientist.

The Society for Biomedical Technology, which was established in 1993, took pioneering steps in the direction of a fully indigenous coronory stent being developed soon. The Kalam-Raju stent was the product of two stalwarts from two different fields -- Dr Abdul Kalam from defence technology and Dr Soma Raju from medicine.

Kalam's dream was realised, thanks to Arun Tiwari, who actually developed the stent. Tiwari who had worked with Kalam for a decade in the Defence Research and Development Laboratory decided to devote full time to the Society for Biomedical Technology which he had founded to realise Kalam's dream.

Explaining how the Kalam-Raju stent was developed, Tiwari said defence scientists had first developed a variety of stainless steel. The material, originally developed to prevent corrosion of naval ships, was refined and adapted to ensure that while maximum flow of blood would be permitted the stent would not be too weak either.

Heart diseases aren't only a rich man's problem as popularly believed, Tiwari said, adding, "It is only because the rich could afford the treatment that it is perceived that way."

Tiwari told Rediff On The NeT that 70 per cent of the cost of cardiac care in India goes for consumables while 25 per cent went to the hospital and the remaining five per cent went to the doctor.

Since all consumables had to be imported, the total cost was nearly Rs 70,000. The coronary stent alone would cost Rs 55,000. The indigenously developed Kalam-Raju coronary stent cost just Rs 15,000, making cardiac care affordable. The cost of the Kalam-Raju stent was later brought down even further to Rs 10,000, he said.

The development of the Kalam-Raju stent had provided the competition that made international companies promptly drop the prices of their stents.

"There is scope to bring down the cost even further," says Tiwari.

According to Tiwari, director, Cardiovascular Technology Institute of the Care Foundation, there are 22 million people in India who suffer from coronary artery diseases and out of them 9.5 million people have an artery already blocked. "The fatal moment could come anytime for them," he says.

Cardiac disease burdens the national economy with Rs 15 billion every year because the consumables have to be imported. This drains precious foreign exchange but the Kalam-Raju stent helps reduce that burden.

Out of the 9.5 million people prone to a heart attack anytime, 4 million patients need immediate intervention but only 20,000 of them had angioplasty performed on them in a year.

"This is because cardiac care is expensive. Those who cannot afford it just go home mentally prepared to die any day. It is this situation we wanted to change making the Kalam-Raju coronary stent available at an affordable cost," Tiwari says.

His efforts have also resulted in the catheter and guide wire used in the stent being developed indigenously.

It is not just the Kalam-Raju stent that has come as a boon to heart patients. Tiwari says a mission has been started to examine heart patients and give them medical advice in the villages while the specialist doctor offered advice from Hyderabad.

"Patients in villagers will no longer have to die because they do not have medical care within reach, both in terms of money and distance," Tiwari says, adding that a telephone and a modem is all that they require.

Tiwari says he intends to have telephones and modems installed at several places in Andhra Pradesh. When a patient is rushed to a doctor, that doctor can quickly take advice from a heart specialist in Hyderabad. The specialist could also examine the patient through the computer and advise the doctor at the other end accordingly.

In the effort to make much-needed heart care affordable to patients, Tiwari says he has another major target in mind for the coming year -- bringing down the cost of a life-saving injection worth Rs 3,200 that has to be administered to a patient who suffers a heart attack.

"I'm determined to eliminate the last zero from the Rs 3,200," Tiwari says.

A mechanical engineer by education, Tiwari taught at the College of Technology, Pantnagar in Uttar Pradesh before he joined the Defence R&D (missiles) wing where he served from 1982 to 1997.

It was during this time that his association with Kalam inspired him to pursue Kalam's dreams of making defence technology benefit the medical world.

In the Defence R&D (missiles) wing, Tiwari designed India's first titanium air bottle for the Trishul missile in 1985. He has authored four books, the most recent being Wings of Fire, Kalam's autobiography.

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