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BERKLEY TOURS AND TRAVEL
3/19
1999
108
prevalence of rheumatic heart disease
as well as contacts with Indian physi-
cians they knew from Michigan. Their
goal was to evaluate whether valvulo-
plasty or one of two surgical proce-
dures worked best for patients.
"We needed a hospital that had a
lot of patients, was willing to do clini-
cal trials, and had a data base," said
Dr. Turi. "We taught the Indian
physicians the procedures and learned
about their patients. For example,
Indians weigh on average a lot less
than Americans. They are more fragile
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Detroit Jewish News
55..).7243
and don't handle medicine as well."
Medical research in India posed
special challenges. While medical
equipment at Hyderabad's Care
Hospital was state-of-the-art, accord-
ing to Dr. Wynne, translators were
needed since most patients do not
speak English. Annual trips to India
involved 10-14 days of intense work
for the team, which includes cardiolo-
gists, the chief of cardiothoracic
surgery at Harper, Dr. Larry .
Stephenson, and a research statisti-
cian.
During one trip, the Jewish
researchers fasted on Yom Kippur.
While their Indian colleagues were
unfamiliar with the holiday, they
understood and respected the tradi-
tion of a religious fast, which is com-
mon in Indian religions.
For the American medical team,
the research study was the start of
medical and personal relationships
with Indian patients and physicians
that continue today. Many patients
were screened by Dr. Susan Farkas, a
cardiology fellow at Harper Hospital.
She joined the study because of her
experience with rheumatic heart dis-
ease in her native Hungary.
Barbara Fromm, a biostatistician,
assessed how the treatment affected
the patients' everyday lives. She has
'interviewed many of the patients
numerous times since 1989. "Even
though the average age of patients was
30, many of them had trouble breath-
ing and seemed like old people," she
said.
Some of the women couldn't per-
form household chores, such as bend-
ing over to sweep floors and bringing
water from a well, so their daughters
would leave school to help care for the
home and other children.
"There is no safety net in India,"
Fromm said, "so people are truly
dependent on their families. With
treatment, their lives were much
improved and many of the women
had children, which is normally diffi-
cult for someone with this disease."
Even though the research extended
over 10 years, locating patients for fol-
low-up was not difficult. Since most
of the patients were poor, they were
grateful for free, up-to-date care and
were willing to travel long distances
by bus for medical exams. "Many
patients do not have telephones and
can't read, but village scribes would
read and respond to letters from the
physicians in Hyderabad," Dr. Wynne
said.
"It was challenging to work in cul-
tures 10,000 miles apart," said Dr.
Turi, "to learn about each other's
patients, cope with jet lag (a 10.5-
hour time difference) and travel time
of two days, and Indian food, which
now I really like. But I became
attached to the people, the place, the
philosophy, art, culture and geogra-
phy.
Their research indicates valvulo-
plasty is more effective than expected.
"Ballooning is superior. The proce-
dure is less risky than surgery and the
valve is more open after seven years
and 10 years," Dr. Turi said.
In addition, valvuloplasty has sever-
al advantages in India. While the pro-
cedure is less expensive than surgery,
its cost is even less in India, where
catheters and balloons are sterilized
and reused.
Also, patients prefer the procedure
because it doesn't leave a surgical scar,
indicating a health problem possibly
detrimental to future marriage.
While one more follow-up visit is
needed for surgical patients, the
research already has had an impact.
Since the five-year results were pub-
lished in the New England Journal of
Medicine in 1994, the balloon tech-
nique has become the treatment of
choice in India and the United States.
The physicians will present their
findings at the March meeting of the
American College of Cardiology.
',