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He was sent over to train in Britain by his rich family. They just wanted him to come home and become a successful doctor in India. But Devi Prasad Shetty had bigger plans. After specialising as a cardiologist at Guy’s Hospital in London in the 1980s, Shetty spent the next 12 years pioneering low-cost heart surgery-using every technique in the book, and some new ones that he invented himself. Telecardiology to remote places on the other side of the globe, portable ECG machines for GPs in the field, and a hospital that does more heart operations per surgeon than anywhere else, there seems to be no limit to his ambitions. Seema Singh caught up with him.

You claim that India will be the largest provider of cardiac care in the world by 2006. Are you mad?

Not at all. India is already the largest producer of doctors, nurses-and heart patients-in the world. With economic liberalisation, the world is increasingly becoming boundaryless. Very soon economic realities will prevail. With painfully long waiting lists and high costs of surgery, the days are not far away when poor patients from all over will come here for heart surgery. One of my friends had an emergency case with a British tourist in Goa. After performing an angiogram, the patient was told he needed surgery which he could get done here or in the UK. He preferred to undergo the surgery here. “There’s every possibility that an Indian would operate on me there,” he said. “So why not get operated by an Indian in India?” We’ll hear more such cases.

Given the waiting lists in Britain, would you consider taking people from there?

Certainly. It’ll be inevitable in a few years. Some insurance company will come forward to provide the connecting link. After all, it’s a matter of life-and that at the fraction of the cost in developed nations.

Since coming back from Guy’s, you’ve helped thousands of poor patients get state-of-the-art cardiac care. What motivated you to take on such a massive task?

I came back home to Kolkata (Calcutta), which is essentially a microcosm of India, a magnified village with well-equipped hospitals but extremely poor people unable to afford modern healthcare. This stopped me from getting cast in a typical doctor’s mould. I was lucky enough to become Mother Teresa’s personal cardiac surgeon, and five years of close association with her and her work changed my life. If I hadn’t returned to Kolkata and not seen so much misery, maybe I wouldn’t have taken up the cudgels this way.

Why is heart care so important in India that it needs special projects and extra cash?

Indians are genetically prone to heart disease: they are three times more vulnerable than Americans or Europeans. In England, the average age of my patients was 65 years. Here it is 45.

How easy it is to get those funds?

Believe it or not, it’s not difficult to arrange for funds when your cause is noble. When I look back just three years ago on how funds came in for the Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata, my resolve to spread the charitable healthcare approach gets stronger. After initial help from a construction businessman (whose father I had operated on) to build a cardiac diagnostic laboratory, there were grants from the corporate sector and soft loans for equipment from Tata Finance. One of my patients, a stock-broker, donated £72,000 as working capital. These helped get the building finished and start the hospital, by which time the Armenian Church came forward with an amazing £500,000. After inspecting us, they were so impressed they increased the amount to £1 million for a neurosurgical, renal and vascular trauma centre. Within six months we will have the largest trauma centre in eastern India. My plans have never suffered for lack of funds.

The medical fraternity has accused you of stealing the media limelight as the only Good Samaritan in town. Does that offend you?

I don’t expect everyone to be supportive of my activities. I am continually inspired by Albert Schweitzer’s words that when you are working for man, don’t expect him to remove stones from your path, expect him to put more there. I am one of the few privileged people in the world who at the early age of 47 has everything a man can ask for. I don’t want anything more in life for my personal gratification. Yes, healthcare is full of politics, but fortunately I’ve never been a victim as I never practised medicine for my personal gain. I began as a social worker and am continuing that way.

Why isn’t this cash coming from international bodies? Shouldn’t they be promoting free or subsidised healthcare generally?

If there is one organisation that can be squarely blamed it is the WHO. Headquartered in Geneva, separated from reality, it runs its global activities with help from government representatives who are mostly bureaucrats. In the countries I travel to, bureaucrats are a class of people who are experts in nothing but authorities on everything. They are not best-suited to guide planning at the WHO. One of the WHO declarations was “Health for all by 2000”. How can a global body make that kind of statement when a country like Zambia does not have an echo-Doppler, without which you cannot detect any heart problem, or when one cannot find a single functioning ECG machine in many African countries?

That doesn’t sound too good . . .

It gets worse. The WHO has saddled most governments with grants and soft loans, not donations. Millions of pounds are given which are ill-spent either on buying expensive equipment which tends to be left unused or on expanding the physical infrastructure. I have met people from the government who say they don’t know how to spend the money. Then comes the repayment, when the axe falls on the taxpayers.

So what should happen?

Shift the WHO headquarters from Geneva to any Third World country where it would be able to assess the problems without any filters. Subsidised healthcare should be extended to all possible areas.

So have you given up on politicians?

Apart from the WHO, I have stopped blaming the politicians and bureaucrats. We are better placed to bring about changes by being outsiders, not by being a part of the system. All that the government can do is to stop being an obstacle. If it decides to be a bystander, things will fall in place. My belief is that within ten years, the government healthcare systems in all Third World countries will fold up. The government will not be able to pay even salaries, never mind offering healthcare. In that situation, organisations like ours should come forward to take over and manage it in a professional manner.

For the past six months you’ve been running telecardiology units at your Bangalore and Kolkata hospitals which link to coronary care units (CCUs) in remote parts of eastern India. How’s it going?

The first eight hours after a heart attack is the golden period for treatment and few district hospitals have the expertise and the equipment to manage cardiac emergencies. So we set up CCUs in remote areas of north-eastern parts of India which are the most backward. These units have been linked to my two specialised hospitals in Kolkata and Bangalore through ISDN lines. We have trained doctors from district hospitals in critical care management and echocardiology. Patients who didn’t have access to cardiac care can now go to their nearest CCU, where doctors, with guidance from specialists at these two base stations, will provide treatment. We can also make final interpretations of ECG, echocardiograph and other reports through telecardiology. We saw 600 patients in the first seven weeks.

Are there any areas of cardiac care which are specially well suited to this treatment-from-a-distance?

All kinds of diagnoses can be made through telecardiology. Once the initial reports are analysed and if the patient requires just medication, not surgery, it will be provided by our experts from here. If the patient needs surgery, he will have to undergo that in his home country or he is welcome to come to us. As the telecardiology network expands and matures, we’ll train doctors to provide advanced services in the local CCUs. Paediatric heart care is another area of concern because 1 in 140 children born anywhere in the world requires heart care.

You’re extending telecardiology to Mauritius, Bangladesh and Malaysia. Why?

In these countries, either affordable cardiac care is not available for the underprivileged, or cardiac care itself is a scarce service. I regularly get patients from these countries, and many times we feel that the patient need not have travelled all that way. Sometimes newborn babies or toddlers are brought to us only to find that either they do not require an operation or they can wait for a few years. Similarly, a patient whose coronary arteries are found to be blocked after investigation through a link-up facility can be advised on the future course of action. If they want to avoid surgery in their home country because that country is just too poor, they can be called to Bangalore and operated on at a third of the cost. The NGOs we’re working with might even arrange for some funding.

This must all get very expensive. After all, the hospital at Bangalore will equip CCUs with instruments and train personnel while the NGOs will only bear local administration expenses . . .

In my 12 years of running the hospital in India I’ve seen that people are increasingly becoming more giving. The opening up of the global economy has created a lot of wealth among middle-class people. It used to be that wealth was accumulated over long periods, often by not-so-legitimate means. But now the people who have become rich do not have to read newspapers to understand poverty. And when good people become wealthy, money gets spent on better causes.

But I’ve heard there’s a difference in the economics of running your hospital . . .

Yes, it’s very different. In Western hospitals, about 60 per cent of the revenue is spent on salaries, while in government hospitals in India, 90 per cent goes on salaries. By contrast, in our hospital only 12 to 13 per cent is spent on salaries. That doesn’t mean our doctors are being exploited. Since their output is ten times more, unit operating costs are very low. To earn a given salary in another hospital, a doctor would have to perform one operation a day. With us he might have to operate on five patients. We also work with zero inventory, so the burden lies with the supplier. And since we are the largest consumers of medical disposables, we procure them at a discount of 30 to 35 per cent.

You’ve moved incredibly fast in 12 years: two big heart hospitals and research centres, one heart foundation, 9000 operations-4000 of which were on children-plans for mobile ECGs to every GP in Karnataka . . . What’s next?

There’s so much to be done. I dream of having a CCU in every government-run district headquarter hospital and linking them to the Bangalore and Kolkata hospitals. Starting from a small village near Bangalore, I want to show the world that some kind of health insurance is possible for the poor who cannot currently dream of heart care.

How would that work?

The idea is to make these poor people believe that just as they spend money on rice, milk and kerosene, they will have to spend a minimal amount, say 10 to 15p a month, even when they are well, towards health insurance. While the rich have private health insurance, the poor need organised healthcare. Today, no health service in government hospitals in India is free, least of all cardiac care. It is subsidised for the poorest of the poor but the quality of service offered is deplorable. We are discussing health insurance with some insurance companies.

Besides cardiac care, what fascinates you?

Nothing. I dream, breathe and live healthcare. And I am fortunate to have found a team that shares my dream.