Lately when I visit Bangladesh , an increasing number of visitors come to greet me, known, fairly known, somewhat known, less known, hardly known or even unknown. They all have one thing common to them. They all carry a CD with them. A CD, very carefully cased, then wrapped in clothe, handled very respectfully and carefully, gets out of the hand bag or shirt pocket and unwrapped in shaky hands. Then the CD is handed over to me with a body language similar to when the British Monarch hands over the Victoria Cross to the recipient.
I can’t cite any data, because there are none. But recently, chest pain caused by coronary artery disease followed by coronary deaths have taken a epidemic proportion in Bangladesh. Every death news I get coming from bangladesh, a middle aged man, women, an elderly, or a young man; there is 90% possibility that the death was due to heart attack.
With rapidly developing cardiology service in Bangladesh, people with chest pain are now getting an angiogram to confirm some blocked coronaries. After the angiogram, these women/men, with the CD of the angiogram are left wth the decision on how to treat the blockage. Thus they start their journey to solve the unsolvable arithmetic.
They are often told, without giving any time to elaborate or Q &A, ” you have block, you need stents. If you put the regular stent this will cost you 1.5 lac, but if you put the medicated stent, it will cost you 4 lac taka”. In most cases I saw, they have no clue what a stent is, what is the benefit of a medicated vs a non-medicated one.
Most cases they have some money left in providence fund they thought of using for daughters marriage or sons foreign trip.
Now they start debating how to better use the money. Should they go to NICVD at Dhaka where it will cost less, or Heart foundation or other new hospitals in Dhaka, or go to India or Singapore.? They get a price quote for life from all these places. Medicated stent …Taka, non medicated stent…taka.
They keep on bracing the madness of Dhaka streets, in search of a solution to the riddle. Is it worthy paying 2 lac for a renewal of life, how to renew it, with medicated or nonmedicated stent? Where to go, NICVD, India? Or rather to save the money for daughetr’s wedding or son’s possible opportunity for a job in malaysia.
With pain in the chest and a CD in their hand, they keep calculating with a resolve to solve the unsolvable riddle.
August 30, 2006 at 1:14 pm
This is a very sad and true picture of the majority of the BD population.
Some probably die without even knowing what hit them – not having the luxury of having a routine check-up.
Z
August 31, 2006 at 2:31 pm
So here’s a question? Why does it cost so much to get a stent put in your arteries? Forget the even more expensive drug eluting stents – despite their quick rise to prominence some questions are arising with respect to their long term efficacy – how about the simple stents? Small pieces of metal selling for high prices because of ‘intellectual property’ protection!
How about saying ‘to hell with that’ and producing them locally to save lives? I bet you you could mass produce them for for less than $100 a piece! May be even less than $20 a piece. If someone has the desire and the expertise, we should talk!
Disclaimer: I am a director of CardioMEMS, Inc. a company based significantly on the sanctity of intellectual property in areas of interventional cardiology. Please note that the above opinion is my PERSONAL opinion and relates to lifesaving technology in the third world and not to commercial IP in developed nations.
August 31, 2006 at 3:05 pm
Good idea.
But, I am not too sure about the copying the intra coronary stent technology. There are now 3rd generation stents and hybrid stents by Driver. I don’t know whether our small industry will be able to cope up with the ever changing technology. Safety is another issue.
However if not stent, it’s about time we embark on producing our own syringes, needles, sutures, hospital beds, surgical tapes. Our pharmaceutical industry of international standard, I feel they would definitely do good job with medical supplies also.
However about the stents, Muhit Bhai, I’ll talk to a couple of friend of mine, who are already in related fields in Bangladesh.
August 31, 2006 at 7:50 pm
Rumi:
The problem with syringes and needles is that they are already pretty cheap and it does not make a great deal of sense to try to go head to head against efficient Chineese manufacturers.
Stents, on the other hand, are expensive – most of the cost arising from the IP ‘charges’. The difference (in efficacy) between the third generation stents and the earlier stents is not nearly as significant as the difference between ‘No stents’ and ‘a stent’. The material cost is tiny – the fabrication cost somewhat larger.
I had a discussion this afternoon with a college classmate – an Indian physician – who is an inventor and a leading researcher in interventional vascular techniques. He is a significant owner (and I am a smaller shareholder) of a small company, ICON, which is actually selling stents (drug eluting) in Bangladesh. Jay tells me that ICON buys its stents from a manufacturer in the US for less than $30 each! The larger expense is the delivery mechanism – the balloon catheter – which costs more than $100. (ICON makes neither. It buys the components, puts on its coatings and pacakages and sells). In my view, the delivery mechanism could be reused in countries such as Bangladesh in order to reduce the cost. There is some reason to believe that such reuse is already common.
I asked Jay (Dr. Jay Yadav) about the possibility of manufacturing the stents in Dhaka and he said that in theory, all you need is an older generation laser that will cut the stent out of a metal tube. I recently saw an alternate fabrication methodology using metal sheets and etched patterns. Having been a semi-conductor process engineer 25 years ago, it did not seem like rocket science to me.
The goal could be to create a complete, deliverable stent for $100. While it might not be the super duper one that J&J or Guidant is selling for $1,000 – $1,500, it should do the job – especially for someone who cannot afford the extra one lac takas. Next, we’ll have to find doctors and hospitals who are willing to do the work.
Jay is going to be in New Delhi for a week in early October at the South Asian regional conference for cardiologists and such. If your friends are based in Dhaka, perhaps they ought to consider visiting and talking to Jay – who knows that I am looking at this from a philanthropic angle and not as a for-profit venture.
Let me know if we can create something here. As always, I am willing to spend some seed money to see if the idea has legs.
Best,
Muhit