Four Decades of Cardiac Surgery in Bangladesh: A Noble Journey That Started with the Help of Japan.

The first-ever open-heart operation in Bangladesh was performed on the 18th of September 1981. Although a few cases of finger fracture closed mitral commissurotomies were performed in the country in the 1960s and 1970s, full-fledged cardiac surgical services began only in Bangladesh after the establishment of the Institute of Cardiovascular Diseases at Dhaka in 1978. A Japanese team that includes cardiac surgeons, anesthetists, cardiologists, nurses, and technician came to Bangladesh and played an important role in the initiation of such a Bangladeshi endeavor. Bangladesh is a South Asian country with more than 170 million people living only in an area of 148460 square kilometers. Information was sought from the hospital records, old newspapers, books, and memoirs written by some of the pioneers. Pubmed and Internet search engines were also utilized. The principal author had personal correspondence with the available pioneering team members. The first open-heart operation was performed by visiting Japanese surgeon Dr. Komei Saji along with Bangladeshi surgeon duo Prof. M Nabi Alam Khan and Prof. S R Khan. Since then, cardiac surgery in Bangladesh has made a significant progress although it may not be enough to serve 170 million people. In 2019, twenty-nine centers performed a total of 12926 cases in Bangladesh. Remarkable advancement in cardiac surgery has been made in terms of cost, quality, and excellence in Bangladesh, but the country is lagging behind in the number of operations, affordability, and geographical distribution, which needs to be addressed for a better future.

Global geographical discrepancy in numerical distribution of cardiovascular surgeries and human resource development in South Asia.

Objective: The region South Asia is in the south-central part of the Asian continent. The 8 countries of the area, Afghanistan, Bangladesh, Bhutan, India, Nepal, The Maldives, Pakistan, and Sri Lanka collectively possess 1.8 billion people living in 5.1 million square miles. Covering 2.96% of World's surface, this area is inhabited by 23.9% of the world population. The objective of this study was to observe the number of cardiac operations in South Asia and the human resource development facilities of cardiac surgery in the region. Methods: Information was collected from the surgeons and anesthetists through personal visits, phone calls, and emails. The websites of various organizations were also checked. Results: The estimated number of cardiac operations collectively performed in the South Asian countries was between 250,000 and 300,000 as of 2019. With more than 6 times the US population, these nations combined performed less than half of the annual number of cardiac operations performed in the United States. The number of operations per million population ranged from 62 to 271 in different countries. This indicates that there should be more capacity-building of surgeons to meet the growing demand of operations. India, Pakistan, Bangladesh, Sri Lanka, and Nepal have their own education and training systems for cardiovascular surgeons. A substantial portion of the seats available for cardiovascular surgery courses remained vacant in South Asia these days. Conclusions: Five countries have their various surgical education and training programs. There should be coordinated efforts to increase the production of new cardiac surgeons in the region.

Know thy neighbors: The status of cardiac surgery in the South Asian countries around India.

OBJECTIVES: The South Asian neighboring countries of India include Bangladesh, Bhutan, Nepal, The Maldives, Pakistan and Sri Lanka. Interestingly all these countries possess either a land or a sea border with India and no border among themselves. These countries have historic, cultural, ethnic and genetic links with India. The paper describes the developmental history and current status of cardiac surgery in these countries. METHODS: Thorough search of the printed and electronic materials has been made. The authors visited all these countries and contacted the eminent surgeons personally or through mails. All the information is cross-checked and compiled. Record keeping is not well organized in most of these countries. Best information often came from unusual sources like Anesthetists' society or the corporate houses. RESULTS: Four of these countries Bangladesh, Nepal, Pakistan and Sri Lanka have their cardiac surgical programs. Collectively they perform around 38000 cardiac operations a year which is a quarter of the cases performed in India. These countries are important sources of medical tourism in India which is worth 3 billion US$ of business annually. CONCLUSION: When the number of operations per million populations is considered, Bangladesh and Nepal are lagging behind India where as Pakistan has a comparable figure. Sri Lanka with 265 cardiac operations/million populations has the best figures in the region. However when compared with the Western countries even the Lankan figures also look quite inadequate.

Assessing the perceptions of a biostatistics and epidemiology module: views of Year 2 medical students from a Malaysian university. A cross-sectional survey.

BACKGROUND: In the era of evidence based medicine, biostatistics and epidemiology are considered as the main elements aiding the health professional to design a research study, understand the literature, and make decisions about patient care. The aim of the study is to explore students' perception about this subject because it plays an important role in determining educational outcome. METHODS: Data were collected from a self-administered questionnaire distributed among 164 Year 2 medical students. The 5-point Likert scale anchored by Strongly disagree = 1 and Strongly agree = 5 included 36 questions in four domains designed to assess the perception of a biostatistics and epidemiology module amongst students. RESULTS: 138 students with ages ranging from 20 to 24 years (Mean = 20.7; SD = 0.62) returned their responses to the questionnaire. This was a response rate of 84.14%. Of the 138 students, 80.7% realized the relevance of the subject to real health issues at the end of the module, while 89.8% believed the module focused on interpretation more than calculation.More than three quarters (78.1%) agreed that lack of practicing exercises was the cause for declining interest in the subject, while only 26.1% believed that lectures were not interesting. Another three quarters (75.4%) believed that there were too many lectures for one day of teaching activities, while 84.6% recommended practical sessions for designing research and data collection. CONCLUSIONS: This study found that students perceived the relevance of biostatistics and epidemiology to real health issues. The major cause of poor interest in the subject was attributed to the short duration of the course, lack of practicing exercises, and the need for practical data collection sessions. Emphasis should be given to early introduction of projects for data collection and analysis.