President, Cardiological Society of India
Cardiologist & CEO
Medical Center Heart Institute
Sr. Consultant Cardiologist
National Hospital of Sri Lanka
</b> So I just mentioned to you the galaxy of people who are coming for WCCPCI and they are giving their view points, what they should do to create a healthy heart and a healthy environment which is the theme of World Heart Federation this year on the occasion of World Heart Day. First of all, I would like to ask Dr. Sumita chowedhury, she is coming all the way from Houston, Texas, and this is our second visit to WCCPCI. I would like to ask you Sumita what is your impression about the conference #1 and #2 would you think as a policy maker or as an advocate of a healthy heart in women, what you would like to contribute, how would you like to have an alliance with the organization like ours to create a global impact.
</b> The honor is actually mine to come here. I had such a good experience last year that I had to come back and I think the energy that I find here at the congress is amazing and it is something that can basically contribute to world health and especially health of women. Heart disease is a big problem in women and the statistics are staggering. We have one woman dying every minute of heart attack or heart disease and these statistics are latest from the American Heart Association. The problem is our society has this myth that it is only the male that is going to die and that is why you see in the movies they will classically show a male actor clenching his chest and falling to the ground and this sort of experience creates a lasting impression on people’s mind that it is not the woman that is going to get a heart attack, it is always the man, but the truth is something totally different. It is usually a woman who is more likely to die and this woman is going to not have this melodrama, is going to have a very different presentation, we call it atypical, but guess what, it is typical for women. So, let us not use the word atypical because these symptoms are what women experience. This is absolutely typical for women.They may have shortness of breath, they may have fatigue, they may experience digestive problems but they also may have some types of chest pain which may not be that pressure like an elephant on your chest, but these are symptoms that women need to understand. This awareness needs to be there and I really congratulate you for taking that first step in India of having this congress of prevention and really getting to the meet of the matter, how can we make a difference, how can we impact by global action and how can we start here in Mount Abu and take it to the rest of the world.
</b> Sumita my question to you is very important and very simple that we see and there is a huge scope of preventive cardiology. Interventional cardiology is just a small fragment of preventive cardiology. Interventional cardiology is not a separate entity. It is a part of tertiary prevention. So, if we promote primordial, primary, secondary and tertiary heart care equally in equal proportions, I am sure we will be able to reduce the rising menace of coronary artery disease not only in India but in the whole globe. My question to you is, staying in United States, how you can alliance with us to create an impact in the whole globe. How we can work together so that we create a huge movement for a healthy heart in women specifically, because I agree with you that in women heart problem is underestimated, undiagnosed, and less understood and I personally feel after the age of 45 the proportion is same whether it is a man or woman and I think if you see the expression or the exposure is given more to a man than to a woman. We would like to have your view points how we can work together, what are the gadgets or technologies required so that we can have a voice in the globe.
</b> I think that you raised a really valuable point. I think India and US needs to work together. I think in this digital age we can certainly collaborate in a big way and in fact this generation lives on the digital media and I think if we are into that which you clearly are, we can make a very big impact. The other aspect is that women often are not aware of this problem and our first big hurdle is to increase the awareness. Even in US, women are not aware and the big problem that we see in the US and also here is that women often think of prevention as preventing genital cancer, how can we prevent cervical cancer, how can we prevent uterine cancer or how can we prevent breast cancer. That gets so much impact, but for every 30 women you have one breast cancer but for every 3 women you have one heart attack victim. So, those statistics are so different and yet women do not realize that and there are big moments in US for breast cancer awareness. We need to do more for heart disease awareness in both countries. So, I am very happy to collaborate with you on this.
</b> Sumita, I think your point is very well taken that a time has come we should talk healthy heart in a digital way.There is no doubt about it.That is our future and I personally feel we must create various apps like a smart heart app for women. When you talk of smart heart app for women, I am sure there is going to be automatically a lot of awareness. We can create various ingredients or components of this app. The whole education today in the world is app based. What is your idea about it?
</b> I love the idea. I think that is the way to go. I think all our outreach efforts should be digital.The app is a very attractive modality especially if it can be for the smart phones. I think most women are into technology.That is the way to reach them and that can be a continuous motivation for them. It can be an app that can motivate them to exercise, to walk, to do the screening and to be aware of the presentation and symptoms. So, definitely it is the way to go.
</b> Thank you Sumita, I think it was very nice talking to Sumita Chowedhury from United States. She is very vivid in her statement that a time has come Indo-US collaboration is a must for a healthy heart in a digital way. Sumita was very clear that time has come, we need to have focus on healthy heart for women and talking of cancer all the time. She also mentioned we have to have a parodyne shift from illness to wellness. We talk of a healthy heart for women in a big way and app application, it is the app which will create a huge educational aura in the women’s mind. In the years to come Sumita, we will be very happy to collaborate with you so that we create healthy heart in a digital way.
</b> Thank you for giving me the opportunity, it is my pleasure.
</b> We have with us R.A.I. Ekanayaka who is the president of very powerful organization from Sri Lanka, Sri Lanka Heart Association. I am very happy that R.A.I. Ekanayaka accepted our invitation coming all the way from European Society of Cardiology. He has not gone back to Sri Lanka. We are very grateful to you sir.
</b> Thank you.
</b> We really welcome you to India. Is it your first visit or a second visit?
</b> This is the third visit.
</b> Oh, third visit. So, he knows India much more than what I know. It is very nice of you and I am sure since you know India so well, we would like to have your opinion on this conference in particular because I am sure this conference is a little different than our usual conferences what I do in Cardiological Society of India. This is a conference having two or a mingle of spirituality and science.We would like to have your opinion on this and #2 I would also like to ask you what is the vision of Sri Lanka Heart Association to create a vision document or a mission document of an alliance of Sri Lanka Heart Association with the Indian Heart Association? How we can work together to create a healthy heart?
</b> First of all, Dr. Chopra, the pleasure is entirely mine and I am very much honored to be invited to this World Congress and which we have enjoyed the past two days very much because it gives extra dimension to the usual congresses that we have. You see, our theme this time is environment of the heart, but when we say environment, I would like to emphasize that we are not thinking of the physical environment alone. Claude Bernard taught us of the Milieu Interieur and as physicians we are thinking of the Milieu Interieur. We are changing our biochemistry. We are treating with drugs to change our biochemistry and the internal milieu and the pathophysiology to control our diseases, but what about the physical environment. Air pollution is now known to cause atherosclerosis. What about the intellectual emotive environment. This is also environment in which we live. So, I love your congress because the vision that you have shown us is not only that we should think of the pathophysiological environment of the body, but we are holistic beings with a spiritual, intellectual, emotive and physical bodies. We as physicians should address this problem, otherwise we end up with what we call the diseases of industrialization and urbanization and the pan epidemic that we see now of noncommunicable diseases in the world is because we have concentrated on the physical world to the detriment of our health because we have forgotten that we have other aspects in our existence and being.
</b> I think it is very nice Ekanayake has mentioned that when we talk of pollution, we talk of only environmental pollution related external to our body. What he is mentioning that it is not only environmental physical pollution outside us, he used a very nice word when we talk of emotional pollution. Toxic emotions, toxic behavior, toxic relationship, and toxic consumption make it toxic being. A very important, very important statement Ekanayake has mentioned. I think time has come, we need to shift from toxicity to purity. I think the purity is possible when we have a complete balance of the internal environment what we call as microcosm and the external environment what we call as macrocosm. Ekanayake was very, very particular and very emphatic when we talk of environment, it has to be environment within us and environment outside us and a balance has to be created at the level of consciousness. It should not be only intellect. It should not be only mind. It should not be only physical. Until we have a complete equilibrium of all these components, we cannot have a healthy heart. Very nice expression sir and I am sure this conference like this if we create on a larger scale, we may be able to achieve that is what our feeling is, but it is all in the hand of God because we all need to understand the heart health, not only organ health, but it has got a strong connectivity in the whole system.
</b> What I will suggest to sir is that we should introduce into the medical curriculum. It is the curriculum that has failed us when it comes to holistic, because we treat and we have no subject in our medical schools at least. I do not know about India, where the Body-Mind Medicine aspect is emphasized. I know in Harvard, I do not know whether elsewhere that Benson that was the first chapter in Body-Mind medicine. The first chapter that was endowed as a professorship to teach this subject that we are no longer machines as Deckert said, but we are actually an interaction between all three aspects of our existence.
</b> I think very nice expression I think there is already a Chair created down in the Harvard by the name of Mind-Body Chair which is existing and a lot of things are happening in the United States. I know about Dr. Deepak Chopra who gave a very fantastic talk in the Harvard only on Mind-Body Medicine that there is a very strong relationship.
</b> Smita, I am sure you have been in USA for a long time and you know everything about what is happening there. What do you think is the scope of mind-body intervention for the healthy heart? Is there the scope or there is a no scope?
</b> I spent nearly a decade training in Harvard and did my Masters in Public Health from Harvard and I have interacted personally with Dr. Herbert Benson. I think it is a valuable component of our (06
</b> I think Smita and R.A.I.Ekanayaka are very, very clear that we are not the packages of flesh and bone physically with our misdesire in our mind all the time, but we are all the web of information and energy interwoven with the emotions and intelligence from the level of the consciousness which has influence in the heart. So healthy heart cannot be created just by putting in a stent in a small tiny artery, we have miles and miles of the arteries in our body, how many stents will we put? We have to think that we have to do angioplasty of so many vessels, tiny vessels, microvessels in the brain and then the middle-sized vessels and then the large vessels and then the largest vessel like aorta, where we also think of putting of a stent, I think the answer is we should think of a method, a spiritual intervention, so that we create a spiritual angioplasty right from the head to the toe at least until the age of 80. After 80, all have to go. We are not permanent here. We are not immortal. We are all mortal, but we should not die at the age of 40. When a person is getting a heart attack, a brain attack, or a leg attack, I think it is very, very important. I think Ekanayake I would like to ask you what your heart association in Sri Lanka has a vision to go ahead with a programmer like this.
</b> Yes we do. In fact, we have started our therapy of relaxation and we have tried and we have got on to the doctoral programs of musical therapy because we find that we are of multicultural society. I am multicultural society the spiritual aspect has to be emphasized as a method of relaxation. Stress relieving and we have gone on to third-world countries, we are all having targets and the targets are moving further and further away from us and we are lagging behind targets that is because the resources and the ambitions and the aspirations do not go hand-in-hand. We have set our targets high. This is very good, that is the way to progress, but we must be, what should I say, have a balanced view and that relaxation response, we have taken it to a very high level, so that even our universities have now accepted a doctoral study that was done and was awarded the Ph.D. in musical therapy and I think that is one way to do it. The spiritual aspect as well as the emotive and relaxation response should go hand-in-hand and the Sri Lanka Heart Association has actually emphasized this matter, not only in holistic medicine but also in social medicine as well.
</b> I think it is very important, Ekanayake mentioned very clearly that what we talk of a Mind Body Medicine is not an alternative medicine, it is a complementary medicine. It should be complemented with the allopathy if you really want to have a better outcome and the same thing has been expressed by Smita. I think time has come, we should talk of spirituality and science together if we really want to have a healthy heart and I remember the insight of both the speakers here that we should understand that we are all spiritual beings with a very occasional physical experience and not physical beings with the occasional spiritual experience. If we understand this, life is worth living and beautiful. According to me, the hell is here and the heaven is also here. We should use our intellect to have perfect choices to have a healthy heart. I am very grateful to you. Thank you Dr. Ekanayake coming all the way from Sri Lanka Heart Association and giving your words of wisdom. In the same way, Smita, I am very grateful to you for expressing your insight about the women care and the women’s heart and I am sure in the years to come, we all will work together to create a global effect. Thank you very much once again to both of you.
</b> Thank you.