Heart Surgery for $1 and a Quarter!

Heart surgery for Rs 5 a month

Twenty-year-old Prasanna, a farmer from Tumkur district of Karnataka, would have normally wasted away after he was stricken with a heart disease. However, a model health insurance scheme has provided a ray of hope to thousands like him, besides setting a splendid example of government-private partnership.

Prasanna underwent an open heart surgery for Rs 60 ($1.25), the annual premium for the Yeshasvini health scheme launched in the cooperative sector in 2003. This quiet health revolution reaching out to the have-nots has resulted in medical treatment to more than 85,000 farmers in the last two years. As many as 25,000 farmers have undergone various kinds of operations, including those of the heart, brain, stomach, eyes and the gall bladder, during this period.

Starting from the 800-bedded super-speciality Narayana Hrudalaya Hospital on the outskirts of Bangalore, it now reaches out to farmers through 170 hospitals across the state.

The scheme came into being ironically at a function where its originator — the Hrudalaya hospital founder and heart surgeon, Dr Devi Shetty — was invited to endorse a milk product. Dr Shetty, a foreign trained cardiologist who went on to become Mother Teresa's personal cardiac surgeon and then an unabashed advocate for providing modern health care to the poor, asked his hosts the Karnataka Milk Federation (KMF) to support a path-breaking idea. What he had to offer to the KMC's Managing Director was this: "I will extend health benefits to all your two million employees for just Rs 5 a month"

Fortunately, for the farmers and Karnataka, the then Chief Minister S M Krishna was also at the function. When this scheme was suggested to him by the KMF Managing Director, he asked his government to fine-tune it. So was born the Yeshasvini (meaning Victor) health programme with KMF members as its first beneficiaries. The scheme was extended to other cooperatives and now covers around 17 lakh farmers in the state.

The government jacked up the premium to Rs 7.50 a month for each member by contributing the extra Rs 2.50 from its own coffers. The manner in which the Yeshasvini scheme took off is also unique. The insurance fee was collected upfront for a year so that initial needs for funds could be minimised. The state government, on its part, made its infrastructure of post offices available to collect the Rs 5 premium, and issue a "Yeshasvini member card".

The initial task of getting hospitals to participate and selling the idea to the cooperatives was conducted by the Trust, but the daily operations were later handled by a third party, which also coordinated payments to hospitals.

Speaking about the scheme, Dr Shetty says out of the 85,000 who had received treatment under the scheme in the last two years, 25,000 had been operated upon. Besides recognising 170 hospitals, the Yeshasvini Trust also recognises four heart hospitals in the state for heart operations.

The scheme covers nearly 1,700 different types of operations which include operations of the stomach, gall bladder, eyes, brain and uterus. The members also get free outpatient consultation in all Yeshasvini recognised hospitals, besides getting discounts on outpatient investigations.

Dr Shetty says the scheme can be easily replicated elsewhere with the Maharashtra and Tamil Nadu governments in dialogue with the Trust to include cooperatives in their states in this programme.

"All it needs is 10 lakh members who have come together for some other reason other than healthcare like a cooperative society or a grameen bank. A monthly premium of Rs 10 to Rs 15 should be collected for the whole year and deposited in the account of the charitable trust responsible for implementation of the scheme. Lastly, recognised hospitals should offer comprehensive packages for the operation so that patients are not charged extra in case of complications".

Dr Shetty says Narayana Hrudalaya is ready to carry out the entire process of launching the scheme free of cost using its expertise and infrastructure in case any state government or organisation desires so. Trained at the Guy's College in Britain, Dr Shetty left a promising career to come back to Calcutta to work on pioneering low-cost heart surgery.

This led to the establishment of the Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata in the nineties and the foundation of Narayana Hrudalaya in 2000 in Bangalore. He has not stopped at building world-class institutions which are aimed at providing quality health care to the underprivileged. He has instituted telemedicine to provide cardiac care free of cost to the poor by roping in ISRO.

Narayana Hrudalaya is also in the process of being declared a deemed university for postgraduate medical degrees and is on the road to becoming a health city, the dream goal of Dr Shetty.

How did he go about it?

"I realised that the bulk of the money of hospitals is earned from heart treatment and that needed to be reduced. We at Narayana Hrudalaya have done just that. We have gone in for large-scale operations and are currently performing 23 surgeries everyday. In Calcutta we are performing around eight surgeries everyday. This has reduced costs to Rs 65,000 for a bypass surgery", he said.

by Jangveer Singh

Jews in Cochin, India

The Cochini Jews

The second Jewish community of India is called 'Cochini Jews'. They are called Cochini Jews because they lived in the city of Cochin in south India. But actually the first settlement of the Cochini Jews wasn't in Cochin but a little north from Cochin in the town of Kudungallur (formly Cranganore).

Like the Bene Israels, the arrival time of the first Cochini Jews isn't clear. But one fact is sure about the Cochini Jews, that they weren't a single emigration. At different times Jews arrived and settled in south India at Kudungallur. According to one version the first forefathers of the Cochini Jews arrived in India during the King Solomon's period. King Solomon had commercial business with a kingdom probably existing in the present state of Kerala in south India. Other version claims that the Cochini Jews are from the Lost Tribes. Another version claims that the Cochini Jews arrived in India after they were exiled from Land of Israel by Nebuchadnezzar. Later on in the history Jews from Spain, arrived in Cochin. The Spanish Jews lived separately from the veteran Jews and considered them as Indian proselytes to Judaism. The Keralans take pride in the fact that the kingdoms of Kerala were world famous and merchants from around the world frequently visited Kerala, since the times of King Solomon and later on Romans, Greeks, Arabs, Chinese and others. Among the merchants, also arrived in Kerala many Jewish merchants and some of them settled in Kerala. The main center of the Jewish community in Kerala was at Kudungallur (referred to in English as Cranganore). The existence of the Jewish community in south India was known to other Jewish communities outside India and some other Jewish merchants also arrived in India. The Jewish merchants were influential community in their state and outside their state and were main reason for the prosperity in their kingdom. As a gratitude for their contribution to the kingdom, the ruler Sri Parkaran Iravi Vanmar gave to the head of the Jewish community Joseph Rabban the village of Anjuvannam and pronounced him the Prince of this village. These Jewish rulers had all the rights preserved to the ruling families of the Indian kingdoms. But till today there isn't an agreement among the scholars on the exact date when this 'Jewish kingdom' was established. Different scholars give different dates to the establishment of this principality. Some claim it to be in the 4 century A. D. Others claim it to be at a much later period around10 century A. D. According to the Cochini Jews the 'princely rights' (written on copper plates and therefore called Copper Plates) were given to them in 379 A. D.

Another fact not clear is : Which Cochini Jews received the 'Copper Plates'? The Cochini Jews are divided in three groups. The biggest group is called 'Meyuhassim' (meaning 'privileged' in Hebrew) or Malabari Jews (Malabar is the name of the coast on which Kerala is situated). These Jews forefathers are considered to have arrived in India as merchants during the period of King Solomon. The second group is called 'Pardesi' (meaning 'foreigner' in some Indian languages). The Pardesi Jews are Jews who came to Kerala at different periods from different countries namely Egypt, Iraq, Syria, Iran, Spain and Germany. These two groups were merchants and had slaves who were converted to Judaism and later on released from their status as slaves and are called 'Meshuhararim' (meaning 'released' in Hebrew). These groups were sometimes referred to by colors. The 'Privileged' Jews were called 'black' Jews, the 'Pardesi' were called 'white' Jews.

The 'Pardesi' Jews looked at the 'Privileged' Jews as impure Jews and as Jewish proselyte. Both these communities claim that the 'prince' was from their community. The Jewish principality survived till the 16th century A. D. In 1524 the Jews were attacked by Moorish Arabs because of the monopoly Jewish merchants had in some commodities. The Jews who were a principality with no real army deserted their principality and asked for shelter from the king of Cochin. The king received them in his kingdom and so was established the Jewish community of Cochin. The area where they lived and did business is even today called 'Jew Town'.

The Cochini Jews knew all of the Jewish traditions and preserved all Jewish traditions. They were particularly strict of Passover and didn't even allow the non-Jews to touch the cooking utensils during this period. As stated before the Cochini Jews were very influential in their society. Numerically the Cochini Jews at their height were 3000 and that was in the 1940s. Of that the Pardesi were only 200. Today there are about 70 Jews in Cochin.