Congenital Heart Defects

In today’s newspaper, I read an interview (”All Lives Have Equal Value“) with Melinda Gates, co-founder of The Gates Foundation. She said “Bill and I care about keeping all kids alive.”

In medical school, we study pediatrics as a subject. One surefire question that was asked in oral examinations related to “Infant Mortality Rate” (IMR).

How is it defined? What is the current figure in India? In Tamilnadu (our home state)? What was the target IMR for the next five-year plan?

Infant Mortality Rate is the number of infant deaths per 1,000 live births in the population. By demographic definition, an infant is a child below 1 year of age. A sub-group within it is the ‘neonate’, who is under 28 days old.

IMR is a metric. An important one. Because it is an index of the overall healthcare infrastructure of a country, state or community.

To me, IMR has meant different things at various stages of my medical career.

In 1987, as a student appearing for my exams, it was a number to memorize and recall when needed.

In 1989, it was a figure to remember, to avoid being shamed in a conference hall when called upon to quote it by the Director of our institute.

In 1996, when I was once again involved in treating children (as a pediatric heart surgeon), it was a magical representation of the impact a simple political and administrative shift could make on a broad population.

In the interim, the impact of a Government backed program had kicked in. The free midday meal scheme for school kids was launched in 1982 by then Tamilnadu chief minister, M.G.Ramachandran – at a cost of around $40 million to the exchequer.

And seven years later, once familiar sights of a pot-bellied toddler with kwashiorkor, or a wasted, thin school child hit by marasmus, were now rarities in the same institution where I had been a medical student… barely 7 years earlier!

In 2001, the same metric was a symbol to my aching heart of just how far we had to go in delivering optimal healthcare to our children. I had spent two years (in U.K. and Australia) training in infant and neonatal heart surgery, and saw infant death rates of 7-9/1,000 in those countries become rallying calls for radical improvement!

In 2010, a full twenty years since I graduated from medical school, the same number that was a factoid to be reproduced in an oral examination, had become the central focus of my daily professional work. Treating congenital heart defects, which now accounted for a large share of infant deaths, brought about this change.

By now, the IMR had dropped from a staggering 126/1,000 live births (in 1987) to just 31.

That means a child born in my home state has a FOUR TIMES better shot at celebrating his or her first birthday than just 20 years ago!

What a miracle in healthcare!

And what a sobering realization that it’s more a policy decision to improve nutrition and provide universal vaccination to the masses or clean drinking water that can claim the lion’s share of credit for this amazing development!

Most infant deaths are the result of infectious/communicable diseases, nutritional deficiences and congenital defects.

And now, with other causes (infections and nutritional) coming under control, congenital defects are responsible for a larger fraction of IMR, and medical science has an important role to play. My role as pediatric heart surgeon is key in this scenario.

Today, IMR is a number that’s once again relevant in a major way to my everyday life as a doctor, a surgeon, a healthcare advocate.

And a dreamer!

Infant Mortality Rate has evolved to become a more DIRECT metric that reports on how effective (or not) our efforts are in treating congenital heart defects.

Yes, it’s just a number. But a pretty important one!

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