Cardiovascular and women’s health in the Indian subcontinent

“Woman, I hold, is the personification of self-sacrifice, but unfortunately today she does not realize what tremendous advantage she has over man” Gandhi

Five years ago, I was an intern at one of the largest teaching hospitals in South India, which provided free medical care for the needy. Huge high-vaulted old stone halls housing the patients were more like dormitories than hospital wards, leaving no room for privacy. For example, the obstetrics ward with a bare minimum of facilities usually overflowed with patients beyond its capacity; hence a lot of the patients and their newborn were accommodated on mats placed on the floor. Patients received only aspirin and β blockers for myocardial infarction, as there were minimal facilities for further revascularisation. Fortunate are the rich who can afford treatment in private hospitals with modern technologies on a par with the developed world, thereby attracting patients from around the world and hence earning the fashionable name “medical tourism”. After working in the UK and USA where anyone presenting with chest pain is triaged appropriately and is catheterised within an hour or receives thrombolysis when needed regardless of their economic status, I felt as though transported to another world in a time machine. I now understand the terminology “worlds apart”!

Why this difference? Coronary heart disease (CHD) has been the leading cause of mortality in the USA, whereas developing countries such as …