Dr. Anil Vaidya is a busy man. As a transplant surgeon specialising in the treatment of multiple organs - the liver, kidneys and pancreas - he is always on call. Waiting outside his cabin at the Apollo Hospitals in Chennai are families from countries far away, like Kazakhstan and those in South East Asia.
Over the last few years, however, Dr. Vaidya has been developing a department at Apollo Hospitals as a ‘Centre for Excellence’ to treat what has previously been left to the mercy of fate - intestinal failure. “Intestinal failure is a mature topic in the West. Not in India. It is not even known in the world of medicine in India,” says Dr. Vaidya.
So why does intestinal failure happen?
Intestinal failure, simply put, happens when your intestines stop functioning – they can’t digest food and absorb the fluids, electrolytes and nutrients essential to live. This could happen to due to trauma – like road accidents in which your intestines are damaged - or due to surgeries in which a part of the intestine has been removed to treat other conditions, like tumours. There are also diseases which can cause intestinal failure.
Among children, usually very young, intestinal failures can happen because of auto-immune diseases and other factors - they could be born with intestines that cannot handle the task of extracting nutrition.
Birth defect doesn’t mean death
In India, thousands of children are born with intestinal failure every year – and most of them die, because the medical process of recuperation can be long and arduous, and expensive. Baby Geetha* was also born with it.
“Geetha’s father was a doctor at a prestigious hospital in Tamil Nadu. He was a pediatrician, in fact. He called me in the middle of the night one day and told me his baby was born with intestinal atresia – a block in the intestine. I told him I cannot even touch the baby now, she has to be on TPN for at least a year before we could have corrective procedures. I never heard from him again,” says Dr. Vaidya, with a sad pause. He suspects the parents gave up on the child and she is no more.
TPN or Total Parenteral Nutrition, is a system in which a patient is given their nutrition in liquid form, via intravenous lines. It is prescribed for patients whose intestines are not able to take on the work of extracting nutrition from food – like baby Geetha. It is expensive, and the chances of survival after that is often bleak. Even doctors think that an intestinal failure is the end of the road for a baby.
Dr. Anil Vaidya
Many of these babies can be saved, he says, “Let the message get out, that your baby can still live.” At Apollo, Dr. Vaidya has created a Centre of Excellence, the only one in all of Asia, to try and save babies who die without intestinal care.
Not a quick fix
The message which also has to get out, Dr. Vaidya says, is that it’s not a quick fix, but a gradual one. Babies do survive, but with prolonged care and treatment. Deepa* maybe one such baby.
Baby Deepa's parents brought her to Dr. Vaidya after several doctors attempted to treat her for her intestinal failure. She was just 9 months old, and she needed a transplant.
“But she is so small now. Just 2.5 kilograms. I have to wait till she’s at least 5 kilograms before I transplant her. If I open her tummy up and put in an intestine, her respiratory muscles will not work. That additional work of breathing is too big. So, I can’t do a transplant now,” he explains.
Until the baby is ready for surgery, she will be on TPN. To keep her alive, she will be fed fluids through her veins. Even the transplant could be tricky. “It could be a stage procedure. The kid might need more than one transplant. I could take one piece of intestine from the parents and put it in. Kids have small tummies. We will see how that goes, and in a year’s time I might need to put in another piece because the kid would have grown,” he says.
In spite of this, babies are surviving. On TPN now, Baby Deepa's chances of survival have shot up, and she is doing much better.
“We have taken just about 10 cases so far in Apollo, but the response from other doctors has been great. Pediatricians are full on with it, they have seen what we can do. They are having training sessions, there is a very positive vibe. They have seen babies get better. Soon, we will be able to save every child with intestinal failure,” says. Dr. Vaidya.
*Names changed to protect identity.
This article has been produced by TNM Marquee in association with Apollo Hospitals.