Mending a Broken Heart French medicine shows the way….


“You have mild aortic stenosis”, the Hong Kong cardiologist told my wife two years ago. “Nothing to worry about”, he added.

“You have critical aortic stenosis” said the Singapore cardiologist in April of this year. “Unless you have a valve replacement immediately you could die at any moment”.

 

My wife, who is a four-time breast cancer survivor, has had more than her fair share of medical challenges and, for the 25 years we have been together I have co-incidentally been writing about health with a staunchly consumerist bent.

Writing about medicine from such a standpoint for as long as I have does not make me medically knowledgeable. If anything it makes it very clear that a little knowledge is not just a dangerous thing but can be worse than no knowledge at all.

What it has done though, is to give me sufficient insight into the highways and by-ways of Planet Medicine as to fill me with awed admiration and anger in equal measure. That is why I have tried as best I can to level the playing field so the consumer – “We the Patient” – has at least some of the information needed to make key choices in a field where we can never expect to be fully in possession of the facts.

In 2011 my wife very nearly died from double pneumonia and spent six months in hospital in Hong Kong. Her doctors, mostly capbable men in their way at the top of their profession, were also a self-satisfied and congratulatory clique, who milked the insurance company for every cent they could. The hospital, theoretically non-profit, pretty much played the same game, while the insurance company made our lives a living hell trying to second guess the doctors every step of the way. What had been one of the best and fairest insurance companies in the world had been taken over by  a group that embodies all that is bad in the anglo-saxon approach to medical insurance, predictably  breaking almost every undertaking they had made upon acquiring the company within two years of acquisition.

With compromised lungs any infection threatened and on occasions did turn into pneumonia, my wife lost her medical cover, which was now approaching US$20,000 p.a.  A dangerous situation for her to find herself.

Fortunate and timely was the advise and aid of the former French Consul in Bali and my wife, who is French and virtually uninsurable, was accepted by the Caisse Francais pour Etrangers (CFE) and obtained medical cover for one sixth the price she had been paying. The CFE is an organisation set up by the French government to provide essential cover for French nationals overseas.  There are no exclusions on grounds of age or pre-existing conditions and, with a small top-up, all claims are re-imbursed in full. Compared with anything the private sector can offer expatriates without a carte vitale it is a no-brainer. Other nations would do well to take note.

Back in the early 1980s, when my wife had been radiated for an earlier cancer it either was not known, or it was felt not necessary, for doctors to warn patients that their heart and lungs could be damaged and lead to serious problems in years to come. To an extent, such failure to inform and warn, was understandable… back then.

Today it is inexcusable. What her Hong Kong doctors had failed to do was to make us aware of the intimate link between heart and lungs. Each of them concentrated on their own speciality as my wife was batted between them while they ran batteries of expensive and often unecessary tests, including a highly invasive, painful and unecessary surgical procedure. This was good business no doubt, but it was lousy doctoring. Yes, they saved her life…  but only just. It should never have been put at risk in the first place, with more timely intervention.

“Time to go back to the Motherland” said the genial Singaporean cardiologist at Raffles Centre. “You have no time to lose. If I needed a valve replacement I’d go to France for the TAVI. They invented it”.

TAVI stands for Transcathetarisation Aortic Valve Implacement, a highly complex procedure introduced in 2002, which allows a team of doctors to work on the heart while it is still beating by entering the vascular system via an artery in the groin. It remains a cutting edge procedure, which avoids the trauma of open heart surgery or SAVR, graphically referred to in the trade as “cracking the chest”, and which cannot be performed upon the aged and infirm for whom the need for a new heart valve remains a death sentence. Though exceedingly intricate TAVI is relatively cheap and getting cheaper as the procedure becomes more widely adopted. It is quick and the patient can be out of hospital and in the monitoring phase within a week. Compared with the lengthy hospitalisation and crippling costs of SAVR, disturbingly being performed upon more young middle-aged people than ever,  such interest is understandable. So is the opposition to it – justified or not. It should be noted that TAVI is fast- developing and intricate field and anyone contemplating it should take considerable care as to the provenance of the team performing it.

Through the connections of a friend, who himself had been a prominent heart specialist, we obtained an introduction to one of the leading TAVI specialists who leads a team at a hospital in Massy, just South of Paris, and who – subject to tests,  agreed to perform the procedure.

There was just one snag though… French bureaucracy. The CFE may be brilliant, but rules are rules. Life-threatening or not, this procedure would not be covered before three months had elapsed since my wife had been accepted. This was a serious worry since the symptoms clearly indicated  her condition was critical. We got to Paris in the nick of time, Her aortic valve was over 90% occluded and she could barely walk more than a few yards.  The procedure took place in early September and was successful, taking a little over one hour. However, as can happen with atrial fibrillatio in TAVI, my wife needed to have a pacemaker inserted. A second routine operation performed by another surgical team a two days later but which did not go altogether smoothly.

The hospital in Massy is actually privately owned, by an Australian group called Ramsay.  In France , even private hospitals have public obligations to the state. Clearly Ramsay expect that by taking over a hospital with a top TAVI team in situ they will profit accordingly. However, apart from the TAVI team, which is superb, this institution seems to be at odds with itself. Clearly the expense of meeting their obligations to the State as well as their shareholders is proving a source of stress for the Ramsay folk…  and it shows.

My wife is currently undergoing her rehabilitiation in a cardiac recovery unit at Bligny, a massive pre-Great War convalescent institution established to treat consumptives with the aid of Rothschild money set in magnificent forests  just20km further South from the hospital in Massy. Here the attitude and the enviromnent could hardly be more conducive to healing and my wife is making good progress, though there remains some way to go for the heart to regain rythym and strength.

The French public health system is impressive. They still take the concept of ”citoyen” seriously, to an extent that some Anglo-Saxons might take as an unwarrantable imposition upon their right to pursue profit. For the French there are obligations and rights.

To me, the right of every citizen to a high standard of medical care, whatever their financial situation, seems to me to be the essence of civilized society. Broadly speaking the French have got it right.

 

Alternative Voice

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