A Lifeline on Wheels
Gauri Kaul Foundation’s initiative of school health screening program achieved the initial target of screening of the first 500 children before the examination dates in most schools preceding the winter vacations recently. It is around 10% of the work which is planned. The program is funded by the Interventional Cardiology Foundation of India.
The Project:
The “Indian Oil Corporation Limited (IOCL) Heart Clinic on Wheels” initiative, targeting school children aged 5-15 in the South Kashmir districts of Kulgam, Shopian, and Pulwama, represents a vital step toward improving paediatric health outcomes in the region. By bringing advanced diagnostic tools directly to schools, this program focuses on the early detection and management of Rheumatic Heart Disease (RHD) and congenital heart disease (CHD), offering a significant public health advantage. The program is a part of the social activities of the Gauri Kaul Foundation, an NGO working in Kashmir valley under the guidance of its Founder Director Prof Upendra Kaul since 2021. The program has the approval of the Director Health Services, Kashmir. Dr Abid Hussain, senior cardiologist of the Gauri Kaul foundation has taken the lead in it and is ably assisted by coordinators including ladies to be present while examining girl students. A proper ethical process with consenting from the parents is obtained beforehand.
The Critical Need for Early Cardiac Screening
Heart disease in children, particularly RHD and CHD, poses a substantial public health burden in many low and middle-income countries. Early and accurate detection, especially in asymptomatic cases, is crucial to preventing long-term disability and premature death.
- Targeting Rheumatic Heart Disease (RHD)
RHD is an acquired heart condition that results from rheumatic fever, which is caused by an untreated or poorly treated infection with Group A Streptococcus (strep throat). The 5-15 age group is the most commonly affected demographic.
Early Detection of Subclinical RHD: Clinical examination alone often fails to detect subclinical RHD—the early, asymptomatic stage of the disease where valve damage is beginning. Portable Echocardiography with Doppler studies is the gold standard for diagnosing RHD, detecting subtle valve changes missed by auscultation (listening to the heart). This screening can identify affected children years before symptoms appear.
Preventing Disease Progression: Timely identification allows for the initiation of secondary prophylaxis—regular penicillin injections—which is highly effective in preventing further streptococcal infections and, consequently, the progression of heart valve damage. Without intervention, these mild, early lesions often progress to severe, life-threatening valve disease requiring complex surgery.
Reducing Morbidity and Mortality: By preventing severe valve damage, the screening program will ultimately reduce the need for complicated and costly heart valve surgeries and significantly lower the long-term morbidity and mortality associated with RHD in these districts.
- Identifying Congenital Heart Disease (CHD)
CHD refers to heart defects present at birth. While some are severe and diagnosed in infancy, many milder defects may remain undiagnosed into childhood, affecting a child’s growth, development, and capacity for physical activity.
- Diagnosis of Missed Defects: The thorough clinical examination, combined with ECG and Echocardiography, allows for the detection of previously missed or undiagnosed CHD, such as Ventricular Septal Defects (VSD) , Atrial Septal Defects (ASD), Patent ductus arteriosus (PDA) and others which may be silently affecting the child’s heart and lungs.
- Guiding Timely Intervention: Early diagnosis is vital for planning interventions, which may range from regular surveillance to timely surgical or catheter-based correction. Intervention at the optimal age ensures better outcomes and prevents irreversible complications like pulmonary hypertension.
- Improving Quality of Life: Identifying and treating CHD can resolve symptoms like shortness of breath, poor growth, and easy fatigability, enabling children to participate fully in school and daily life, greatly improving their long-term quality of life.
The Advantages of the “Heart Clinic on Wheels” Approach
The deployment of the “IOCL Heart Clinic on Wheels,” as directed by the representative sampling methodology of Prof. Shazina Saeed of the Amity Institute of Public Health, Amity University, provides distinct benefits for a geographically and economically diverse population like South Kashmir.
1) Accessibility and Outreach: A mobile clinic directly addresses the challenges of poor access to specialist healthcare in remote or rural areas. By visiting the 40 identified schools in each of the three districts, the program brings expert paediatric cardiology services, including specialized equipment like portable echocardiography, to the children’s doorsteps, overcoming barriers of travel, cost, and time.
2) Comprehensive Diagnostics: The methodology uses a powerful diagnostic combination:
o Clinical Examination: A thorough initial screening for signs, symptoms, and murmurs.
o ECG (Electrocardiogram): To detect electrical abnormalities and signs of chamber strain.
o Echocardiography with Doppler: The definitive, non-invasive imaging tool to visualise heart structure and function, which is critical for confirming RHD and CHD diagnoses, and differentiating between significant and innocent heart murmurs.
3) Cost-Effectiveness and Efficiency: Screening a large, representative sample of the target population (school children) in a single, mobile outreach effort is far more cost-effective than waiting for symptomatic children to present individually at a distant tertiary care centre. It utilises the school as an efficient, organised venue for mass screening.
4) Public Health Data Generation: The ongoing program in Kulgam, and subsequently in Shopian and Pulwama, will generate crucial epidemiological data on the prevalence of RHD and CHD in the region. This data is essential for local health authorities to plan and allocate resources effectively for long-term paediatric cardiology services and primary/secondary prevention strategies.
Tail Piece:
The mobile screening program is a proactive, medically advanced strategy that leverages technology and outreach to interrupt the debilitating progression of rheumatic heart disease and ensure that children with congenital heart disease receive the timely care they need, fulfilling the promise of a healthier future for South Kashmir’s next generation.
Prof Upendra Kaul, Founder Director Gauri Kaul Foundation
