Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 277-280

Vascular awareness in India: What more needs to be done


1 Department of Vascular and Endovascular Surgery, Starcare Hospital, Kozhikode, Kerala, India
2 Department of Vascular and Endovascular Surgery, Kauvery Hospital, Chennai, Tamil Nadu, India

Date of Submission24-Oct-2022
Date of Acceptance24-Oct-2022
Date of Web Publication8-Nov-2022

Correspondence Address:
Sekar Natarajan
Department of Vascular and Endovascular Surgery, Kauvery Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_95_22

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How to cite this article:
Rajendran S, Natarajan S. Vascular awareness in India: What more needs to be done. Indian J Vasc Endovasc Surg 2022;9:277-80

How to cite this URL:
Rajendran S, Natarajan S. Vascular awareness in India: What more needs to be done. Indian J Vasc Endovasc Surg [serial online] 2022 [cited 2022 Dec 5];9:277-80. Available from: https://www.indjvascsurg.org/text.asp?2022/9/4/277/360552



Vascular surgery is the best-kept secret in medicine

Alan M. Dietzek, MD[1]

Over the past few decades, there has been an exponential rise in patients suffering from vascular diseases, the most incriminating risk factor being diabetes. Unlike other health issues, over 80% of our population is unaware of vascular diseases or has never heard of vascular surgery.[2] Health awareness plays a significant role in changing people's beliefs and behaviors toward certain illnesses. The role of a vascular surgeon in creating the awareness is not only to draw a few patients toward vascular surgery, but it might also help many patients save their limbs and life.


  Why Vascular Awareness in India? Top


India is fast becoming the diabetic capital of the world, with an estimated prevalence of 8.9% in a population of 1.4 billion.[3] It was reported that there were 77 million diabetics in India in 2019, and this is expected to increase exponentially to about 134 million by 2045.[3] Diabetes seems to be the most critical risk factor for the onset of peripheral arterial disease (PAD). It is predicted that 20% of people with diabetes will develop PAD, but in India, the incidence could be as high as 27%.[4],[5]

By 2045, about 27 million Indians could be suffering from PAD which is the third leading cause of cardiovascular morbidity and accounts for about one-third of lower-limb amputations.[6],[7] PAD is just one of many pathologies, apart from other vascular conditions such as aneurysms, carotid artery diseases, malformations, and venous diseases, that require expert care by a vascular specialist. Unfortunately, as against the availability of 3000 practicing vascular surgeons for a population of 333 million in the USA, currently, there are only 400 specialists in India for a population of 1399.4 million, and this disparity continues to increase.[8]

Increasing the number of vascular surgeons and also creating awareness about vascular diseases among the lay public should go hand in hand to overcome this looming health crisis. The increasing burden of vascular disease and the widening supply–demand ratio of qualified vascular specialists would push many more patients to limb amputations, strokes, and death, most of which are preventable by timely intervention. The authors discuss the core issues that must be addressed urgently to overcome these in this review.


  Catch them Young Top


In 2022, there are 643 medical colleges in India, but only about 20 have an established vascular unit, most of which are in the southern state of Tamil Nadu. Most medical graduates and surgical trainees have limited exposure to open or endovascular procedures during their training. Hence, most doctors are largely unaware of the scope of vascular surgery and are unable to identify the vascular diseases or refer them to the right specialist. Knowledge of vascular surgery and exposure obtained in medical school seems to potentially impact their career decisions promoting them to choose this speciality after their postgraduate training.[9] About half of the vascular trainees in India have either worked in a vascular unit or with a vascular surgeon during their residency.


  More Impactful Vascular Training in India Top


The first training program in vascular surgery was established in 1985 at Madras Medical College, Chennai, offering a 2-year (MCh) course.[2] After 37 years, the number of general surgery seats has increased from 1175 in 2009 to 3982 in 2022.[9] However, unfortunately, only nine medical colleges currently offer training programs in vascular surgery, of which five are in the government sector, and ironically none of the national institutes of excellence offers training programs in vascular surgery. The Vascular Society of India (VSI) was established in 1994 to establish the vascular training programs and propagate the specialty in the country. After a series of deliberations that the VSI had with the National Board of Examinations, an autonomous body that oversees postgraduate training programs in India, the first 3-year training program (Diplomate of National Board) was initiated in 2007. Currently, 52 vascular surgeons graduate from all available training programs in the country every year, which is a great leap from the past but still utterly inadequate [Figure 1].
Figure 1: Map of India showing the distribution of training centers in vascular surgery as of 2022

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  Bridging Gaps in Vascular Awareness Top


In the past, most trainees attended short training fellowships abroad to learn advanced vascular techniques and acquire endovascular skills. Now, most vascular units have become fully equipped to train fellows in all the aspects of vascular surgery, and the need for overseas training has dwindled over the past few years. While we have largely bridged gaps in vascular training successfully, there is still a large lacuna in vascular awareness in society. In a survey in the United States, only 22% of people correctly identified what a vascular surgeon does, and most thought that a cardiologist is the one who treats blocks in the peripheral arteries.[1]


  Educating Medical Professionals Top


To promote vascular education among medical professionals, VSI has been actively involved in conducting continuing medical education programs, annual conferences, and hands-on workshops in various cities. However, as vascular surgery became recognized as a distinct specialty, turf battles between allied specialties evolved, posing newer challenges to vascular surgeons worldwide.[10] The relative anonymity of vascular surgery and a never-ending struggle for fair recognition of our specialty seems to continue not only in India but also in the West.[1] Publishing articles that discuss the results of procedures done by our colleagues in other allied specialty journals will help increase the acceptance of vascular surgeons in the medical community.


  Changing Trends in Health-Care Awareness Top


The impetus of all vascular societies now seems to have shifted from educating medical professionals to the lay public, thereby opening newer dimensions of vascular awareness with more emphasis on digital platforms and social media. The Internet has obviously revolutionized how information is accessed and shared; health care is no exception. Over time, Internet has become a more popular source of health-care information than the physician, relative, or friend.[11] We often believe and argue that we are the best-suited doctors to provide the most comprehensive and better vascular care than other specialists. However, how do patients know this unless we propagate this information to them? As vascular surgeons, we should not shy away from this medium but should evolve strategies for web-based vascular awareness.[12]


  Increase Web Presence Top


Today, the Internet is the largest virtual marketplace, but unfortunately, only half of the searches on Google and YouTube mention vascular surgeons as the authority to treat vascular conditions.[13] Vascular societies, units, and individual practitioners should host websites and have professional pages on social media handles. The Internet can be used to define and propagate vascular practice and give more visibility to our unique services. Furthermore, the target audience perceives it as a service because the information relevant to their health problem is provided at no cost.[11]


  Branding and Marketing Top


Branding is about creating a unique identity in the public domain that stands out from other similar services that can be easily communicated and usually marketed. This exercise helps to increase visibility and prestige in the community. For example, branding allows the public and physicians to clearly differentiate vascular surgery from the commonly misunderstood cardiothoracic and vascular surgery. Once a brand is established, appropriate marketing is used to disseminate this information.

Marketing in health care is often looked upon as a “business” tactic used by giant corporates and is considered unethical for medical societies. Moreover, marketing is often confused with advertising. The former is about creating awareness about a “well-established” service or brand like vascular surgery and is ethical. In contrast, advertising primarily aims to generate brisk business for a relatively less established product or service. Marketing generates positive public relations, improves the public image, and helps to showcase the specialty to society, and should be adopted by all vascular surgeons.[11]


  Optimal Use of Social Media Top


Social media is one of the most rapidly growing and evolving technologies of today, and India has the most numbers of users in the whole world. In 2022, there are 467 million YouTube and 329.65 million Facebook users in India, almost double the number in the United States. Social media is fast becoming an integral part of an individual's daily routines across all age groups. It is unsurprising that health-care institutions and societies are exploring these mediums for improved and cost-effective branding and marketing. Society or professional websites can be linked to these social media handles. Facebook can be used to publicize new techniques, professional achievements, and milestones.[14] Further, this can be employed for live educational lectures related to the specialty and for direct patient interaction. YouTube can be utilized for presenting the videos of procedures, device demonstrations, and state-of-the-specialty videos offering a broad overview of vascular surgery. Despite that this is a relatively unknown specialty, effective use of social media has been shown to increase public, nonphysician, and remote geographical referrals.[15]

However, surgeons should also be apprehensive of implicit ethical issues of social media operation in health care.[16] Indeed although, there are no specific guidelines regarding this. In 2022, the National Medical Commission (the apex body of health-care professionals in India) proposed draft recommendations to address this issue. The guidelines do not stop any physician from having their websites or social media pages but specify that the information should be factual and can be substantiated. The information should not be deceptive or exploit a layperson's vulnerability or lack of knowledge.


  Initiate Big-Impact Campaigns Top


Merely getting attached to social media is not enough because the amount of information on the Internet is crazy and unimaginable. We should generate good and impactful content that addresses sensitive health-care issues. India has a very high incidence of PAD, and amputation is a very emotional health-care issue, best managed by vascular surgeons. Awareness campaigns about amputation prevention, showcasing our results of limb salvage, will not only invite public attention but will also increase the self-esteem of vascular specialists. Campaigns titled “Amputation-Free Kerala” and “Amputation-Free Uttarakhand” launched in the southern state of Kerala and the northern state of Uttarakhand received comprehensive social media coverage [Figure 2]. A national-level campaign titled “Amputation-Free India” would go a long way in popularizing vascular surgery in the country.
Figure 2: Honorable Governor of Kerala, Shri Arif Mohammed Khan launched the amputation-free Kerala campaign of the Vascular Society of Kerala, through his official social media handles on September 02, 2021

Click here to view



  Involve Social Media Influencers Top


A social media influencer is someone who has established credibility in society, has access to a huge audience, and impacts the decisions of others based on their endorsements. Campaigns endorsed by political figures and celebrities and promoted on their social media handles make it easier for our specialty to connect with the public [Figure 3].
Figure 3: Honorable Governor of Uttarakhand, Lt General Gurmit Singh launched the amputation-free Uttarakhand campaign of the Vascular Society of India, on October 02, 2022. The message was shared by Governor's office and tagged to the official Twitter handles of the President of India, Prime Minister of India, and Home Minister of India

Click here to view


To be effective, vascular awareness should be an ongoing process that works in tandem with clinical practice. This not only helps many patients get the right treatment but also saves many of them from getting the wrong treatment.

This journey is not about winning few patients or few procedures - it's far greater than that. It's about taking the journey that differentiates and defines us and setting the stage for others to follow.” – Manish Mehta in his Presidential Address of the Eastern Vascular Society.[12]



 
  References Top

1.
Dietzek AM. Vascular surgery is the best kept secret in medicine and my thoughts on how we can change that. J Vasc Surg 2019;69:5-14.  Back to cited text no. 1
    
2.
Sekar N. Education in vascular surgery: Critical issues in India. J Vasc Surg 2008;48:76S-80S.  Back to cited text no. 2
    
3.
Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol 2021;69:2932-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Elhadd TA, Robb R, Jung RT, Stonebridge PA, Belch JJ. Pilot study of prevalence of asymptomatic peripheral arterial occlusive disease in patients with diabetes attending a hospital clinic. Pract Diabetes Int 1999;16:163-6.  Back to cited text no. 4
    
5.
Krishnan MN, Geevar Z, Mohanan PP, Venugopal K, Devika S. Prevalence of peripheral artery disease and risk factors in the elderly: A community based cross-sectional study from northern Kerala, India. Indian Heart J 2018;70:808-15.  Back to cited text no. 5
    
6.
Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. Lancet 2013;382:1329-40.  Back to cited text no. 6
    
7.
Pooja GD, Sangeeta L. Prevalence and aetiology of amputation in Kolkata, India: A retrospective analysis. Hong Kong Physiother J 2013;31:36-40.  Back to cited text no. 7
    
8.
Williams K, Schneider B, Lajos P, Marin M, Faries P. Supply and demand: Will we have enough vascular surgeons by 2030? Vascular 2016;24:414-20.  Back to cited text no. 8
    
9.
Singh N, Causey W, Brounts L, Clouse WD, Curry T, Andersen C. Vascular surgery knowledge and exposure obtained during medical school and the potential impact on career decisions. J Vasc Surg 2010;51:252-8.  Back to cited text no. 9
    
10.
Levin DC, Rao VM, Bonn J. Turf wars in radiology: The battle for peripheral vascular interventions. J Am Coll Radiol 2005;2:68-71.  Back to cited text no. 10
    
11.
Satiani A, Satiani B. Marketing strategies for vascular practitioners. J Vasc Surg 2009;50:691-7.  Back to cited text no. 11
    
12.
Mehta M. Branding vascular surgery should start with Why. J Vasc Surg 2019;69:1333-41.  Back to cited text no. 12
    
13.
Phair J, Dalmia V, Sanon O, Leinbach C, Rai A, Lipsitz E, et al. The current state of vascular surgery presence and educational content in Google and YouTube internet search results. J Vasc Surg 2021;74:616-24.e6.  Back to cited text no. 13
    
14.
Indes JE, Gates L, Mitchell EL, Muhs BE. Social media in vascular surgery. J Vasc Surg 2013;57:1159-62.  Back to cited text no. 14
    
15.
Turnipseed WD. The social media: Its impact on a vascular surgery practice. Vasc Endovascular Surg 2013;47:169-71.  Back to cited text no. 15
    
16.
Denecke K, Bamidis P, Bond C, Gabarron E, Househ M, Lau AY, et al. Ethical issues of social media usage in healthcare. Yearb Med Inform 2015;10:137-47.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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  In this article
   Why Vascular Awa...
  Catch them Young
   More Impactful V...
   Bridging Gaps in...
   Educating Medica...
   Changing Trends ...
   Increase Web Pre...
   Branding and Mar...
   Optimal Use of S...
   Initiate Big-Imp...
   Involve Social M...
   References
   Article Figures

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