Making heart-lung machines work in India: Imports, indigenous innovation and the challenge of replicating cardiac surgery in Bombay, 1952-1962

Abstract

In 1962, surgeons at two hospitals in Bombay used heart-lung machines to perform open-heart surgery. The devices that made this work possible had been developed in Minneapolis in 1955 and commercialized by 1957. However, restrictions on currency exchange and foreign imports made it difficult for surgeons in India to acquire this new technology. The two surgeons, Kersi Dastur and PK Sen, pursued different strategies to acquire the ideas, equipment, and tacit knowledge needed to make open-heart surgery work. While Dastur tapped Parsi networks that linked him to local manufacturing expertise, Sen took advantage of opportunities offered by the Rockefeller Foundation to access international training and medical device companies. Each experienced steep learning curves as they pursued the know-how needed to use the machines successfully in dogs and then patients. The establishment of open-heart surgery in India required the investment of substantial labor and resources. Specific local, national, and transnational interests motivated the efforts. Heart-lung machines, for instance, took on new meanings amid the nationalist politics of independent India: Even as surgeons sought imported machines, they and their allies assigned considerable value to 'indigenous' innovation. The confluence of the many interests that made Sen and Dastur's work possible facilitated the uneasy co-existence of conflicting judgments about the success or failure of this medical innovation.

Doctor sahab: Doctors and the public in the ‘golden era’ of the Indian medical profession

“…Besides, in the case of emergency care and life‐threatening ailments and injuries, modern surgery (available in hospitals) was widely considered an appropriate and effective option: Even someone as sceptical of modern science as Mohandas Gandhi had been persuaded to undergo an emergency appendectomy in 1924 (Guha, 2016). Elective surgeries like cataract operations and tonsillectomies, as well as various abdominal and thoracic procedures, were common both in public and private hospitals (Jones & Sivaramakrishnan, 2018a, 2018b). For example, a 1944 report on blindness in India talked about how the country’s eye doctors had to ‘struggle against time to get through the mass of treatment and operative work queuing up endlessly before them’ (Singh et al., 1944).…”

Changes of heart: Debating the role of cardiology and cardiac surgery in India, 1948–1968

“…While on furlough in the US, Betts ‘spent considerable time’ learning the latest cardiovascular techniques ( Grant in Aid , 1955). The ability to travel to learn new surgical knowledge and techniques was invaluable (Jones & Sivaramakrishnan, 2018a). Betts returned to Vellore in June 1954 and began his cardiac work ‘in earnest’ (Betts, 1957, p. 101).…”

“…Despite these frustrations, Sen’s team continued to make progress. Sen achieved his first clinical success with open‐heart surgery in 1962 (Jones & Sivaramakrishnan, 2018a; Times of India, 1962b). These developments captured the public imagination.…”

“…When electrocardiograms proliferated in Europe and the US in the 1920s, or heart‐lung machines in the 1950s, they did not automatically appear elsewhere. Indian surgeons, for instance, strategised to bring heart‐lung machines to India and reconfigured them as an indigenous technology (Jones & Sivaramakrishnan, 2018a). Social scientists have paid less attention to the dissemination of institutions.…”

Pro-Poor Innovations to Promote Instrumental Freedoms: A Systematic Literature Review

“…Another example of PPI's potential for complex health procedures is their application in critical care areas such as maintenance of intensive care units, which often require expensive drugs and equipment [106]. In addition, articles on indigenous innovation with locally generated solutions for heart [107] and skull base [108] surgery were also found in developing countries.…”