Introduction

Bangladesh is a densely populated country inhabited by more than 160 million

people and growing by the year. But the health care industry in the country is far
behind compared to the overall growth of the medical field in rest of the world and
the ever growing population of the country. Medicare facilities provided by the
govt. are inadequate as compared to the requirement of the people. Private clinics
and hospitals have come up and are still coming up to meet the requirements but
those too have so far failed to create confidence among the patients so far overall
quality of treatment and service management are concerned. A general perception
of a lack of skilled manpower, expertise and malpractices in management, poor
facilities, unhygienic environments, lengthy procedures, unsystematic techniques,
poor medical and physical infrastructure, lack of specialized treatments,
medications and equipments has hampered the growth of this industry. As a result,
well-to-do patients prefer to go to the neighboring countries as well as other
developed countries for better treatment. The restricted growth in research related
to health issues and technological advancements and innovations in the region has
caused serious damage not only to the health of people but also a big loss to the
profitability of the industry.
This is the age of modern amenities and comfort. People become lazy because of
computerization of day to day usable equipment. More over the urban people
become accustomed to rich food. Globalization is changing the food habits of the
urban population of the country among many things but not their exercising habits.
Unless their doctors tell them to, generally people do not make the sincere effort to
exercise and stay fit. The heart need not work hard; its blood vessels are not
adequately used and the heart muscles are not being per fused with sufficient flow
of blood. Slow flow of blood in the blood vessels causes deposits of fats, calcium
and other particles being carried by blood. This sort of life style leads to coronary
artery disease which demands more and more heart hospitals where invasive
procedures of treatment like bypass surgery & stenting etc are being exercised.
These invasive treatments are not preventing the incidence of heart diseases rather
sometimes these are becoming factors of heart diseases. But we need prevention
and permanent solution of heart diseases. SAAOL HEART PROGRAM is the way to
get rid of it.

Company Background
The Science And Art Of Living (SAAOL) was established in 1995 and is the most
comprehensive cardiac rehabilitation and reversal program in India. In the year
2012, SAAOL had 22 branches spread in the Asian Sub continent.
SAAOL has a double meaning. Firstly, it is an acronym for Science And Art of
Living. Secondly, it is Rajasthani word which means to do things in the best
possible way. In reality, both these two meanings perfectly symbolize SAAOL. The
method is an innovative combination of Medical (Allopathic) Treatment along with
the training of Yoga, Meditation, Stress Management, Education about Heart
Disease and Dietary Management. The combination is so perfect that not only can it
prevent coronary heart disease but it can also reverse the blockages in the arteries.
SAAOL had a wonderful and adventurous journey for the last nineteen years (1995
to 2014). As it was a completely new concept and more so because it works
diagonally opposite to whatever the common practice has been in the last few
decades. Gaining public confidence was a big challenge. Initially it was very difficult
to convince people that it will work and we had to explain for hours to the
prospective participants. Doing it in government hospitals was easy, but in a private
setup it was a totally different ball game. But as time passed by, things gradually
became easier as the public were experiencing the fruits of the method. By word of
mouth the good news of SAAOL spread throughout.
Our ex-participants are so convinced and improved that they started recommending
their near & dear ones to SAAOL. The media also supported us. Lots of people who
got reblockages after Angioplasty and Bypass Surgery joined us because they were
left with no other alternative, The SAAOL Way lead them to a stage of
improvement. The word sparkled like fire and people from distant places came to
join the SAAOL Heart Program.
There were people from many states (Punjab, Haryana, UP, MP, Himachal Pradesh,
Rajasthan, Bihar, West Bengal, Maharashtra and many more). A few of them also
came from USA, U.K., Middle East, Nepal, Sri Lanka and even from South Africa and
Kenya. As Delhi program started doing well we were requested by a lot of people to
hold the SAAOL Heart Program training in different parts of the country, then,
throughout the sub continent.
In Bangladesh SAAOL Heart Program has proven very effective for Coronary Artery
Disease (CAD), also known as Coronary Heart Disease (CHD). The most modern
technologies applied all over the globe are being applied here without any surgery
or other invasive programs. For the past six years, it has been gaining popularity as
we have earned a tremendous success rate (98%).

History of the concept

Dr. Dean Ornish, a young medical doctor based in San Francisco, U S A is known as
the pioneer in the reversal of heart disease. From his earlier days as medical
student he learnt yoga and meditation from an Indian Guru. So deep rooted was his
belief on the usefulness of the yogic way of life that he started a unique research
project where he treated a group of heart patients with proven blockages in their
coronary arteries (by quantitative angiography and PET scan) by the yogic way of
life, vegetarian diet and stress management.
Another similar group who took the medical management served as control
patients. The results of the scientific trial were an eye opener for medical doctors all
over the world. Published in the "Lancet", the most prestigious medical journal, the
results showed that most of Ornish's patients not only showed a reduction in angina
and coronary risks but also angiographically proved the reversal of blockages in
their coronary arteries.
Magazines like Readers' Digest and New York Times also published these reports.
With Ornish's experiment a new era was established in the management of
coronary heart disease and alternatives to angioplasties and CABGs were available.
In 1995, JAMA (Journal of American Medical Association) published results of Dr.
Dean Ornish's patients after 5 years of follow-up, which also showed a persistent
reversal of coronary blockages. The latest edition of Braunwald's Text Book (1997),
the bible of Cardiologists, also clearly talks and recognises the reversal of
blockages.
Dr. Ornish propagated the ancient Indian technology of Yoga for heart disease
treatment by publishing a 500-page book, which is now an international best seller.
He is now one of the busiest physicians in the USA and also an advisor to
the President of USA. SAAOL Heart Program draws it's inspiration from the
extensive work of Dr. Dean Ornish and is a similar version separately developed
by Dr. Bimal Chhajer in India, the land of origin of Yoga. Dr. Bimal Chhajer et al did
all the preliminary research at the All India Institute of Medical Sciences. It has
been developed to be more feasible and to suit even a modernized busy executive.
The meditation & diet program are most suitable for the Indians.

Mission

To foster independence: enabling individuals to self-monitor their activities and to

take primary responsibility for healthier lifestyle behaviors and risk factor reduction.

Vision
To change the complete lifestyle and reduce the risk of heart disease through diet
modification, stress management, exercise, yoga, meditation, education, and
counseling.

Services
The age of advanced medical technology has tried Bypass Surgery and Angioplasty
for the treatment of coronary heart disease and failed because of the early
reblockages & side effects. Science then looked for the cause of the blockages and
discovered that the real cause remains unsolved by modern technology and this
clue led to the inception of SAAOL Heart Program. It is the latest, scientific, noninvasive, permanent and safe treatment for coronary blockages, which is the most
common form of heart disease.
The SAAOL Heart Program in Bangladesh has been rendering very effective
treatments for only Coronary Artery Disease (CAD) by applying the most modern
technology now being practiced worldwide for Coronary Heart Disease(CHD) the
other name for CAD without any intervention like surgery and other invasive
procedures.
We feel pleasure to claim that our non-invasive treatment procedures applied to the
CAD patient for the last six years earned tremendous success (98%) which is
increasing our popularity in our country.
Significance in Bangladesh
Coronary artery disease (CAD) is an increasingly important medical and public
health problem, and is the leading cause of mortality in Bangladesh. Like other
South Asians, Bangladeshis are unduly prone to develop CAD, which is often
premature in onset, follows a rapidly progressive course and angiographically more
severe. The underlying pathophysiology is poorly understood. The causes are not
only limited to Genetic predisposition, high prevalence of metabolic syndrome and
conventional risk factors but also other lifestyle related factors, including poor
dietary habits, excess saturated and trans fat, high salt intake, and low-level
physical activity may be important as well. According to the latest WHO data
published, Coronary Heart Disease Deaths in Bangladesh reached 163,769 or

17.11% of total deaths. The age adjusted Death Rate is 203.69 per 100,000 of
population ranks Bangladesh #25 in the world.
SAAOL Heart Program is an initiative to alleviate this terrifying statistics. The people
of Bangladesh need a sustainable, cost effective and most importantly a permanent
solution to this ever growing problem. Recent data indicates CAD prevalence
between 1.85% and 3.4% in rural and 19.6% in an urban sample of working
professionals. The SAAOL way is the only long term solution that the people need to
be aware of. Awareness is key as globalization and urbanization has swept across
the globe contributing to hectic schedules of urban life and irregular eating habits
among many other bad habits which may be the cause of CAD.
Medical Tourism is one of the fastest growing healthcare industries. The world is in
a healthcare crisis, given the ageing population, increasing costs and long waiting
patients from developed as well as developing countries. Streams of people now
quite often travel abroad with the objective of obtaining immediate health care at a
fair cost and care. Many countries are well aware of the situation and they are
strategically positioning themselves as a competent Medicare destination. Outbound
medical tourism to different countries from Bangladesh has been huge. The most
preferable destination being India as its the most cost-effective destination. A good
number of people also prefer Malaysia, Thailand, Singapore and other neighboring
countries. A total of 0.12 million patients of the country traveled to India, Thailand
and Singapore alone in 2011-12, taking approximately an amount of US$875.80
million out of Bangladesh through official channel for medical treatment, according
to a study. And this is only the official figure. Experts believe the unofficial figure
might exceed US$2 billion annually or nearly 1.94 per cent of the GDP of
Bangladesh. Despite increase in budgetary allocation, number of hospital beds,
doctors and nurses over the years, medical services in Bangladesh could not check
the flow of outbound patients seeking medical treatment outside the countries.
Thus the country is losing a tremendous amount of foreign exchange. Among the
many treatments that prompt a Bangladeshi to ponder about travelling abroad,
cardiovascular treatment has been ranked among the top.
The SAAOL Heart Program aims to contribute to a more independent Bangladesh
where so many patients with CAD can have the best treatment possible. SAAOL
aims for a permanent solution for the individual people from the terrifying death
rate from CAD and side by side the nation as a whole to provide the solution on
their home soil.

Technical Aspects

There are thousands of arteries in the heart. The three main coronary arteries first
give origin to about 10 branches which in turn give rise to 100 branches and the
hundreds give thousands of branches. These branches are called Capillaries. They
all are connected to each other and can give or receive blood from each other.
These channels can be a good source of blood to heart muscles when some of the
major or minor arteries get blocked. If, somehow, these channels can open up or
made broader, the deprived heart muscles can get adequate blood supply. This can
be called a Natural Bypass. Scientifically this treatment can be called "Pneumatically
Assisted Natural Bypass" or "PAN Bypass.
These natural channels are very much present in sports persons or athletes. As
they do a lot of exercises throughout their career, the heart muscle develop these
capillaries into broader tubes. Once these tubes are developed the athletes do not
get angina even if they develop blockages to the extent of 80-90%. Their heart
muscles do not die even if they suffer from a 100% blockage.
But we cant make a heart patient run like an athlete. Nor can we ask them to
perform severe exercises because on slightest exertion they will get angina. But
now scientists have designed a new machine which can develop these parallel
channels. This machine can artificially increase the flow of blood in the coronary
channels by directly increasing the pressure at the root of the coronary arteries. A
one hour treatment with this machine can start opening this parallel artery/
capillary system supplying more blood to the heart muscles. This treatment has to
be continued for about thirty sessions to fully develop the second Natural Channel.
Thus it can easily replace the Surgical Bypass surgery, the pet of most of the Heart
hospitals.
The advantage of this treatment is that there is no admission to a hospital, no
withdrawal from your work, no invasion to the body and the cost is low. It has no
side effects of the surgery.
We know that the blood flow to the coronary artery occurs during the phase when
the heart muscles relax called the diastole. Blood cannot enter the majority of the
arteries during systole as the heart muscles contract during this period making the
flow impossible. This machine supplies more blood to the heart muscles during the
diastole. It has some pressure systems which are wrapped around the body parts
which have extra blood storage. The pressure systems are activated regularly
synchronizing in such a way that much more blood reaches the origin of the
coronary arteries during every diastole of the heart. Thus the coronary arteries get
filled up completely with blood during these periods flushing so much blood in the
dormant but stretchable elastic capillaries that they become broad.

In other words, this machine works on the heart arteries in 30 hours opening the
arteries much more than the athlete does in 30 years. It is much better than
Bypass Surgery or Angioplasty.
This machine has seen a lot of popularity in the last twenty years. About 200
centers in USA use this machine. In China it has almost replaced Bypass Surgery
and Angioplasty. There are as many as 10000 centers in China which are using this
treatment for the heart patients. In India, the machine is available in most of the
big hospitals like Escorts heart Institute, New Delhi, Metro Heart Institute.

Marketing Aspects
Coronary artery disease (CAD) is an important medical and public health issue
because it is common and leading cause of death throughout the world. Bangladesh
has been experiencing epidemiological transition from communicable disease to
non-communicable disease (NCD). But deaths due to chronic diseases, specially the
fatal four i.e. cardiovascular disease (CVD), cancer, chronic respiratory disease and
diabetes, are increasing in an alarming rate. CAD is an important contributor to one
of the four i.e. CVD. Of all South Asian countries, Bangladesh probably has the
highest rates of CVD and yet is the least studied; in the global combat against CVD,
Bangladesh is a country missing in action. Besides epidemiological transition,
widespread environmental contaminants such as arsenic in groundwater or
particulate matter in air, or specific vulnerabilities in the genetic or metabolic makeup, may play important role in the etiopathogenesis of CAD in this population.
According to the latest WHO data published, Coronary Heart Disease Deaths in
Bangladesh reached 163,769 or 17.11% of total deaths. The age adjusted Death
Rate is 203.69 per 100,000 of population ranks Bangladesh #25 in the world.
Patients from Bangladesh travel to different medical tourism destinations to receive
medical care. The medical tourism destination is determined depending on the
income of the individual and nature of the disease. Cardiovascular treatments is
ranked among the top reasons why the outbound medical tourism figure is so
gigantic from Bangladesh and growing due to the insufficient medical facilities being
provided in the country. People target a particular destination for medical tourism
because of the following factors: i) The advantage in costs, i.e. lower cost of a
treatment at a particular country than other destinations. ii) The availability of
expertise is better in the preferred country than other countries. iii) The efficiency
and effectiveness of the expert treatment in a particular country. iv) The availability
of technology, medical facilities and the time taken for the treatment in a particular
destination. v) The method used for treatment in a particular destination. vi) The
convenience for the treatment in a particular destination. vii) Tourist attractions and

the beauty of the place. viii) Availability of accommodations, transportation,

entertainment, shopping and food outlets and ease of communication. More and
more countries are positioning themselves as a competent medical care destination.
The unofficial figure might exceed US$2 billion annually or nearly 1.94 per cent of
the GDP of Bangladesh but if the situation remains as it is the figure will rise up
significantly in the future.
Awareness
People must be aware of the significance of CAD and root causes that lead to it.
Among the non-modifiable factors age, sex and Heredity are notable. But if they are
made well aware about the modifiable factors and monitor their own self, the
alarming rate might be decreased to some extent. The SAAOL Heart Program aims
to empower the people and awaken their hidden potential within. We aim to
educate alongside our non-invasive treatment to build towards a permanent
solution to the problem. The aim is to build a more responsible, self aware, self
responsible society for the future. We human beings at times limit our own potential
to grow. Among many modifiable factors, there are:
HIGH BLOOD CHOLESTEROL: Recognized as one of the first three risk factors
leading to heart disease. A fat particle with a complex structure, if present in more
than adequate quantity in blood gets deposited to create blockages. A diet rich in
cholesterol source is a major culprit.
HIGH BLOOD TRIGLYCERIDES: Increased level of Triglycerides or fat in food is
another factor for heart disease. A level of 160 mg/100ml is associated with
increased incidence.
HIGH BLOOD PRESSURE: A "silent killer", High Blood pressure puts an extra strain
on the heart and is also a major cause for deposition of cholesterol and fat in the
coronary arteries.
OBESITY: Lack of physical exercise & wrong food habits will make a person obese
and increases their chances of getting a heart disease.
STRESS AND MENTAL TENSION: Psychological stress is recognized as most
important risk factor for heart disease. In absence of other risk factors people can
still have angina, if stress is not controlled as it leads to spasm of coronary arteries.
SEDENTARY LIFE STYLE: Modern mechanization makes everything available easily,
as a result physical activity of people is almost nil which predisposes them to many
disease.

INTAKE OF ALCOHOL: Alcohol owing to it's structural similarity with glycerol is

associated with major risk. It is a source of empty calories and leads to diseases of
liver, gastritis etc.
LOW HDL CHOLESTEROL: HDL is also called "good cholesterol " can be another
factor for CHD as it binds cholesterol and remove it from blockages.
SMOKING OR TOBACOO CONSUMPTION: Smoking or Tobacco Consumption studies
have proved that smoking substantially increases the risk of heart attack.
Consuming tobacco in any form is equally hazardous as both are bad for health.
DIABETES MELLITUS: Uncontrolled blood sugar levels associated with obesity, high
blood pressure and high cholesterol levels are responsible for CHD.

Non-invasive Treatment
A non-invasive treatment is advantageous for patients at high risk for complications
from heart-lung bypass, including those with vascular disease, a history of stroke or
transient ischemic attacks, heavily calcified aortas, carotid artery stenosis, and
heart or kidney problems, and those over age 70.
Doctors recommended that, at the initial diagnosis of Heart Failure and any time
symptoms worsen without obvious cause, patients with Heart Failure, no angina,
and known CAD should undergo risk assessment that may include noninvasive
stress imaging and/or coronary angiography to assess severity of coronary disease
and the presence of ischemia.
It is also recommended that patients with Heart Failure, no angina, and unknown
CAD status who are at high risk for CAD should undergo noninvasive stress imaging
and/or coronary angiography to assess severity of coronary disease and the
presence of ischemia.