Transcript Cardiology Practice in Grenada West Indies

Cardiology Practice in
Grenada, West Indies
Presented by:
Peter G. Bourne, M.D., M.A.
and Rozann Hansford, R.N
Introduction
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Grenada is a three island Caribbean
nation and a member of the Windward
Islands
Sister islands: Grenada, Carriacou and
Petit Martinique
Total land area: 133 miles squared
Population: 89,000 (U.S. Census,2001)
Map of Grenada
Mortality Indicators
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Life expectancy at birth:
Male…….62.7
Female… 66.3
Infant Mortality Rate: reported (less
than one year) 19.5 per 1,000 live birth
PAHO, 2001
Socioeconomic Profile
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GNP per capita…...6,330.00 (2001)
GDP growth rate….8.2% (2001)
Adult literacy rate…85% (1996)
Annual national health expenditure,
proportion of GDP……………..2.4% (2001)
Major industry:Tourism and agriculture
(cocoa, nutmeg, bananas)
PAHO, 2001
Mortality and Morbidity Profile
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Rapid economic development has
caused an epidemiological shift in
disease pattern
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Heart disease, cancer and diabetes are
leading causes of death (previously
infectious disease and malnutrition)
Mortality and Morbidity Profile (con’t)
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Disease transition has created need for
programs aimed at prevention,
treatment and diagnosis of chronic
diseases
No cardiologist or cardiovascular
prevention program existed in Grenada
prior to the year 2000
Program Description
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“Visiting Cardiology Program” commenced in
January 2000, we started the program with only
a stethoscope and a strong desire to see it work.
Conceived of and directed by the school’s Vice
Chancellor; managed by a cardiovascular nurse
Financial support for cardiologist’ travel and
lodging by St. George’s University Medical
School. All other funding through cardiologist
donations and community fundraising activity
Program Description (con’t)
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One cardiologist (typically an SGU
alumnus) is invited to the island monthly
Community physicians select patients
for outpatient evaluation
Visiting cardiologist also accompanies
housestaff physicians on hospital
rounds and presents a monthly lecture
on a cardiovascular topic
Outpatient Evaluations
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Outpatient evaluations include;
cardiovascular exam,
echocardiography, EKG (on each
patient), cardiac event monitor or
stress test (when indicated)
All equipment for diagnostic services
was donated by the cardiologists
Pacemaker Program
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Initiated in May 2000, under the
auspices of the SGU Visiting
Cardiologist Program
Pacemakers are implanted in the
operating room of the general hospital
by a qualified visiting cardiologist
Pacemakers are donated by
“Heartbeat International”
Dr. Mark Lanzieri, visiting cardiologist
and SGU alumnus, implants first cardiac
pacemaker in Grenada
SGU Visiting Cardiologist Program
Dr Mark Lanzieri, SGU SOM alumnus, performing Grenada's
first cardiac pacemaker implant.
Emergency Cardiovascular
Care Program
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An Emergency Critical Care (ECC) program
was initiated in May 2000. Prior to the
program, cardiac resuscitation was not
practiced in Grenada
The program is directed by one of the
visiting cardiologists, who is also a leader in
the American Heart Association
Over 150 Grenadian Health professionals
including physicians, nurses and ambulance
drivers have been trained and certified in
advanced cardiac life support (ACLS)
Emergency Cardiovascular
Care Program (con’t)
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To promote attendance in first time takers, we
modified the existing ACLS course to emphasize
only those skills that are most important for
survival (AED and CPR)
Ten Automatic External Defibrillators (AED) were
donated by a cardiologist and are in place in the
ambulances and at the general hospital
AED training is done by cardiologists at the
general hospital on a monthly basis
Attendance is compulsory for all hospital staff
Dr. Henry Halperin, Visiting Cardiologist, Chairman
ACLS Subcommittee, American Heart Association,
demonstrates appropriate hand position for CPR
to health professionals in Grenada
Program Results
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A cadre of 8 cardiologists have joined
the “Visiting Cardiologist Program”
and routinely visit the island to provide
tertiary cardiovascular services
Cardiologists have fully integrated into
the Grenada Public Health System
Program Results
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Cardiologists have donated all
equipment necessary to establish a
cardiovascular diagnostic service;
echocardiography, EKG machines,
cardiac event monitors, treadmill
Over 600 patients have been seen in
the outpatient cardiology clinics
Program Results
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A successful pacemaker program has been
established at the general hospital. Ten
pacemakers have been successfully
implanted to date, completely free of charge
to Grenadians.
An emergency cardiovascular care program
has been established, is ongoing and
resuscitative measures not previous
practiced are now considered standard of
care. As a result, many victims have survived
their cardiac arrests.
Conclusion
We have demonstrated that in the
absence of specialty care, a visiting
specialist model of health care delivery
can be successfully and inexpensively
integrated in to the public health
system of a developing nation