Cardiology Practice in Grenada, West Indies

Presented by:

Peter G. Bourne, M.D., M.A. and Rozann Hansford, R.N

Introduction

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

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

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

Rapid economic development has caused an epidemiological shift in disease pattern

Heart disease, cancer and diabetes are leading causes of death (previously infectious disease and malnutrition)

Mortality and Morbidity Profile (con’t)

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

“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)

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

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

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”

SGU Visiting Cardiologist Program

                                                                                                                                                         

                            

Dr Mark Lanzieri, SGU SOM alumnus, performing Grenada's first cardiac pacemaker implant.

Dr. Mark Lanzieri, visiting cardiologist and SGU alumnus, implants first cardiac pacemaker in Grenada

Emergency Cardiovascular Care Program

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)

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

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

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

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