Cardiac care unit gearing up for surgery
-hundreds of patients treated non-invasively By Iana Seales
Stabroek News
November 26, 2006

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Since the Caribbean Heart Institute (CHI) first opened its door to the public in October at the Georgetown Hospital and promised a comprehensive cardiac care programme, several hundred Guyanese have been evaluated as a phased rollout of services leading up to open-heart surgery gets underway.

Open heart surgery, angioplasty, vascular stenting and heart valve replacement are just a few of the cardiac services the private company is projecting for 2007 but in the case of stenting, in just another two months.

Stenting which involves the insertion of a wire mesh tube during angioplasty to prop open an artery will be the first invasive service introduced and will be followed by balloon angioplasty. The other services will eventually be phased in.

Following a successful dry run in September CHI has seen and treated in excess of 200 patients with various heart ailments to date. Treatment has so far been non-invasive and included holter monitoring (a machine that continuously records the heart's rhythms), EKG testing (a test that measures the electrical signals that control the rhythm of the heartbeat) and ultrasound. CHI has struck an arrangement with the government for the establishment of cardiac care here. A number of Guyanese doctors with many years of experience are included in the team but this is CHI's first project as a unit.

CHI recently announced a pacemaker evaluation service and has commenced a paediatric cardiac programme. Dr. Richard Ishmael, a specialist in Pediatric Cardiology was in Guyana a week ago and conducted the first clinic at CHI. CHI technician Jason Solomon monitoring an angiogram from his desk inside the cath lab.

A four-bed coronary care unit, digital catheterization lab with electrophysiology capability, operating room for cardiac surgery, a networked computer system, electronic medical records and a team of trained technicians attests to CHI's preparedness.

During a recent interview with Stabroek News, the cardiac team, which has taken up quarters in the spanking new state-of-the-art building constructed in the eastern wing of the Georgetown Hospital, said everything is in place and it is only a matter of a few months before the unit is operating fully.

To date the institute has performed numerous angiograms -imaging tests that use x-rays to view blood vessels in the body and study narrow, blocked, enlarged or malformed arteries. Close to 90 percent of the patients seen so far at CHI are candidates for surgery and stenting.

The costs attached to the services currently being offered such as ultrasound and EKG are the same compared to other local private institutions. The angiograms cost around US$1,200 whereas in Trinidad and Barbados persons pay between US$5,000-6,000.

Dr. Romeo Vandenburg, Chief Executive Officer of CHI in a recent interview with Stabroek News said the absence of a ventilator support is the only thing preventing open heart surgery because the expertise is here, the technology is available, the operating theatre is ready and the coronary care unit is fully equipped. But it is not CHI's policy to rush, according to Vandenburg.

"When we opened our doors the commitment we gave was that the institute would offer a comprehensive programme in 18 months time. We said everything would happen in steps and we are sticking to that because safety comes first and we pride ourselves on that. But people might be surprised to know that some things could happen very shortly".

In terms of being prepared, Vandenburg said it took them two years to get things right before actually setting up. He personally spent time travelling around the Caribbean to countries with solid cardiac programmes such as Trinidad and Barbados to understand how things are done and then borrowed various concepts.

CHI and the Government of Guyana had been in talks for over a year and when the decision was finally made for them to move in they did it very quietly. The section of the hospital they now occupy was torn down and reconstructed.

With some assistance from the local government, Vandenburg said the cost of setting up was somewhere around US$900,000, adding that after additional equipment is brought in the figure could reach close to US$1.1M.

"We visualized a place where people will come and feel comfortable. But it was also about being on par with the places in the Caribbean. The equipment they use overseas is here, the technology is here and we have the doctors too", he noted.

CHI currently has an inclusive policy and is working with a team of professionals from abroad and in Guyana. Vandenburg made the point that the doctors who treat patients in Trinidad and New York among other countries are right in Guyana and will be for sometime.

From the outside the institute looks pretty ordinary but this perception quickly changes after stepping inside. The interior design is impressive and that is just the beginning.

Some patients are provided with holter monitors which they take home so that the heart could be monitored during normal activity. Upon the patient's return to the hospital the physician is able to see what actually happened and at what time.

Dr. Haydock Wilson, Medical Director at CHI noted that holter monitoring has been very effective since the institute opened. He said patients in the past would complain about problems but often it was when they were at home or on the road. Now that holter monitoring is available he said they have been able to understand better what is happening with a particular patient.

The four-bed coronary care unit is one of the strengths of the centre. There is an individual bed monitoring system that is computerized. Wilson is also able to see what is happening from his desk.

The Cath Lab which was once an x-ray room at GPHC is where the angiograms are done. Shortly, much more will be happening in the lab, according to the CHI team.

After CHI would have built a reputation and good standard, Vandenburg said the plan is to eventually market services to the wider Caribbean so as to offset the cost that Guyanese will be paying. He reiterated that CHI must have everything in place and must be offering all forms of invasive cardiac services before putting itself out there.

CHI is a private company but the decision to open at the public hospital was an easy one to make according to the CEO. He said they are about service and since the Georgetown Hospital is open to everyone it was the suitable choice.

"The idea is not to scare people away. We may be private but our costs are affordable and we will treat anyone. We want people to come in and see usā€¦", Vandenburg noted.

Among the doctors that CHI lists in its cardiac team are Gary Stephens, Jeffrey Massey, Ronald Henry, Ramsundar Doobay, Haydock Wilson, Surujpaul Ragnauth, Padma Persaud, Charles Gaymes and Richard Ishmael.