Cardiology Practice in Grenada, West Indies

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Cardiology Practice in Grenada, West Indies

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

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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)

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Map of Grenada
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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

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Socioeconomic Profile

• GNP per capita...6,330.00 (2001)
• GDP growth rate.8.2 (2001)
• Adult literacy rate85 (1996)
• Annual national health expenditure, proportion of
  GDP..2.4 (2001)
• Major industryTourism and agriculture
• (cocoa, nutmeg,
  bananas)
• 
  PAHO, 2001

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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)

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Mortality and Morbidity Profile (cont)

• 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

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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 schools Vice
  Chancellor managed by a cardiovascular nurse
• Financial support for cardiologist travel and
  lodging by St. Georges University Medical
  School. All other funding through cardiologist
  donations and community fundraising activity

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Program Description (cont)

• 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

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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

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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

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

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Emergency Cardiovascular Care Program (cont)

• 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

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Dr. Henry Halperin, Visiting Cardiologist,
Chairman ACLS Subcommittee, American Heart
Association, demonstrates appropriate hand
position for CPR to health professionals in
Grenada
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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

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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

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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.

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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