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Cardiology Practice in Grenada

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					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”
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
   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

				
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