Cardiology Practice in Grenada, West Indies

1. Cardiology Practice in Grenada, West Indies Presented by: Peter G. Bourne, M.D., M.A. and Rozann Hansford, R.N

2. 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)

3. Map of Grenada

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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”

12. SGU Visiting Cardiologist Program Dr. Mark Lanzieri, visiting cardiologist and SGU alumnus, implants first cardiac pacemaker in Grenada Dr Mark Lanzieri, SGU SOM alumnus, performing Grenada's first cardiac pacemaker implant.

13. 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)

14. 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

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

16. 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

17. 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

18. 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.

19. 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