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 Introduction Grenada is a three island Caribbean nation and a member of the Windward Islands Sister islands: Grenada, Carriacou and Petit Martinique

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Cardiology practice in grenada west indies l.jpg

Cardiology Practice in Grenada, West Indies

Presented by:

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


Introduction l.jpg
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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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 rate…85% (1996)

  • Annual national health expenditure, proportion of GDP……………..2.4% (2001)

  • Major industry:Tourism 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 (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


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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 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


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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


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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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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.


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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 (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


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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 Subcommittee, American Heart Association, demonstrates appropriate hand position for CPR to health professionals in Grenada

  • 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 Subcommittee, American Heart Association, demonstrates appropriate hand position for CPR to health professionals in Grenada

  • 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 Subcommittee, American Heart Association, demonstrates appropriate hand position for CPR to health professionals in Grenada

  • 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 Subcommittee, American Heart Association, demonstrates appropriate hand position for CPR to health professionals in Grenada

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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