CHI provides affordable cardiac care for Guyanese, new treatment protocols have seen 10-fold drop in death rates and halving of hospital stay

Dear Editor, My fellow Alumnus of the University of Guyana, now residing in the UK, Dr. Mark Devonish has recently advanced some very apposite points about cardiologists and the practice of cardiology in Guyana. His expressed goal is “patient information!”

I will now provide, apropos, patient and personal information for Mark and the general public.

Background In 2004/2005 the Government of Guyana (Taxpayers) spent $500,000 USD – half million US dollars – to send 10 Guyanese patients overseas for cardiac treatment. This averaged $50,000 USD per patient. For a country like ours this was an unsustainable situation. This led to the birth of the Caribbean Heart Institute (CHI) in 2006 which is a public-private partnership with the Government of Guyana and the Board of Directors of CHI. The cost of treatment has been continuously revised to its current position where we can now provide care for 100 patients instead of 10 patients (2004/2005) for the same cost. CHI provides the cheapest bypass surgery in the Caribbean since there are no fees charged by the cardiac surgeon or the perfusionists. We are also the cheapest for coronary angiograms, angioplasty and coronary stent implantation. For general information – a coronary angiogram is the procedure to take pictures of the arteries of the heart to find blockages. Angioplasty is when we stretch the blockage with a balloon to open it, and stent implantation involves putting in a mesh-like tube to keep the artery open. The prevalence of heart disease in Guyana is almost at epidemic levels. I have had patients as young as 28 with heart attacks and as of recent there has been a surge in males in their mid 30s coming in with massive heart attacks. While the disease may have been seen in only the older population previously, we are now experiencing more severe heart disease in the under-50 age group too frequently. Unfortunately, too many patients think that their symptoms are related to “gas” or something non-cardiac. By the time they reach hospital they would have been 3-4 days without appropriate treatment. Misinformation can scare patients, undermine trust and cause more delays which results in dire consequences, including death.

Practice Privileges A long time ago I decided to live and practice in Guyana and the Caribbean and consequently did not pursue residence in North America

and the UK even though I have done advanced studies in Canada and the USA. In Canada I trained at the University of Toronto in Adult Cardiology and Interventional Cardiology and then moved to Boston USA at Tufts University for Clinical Cardiac Electrophysiology. I live and practice in the Caribbean and I am fully qualified to do so in the fields of Adult Cardiology, Interventional Cardiology and Cardiac Electrophysiology. Guyana and the Caribbean needs its own citizens to develop its systems and I am proud to be a part of this pioneering brigade. Since returning to Guyana I have been able to provide care to patients not only in Guyana but also those in Trinidad, Jamaica, The Bahamas, Tortola, St. Lucia, Grenada, Antigua, Suriname, St. Vincent, Barbados and Cayman Island.

Surgical Backup Dr. Devonish observes that Coronary Angiograms and other Coronary Interventions should have a backup team of surgeons around.

In resource rich communities abroad this is feasible. In Guyana there is a paucity of Personnel and Equipment to facilitate this on every occasion.

We are forced to work with limited capabilities until Government /Private Entities can provide them.

With our “oil rich” economy on the horizon, we will be able to match overseas standards.

There are three cardiac catheterization facilities in Guyana and my work is mainly done at 2 of these. A single surgery team in the city is sufficient back-up. We do have a visiting cardiac surgery team every month from New York that provides heart surgery for those needing it. Without early angiograms and angioplasty people will suffer unnecessarily. I am good at it, my team is good at it and our patients survive now when previously they had no options. The written guidelines for cardiology do not consider cardiac care in the developing (Third) world therefore we have to blaze our own paths, adjust according to our needs and resources. Careful patient selection,