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CHI provides affordable cardiac care for Guyanese, new treatment protocols...

improved techniques and team growth minimizes complications and adverse outcomes. We have never had a complication which required surgical rescue.

Statistics I will provide some of our results for your consideration. In July 2017, I presented data of our programme in Trinidad at the Caribbean Cardiac Society meeting which showed that before implementing the new treatment protocols there was a 28% rate of death for heart attack patients and an average of 8.8 days of hospital stay. After implementing the new protocols which include angiograms, angioplasty and stenting, there was a drop in death to 2.4 % and hospital stay was reduced to 4.6 days. This represents a 10-fold reduction in death rates and halving of hospital stay. If one considers that it costs USD $2000$6000 per day to treat a hospitalized cardiac patient this translates to savings of $USD 8000 - $24000 per patient.

The following represents data for the first 6 months of 2018, prorated for the entire 2018.

My team and I would have had approximately 8500 patient visits for clinics, admissions and inpatient consultations over 1 year for the 2 facilities I cover. Out of this there are 382 angiograms (4.5%) and 270 Angioplasty with Stenting (3.2%). This represents a very small percentage of cardiac patients receiving invasive care. There are many more patients who should have the benefit of an Angiogram with proper Revascularization (Stent or Bypass Surgery) but for various reasons they are unable to get this level of care. Most of the complex and difficult cases are planned to occur when the surgical team is on ground or arriving. Angiogram and angioplasty with stenting are not the first choice of investigation and treatment. Several non-invasive methods are available and utilized to manage patients before any invasive procedures are done. These would include ECG, Echocardiograms, Stress Testing, Ambulatory blood pressure monitoring, Holter Monitoring and Sleep studies.

Clinical audits of outcomes are mainly done by the Libin Cardiovascular Institute, University of Calgary, who also assisted in development of treatment protocols, training, research and infrastructure development specific for our needs and resources. Additionally, real-time consultations are done with colleagues in Trinidad when necessary. Pre-surgical assessments are done by the surgical team based in New York. My results are comparable to regional and international standards because I was properly trained by world class teachers, professors and proctors.

Since returning to Guyana I was able to do the first implantation of an Intracardiac Defibrillator, first cardiac resynchronization device, first implantable loop recorder, first pacemaker lead extractions, first radiofrequency ablation for atrioventricular node re-entrant tachycardia, first ablation for Wolff-Parkinson-White Syndrome, first ablation for concealed retrograde accessory pathway. As the head of Cardiology I was instrumental in opening the first Cardiac ICU in the public sector (GPHC) and also the Cardiac ICU at Woodlands Hospital. I have established protocols for the treatment of heart attack (Acute coronary syndrome), heart failure and cardiac arrhythmias based on our resources. I lead the initiative to ensure that every patient admitted to GPHC with a heart attack can have free angiogram and stenting without delay once they meet clinical criteria. I have competent, young, dedicated and enthusiastic healthcare professionals who make up my teams, working with the singular goal of improving Healthcare in Guyana.

Challenges Obviously there is much room to grow and improve our national healthcare delivery systems. Patient and care-giver education is critical in prevention, early detection and intervention to manage cardiovascular health. It is also true that cost is a major determining factor in seeking and providing healthcare. For this reason, I am a strong supporter for a National Health Insurance initiative to be developed in Guyana. This is what we should be debating instead of petty personal grouses. Every citizen should have the right to the highest quality of care available without fear of discrimination, loss of dignity or bankruptcy regardless of gender, social status, financial means, ethnicity, sexual orientation, political affiliation or any other criteria used to divide us. For this to occur we would need every Guyanese and many non-Guyanese on board.

Until that goal is achieved there would be much discussion, some heated and contentious, but hopefully we would find consensus to benefit all Guyanese. Yours faithfully, Dr. Mahendra Carpen, MBBS DM FACP FESC FACC (Interventional Cardiologist and Cardiac Electrophysiologist) Head, Internal Medicine/Cardiology Georgetown Public Hospital