Cardiac care unit making strides with focus on treatment and training

With heart disease continuing to be the leading cause of death among Guyanese, the recently-established Cardiac Intensive Care Unit (CICU) is meeting the needs of patients by offering specialized treatment and care.

The CICU, located at the Georgetown Public Hospital Corporation (GPHC), is a project resulting from collaboration between the Guyana Partnership for Advanced Cardiac Care (GPACC), the Ministry of Public Health and the Calgary University’s Libin Cardiovascular Institute in Alberta, Canada, and forms part of comprehensive plan to tackle heart disease in Guyana.

Co-director of GPACC and resident cardiologist at the GPHC Dr Mahendra Carpen, in a recent interview with Stabroek News, said the project supports the provision of infrastructure development to facilitate cardiac treatment as well as focuses on training a new generation of cardiac care providers to serve the Guyanese public.

And though he is aware that the unit was only formally commissioned less than six months ago, Dr Carpen is content with the strides made so far, with much support from the local administration through the GPHC and its overseas counterparts, and particularly doctors Wayne Warnica and his wife Debra Isaacs, both of the Libin Cardiovascular Institute.

Dr Mahendra Carpen

“It is indeed a young, developing service but we are very proud of where it has moved in such a short space of time and we have had constant assistance from our overseas partners, thus allowing it to become more and more successful; we hope that it will have more interest shared in having it sustained at a high level,” Dr Carpen said.

In terms of patients, Dr Carpen said the unit caters to anyone with a cardiac condition, whether that person is referred from an outlying government hospital or is coming from the emergency room at GPHC. “Once they have a cardiac condition, they are admitted and treated the same way, regardless of if they have means of getting treatment privately or if they do not; there is no discrimination,” he noted.

Unaware of risk factors

Unfortunately, the cardiac unit is almost always at 90% occupancy or above due to the number of persons who suffer from heart disease, Dr Carpen said.

Asked about the reason for such a high rate, he explained that the frequency of such cases is due to a combination of things. “Some of it is definitely genetics but a lot of it has to do with people being unaware of their underlying risk factors for heart disease; too many of my patients are coming with heart attacks not knowing they were diabetic or have high blood pressure and are still smoking… smoking is the number one preventable habit for heart disease and it’s particularly worse for women,” the doctor said.

Additionally, persons of South Asian descent, including Guyana’s Indian-Guyanese population, tend to have smaller coronary arteries, and thus they experience blockages a lot easier.

“Their cholesterol particles tend to be smaller and are much more dangerous, so often times I don’t pay too much attention to the cholesterol number when the results come back from the lab because these patients are at a higher risk, so we have to treat them with more caution,” Dr Carpen said.

He also reiterated that poor diet and lifestyle choices are also among the contributing factors for heart disease. “A lot of things come together to create a bad outcome,” he noted.

Comprehensive training

Currently, the unit is equipped with 16 intensive care-level beds, including ventilators and crash carts, and it is fully functional 24 hours a day, seven days a week.

With regard to staffing, the unit comprises a team of individuals who specialize in cardiac care to ensure that patients are properly catered to.

This, Dr Carpen said, includes an estimated 15 to 20 specialized and highly motivated nurses, who, according to him, provide “wonderful care” to patients of the CICU; a dietary pharmacist, persons who offer social work support; clerical staff, and cardiologists.

“Medicine has been basically moving away from the single person approach to a team approach of managing patients and this is the motto and philosophy behind putting together a group of professionals who are able to address all the particular needs of a cardiac patient,” Dr Carpen said.

However, before anyone joins the CICU team, he or she has to undergo comprehensive training, which is offered at various levels.

“There are various levels of training offered to all professionals; for people who are doing ECGs [electrocardiograms], for example, they have to be trained and certified and the GPACC group has been leading that effort to make sure that these people are trained properly. There are specific time and specific core content that they have to do but after finishing the training is not that you’re done and you’re ready to go, it’s a continuous training that happens on the job, continuous assessment as well,” Dr Carpen said.

“There is also more advanced  training for nurses who may specialize in heart failure management and these are  highly-skilled, highly-trained nurses who are basically steered in the direction of being care givers to patients who have heart failure and that there again is a different type of education; it’s online, it’s interactive, it’s interpersonal and we have visiting faculty come down from the University of Calgary and we are hoping that in time, the nurses who have been identified to do that particular  thing can go overseas to get that additional training and come back… It’s not just six months and you’re done; at the end of the six months they are assessed as being ready once you satisfy all the relevant criteria and then your training will continue for another year or two while you’re on the job,” he added.

The same approach, he said, is taken with doctors since part of the mandate is to identify talent and interested young doctors who can then be trained to become advanced care providers in cardiology. “It’s a comprehensive approach to training and education. Essentially, we are building a service that is going to last for a long time to come,” he further added.

More recently, the CICU benefited from the donation of stress testing equipment from its overseas partners. “In order to diagnose and manage patients appropriately in cardiology, there are certain basic tools that are used apart from examining patients and checking medical history and that would include the basic ECG and echocardiogram. Those two basically look at the heart while the person is resting. Often times, however, the problems of the heart only become apparent when you increase the rate or you put the heart under stress. So the stress testing equipment that was donated is functional within the department and essentially serves that purpose,” Dr Carpen explained.

“Patients basically walk on a treadmill or they have medication to speed up their heart and then we either have an echocardiogram while the heartbeat is fast or we do the ECG to essentially establish whether or not there are underlying diseases that only show up when the heart is under stress and that is the standard international way of checking to see if patients have underlying heart disease and it is certainly a good screening tool that does not require an invasive procedure for patients who you suspect may have a cardiac problem,” he added.

Health sector reform

Commenting on Dr Isaacs’ involvement in the programme, Dr Carpen explained that everything is done on a voluntary basis. “Dr Isaacs comes on a voluntary basis and dedicates her time, efforts, energy and resources to help us in developing our programme. As part of their international programme as well and global help, I think over the years she has fallen in love with Guyana; it’s an easy place to fall in love with and they have been coming very often…I believe in the last two years there has been at least 30 trips and these were all with their own resources,” he said.

Looking to the future, Dr Carpen said not only does he hope to see the CICU spur more national development, but he would also like to at some point to see every citizen being able to access to health care at the highest level, irrespective of financial standing and social standing.

However, for this to happen, he noted that there needs to be health sector reform. “We need to be brave enough to approach it because without it we will still have the differences in quality care based on factors that are easily identified as discriminators,” he related.

Additionally, it is his hope that the CICU can be used as model for other areas of medicine offered locally. “Even though cardiovascular disease is the number one killer for Guyanese and generally people in the developing world, there are other sicknesses that need to be addressed and I  think this is a wonderful way of getting partnerships based on means and ways  of treating diseases and helping people,” Dr Carpen said.

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