Latest update March 28th, 2024 12:59 AM
Jun 02, 2015 Letters
Dear Editor
Over the past few months there has been an increase reference to the Caribbean Heart Institute (CHI) in the print and social media. More recently allegations of a deliberate plan to undermine CHI by the previous administration have surfaced as well as a letter from the well-respected Dr. Hughley Hanoman. Much of this has negatively impacted on staff morale and our efforts to expand the service portfolio of CHI. Patients are uneasy and valuable time is spent answering questions that should not have arisen in the first instance.
I am writing to highlight the facts and to curb uninformed speculations. The Caribbean Heart Institute has been in existence since 2006 serving the Guyanese population as well as patients from the wider Caribbean. Since its establishment there has been about 200 open-heart surgeries, 800 coronary angiograms, 250 coronary stents, 100 pacemakers and ICDs, 6000 echocardiograms, 2000 stress tests, countless ECGs, outpatient and inpatient consultations for cardiac diseases. The patient outcomes at CHI are comparable to larger and more experienced centers regionally and internationally. I have presented some of this data at the 2013 Caribbean Cardiac Society meeting in Curacao. Prior to CHI’s existence patients had no realistic options for many of these services unless they were privileged to go overseas. The costs for these services at CHI are at a fraction of what it costs in Trinidad, Barbados, Jamaica and the USA. This lower cost is achieved by a combination of factors. Significant among these for open-heart surgeries are the free services from the Surgeon (Dr. Gary Stephens) and perfusionist.
The operational model for CHI is quite novel (Public Private Partnership) – Government buys the major equipment (Catheterization Laboratory) and provides the space for function while a group of private investors purchase the monitor, consumables etc. required to keep the institution operational. In this model there is no cost billed to the patient for facility or equipment use.
In cost ratio analysis this usually accounts for 60-80% of the total billable cost. This is why CHI can do cardiac interventions at 25% of the cost compared to private centers in Trinidad. CHI functions on a small profit margin only so much so as to allow for the recruitment and retention of the requisite skilled professionals and to ensure its long-term survival. Given the scale of Guyana’s economy and lack of proper medical insurance the majority of patients requiring cardiac interventions are unable to afford even this reduced cost.
Therefore the Government, through the Ministry of Health, still had to provide partial funding to patients. Unfortunately over the past two (2) years this assistance to patients has been drastically reduced. The process to access this help for the ordinary person has been exhaustive and starts with a letter from CHI, addressed through the Director of Medical and Professional Services (DMPS) of the Georgetown Hospital, to the Ministry of Health. There is an assessment scheduled in the office of the DMPS then this is forwarded to the Ministry of Health. From here the request is sent to Cabinet and then the decision is relayed to CHI through the Ministry of Health. This process routinely takes 2-3 months although a few special cases were approved VERY quickly. This system is very inefficient when dealing with life saving and life changing procedures which are best addressed within hours of the patients’ presentations.
Much has been made of the new Hybrid facility currently being developed. Once I had accepted the job to come home and manage the CHI, Dr. Stephens consulted me on the type and specifications of the new equipment given my unique dual advance Fellowships in Interventional Cardiology and Cardiac Electrophysiology, a field of study that remains a mystery to even the most experienced physicians. I advised on the hardware and software required to accommodate Interventional Cardiology, Peripheral Vascular Interventions and Cardiac Electrophysiology. The requirements for open – heart surgery were comprehensively dealt with by Dr. Stephens. This new facility can therefore be used to perform four (4) types of cardiac services. Once completed this would be the only such facility in the English speaking Caribbean, allowing us to provide better care to patients. Incompetence and mismanagement from the non-CHI team has so far delayed the installation and functioning of this facility.
Obviously there are lots of areas that can be improved and various models can be useful, however care must be taken to ensure that a realistic and sustainable system is within reach before the previous one is dismantled. The management of CHI has always been interested in meaningful dialogue aimed at enhancing patient centered care in Guyana. We would welcome any initiative that will improve delivery of care and maximize the benefits of limited resources. The reality is that tertiary cardiac care is not free anywhere in the world, the developed world provides for its citizens by heavy taxations and extensive health insurance coverage. Therefore no third world Government should be expected to provide tertiary care for free – this is not tenable. There is no better time for Guyana to pursue Health Sector reform.
Dr. Mahendra Carpen, MBBS DM FACP
THIS IDIOT TELLING GUYANA WE HAVE NO SAY IN THE 50% PROFIT SHARING AGREEMENT WE HAVE WITH EXXON.
Mar 28, 2024
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