Cardiac Report IMHO

IMPROVING THE CARDIOLOGY UNIT OF JAFFNA TEACHING HOSPITAL & ENHANCING THE SERVICES PROVIDED December 2008 Table of Contents Background……………………...1 Current Cardiac Facilities & Care……………………………….2 Suggestions to Improve Cardiac Services: High Dependency Unit……3 Cardiac Catheterization Lab……………………..3 Coronary Care Unit………..4 Cardiac Ward………………4 Cardiac Rehab Center…...4 Estimated Costs……………….3,4 Conclusion………………………4

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International Medical Health Organization (IMHO)

Proposal for Cardiac Catheterization Lab, Cardiac Ward, Cardiac Rehabilitation Center, & Coronary Care Unit BACKGROUND The International Medical Health Organization (IMHO) is an international humanitarian organization that focuses on developing and improving healthcare infrastructure and services in underserved regions across the globe, with particular focus on Sri Lanka. This year IMHO is planning to engage and enhance various medical services provided by the Jaffna Teaching Hospital in improving overall cardiac care and services by establishing a Cardiac Catheterization Lab with facilities for investigation and intervention. IMHO was founded in 2003 in the United States, by healthcare and other professionals who recognized a desperate need in bringing health and medical care to impoverished communities in lesser-developed regions where healthcare facilities are usually well below the standards of developed countries. By working with local healthcare professionals and facilities, IMHO is able to significantly improve the overall quality of care in disadvantaged areas. While initial efforts at improving cardiac care at Jaffna Teaching Hospital by establishing a cardiac care unit were significant, there is still much to be done.

As the humanitarian situation in the Northeast of Sri Lanka worsened after years of conflict, over a half-million people fled the northern city of Jaffna from 1981 to 2007 (50% of the total population). This paved the way to a severe dearth of professionals, much to the detriment of the health sector in Northeast Sri Lanka. Additionally, primary, secondary, and tertiary healthcare facilities, including hospitals such as the Jaffna Teaching Hospital, continue to lack many basic facilities and supplies. All of this has added great strain to the workload and capacity of those at the Jaffna Teaching Hospital.

In 2005, after recognizing the dire need for improved cardiac care, a cardiology unit was established at the Jaffna Teaching Hospital with the generous support of Dr. G.R. Handy, a pioneer cardiologist in Sri Lanka. The present need remains firmly fixated on a cardiac catheterization lab.

Present State of the Jaffna Teaching Hospital Cardiology Unit CURRENT CARDIAC CARE & FACILITIES At present, cardiology services are only available in the northern peninsula at the Jaffna Teaching Hospital, which puts it both in very high demand and in a very precarious position. Current facilities include a coronary care unit with 7 beds, a cardiac investigation unit with echocardiogram equipment, exercise treadmills, and Holter monitor, and cardiac rehabilitation unit. In addition, an outpatient clinic is run twice a week, and there is a newly established cardiac ward that will likely serve as the future high dependency unit.

“Vivamus porta est sed est.�

The statistics from 2007 (January-December) show that 578 patients were admitted to the Coronary Care Unit at the Jaffna Teaching Hospital. A further 4,959 patients with heart-related conditions were treated at the Echocardiography Unit, and another 3,483 patients were treated in the medical wards. All of these patients were directly admitted to the Jaffna Teaching Hospital or were transferred from other hospitals.

Finally, out of all the thousands of patients, a total of 190 with serious cardiac ailments were transferred by air to tertiary healthcare facilities at government hospitals in Southern Sri Lanka for further investigation and management. These transfers were done with the help of the International Committee of the Red Cross (ICRC). This is the only mode of transport available for the transfer of patients from Jaffna to Colombo, which occurs twice a week. For each trip about 5-8 patients are transferred, facing tremendous hardship during this process. While several hundred patients independently went to private hospitals, a huge number could not afford private care or a trip to Colombo, and thus had to make do with the care available in Jaffna.

Sadly, a few patients have been lost while awaiting transfer or during transfer, including a 19 year-old boy with atrial myxoma who died in CCU while awaiting transfer, and a 30 yearold gentleman with severe aortic stenosis who was awaiting AVR when he died during transfer. If proper facilities were available at the Jaffna Teaching Hospital, these patients and more would have surely benefited. With improved facilities and equipment we expect to effectively care for more patients than ever before.

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How to Improve Cardiac Care in Jaffna

PLANS TO IMPROVE CARDIAC CARE & SERVICES 1. Establishment of a High Dependency Unit (HDU)—COMPLETE A high dependency unit is important to manage patients who no longer needed to be in the CCU but are not yet ready to be transferred to ordinary wards. Thus, IMHO originally planned to establish a high dependency unit which has since materialized.

Establishment of a high dependency unit will enhance the efficient usage of CCU beds.

Furthermore, high dependency unit beds will be utilized to observe patients after procedures.

2. Establishment of a Cardiac Catheterization Lab with facilities for investigation & intervention—MOST PRESSING CURRENT NEED! Currently the greatest and most significant need is that of a cardiac catheterization lab. Once a lab is established, this equipment can be used by trained doctors and personnel to perform the following: •Coronary angiogram •Percutaneous coronary intervention •Pacemaker implantation •Balloon valvuloplasty especially PTMC •Device closure of congenital defects

Estimated Costs of Cardiology HDU—Complete Cardiac Bed

10 x 80,000

800,000

Mattress

10 x 5,000

50,000

Defibrillator

1 x 650,000

650,000

Cardiac monitor

2 x 600,000

1,200,000

ECG recorder

1 x 150,000

150,000

Pulse oxymeter

2 x 140,000

280,000

Syringe pumps

10 x140,000

1,400,000

Sphygmomanometer

4 x 7,500

30,000

Sucker

2 x 40,000

80,000

Total cost SLR= 4.64million (US$ = 46,400)

The necessary human resources are available at the Jaffna Teaching Hospital. At present there are two UK-trained interventional cardiologists with necessary training working full-time in Jaffna already. A CT Surgeon is also ready to go. Therefore, necessary and competent cardiac consultants are currently available at this hospital. Nursing and paramedical staff from Colombo (National Hospital of Sri Lanka) could easily be trained. Once this facility is up and running, many lives will be saved by eliminating unnecessary transportation and providing overall a much higher quality of care. Additionally, we will be training the next generation of doctors to serve the people of this area. The Ministry of Health will provide funds for all running costs and resources once this unit is established at the Jaffna Teaching Hospital, which is where the cardio cath lab will be housed.

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www.theimho.org SUGGESTIONS TO IMPROVE CARDIAC CARE & SERVICES, continued…

The building is being constructed with the support of a UN agency and local donors. The cardio cath lab is also a joint venture between diaspora medical organizations in Canada and the UK. We are hoping to launch this initiative as soon as possible.

3. Expansion of Coronary Care Unit Increasing the bed strength to ten would be a positive step towards increasing capacity and impact of the Coronary Care Unit. Additional training for the current doctors and nursing staff is also needed.

4. Establishment of Cardiac Ward Patients who are being treated at the cardiology unit are transferred to other medical wards later for further management. It would be extremely beneficial to patients if ward facilities for cardiac care were made available. Thus, we plan to establish a ward with 40 beds for this purpose.

ESTIMATED COST TO ESTABLISH A CARDIAC CATHETERIZATION LABORATORY Philips Integris Allura X per FD10C Digital Cathlab: US $800,000 ($200,000 left to go!) *Includes all equipment necessary to establish a full cardiac cath lab, consisting of multiple complex components available in Sri Lanka

5. Upgrading Cardiac Rehabilitation Clinic The existing cardiac rehab clinic presently functions with bare minimum facilities and supplies, so there is great need to expand upon these. Apart from the facilities themselves, there is high demand for more equipment in order to enhance the present functions of the clinic. Materials needed include audio-visual aids, health education materials, books, leaflets, and other resources. Present staff who man this clinic are also in need of further training.

CONCLUSION Given the dire need for improved care and services, as well as Jaffna Teaching Hospital’s role in providing the only cardio care available in the entire northern peninsula, it is imperative that we improve and expand upon the existing cardiology unit. Foremost amongst these concerns is the establishment of a cardio catheterization lab, which will cost an estimated USD$800,000 for the equipment. Through a matching donation program, IMHO is responsible for raising $400,000 for this project, of which $200,000 has already been raised! We are thus in need of another $200,000 in donations to make this critically important project a reality.

Once the unit is fully established, the Ministry of Health will take over in covering all ongoing operational costs. The research and data show that if we effectively address the concerns outlined in this proposal, we can reduce the rate of mortality and hardship, while greatly increasing the overall quality of cardio care available to many needy persons in this highly underserved region.

We seek your support—please make a tax-exempt donation to IMHO today by sending a check to: Dr. Rajam Theventhiran, IMHO Treasurer, PO Box 61265, Staten Island, New York 10306, USA 4