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| Wednesday, 3 September 2003 |
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Dedicated doctors and staff at the CU by Fathima Razik Cader Notwithstanding the non-availability of essential resources (as highlighted in the introductory article on 20 August - DN), the doctors and the medical staff at the Cardiology Unit (CU) of the National Hospital of Sri Lanka, continue to carry out their duties with utmost dedication. This statement can be proved when one takes note of the manner in which patients at the CU are being taken care of. In as far as the care of patients at the CU and the Coronary Care Unit in particular are concerned, they require round-the-clock attention. International recommendations stipulate one nurse to a maximum of two patients. Ratio This ratio is difficult to achieve in Sri Lanka and till such time such issues are fully addressed, the medical staff cope as best as they possibly can under the circumstances. So whilst these 'deficiencies' are there in the CU, in the recent past, the treatment mobilities offered to patients, completely free of charge, have advanced tremendously. Unlike say around 15 years ago, now in between cardiac surgery and medical therapy, there is what is called interventional therapy. This means, patients who need treatment for heart diseases do not always have to undergo surgery. Instead, doctors, by passing wires, are able to 'manipulate' the anatomy of the patient and thereby bring about near normalcy or full normalcy in a patient. All along, doctors serving at the CU of the National Hospital were qualified and capable of performing such methods of treating a heart condition but were not in a position to do so due to lack of facilities. One way of treating Ischaemic Heart Disease due to a blockage in the coronary arteries is via by-pass surgery, but Angioplasty will effectively clear the blockage without having to resort to surgery. Plus the many advantages after such treatment adds to the popularity of such methods to help cardiac patients. Methods Additionally, such methods can be repeated if necessary, without causing further damage to the patient's condition. Further, as most patients who have been so treated would testify, the recovery is so much faster. But as far as state hospitals go, the high costs involved make it extremely difficult to carry out such methods of treatment regularly, resulting in patients having to wait extremely long periods of time before they are wheeled into the operating theatre. Dr. Pramod Ranatunge, Resident Cardiologist at the CU of the National Hospital, is upbeat about the new methods of treating heart diseases. He says, "The pain that a patient has to endure on account of these new modes of treatment as compared to surgery is negligible and in fact, sometimes painless". These new therapeutic procedures using cardiac catheterization are Coil Occlusion or Persistent Ductus Arteriosus (PDA), which is an abnormal communication between the aorta and pulmonary artery, device closure of Atrial Septal Defect which is an abnormal communication between two upper chambers of the heart, septal abalation in Hocm which is an inherited condition that enlarges and predisposes sudden death, Balloon Mitral Valvuloplasty - a common condition seen as a complication of chronic rheumatic fever, Balloon Pulmonary Valvuloplasty and Coronary Angioplasty and Stent Implantation. These conditions of the heart that in the past were surgically treated, are now non-surgical procedures. "There is no surgery, no scar, a short hospital stay (around three days), no stay at the ICU and excellent recovery", says Dr. Ranatunge. An aspect worthy of mention is Cardiac Rehabilitation (CR), now a full-scale and permanent feature at the Cardiology Unit. Precaution Whilst it is an accepted fact that precaution is always better than cure, this aspect of rehabilitation as far as heart patients go, is on par with hospitals in the developed countries. With the limited facilities and resources available, Dr. Sepalika Mendis, also a Resident Cardiologist, is actively engaged in addressing this vital area - that of ensuring that patients once treated, with or without surgery and discharged, do not suffer further set-backs but on the contrary, take good care of themselves and are on the road to complete recovery. And thankfully, patients are very co-operative and have taken cognizance of the fact that they need to be on track and return to an active and satisfying life. Cardiac Rehabilitation has therefore, become an integral part of the care of a person who has had a heart attack or undergone interventional therapy or surgery. How does CR work? In reply, Dr. Mendis said, "It is a programme which combines and co-ordinates the use of medical, psychological, educational, vocational and physical measures to assist people with coronary heart disease to get back to a normal life". Dr. Mendis added, "We have a team comprising a physiotherapist, psychologist, dietician, nutritionist, pharmacist and cardiologist and each one has a valuable role to play in our CR programme". Describing CR, Dr. Mendis went on to say that it is an outpatient programme and one person can accompany the patient for the sessions. The idea behind having another person with the patient is to teach him or her too, the procedures that the patient should follow at home. Prior to commencing the programme, the participants (patients) undergo a medical assessment by a medical officer. sessions Of four weeks duration, the programme has eight sessions where basic life-support is taught (in the event of a heart attack in the home), resuscitation, healthy diet, physical exercises and other important aspects of rehabilitation are covered. Patients are assessed after three months and thereafter, after six months and are referred to their respective doctors with the assessment. Being the only such centre in Sri Lanka, Dr. Sepalika Mendis intends promoting this programme in other Government hospitals and private hospitals too. In reply to a question on the reception to this programme, Dr. Mendis said that, over 200 patients have been rehabilitated to date and notes with satisfaction that, of the 71 percent of the patients who were smokers, 84 percent had given up smoking. In addition, blood pressure, blood sugar and cholesterol levels of such patients also showed a marked improvement. exercise CR also encompasses cardiac monitoring that includes exercise tolerance tests, 24 hr. BP monitoring and 24 hr. Holter monitoring, supervised exercise to ensure that participants improve their fitness levels in a safe and appropriate way, education sessions, relaxation sessions with individual counselling if so required, screening for cholesterol and blood sugar and dietary sessions where each persons diet is individually assessed. Dr. Mendis and the team are 'rewarded' for their hard work when patients show their appreciation in so many ways - not just with thank you letters and cards but also by donating healthy food towards the programme that subsequent participants can partake of. "The fellow-feeling is very evident", avers Dr. Mendis. The all important question of admitting a patient to a hospital promptly is always emphasized by any doctor and consultant cardiologist, Dr. Ruwan Ekanayake, stresses the need to get admitted to a hospital no sooner one has a cardiac complaint. "Heart attacks are commonest between 6.00 am and 10.00 am and this is a world-wide trend. In Sri Lanka, unfortunately, patients wait till 4.00 p.m. to seek the services of a specialist through a channelling centre and this is very dangerous", he said. "The patient needs immediate therapy and medication should be given within six hours in order to avert loss of life or undue damage to the heart," added Dr. Ekanayake. Thankfully, the National Hospital of Sri Lanka, now has an Emergency Treatment Unit where trained doctors, nurses and support staff immediately attend to the patient who is referred to this unit by he doctor in the OPD. Unfortunately, though, some patients go direct to the CU and the doctor in the CU is (reluctantly) compelled to send the patient back to the OPD because technically, the CU cannot administer any drugs to the patient without a registered Bed Head Ticket. What is on the horizon is a proposal to set-up a Chest Pains Clinic in the CU (which is a feature in many hospitals overseas) and when this becomes a reality, admission to the CU of the National Hospital will perhaps be a hassle-free and smooth exercise. Meanwhile, we need to be patient, as all State hospitals (as stated in last week's article) sadly, lack the financial resources to give optimum care and treatment. This should then be an ideal opportunity for a social service organization or a non-governmental organization (with health as part of its portfolio) to make a positive 'contribution' by harnessing its resources to organize appropriate fund-raising programmes in collaboration with the doctors' at the Cardiology Unit - a step I hope they will welcome. The 'heart' of the matter is money or rather the lack of it. Believe me, the doctors and the staff at the CU are smiling through it all. |
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