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Report from Guyana: Libin Institute, AHS members improve health conditions

New 14-bed cardiac intensive care unit opens in Georgetown as part of a five-year commitment
May 23, 2017
University of Calgary faculty of nursing professor Karen Then, centre, poses with nursing staff from Guyana, where she has been involved in the Guyana Programme to Advance Cardiac Care. Photo supplied by Karen Then

University of Calgary faculty of nursing professor Karen Then, centre, poses with nursing staff from Guyana, where she has been involved in the Guyana Programme to Advance Cardiac Care. Photos supplied by Karen Then

Nurses do rounds at at the 14-bed cardiac intensive care unit opened by the Guyana Programme to Advance Cardiac Care. The CICU began operating in December 2016. Photo supplied by Karen Then

Nurses do rounds at at the 14-bed cardiac intensive care unit opened by the Guyana Programme to Advance Cardiac Care. The CICU began operating in December 2016. 

The new cardiac intensive care unit is co-directed by Libin Institute doctors Debra Isaacs and Wayne Warnica.

The new cardiac intensive care unit is co-directed by Libin Institute doctors Debra Isaacs and Wayne Warnica. 

Karen Then, centre left, and Debra Isaacs, centre right, pose with nursing staff from Guyana.

Karen Then, centre left, and Debra Isaacs, centre right, pose with nursing staff from Guyana.

Guyana has a problem with cardiovascular disease. “The people of Guyana suffering from heart conditions often present at advanced stages that we would see in Canada only rarely,” says the University of Calgary’s Wayne Warnica, co-director of the Guyana Programme to Advance Cardiac Care (GPACC).

GPACC opened a 14-bed cardiac intensive care unit (CICU) — the South American country’s first facility of its kind — in December 2016 in the capital of Georgetown, with support from the Libin Cardiovascular Institute.

Today, almost six months later, the level of cardiac care in Guyana for both adults and children continues to improve, thanks to the continuing efforts of a multidisciplinary team of volunteers from the Libin Institute and Alberta Health Services (AHS).

New clinic amplifies other programs

Warnica, adult cardiologist and professor emeritus of cardiac sciences and medicine, says it’s not uncommon to see heart attacks in people in their 30s. The average resident has a poor diet and exercises infrequently, which contribute to the cardiac problems. The Canadian volunteers see a prevalence of sub-optimally treated diabetes and hypertension and a high incidence of congenital and rheumatic heart disease.

The intensive care unit amplifies GPACC’s other programs, which include a heart function clinic, a cardiology clinic, an in-patient ward cardiology service, an active echocardiography and treadmill lab, and a cardiology patient database to help manage patient records and track patient care.

According to Warnica, until the development of the GPACC programs — all of which are located at the country’s largest public health-care facility, the Georgetown Public Hospital Corporation — there was no consistent access to cardiac diagnostics and no facility or expertise for monitoring and managing cardiac patients in Guyana.

Support in person and online

Warnica said numerous AHS medical, nursing and allied staff have visited the country — often multiple times — over the last five years to develop and provide cardiac care to the Guyanese. They have also participated in online and videoconferencing training.

He said although the CICU is a step forward, the end goal is to train local professionals to take over their own cardiac health care.

That’s why GPACC puts a large focus on training and education. Dr. Debra Isaac, co-director of the GPACC, is a cardiologist and University of Calgary clinical professor at the Cumming School of Medicine.

Her involvement in Guyana began in 2012 when she started the Guyana Echocardiography Education Program with donated equipment, volunteer medical specialists and technologist instructors, with support from the Libin Institute.

University faculty have trained Guyanese nurses, doctors, pharmacists and other support staff on everything from filling out a chart properly and performing and interpreting electrocardiograms in patients of all ages, to diagnosing and managing pediatric heart patients, thanks to a partnership with the International Children’s Heart Foundation, Isaac explained.

Goal: Train locals to manage cardiac programs independently

GPACC organizers have also created a succession plan that involves training nurses and doctors to manage cardiac programs independently within five years.

That plan includes Guyanese physician Dr. Michael Chin, who receives support from GPACC as a cardiology resident at the University of Calgary’s Cumming School of Medicine and is expected to assume responsibility in his home country.

“It’s all about sustainability of the program,” said Isaacs. “The goal is for them to say ‘thank you very much, but we don’t need you anymore.’”

Karen Then, PhD, a University of Calgary professor in the Faculty of Nursing and cardiovascular nurse practitioner, agrees that education is critical.

She helped set up a collaborative cardiology nursing training program from which 16 Guyanese nurses have already graduated with cardiac certification. Then has visited the country numerous times and said training has been an uphill battle.

She explained nurses in the country generally have no specialization and care for 25 patients or more each. They are moved from unit to unit — sometimes daily — without consideration to their knowledge and skills.

Teaching an uphill battle

Therefore, they don’t have the opportunity to learn to perform adequate patient assessments or to develop a collaborative approach to health care. “We are teaching them how a team works,” said Then, noting the work done in the CICU has been recognized by the Guyanese Minister of Public Health, Volda Lawrence, as a model for other units at the public hospital in a recent news article (available here).

That work included developing a closed unit, which keeps nurses from being transferred to other departments and setting up the highly intense nurses training program, which includes on-site theory and supervised clinical practice and training as well as online learning, frequent teleconferencing sessions, ongoing training and annual recertification requirements.  

According to Warnica, the response of the nurses towards the training has been positive. “They love to be taught,” he said.

The program’s next big push is in public education, because, as Warnica explained, physicians may not even realize their patients have suffered heart attacks.

“Too often it’s too late when they come to us [at the CICU], because most of the damage has been done, so that all we can do is try to treat their already damaged hearts,” said Warnica, explaining most of the population hasn’t been taught the warning signs of cardiac problems.