Carolinas HealthCare System together with Karl Heusner Memorial Hospital performs first open heart surgery in Belize
On Monday, physicians from the Karl Heusner Memorial Hospital (KHMH), in Belize City, Belize, and from Carolinas HealthCare System (CHS) performed the first open heart surgery in the country of Belize.
Adrian Coye, MD, Medical Services Director at KHMH and R. Mark Stiegel, MD, FACS, cardiothoracic surgeon with CHS's Sanger Heart & Vascular Institute (SHVI) performed a coronary artery bypass graft on a 72-year-old Belizean man. The patient is recovering at the hospital, where he will be monitored for at least three days post-surgery. Today the surgeons will perform a mitral valve replacement on a 56-year-old Belizean woman, completing a second heart surgery.
"This is a very special moment that has allowed everyone involved to make history in Belize," said Dr. Coye. "Belizean patients should receive the same level of care as others worldwide, and we are thrilled to have reached this point in what we can offer for medical services in our country."
Although heart disease is the second leading cause of death in Belize, the country lacked a modern cardiovascular diagnostic and interventional facility up until 2011, when CHS's International Medical Outreach (IMO) Program began providing support. Before that time, patients would either not receive treatment or would travel to neighboring countries for cardiac services. Today, due to ongoing support from the IMO Program, KHMH has the equipment and medical expertise necessary to diagnose and treat patients with heart ailments in the country.
"This is an exciting time for the people of Belize, and we hope this achievement paves the way for future improvements in the country's healthcare services," said Francis Robicsek, MD, PhD, founder and vice president of the IMO Program, a partnership between CHS and the Heineman Foundation of Charlotte (Heineman). "In collaboration with SHVI, we will continue our support to KHMH and emerging cardiology program to provide sustainable cardiac care in Belize."
The IMO Program donated and installed the country's first fully-equipped cardiac catheterization laboratory in February 2011 at KHMH, one of only two major hospitals in Belize. The laboratory, also equipped with diagnostic imaging equipment, modernized cardiac care by 30 years.
Since October 2011, the IMO Program has sent cardiology teams from SHVI to perform catheterizations in Belize each month and will continue to send teams until the interventional cardiologist at KHMH is trained to perform catheterizations alone. The procedures performed in the laboratory have helped identify several patients in need of open heart surgery.
"We are proud and privileged to support our colleagues in Belize and to help them offer advanced cardiovascular services for the benefit of their citizens," said Michael Tarwater, Chief Executive Officer of CHS. "Our involvement in this momentous accomplishment is an outcome of CHS's commitment to healthcare innovation and its quality cardiology programs through SHVI. We look forward to continuing our collaboration globally."
The open heart surgery program at SHVI was ranked in the top 15 percent in the United States for coronary artery bypass graft and received a three out of three star rating by The Society for Thoracic Surgeons from July 2010 to June 2011.
The IMO Program also helped make possible the first heart transplant surgery in Costa Rica in 2007, and it co-founded the largest, most comprehensive heart institute in Central America, located in Guatemala City, in 1984. The institute was established nearly a decade after the Program assisted with the first five open heart surgeries in Guatemala.
Since the 1960s, the IMO Program has donated a variety of medical equipment to hospitals and clinics worldwide, and it has facilitated free educational opportunities for medical personnel from facilities globally. Dr. Coye and other medical staff at KHMH have benefited from educational experiences at CHS's largest hospital, Carolinas Medical Center, in Charlotte.
"This is a milestone in the history of KHMH and of medicine in Belize," said Gary Longsworth, MD, Chief Executive Officer of KHMH. "The procedures prove what can be done when you have a committed and determined team, as well as wonderful cooperation from organizations like CHS and Heineman."
Carolinas HealthCare System (www.carolinashealthcare.org), one of the nation's leading and most innovative healthcare organizations, provides a full spectrum of healthcare and wellness programs throughout North and South Carolina. Its diverse network of more than 650 care locations includes academic medical centers, hospitals, healthcare pavilions, physician practices, destination centers, surgical and rehabilitation centers, home health agencies, nursing homes and hospice and palliative care. Carolinas HealthCare System works to improve and enhance the overall health and wellbeing of its communities through high quality patient care, education and research programs, and numerous collaborative partnerships and initiatives.
Karl Heusner Memorial Hospital (www.khmh.bz), located in Belize City, Belize, is the country's flagship hospital, providing tertiary care for the nation and serving as the secondary care hospital for the Central Health Region. Founded in 1820, the hospital originally was called the Old Belize City Hospital and was renamed in 1995 in honor of Dr. Karl Heusner, a Belize native known throughout Latin America and the Caribbean for his expertise in tropical diseases. Karl Heusner Memorial Hospital was formally incorporated as a statutory authority by way of the KHMH Act of 2000, which elected it as the country's national referral hospital.
First Open Heart Surgical Procedures Done In Belize
The first open heart surgery in Belize's medical history was performed this week at the KHMH.
It is a great leap forward - and one that was only made possible with the collaboration of a team of medical partners from the United states.
But, don't get it wrong, it was a Belize mission - and today we found out what was required to get it done - and why it matters - even if you'll never need open heart surgery:
Jules Vasquez Reporting
Dr. Bernard Bulwer - Echo-Cardiologist "This huge undertaking of a cardiac surgery, which - in the words of CEO in the Ministry of Health, he said that he did not believe he would see the day in his lifetime, cardiac surgery in Belize at the KHMH. Now, it has happened."
And this is the team - or at least some of them that made it possible - participating in the first two open heart surgeries in Belize's history.
Dr. Francis Gary Longsworth - CEO, KHMH "Certainly, it is cutting-edge surgery, and the surgery that was done here is no different or no less than the surgery that similar patients will get in the USA, Canada, Europe - anywhere in the world."
And anywhere in the world, it would cost about one hundred thousand US dollars - but for these first two patients, it was free.
But the real miracle is that it happened at all - the team was led by Mr. Adrian Coye:
Mr. Adrian Coye - Cardio-Thoracic Surgeon "I trained both in Jaimaica and in the UK, and I qualified in both countries. I experienced both what it is to be pioneering already, and what it is to work with everything in place. What I did on Monday, is virtually impossible because I made these gentle folks work in 94 degree temperatures to do a case that we know had to be done, and anywhere else, they would have just cancelled the case."
But they soldiered on and pulled it off - the first surgery lasting about three hours, the second about four hours. Two history making procedures performed without a hitch by Coye with support from a team of international partners led by the legendary Dr. Francis Robicsek and assisted by Dr. Robert Stiegel, as well as a team of many others.
Open heart surgery is especially complex because - as the name implies - they have to open the heart which means stopping it - while this machine continues to feed oxygenated blood to the brain and the rest of the body:
Mr. Adrian Coye "Open heart surgery involves making a generous incision - or in some cases, small incisions on the chest - to access the heart. The heart ailments may be variable. The valves may be tight, leaking, not working so well, or we may have blockages of blood flow to the heart muscle, of what's called the coronary vessels. We arrest the heart with a special agent, and in that light, it allows us to make incisions on the chambers, to see the valves, to take out the valves, and putting in new ones."
Dr. Bernard Bulwer "Open-heart surgery is the only type of surgery that requires that your heart and your lungs go out of operations. That's why you have to have a heart-lung machine, and so that has been the thing that has bedeviled, or made heart surgery so challenging."
Mr. Adrian Coye "But, to do it well, you have to have people who know what they're doing, and there is a team effort. This is what we were able to demonstrate, that by having the right people in place, the right team, then it is possible here, even at the KHMH."
And that is a theme they kept coming back to - that the high accomplishment of this surgery can be the impetus that lifts the much-battered institution out of the morass of public accusations and bad press:
Dr. Bernard Bulwer "It is about the impact that it has on the entire institution, on the art of what is possible - on moral. The KHMH has strived - and in my recent tenure - it has strived because we said that the way to get an istitution that is beaten up, week after week in the media - the way to get an institution which has to operate on the same budget, how can we take that status quo, and take it to what we see now? It is because of the good will of the Belizean people, the good will of the international community, and the good will of everyone who has been involved. And we pray that the entire services of this institution, across the spectrum, will continue to grow, and the moral of all involved. We remember the KHMH, not for stuff which sounds juicy in the media, but for an indispensible institution, worthy of all the help and support."
Whether the surgery can transform the culture at the KHMH is left to be seen, but it can save lives:
Mr. Adrian Coye "There are a lot of Belizeans with coronary artery disease, and you hear in the media sometimes that young professionals falling down from a massive heart attack. Now, that is treatable; that's what we're getting at, the fact is that they are treatable conditions."
But don't expect the next open heart procedure next week - we're not quite there yet:
Dr. Francis Robicsek - Chair Emeritus, Department of Cardiovascular and Thoracic Surgeries "I want to say that we are extremely lucky on one end to have a high-level trained cardio-thoracic surgeon, but you will need to fill in the holes. You need some additional training for some of the personnel, and you need personnel - especially Belizean invasive cardiologists."
Mr. Adrian Coye "The whole purpose is not for just 2 surgeries to be done. We're saying that we're building toward having our own local team, and to be independent in our own way. But, we have a beautiful partnership that will nurture us and help us with training and all of that. Everything is a process. This is the first part - the first step, as they say in the thousand-mile journey. But we have to be responsible in the steps that we take, and we don't want to embark on something that we cannot maintain. So, every step along the way, we have to build the foundation."
And that foundation finds its cornerstone in Mr. Adrian Coye - whose vision has been realized against all odds:
Dr. Bernard Bulwer "Dr. Coye did, in my opinion, one of the craziest things. Less than 2 years ago, he came back to Belize to start cardiac surgery, when at that time, we did not even have a proper cardiology service. We did not have the type of echo-cardiograph support, which was reliable. We did not have a cardiac catheterization laboratory. So how can you even talk about doing cardiac surgery? We have seen - because of a dream and a desire - all of the different pieces come into place."
Mr. Adrian Coye "Yes, we rose to the challenge, and what I had to do is what I was trained to do. It was fairly straight-forward, but what was difficult was to reach that point. And that was really where you literally were carrying mountains on your shoulders, just to reach that point. To make that step - I think - took, personally, great courage for me to just say, 'Let go ahead and do this case.' I am living the dream, and I'm very honored to be here to serve my people, and I hope that this is the beginning of greater things to come."
The 86 year old Dr. Robicsek was also the one who spearheaded the donation of the Cardio-Cath Lab in February.
Heart disease is considered the number one killer in the world. And if statistics are correct, the majority of people who suffer from acute heart disease live in areas not considered to be first-world countries. Now in Belize, people who suffer from heart disease who may in the future need open heart surgery will be able to access this life-saving procedure. Today the Karl Heusner Memorial Hospital held a press conference to announce that over the past week, with the assistance of a team of visiting heart specialists from North Carolina, it performed its first set of open heart surgeries on patients who ordinarily would have perished if left untreated. Chief Executive Officer at the KHMH, Dr. Gary Longsworth, told reporters how this cutting edge procedure became possible in Belize.
The surgeries were led by Dr. Francis Robicsek, a pioneer in cardiac surgery at Charlotte Memorial Hospital in North Carolina and Belize’s own Cardiothoracic Surgeon Specialist at the KHMH, Dr. Adrian Coye.
The procedure is so sophisticated and enduring, that the hospital will conduct surgeries of this sort on an elective basis under normal circumstances. However, Dr. Bulwer says that it is something that people can completely avoid, if they keep a healthy diet.
Today’s reality is the dream of the lat Sir Barry Bowen, who appealed on behalf of Belize to his friend, Dr. Robicsek, to bring cardiac surgery to Belize. Soon after that appeal, the KHMH received the donation of the CATH Lab, which came through the generousity of Dr. Robicsek and local donors. Since the program’s inception 52 patients have received coronary angiography, which is a procedure different from open heart surgery conducted over the past week. The type of open heart surgery which would previously require Belizeans to travel abroad, costs around two hundred thousand dollars. A price has not been set for the procedure at the KHMH as yet, but as the hospital always assures, payment plans can be worked out with patients and their families. Altogether, the team that performed the first set of surgeries included eight persons, including Drs. Pedro Arriaga, Jorge Hidalgo and Bernard Bulwer.
Belize’s 1st successful open heart surgeries done at the K.H.M.H.
This week marks a milestone for the medical field in Belize; the first two successful open heart surgeries were carried out at the K.H.M.H. This medical procedure is available in a limited number of countries so for Belize, it’s major news, particularly for patients afflicted with ailments including defective heart valves, or heart muscle blockages. This singular achievement took concerted efforts, including those of the Bowen and Bissell families, who along with foreign specialists and local doctors brought in a “cath lab” to Belize back in 2011. To celebrate, the K.H.M.H. called a press conference on this major feat. News Five’s Andrea Polanco was there.
Andrea Polanco, Reporting
Dr. Adrian Coye, Belizean cardio thoracic surgeon, performed the first two open heart surgeries at the K.H.M.H. on Monday and Tuesday. The surgery, which would normally cost around at least one hundred thousand U.S dollars, will soon be available at the K.H.M.H. at a much affordable cost. The hospital secured a cardiac catheterization lab last year through Coye’s efforts partnering with international medical teams. Coye says it marks a historic moment for the institution and Belize.
Dr. Adrian Coye, Thoracic Surgeon, K.H.M.H.
“First of all it’s not available in most countries in the world, so Belize is very special in that it has started that journey. An open heart surgery has maybe a sixty year history where in the past, Francis himself was a pioneer, he would build his own machine and carry it in the back of the vehicle and go from hospital to hospital and the machine, which we call the heart lung machine is the back bone of the technology to allow us to do what we call open heart surgery. What I did on Monday is virtually impossible because I met these folks to work in ninety-four degrees temperature to do a case that we know that had to be done and anywhere else they would’ve just cancelled the case. Yes, we rose to the challenge and what I did was what I was trained to do. It was fairly straight forward but what was difficult was to reach that point. We know it’s expensive but there are other ways and short cuts that can be done more cost effectively. The bottom line is that you can give back someone the quality of their life and they can live longer and be contributing members of society.”
To access that procedure, the K.H.M.H. team had been conducting screening for the past two years. Two persons, listed as moderate risk patients, a seventy-three and fifty six year old underwent the open heart surgery which required one or more incisions made on the chest to access the heart. The first surgery was four hours long and the second one took three hours, along with a team of about twelve to sixteen medics. The cardiac surgeries were successful.
Dr. Adrian Coye,
“We did the first patient, was a coronary by-pass grafting or as we say in colloquial terms, cabbage; and I did a three vessel by-pass graft for that patient and he had the narrowing of blood vessels that fed the heart muscles. Now, it means that if he wanted to walk up the steps, or go for a walk, he has angina; chest pains and he can’t go to work. He is seventy two and complains that he can’t be working because everywhere he goes he has pain in his chest. The second patient that we did had a mitrol valve replacement because she had a background history of rheumatic heart disease; her valve became very tight over time and also regurgitant that means it doesn’t close very fully and that caused severe changes. In fact she was living in the Lion’s Club for the last two being so afraid to go home because of the shortness of breath symptomatic all hours of the night and she desperately needed to have her surgery done.”
The surgeries were done through the assistance of specialists from North Carolina, including, Dr. Francis Robicsek and eight other team members.
Dr. Francis Robicsek, Chair Emeritus, Dept. Cardio Vascular Thoracic Surgeries
“I want to reiterate that this whole thing started with Barry Bowen and ended up with Dr. Coye. I shouldn’t say ended up because as he said, this is just the beginning. It’s not only the beginning of Cardiac surgery but it’s the beginning and continuation of our friendship. We are extremely proud of him and it was an honour for us to participate and thank you for letting us be here.”
Robert Stiegel, Cardio Thoracic Surgeon
“This has been quite a journey and we certainly appreciate the opportunity to participate in this. The folks that came with me volunteered their time and energy and resources to come down here with us to do this and I would like to thank them from the bottom of my heart and Darren, thank you. It was well-worth it.”
With the increase in coronary artery and rheumatic diseases, Dr. Coye says that they can now do much for those patients.
Dr. Adrian Coye
“There are lots of Belizeans with coronary artery disease; you hear about young professionals in their forties dropping down and dying from a massive heart attack, now that is treatable and that is what we are trying to get at. The fact is that they are treatable conditions. We have patients in their twenties who die from Rheumatic heart disease who die at a young age again from the valves that change and open heart surgery can deal with those issues.”
Dr. Bernard Bulwer, who is now an associate professor at a U.S medical school, and former director of medical services at the K.H.M.H., says that the giant effort of Dr. Coye and all partners, made what seemed like the impossible, possible.
Dr. Bernard Bulwer, Former D.M.S., K.H.M.H./Professor, Cardiovascular
“Dr. Coye did, in my opinion, one of the craziest things. Less than two years ago he came back to Belize to start cardiac surgery, when at that time we did not even have a cardiology, a proper cardiology service. We did not have the kind of eco-cardiography support which was reliable. We did not have a cardiac catheterization laboratory. So how can you even talk about doing cardiac surgery? There was opposition to the cardiac cath lab coming here and I don’t know if we say these words in the media but I said, hell no. It came and then the rest started falling into place. I am totally grateful and I make it public, Dr. Coye who is an officer and a gentleman and quite docile, he teared up last night and that’s an understatement, because we saw people right in front of our eyes, a particular patient died simply because we did not have the tools in place to save that that woman’s life.”
Since the start of K.H.M.H.’s cardiac program, fifty two patients have received coronary angiography; x-ray images to show the insides of the coronary arteries. Reporting for News Five, I’m Andrea Polanco.
According to Dr. Adrian Coye, heart patients will be evaluated and surgery will be scheduled based on urgency and the availability of the U.S. team.