The many weeks away from school did notallow for the same advantage for one particular seven-year old girl, who we will refer to as Tina. This child was suffering from the congenital heart defect called “tetralogy of fallot”.Due to her rare, complex, abnormal heart defect, this child could not get enough blood to reach her lungs. Such a condition results in an oxygen-shortage, as instead, oxygen-limited (poor and blue coloured) blood flows through a person’s body.

Since the oxygen level in the blood, leaving Tina’s lungs is below normal, she suffers from cyanosis, that is, a bluish tint comes over her skin, lips and finger nails, and there are “tet spells.” The latter condition actually occurs, whenever there is a sudden rapid drop in the oxygen level in her blood. This happens in response to an activity like eating too fast or being involved in too much exercise. When a tet spellis triggered, the victim experiences great difficulty breathing, becomes tired and limp, and suffers from fainting spells; these all have the potential to be fatal.

Imagine the precarious and delicate situation of victims of tetralogy of fallot!Well, this was all true before August of last year, as in that very month, a successful cardiac surgery was carried out on Tina. Now this child is normal, healthy and, today, like every other child her age; she is enjoying the special joys, associated with being a child, including the freedom of the school breaks.

Blessed lot

Tinawas one of a first batch of 20 children, who in less than one year, had their lives completely transformed and why? The answer lies in a successful collaboration between the Government of Guyana (via the Ministry of Health) and the University of Calgary. This kind of wise thinking helps in a very broad-based way as it shifts the emphasis from the personal to the national.

The Government of Guyana and the University of Calgary’s collaboration began three years ago, with Dr. Debra Isaac, MD, PhD, a heart transplant surgeon from the University of Calgary,Canada. Dr. Isaac came here at the request of the Ministry Health.  It was in January 2012, that she arrived, and instantly she manifested professionalism and empathy.  She came with cardiology equipment for the Georgetown Public Hospital Corporation (GPHC), but soon realised that nobody knew how to use them, interpret the results, and what to do with those results, if by chance some were obtained. As a result, an urgent meeting was held with the Ministry of Health and the GPHC; it was the great turning point. The meeting saw the forging of a profitable relationship, centred on the building of capacity in the hospital system, to deliver echo-cardiology services. These services were to focus on three vital areas: Echocardiography Education programme-Post -Grad programme for Guyanese graduates; a Guyana Paediatric programme; and a heart failure clinic at the GPHC for adults.

Guyanese Paediatric programme

When Dr. Isaac first came to Guyana, the focus was on setting up an echo laboratory, at the GPHC. This was for the purpose of training the local medical personnel to manage the lab without overseas input.But during all this time, the team started seeing a high number of children with heart diseases.

Dr. Isaac, at that time, did opine that, “These are problems, that we would normally see, operated on by the time a child would be about 4 to 6 months old; here (however), I am seeing children who are 7, 8, and 12, who have had this problem, that  has not been fixed, which is a major issue.”

She soon realised the foundational issue, that is, it was that no one really knew what to do with these children, as there was not a very good paediatric cardiology clinic in Guyana. This was made worse given that there was no expertise locally. She explained that heart diseases in children are quite different from those in adults.  With adults, only a small proportion actually needs surgeries; what most of them need are good medical care, medicine, and follow-up care; but with children, a majority of them needs surgery as well as good medical care.

Dr. Isaac said that the team found out what was happening with children in Guyana was that occasionally, one would be brought for consultation, but there was nowhere a process, in prioritising of the children, according to needs. “As a result, it was fairly random- which child was put forward for surgery; there was no consistency,” she said.

The goal then was to set up a system in Guyana, where all children were going to have an equal opportunity; if they have a congenital heart disease, to receive treatment in order of priority.

With the Ministry of Health’s approval, the Guyana Paediatric Cardiology Steering Committee (GPCSC) was established. In birthing this programme, the committee also set up a referral system, and forms went out to all paediatricians.This was in order that there was some sort of evaluation, as regards listing the children, suspected of having heart diseases, and then making sure that they had their echocardiogram done at the GPHC. The committee then determined if these children were candidates for surgery.

It was explained that previously, children were sent to India and other places for surgery, but “these children would get to India and only would then find out that they did not have what they were supposed to have, and in some cases, did not have a heart problem at all-a waste of resources, both from Guyana and the charitable organisation (helping out).”

To prevent this from happening, a partnership with a charitable organisation, called Baby Heart International, was forged. Baby Heart International is a group of paediatricians, cardiologists and cardiac surgeons who go to various places across the world and do two-week missions. However, they only do surgeries where good, accommodating infrastructure exists.

Through this partnership with Baby Heart, which started in January 2014, the first batch of 20 children was successfully operated on, including Tina.

Dr. Isaac said, “she (Tina) had tetralogy of fallot that should have been fixed when she was four months old, and here she is about seven years old and her oxygen level was the lowest I have ever seen in a child. Normal oxygen level should be about 95 percent; hers was 49 percent.”

The specialist explained that, “Normally at home, if the oxygen levels get below 70, we get really worried. Hers was 49, and when I saw her,  I thought,‘My God, this child would not live unless we do something...if we did not operate on her, I do not think that she would be here for Christmas’ and that was what happened.”

The GPCSC had the help of the Caribbean Children Foundation and Three Rivers to pay for the children to get to the Dominican Republic and Honduras. This was a lot cheaper than going to India, and a shorter journey for the sick children. Then Baby Heart International paid all of the expenses, once the patients were there. These included the cost of the operations and the living expenses for the two-week tenure.

However, operation is not the end of the story-the team still must see these children after their surgeries. In many cases, the children do need another operation, when they are older, for something related to their overall original condition. They also have to get the right medication, and so Calgary has established a programme, where Dr. Isaac visits Guyana at least four times per year, and usually she brings along many needed colleagues. “We see these children, and we see new referrals,” Dr. Isaacs explained.

Sadly, Dr. Isaac said that for a lot of the kids, that team’s visit is sometimes too late. This is because many times, something that happens with some abnormalities of the heart causes problems in the heart or the lungs. If these secondary conditions deteriorate, the team cannot fix the heart, because the damage is irreversible.

“The kids could go through a bunch of surgeries and would not survive them. So there are certain cases that the team cannot do anything about, but even if they cannot be operated on, a least they try with medication and other kinds of support to assist. These sets of children will have shortened lives by quite a bit; but, the team still helps as best as possible, to ensure that they live the best life possible for however long they can.”

Since Tina’s batch, another batch of 20 children had their lives transformed through this collaboration. This time around, though, Baby Heart carried out these operationsright in Guyana at the Georgetown Public Hospital Corporation (GPHC.) Further, this batch of children also benefitted from a special Intensive Care Unit (ICU) that the Calgary team refurbished at the hospital to facilitate post-surgery care.

Forging medical agreement

One of the specifics of Government’s health institutions’modernisation is the introduction of advanced medical services, for better quality care for citizens. Also, since non-communicable chronic illnesses are common and alarmingly high in numbers, Government, through the Ministry of Health, has sought to advance responses to these illnesses, with timely and strategic assistance from medical institutions overseas. The Calgary University is among the overseas institutions in this area. It has been aiding the process of upgrading and transforming Guyana’s state health service. Other institutions include the Vanderbilt, Humber and George Washington Universities.