Healing Hearts on an Island Nation
Date: June 7, 2013
It’s numbers that drive cardiologist Lowell Maughan, medical director of Johns Hopkins Medicine’s Trinidad and Tobago cardiology program. Around the start of his career at Hopkins Hospital in 1973, the mortality rate of patients presenting with acute myocardial infarction was 30 percent. By creating a specialized coronary care unit—with staff specifically trained on the complexities of cardiac care—Hopkins successfully slashed that rate in half.
This experience has served as Maughan’s inspiration as he has worked tirelessly to improve cardiac care in Trinidad and Tobago, an island nation of 1.3 million people and five public sector hospitals.
In 2006, Trinidad and Tobago’s government asked Johns Hopkins Medicine International to collaborate, along with local educational institutions, on the Trinidad and Tobago Health Science Initiative (TTHSI). The multipronged effort aimed to improve the public sector’s resources for medical education and reduce cardiovascular disease and diabetes. At that time, the World Health Organization attributed 37 percent of the nation’s deaths to cardiovascular disease.
Once appointed chief medical director, Maughan made an unsettling discovery: A public health care system that serves 1.3 million people employed a single trained cardiologist.
Nearly six years later, those numbers have improved dramatically. When TTHSI’s cardiology program ended in February, that number had septupled—with five of the additional cardiologists having graduated from a Johns Hopkins School of Medicine cardiology fellowship program that Hopkins faculty delivered locally.
As Maughan and in-country stakeholders mapped the path toward a viable national cardiac service, he knew that better diagnosis by primary care providers would be meaningless without improved secondary care.
So he and his Hopkins team conceived a cardiology fellowship that would be delivered at Trinidad’s Eric Williams Medical Sciences Complex, using mostly experts who were already traveling there to provide other training, in addition to Johns Hopkins cardiologists. It would immediately benefit Trinidadian patients while allowing the local physicians to train in an environment more like what they’d encounter post-fellowship.
The requirements of the 24-month fellowship mirrored Hopkins’ ACGME-accredited program—including the same number of procedures and didactic hours. With Hopkins’ blessing, Johns Hopkins cardiology faculty and staff traveled to Trinidad for more than 120 weeks across two and a half years to train five fellows, all native Trinidadians who had received MDs at the University of West Indies. The first three completed fellowship training in February 2012, another in July, and the last one in February.
Midway through the fellowship program, Maughan’s path fortuitously crossed with that of San Fernando General Hospital’s medical director, Lester Goetz, who needed advice on how to improve care for cardiac patients: Almost 40 percent of San Fernando’s admissions were cardiac-related and 60 percent of those required follow-up care at a better equipped hospital that was hours away in bad traffic. When he mentioned a newly emptied space (with a yet-to-be-determined fate), Maughan shared the benefits of having a dedicated cardiology unit.
Maughan’s words were lighter fluid to Goetz, who used them to blaze through the bureaucracy and open the island nation’s first public cardiac specialty ward in November 2011. Reshma Singh, one of the first three Hopkins-trained cardiology fellows, arrived three months later to serve as the ward’s cardiologist. “Things happen faster for the patients now that I’m caring for them here instead of referring them elsewhere,” says Singh.
As word spread, two Trinidadian cardiologists who were working abroad returned home to be part of the sea change. Today, dozens of technicians and nurses who’ve received specialized cardiac care training from Johns Hopkins experts support this batch of new cardiologists, while primary care providers across the islands continue training on how to better diagnose and appropriately triage cardiac issues. Cymantha Governs