catheterization laboratory

With heart disease one of the leading causes of death in T&T comes a revelation that the Scarborough General Hospital has a multi-million dollar Cardiac Catheterisation Laboratory which has not been used for years and instead patients are being transferred from Tobago to the Eric Williams Medical Complex (EWMSC) putting additional pressure on the system and poorer outcomes for Tobagonians who get heart attacks or have heart problems.

In addition, according to the Public Sector Investment Programme, $70 million was spent on the facility which has become a proverbial white elephant.

The PSIP 2015 showed that $50 million was “utilised for the supply and installation of a Modular Cardiac Catheterisation Laboratory and Magnetic Resonance Imaging Unit for the new Scarborough Hospital in Tobago.”

The document noted that during the period under review (2014) “the order was placed for the equipment and excavation works and foundation works commenced.” The PSIP 2015 added that the project was scheduled for completion in February 2015.

Subsequently, the PSIP 2016, which would have been presented in October 2015, said: “The Cath Lab at the Scarborough General Hospital in Tobago utilised the sum of $20 million and is due to be opened in 2015.” It continued to note that the Cath Lab will aid medical professionals to efficiently diagnose diseases of the heart, valves and coronary arteries.“

This means that $70 million would have been spent on the establishment on the Cath Lab in Tobago.

Ironically it was also disclosed in 2016, that the Magnetic Resonance Imaging (MRI) Unit also purchased the wrong sized MRI machine at the cost of $34 million. Another waste of taxpayers money.

The non-functioning of the state lab was revealed to the Business Guardian by the medical chief of staff, of the hospital, Dr Victor Wheeler. When asked about the utilisation rate of the Cath Lab at Scarborough, Dr Wheeler said:“It’s not functional at the moment.”

When pressed as to the reason why the Cath Lab was not functional, Dr Wheeler noted that it has not been functional for approximately five years. According to the medical chief of staff the lab is not operational because “there’s no staff that we can have to use it.”

Consider that there is no Cath Lab at the Port-of-Spain General Hospital, none at San Fernando General Hospital nor at the Sangre Grande Regional Hospital and the one in Tobago is simply not being used due to a lack of staff.

Dr Wheeler added that before he assumed office the Scarborough hospital had a contract with a ‘Trinidadian service provider’ to operate the laboratory. Although Wheeler noted that this contract was not renewed, he did not have the information concerning the company nor the terms of the contract under which it was hired.

In a recent interview, Interventional Cardiologist, Dr Ronald Henry said the Cath Lab in Tobago was not utilised because the human resource capacity was not developed in tandem with the infrastructure.

Dr Henry said: “If the human resource isn’t developed in parallel, then you would end up expensive white elephants being built. This is the challenge for developing the way forward.”

Responding to subsequent questions, Dr Henry argued that this human resource component has to do with the availability of medical professionals and facilities that would cater to the “provision of emergency angioplasty to persons suffering with Acute Myocardial Infarction.”

He noted a procedure is properly called Primary PCI (Percutaneous Coronary Intervention) referred to as PPCI.

Dr Henry argued that the evidence supporting his contention is founded upon his experiences when he started the country’s first Cath lab at EWMSC around 1990, with a team that he had trained in-house.

He disclosed that four years later, on February 22, 1994, the same team performed the country’s first coronary angioplasty. He noted that a quarter century later, EWMSC still does not offer the country a PPCI service, despite having state of the art Cath labs.

Henry contended: “The lesson here is painfully obvious: The provision of increasing infrastructure, as important as it is, does not naturally evolve into the long anticipated and overdue PPCI service.”

The proper implementation of a National PPCI Program, according to Henry, would “decrease the duration of time spent in hospital, hence saving dollars, increase the survivorship and also increase the return of the productive members of society back to work, which has huge economic benefits.”

He said that the old way of doing things, where medicine is given to patients with heart attacks and the outcome is awaited, contributes to the loss of lives and ultimately the loss of productive members of the labour force.

As a result of this type of treatment, people not only stay away from work longer, but many of them never return to work, because even if they survive they have parts that are weakened permanently. A properly managed and PPCI program would assist in avoiding these circumstances, according to Henry.

Henry also emphasised that if T&T were to institute a National PPCI Program, “this would also create the opportunity to negotiate Government to Government arrangements so that Caricom states with less resources could tap into our National grid using a Hub-and-Spoke model. This would mean inflows of much needed foreign exchange for T&T.”

The Business Guardian reached out the Ministry of Health to obtain comments from the Minister of Health but was re-directed to the Tobago House of Assembly’s Division of Health Wellness and Family Development.

The Division of Health Wellness and Family Development (DHWFD) confirmed that the Cath Lab is not currently in operation.

Tracy Davidson-Celestine, Secretary of the DHWFD pointed out that the Cath Lab “has occupied our attention and several options are being explored for it operations.”

She added: “We are committed, the Division and TRHA, to make this happen in the quickest time possible. But this is not an easy or cheap task.”

The secretary also said: “It will be premature to discuss the details as much work has yet to be done and resources considered.”

She admitted that the Cath lab has “been on the back burner” for a long time and indicated that officials are working towards a solution.

According to Davidson-Celestine the DHWFD is working at a steady pace to bring all hospital services to the levels “to meet the needs of the public and international standards.” She asserted that they are working on a range of service improvements and projects alongside the TRHA.

Davidson-Celestine contended that “Tobago continues to be one of the leading locations the region in number of health care facilities per capita and that’s because at DHWFD we put people first.”

She continued: “While we are not perfect and encounter challenges every day, including COVID 19, we are working non- stop to continue to provide health care services.”

Currently, the Scarborough General Hospital employs one interventional cardiologist, Dr Clifford Thomas, who visits Tobago twice per month. According to the Medical Chief of Staff the Scarborough General Hospital has full time radiologists but not interventional radiologists.

However, Dr Wheeler also disclosed that patients that must undergo cardiac procedures are transferred to Trinidad.