Tim and colleagues, regarding Late Justice Jalina (AMI)

Just to highlight some few aspects on draw backs on services to Heart Attack
Patients in PNG in line with services and functions of Sir BKHI and National
Heart Foundation as well as emergency departrments throughout our country.

1. Sir BKHI is more or less a clinic and basic diagnostic centre. It is more a
preventative unit rather then a treatment or curative facility unless new
services are added in the last 5 years. There would not be any definitive
curative procedures there in terms of newly diagnosed or established AMI...theat
will need a coronary care unit of facility to cater for that.
2. The National Heart Foundation functions basically as again preventative
measures in terms of information desemination. So in an acute case, it has no
role. Its major role is post episode or pre-episode. Again no hope for any help
for AMI.
3. Emergency is probably the nearest and best portal of entry and attendence for
AMI episode. As you and I know, lots of staff and facilities needed for
effective treatment of AMI to salvage the ischaemic heart. That basically boils
down to TRAINING, EQUIPMENT and TREATMENT OPTIONS. Idealy, all base hospitals
and provines with high economic activities be given more priority as these are
areas where bulk of well to do economic working class who seemed to have this
life style disease. PS. I am not omiting other centres (studies need to verify
areas of high prevelance) and target staff and facilities or up grade those
areas to cater for that particular high risk group.
4. Most if not all GP clinics and health centres must have facilities to screen
risk factors for IHD in suspected cases (Cholesterol, smoking, ETOH++, +ve FHx,
past Hx IHD, etc). So appropriate preventive measures are adviced.
5. BEST THING PNG can hope for is to establish at least 4 FUNCTIONAL CORONARY
CARE UNITs in all major or base hospitals with effective evacuation system to
have patient delivered to the facility within 1/2 hr may guarentee some safety
depends of staff on the ground.
6. The Government must now take ownership of its citizen in a real sense and
provide staff and facilities to avert more Sir Buris and Jalinas. Instead of
jetting off to Singapore and Malaysia, down under or else where, one should sit
down and look at why one decide to jet out that way...may be we do not trust
our countryman, maybe we lack facilities, maybe we have too much money to spend
and feed our ego, many many reasons but to me it is pure ignorance and careless
at its best. We really need a coronary care facility in each base centres for to
make some difference so people can live longer. Just over 50 is too young and
not too old as many may see.
7. A functional cardiac unit does not mean sending one or two abroad for
training and get them back to function. It means more nurses and doctors and
technical staff, facilities and medication plus ongoing preventative measures
(screening, phamplets etc). Who should feel responsible? - DOH plus University
of Papua New Guinea and Prime Minister Sir Michael Somare.

So; for late Sir Buri Kidu and Justice Jalina and many many more that eixt
early, that was the care offered to them then...And for many more to come, who
do we turn to?

I am sure one day we will get there but the ride there is rough....the old
generation is taking this current generation for a ride into Cardiac disaster as
I can forsee no progressive plan in place, and if it is, it is at snail's pace.

Good point Tim.

JT




>>> "Tim Haina" <png_hausboi@...> 20/12/2007 4:08 am >>>
It saddens me to hear about the passing of yet another prominent
PNGean. This time it is the untimely death of Justice Jalina (see
http://www.thenational.com.pg/121907/Nation%202.htm).

A heart attack is the suspected cause.

Diseases of the westernisation are going to increase especially
amoungst the 'elite' in PNG and inevitably these are going to be men
and women who are educated and hold key positions both public and
private.

These individuals are irreplacable yet despite the fact that so many
prominent leaders are succumbing to AMIs there has been no
significant focus on this issue by the government/private sector.

Not everyone can fly to Australia for management and it would be in
the countries best interests to try to develop the ability to manage
myocardial infarctions better.

We need to find a novel solution to address this problem for PNG.

Unfortunately we do not have the money nor the technical expertise
for cardiac salvage and also the burden of disease is predominantly
related to infections however we need to take an interest in looking
after our leaders and certainly the middle income PNGeans who may not
afford to be Medivaced to Australia but who nonetheless are exposed
to the risks of coronary artery disease.

I have only ever seen streptokinase in PMGH and as soon as you start
to travel to other areas there is no means to manage AMIs effectively
(in fact we tend not to use streptokinase but recombinant tissue
plasminogen activators as our clot busting agents and in some centers
cardiac catheterization is used).

My family lawyer also collapsed and passed away prior to my visit to
Alotau from a suspected AMI. He was middle aged and otherwise
relatively healthy.

Does anyone know what programs are available in the country and what
the status of training towards the management of AMI is like?

What is the status quo with the Sir Buri Kidu Heart Foundation;
National Heart Foundation and the status of medical / emergency
training ; Dr. Kevau etc ...?

There may be something that we can offer if we can come up with an
approach that will deal with the PNG constraints to allow us to
prevent and or improve the outcomes of our fellow PNGeans who suffer
a heart attack.

Cheers;

Tim