I know some of you have been waiting for this part of my journal. Health care system is sooooooooo.........different here in SPS. Needless to say I would not want to be poor here. As I have mentioned before the differences between the rich and the poor are GREAT! Essentially there is no what we would call middle class here.
Today, I went to a private (pay per service) hospital to check it out. It has the first cath lab ever started in Honduras. After arriving at a small hospital, with my broken Spanish it took me an hour to find what I was looking for. There is only one cath lab in this hospital with two interventional cardiologist. They do about three to four cases a day...it includes Coronary cath, pacemaker placement, kidney stents and fem-pop stents. They do quite a bit of things here. However, even though they do interventional cath there is no CT surgeon on call. When I asked, they just said...well usually by the time the surgeon gets here the patient is dead...so no point. Things are just done very differently here....very pragmatic to say. In reality....open heart surgery is too expensive...they are only done in pay per service hospitals, i.e. not done in any public/county hospitals. Even then, they do one or two cases a month between 5 CT Surgeons. So they don't really do them...and when people need CT surgery...they go to either Colombia or Mexico. Interesting huh?!?!??!?!
So I was at this hospital to see a diagnostic cath and a pacemaker placement. The diagnostic cath was pretty standard and the differences is both of the interventional cardiologist are in the cath lab working on the patient. They don't use artifical closure of the artery...just plain old pressure. The second case gets more interesting..... A patient with history of Sick Sinus Syndrome(SSS), EF less than 35 and known episodes of VT. Usually from my understanding...pt usually get a bivi-ICD with those diagnosis. However, in this case the patient is a 'poor' patient and she got a single lead pacemaker. Hmmmmm......The explaintion was.
1. Pacemakers are re-used here. (YES, they are...as patient dies they take the working pacemaker out and refurbish for the next person. They usually go from patient to patient on average 3 to 4 times before it is discarded. Very interesting concept of 'recycle'. So, for this patient the pacemaker was refurbished and there wasn't any refurbished ICD....therefore she gets the next best thing.
2. Even though pacer was free the patient had to paid for the leads...it is $150 USD (average income here is $100USD a month) the family can only afford one lead so she only got one, not two...which would be the proper treatment.....
Therefore she got a one lead pacemaker in hope it will help with the SSS...
So different here....in a 4 hour period.....the doctor saw 5 patients...3 pacemaker checks and 2 follow ups. They actually spend over an hour with the patients. Incredible!!! They sit and chat with the patient and the family....social...and such. Sooooo...lay back. I can't imagine how would that be if it was the US....hehehhe
