Doctor Proves that Quality Health Care is Possible in the Third World

By Jay Walljasper, Ode. Posted March 19, 2008.

Cardiologist Ernest Madu sits in his office in Kingston, Jamaica. The walls are lined with framed diplomas and certificates. He hands me a leaflet showing a 4-month-old baby girl born with a disrupted valve in her aorta. The poster advertises a community campaign to raise $60,000 to fly her to Miami, Florida, for surgery. "I heard that she died," Madu says, a sombre look overtaking the usual brightness in his eyes. "If that child had been born in the U.S. instead of Jamaica," he adds, "she would have grown up to do what she wanted to do in life: Go to school, get married, have children, have a career. She died because she was Jamaican.

"Every life is valuable. A person in Indonesia is as important as one in Germany. Unfortunately, we live in a world now where if a person lives in a poor country, it's okay that their health is not as good. We need to find ways so that health and survival are equitable around the world."

For Madu, who is from Nigeria but practiced medicine for years in the southern U.S., access to medical care in the developing world is not simply an abstract issue of fate and fairness. It is a matter of life and death, which he faces every day in his work as CEO of the Heart Institute of the Caribbean (HIC). He and his wife Dainia Baugh, an internist, founded the HIC four years ago to prove it's possible to provide high-quality health care in a poor country like Jamaica. It's their hope that the hospital will become a model that spawns similar facilities throughout the global South.

This is a hugely ambitious goal. But when shaking hands with Madu, a powerfully built man with an even more powerful presence, you sense he possesses the charisma, determination and first-hand experience to make it happen.

People in developing nations die needlessly, Madu explains, because their countries lack basic medical services that patients in even the most impoverished or remote communities in North America and Europe take for granted. Before the HIC opened in Jamaica, there was no chance of receiving routine cardiology procedures like stress tests, electrocardiograms (ECGs or EKGs) or angioplasty.

"People have been indoctrinated to believe that good medical care can't happen in a place like Jamaica," Madu says. "It's simply assumed that ill people must go abroad for good treatment -- that is, if they can afford it and live long enough to make the trip. It's a mindset we have to get beyond if we want to improve health. Fifty percent of people having heart attacks die within 24 hours without the proper medical treatment. Even if you are rich enough to own a plane, it may be too late."

Patrick Walsh, a 47-year-old Kingston resident, declares he would not be alive today if not for the Heart Institute of the Caribbean. "I've come back from sudden cardiac arrest twice because of the defibrillator they implanted in me. It shocked me back to life." Complaining of swollen legs and shortness of breath, Walsh was referred to the HIC by his doctor. He was diagnosed with congestive heart failure and surgically outfitted with a defibrillator, a device incorporating a pacemaker that responds to a rapid or arrhythmic heartbeat with a shock so the pacemaker can continue to work. Such surgery was not available in Jamaica until the HIC opened.

"Dr. Madu assisted me by knocking off a balance of $9,000 from the bill," Walsh adds. "I am very grateful for that."

The hospital treats many poor patients, with a policy of not turning away anyone who needs help. "We charge only what they can afford to pay," Madu says. "Jamaicans are proud people, so many times the whole family -- the brother who is a cab driver in Los Angeles -- will send us money." Madu notes that the HIC provides more than $1 million a year in free or reduced-rate care.

The HIC does not yet have the capacity for pediatric cardiac operations, such as replacing the faulty valve in the little girl's heart, but Madu estimates that with the proper equipment and medical expertise, the operation could be performed in Jamaica for less than $10,000, increasing the chances for that little girl and others to live.

Another reason people in developing countries die needlessly is that medical authorities overlook the rising tide of so-called modern diseases -- such as heart disease and diabetes -- in these societies. It's assumed that malnutrition and infectious diseases like malaria or AIDS are the real threats. "Hypertension is a growing problem in Africa," notes Seyi Oyesola, a London anesthesiologist who regularly travels home to Nigeria on a volunteer open-heart surgery team. "Doctors don't detect hypertension when they are told it's not a problem and that they need to focus on malaria."

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Jay Walljasper is the executive editor of Ode Magazine.

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