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June 27, 2020

Improvements made in NICVD over the years


June 27, 2020

Prior to PPP govt, the NICVD had witnessed years of neglect, and was in a deteriorating state. Due to limited funding, the hospital was consistently under-equipped — no ventilators were made available on the medical side or in emergency rooms. The hospital was severely under-staffed, with only one nurse catering to every 30 patients in the wards. The surgical mortality rate was at an alarming 23%. There was no mechanism to facilitate first aid to serious emergency patients in congested pockets of the city. Hence, an increasing number of deaths — as we all know, time is muscle when it comes to a heart attack patient.

Patients often have to wait for over a year, before they could be fully diagnosed and treated. Furthermore, the federal government was only partially subsidizing the program, hence, patients would be liable for covering extremely high fees such as paying Rs100,000 for an angioplasty and and Rs10,000 for an angiography. In addition to this, poor patients travelling from remote areas would accrue travel expenses, accommodation expenses, medicine expenses, and as a result, debt. For a country where 1/5 people is at high risk for cardiovascular disease, the previous system robbed the common man’s basic right to affordable and accessible care.

With the unconditional and relentless support of the GoS, from merely one deteriorating facility in Karachi, NICVD today takes pride in its 26 units across Sindh, that includes 10 hospitals and 16 Chest Pain Units. All this transformation has come about in a short span of five years. In fact, last year alone, over 2 million adult and pediatric cardiac patients have benefitted from the NICVD 24x7 services, accessible to the poorest of the poor, at their doorstep across the Sindh province. The NICVD has extended its free of cost services to Sukkur, Hyderbabad, Larkana, Nawabshah, Mithi, Tando Muhammad Khan, Tando bagho, Ghotki, Umerkot, Khairpur, Jacobabad, Sehwan and across the congested metropolis of Karachi.

Primary angioplasty is the standard treatment for heart attack patients’ worldwide. Today, NICVD Karachi is the world’s single largest center for primary angioplasties, having successfully completed 8,956 cases in 2019.

Overall, the number of patients treated in 2019 as compared to in 2014, has increased by over 360pc with approximately 500,000 patients treated in 2014, and approx. 2.3 million in 2019.

Due to the improvement in the quality of surgeons, upgradation and provision of state of the art equipment, and more accountability, NICVD prides itself in performing 4,000 surgeries per year, with a much decreased mortality rate of 4pc.

High dependency units were established, which were previously non-existent. Ventilators were added to the emergency rooms and the medical side. ECHO procedure, barely 70 per day (prior to 2015) have been increased to 350 per day.

Improved nurse to patient ratios have reduced mortality rates. The nurse to patient ratio in special care units is now 1:1 for patient-ventilated and 1:2 for non-ventilated patients. Furthermore, the number of nurses to patients have increased by three times in the wards. Along with the provision of free-of-cost in-patient services, all OPDs and medicines are also provided for free. In fact, the implantation of pacemakers and lifesaving device like the ICD/CRT-P/D is totally free.

NICVD’s Chest Pain program is one of a kind in the world. The goal was to facilitate first aid patients in congested pockets of the city, who could not arrive in time due to distance or time travelled. Almost 380,000 people touched the Chest Pain Units, out of which 8,500 were immediately referred to the main facility for urgent heart attack treatment, the angioplasty. The unique CPU program is truly a gift from the Sindh government to the citizens of Karachi. In fact, the Egyptian government is looking to replicate the same model in Cairo.

Another key success factor, can be tied to excellent human resource investment. Internationally trained top quality cardiologists, cardiac surgeons, pulmonologists, nephrologists, nursing experts and health care management experts, with tons of experience have been added to the NICVD portfolio. All TRMOs have been phased out, and more than 462 Post Graduate/Fellows are being trained under the top doctors in the field.

Also, all faculty/consultants and non-clinical staff are disallowed any private practice or work outside the hospital; every NICVD employee now works full-time at the NICVD, hence ensuring full-time, dedicated international level quality care for patients, and their families.

Latest procedures of international standards such as TAVI, Cryoablation, 3D Mapping, Minimal-Invasivse Cardiac Surgery, Off-Pump/Beating Heart Surgery have been initiated in the last 3 years, making NICVD a pioneer of innovation once again in the public sector healthcare industry. In fact, it was the NICVD’s staff that went on to train the armed forces institute on successfully conducting the TAVI procedure.

The LVAD program at NICVD is a destination therapy, and at its initial stages. Some 2/5 patients have survived and are doing well in their respective communities.

The NICVD has expanded its education and fellowship program from one basic general cardiology program to three sub-specialty fellowship programs including; interventional cardiology, electrophysiology and critical care medicine. In fact, the NICVD’s critical care program has been instrumental during times of Covid-19.

Today, the NICVD is a world renowned institution, providing free of cost, high quality care to all citizens, irrespective of socio-economic status. Important to note that, numerous patients are also treated from outside of Sindh.

The writer is Executive Director NICVD